Health care consumer assistance programs: A cornerstone for successful health reform

The US health care system is complex. Health reform discussions in Congress may bring meaningful improvements to the system, but will not simplify it. Millions of people may receive access to affordable coverage, but will likely experience difficulties understanding the new rules, enrolling, accessing subsidies and navigating their coverage. Such difficulties are magnified for vulnerable communities, including those with high medical needs, limited English proficiency, and the elderly. For these reasons, consumer assistance programs are uniquely positioned to ease the potentially traumatic effects of health reform in the States, whether it is implemented nationally or incrementally at the State level. The Managed Care Consumer Assistance Program (MCCAP) is one of the largest health care consumer assistance programs in the country. Created in 1999 to respond to the transition of millions of New York State Medicaid beneficiaries from a fee-for-service system into managed care plans, MCCAP has assisted nearly 140,000 people with health insurance and access issues. MCCAP is a decentralized network of 24 community based organizations which are trusted resources in their communities and experienced in working with vulnerable populations. Additionally, MCCAP serves a sentinel function by aggregating data about barriers to care and advocating for effective policy changes that both protect consumers and improve the system for stakeholders. Development of consumer assistance programs, like MCCAP, will be important for policymakers seeking to ensure that health care coverage expansions – whether brought by federal or state reform – translate into access to affordable and quality care for millions of Americans.