The Center on Health Insurance Reforms (CHIR) at the McCourt School of Public Policy is an independent, nonpartisan policy and research center founded in 2011, where faculty and staff are engaged in research that improves consumer access to affordable and adequate health insurance. Funding to support CHIR’s work comes from a variety of foundations and organizations, including the Robert Wood Johnson Foundation, The Laura and John Arnold Foundation, and the Commonwealth Fund, among others.
Following the murder of George Floyd in 2020, CHIR faculty made a pledge to better understand and document the challenges facing communities of color. Through their research, CHIR experts have been posing questions that assess the disparate impacts of policy choices on those communities, adopting data collection practices that proactively seek out diverse voices and working to develop policies that place health equity front and center.
In one project funded by the National Institute for Health Care Reform, CHIR researchers are assessing efforts to improve access to primary care for underserved populations. CHIR’s Navigator Resource Guide, a tool supported by the Robert Wood Johnson Foundation and designed to help consumers explore health insurance plans and benefits available to them under the Affordable Care Act (ACA), has been updated to include Spanish-language content and to spotlight outreach efforts by organizations working with diverse communities.
Monitoring state-based efforts to advance health equity
Another longstanding project, funded by the Commonwealth Fund, enables CHIR researchers to monitor and analyze how all 50 states and the District of Columbia are implementing the ACA’s private insurance reforms and improving their health insurance marketplaces. As an expansion of this work, CHIR began monitoring health equity in 2021. Assistant Research Professor Christine Monahan and Research Fellow Jalisa Clark, supported by 2022 Richmond Foundation Fellow Nadia Stovicek, are tracking state action to address disparities and inequities in health, health care and health coverage through reforms to and regulation of the private health insurance market.
CHIR researchers found that states like California, Connecticut and Massachusetts have taken the lead in advancing health equity by first assessing internal accountability: hiring chief equity officers, forming social justice advisory committees and developing internal plans to ensure agency policies and practices advance equity.
Some states have prioritized the collection of customers’ demographic data to identify and address disparities and target resources appropriately, though states’ efforts to improve race and ethnicity data collection remain a work in progress. Several states have also worked with health insurers to build provider networks and design benefit packages that advance health equity, such as the elimination of cost-sharing for diabetes-related care to address racial disparities in diabetes prevalence and outcomes.
Diversifying the health insurance market and the consumer experience
State-based marketplaces also have a responsibility to reach out to consumers and help them enroll in a health plan that meets their needs. This includes working with organizations serving communities of color and diversifying the health insurance broker industry to better represent marketplace customers. CHIR is currently exploring how marketplaces are meeting the needs of individuals with limited English proficiency who depend on language access services.
“We are looking at the states that run their own health insurance marketplace and getting a sense of what the language access landscape looks like from insurance enrollment applications to staff job descriptions,” said Nadia Stovicek (MPP‘23), who is currently involved in CHIR’s language access survey project as a research assistant on the health equity team. “Culturally competent care is so important, and language access is a huge part of that.”
CHIR’s research is already helping inform state officials about what other agencies are doing to advance health equity. Federal policymakers, too, can take lessons from CHIR’s findings as they work to fulfill President Biden’s Executive Order on advancing racial equity and support for underserved communities.