For this past Thursday’s Covered California board meeting, our Elizabeth Abbott, director of administrative advocacy for Health Access, provides these notes:
At the February board meeting last week, Covered CA reported on progress on enrolling of Californians into an array of health coverage plans offered through the new health benefits marketplace. The staff reported progress in signing up people who have not had insurance due to its cost or because they were precluded due to a pre-existing condition (which is no longer permitted.) Of those enrolled, 85% are also getting financial assistance to help pay for their coverage. There are a little more than 5 weeks remaining in the first open enrollment season under the Affordable Care Act (“Obamacare”). People have until March 31, 2014 to sign up for this year (and to avoid a tax penalty.)
There was some concern expressed at last month’s January board meeting that the Exchange had not met their enrollment targets, compared to projected numbers in certain parts of the state and with certain groups of Californians. Here are the changes just put in place by Covered CA to smooth out some of the kinks:
- In response to unreasonably long waits to talk to their call center staff, they have hired an additional 350 customer service representatives, 250 of them now in training to be ready to answer calls early next month.
- They have selected a new Outreach and Marketing Director with a newly refocused marketing and outreach campaign. He unveiled a new series of radio, TV, digital, billboard ads, and social media with a catchier and more focused campaign in English (“I’m in it!”) and Spanish (“Yo tengo un plan de salud” [“I have a health plan”]). These are aimed at two under-enrolled demographic groups in the Exchange so far: young adults without coverage and the Latino population in the state.
- They reduced much of the backlog of certifications of brokers/agents and community assisters who are set to provide in-person help for people to sign up for a health plan under Covered CA.
- They established an expedited number to call for brokers and enrollment assisters to resolve complex situations or confusion when things do not go the way they are supposed to.
And The Box Score So Far:
California is undoubtedly in first place among the states to have signed up eligible people to the exchange. The enrollment total is a whopping 728,410 through January 31, 2014 and continuing at a blistering pace so far in February. California’s enrollment is 26% above our own projected estimates.
Individual targets also seem to be improving. While the numbers for Latino enrollees are still too low, those numbers jumped 62% in January, the highest percentage for any demographic group. Similar concerns were expressed regarding the enrollment of young adults which are up too, but are still running about 75% of their projected percentage of the population. All geographic regions in the state are exceeding their enrollments, except for the Central Valley; however, it has improved too. The best performance record by region went to the Greater Bay Area which exceeded its targeted population goals at 182%! And 571 small employers signed up to provide coverage for around 5,000 employees in the SHOP Exchange.
The testimony included a wide range of respondents, from appreciation to Covered California for their nation-leading work and thanks for the corrections they have made, to complaints and calls for accountability for those issues that have gone wrong. Several testifiers gave constructive advice about how to improve systems, from fixing a letter that confused many patients into thinking they weren’t getting coverage when they were, to ways to better reach out to Latino audiences. Finally, there was some suggestions that Covered California should also look at issues of retention and utilization: after getting people enrolled, helping them stay covered, and helping them best use what may be a new health system for them.
The 7th Inning Stretch
There are 5 more weeks to sign up every last eligible Californian through March 31, 2014. The work continues for the brokers/agents, community assisters, and newly-minted customer service personnel to make sure we get everyone signed up. This means all of us talking to friends, neighbors, acquaintances, and business associates to be sure they are aware of this opportunity and offering them assistance or just a reminder to the procrastinators.
The Next Season
Covered CA is already looking to what the Exchange’s offerings will be for next year. Because this inaugural enrollment period began on October 1, 2013 and will last through March 31, 2014, little time remains to prepare for the 2014-15 enrollment period, which is expected to be shorter and is likely to begin in November 2014 (as determined by the federal government,). Covered CA argued it had little time to adjust health plan offerings, review proposed premium rates, negotiate new health plan contracts, and modify the marketing and outreach plans based on the exchange’s first year of actual experience. As a result, the board looked to make only the most essential changes for the 2014-15 plan year, especially on qualified health plan recertification, model contracts, and even standardized benefit designs. Consumer advocates understood the thinking and voiced support for some of the specific changes made to the standardized benefits (pediatric dental, some adjustments in cost-sharing, etc.), but disappointment that other issues (like co-insurance products that are inherently confusing) were not addressed in this round. Covered California promised to undergo more substantive revisions for the 2016 plan year.
The board also hosted a discussion on regulations for certified application counselors, but which was kept open for further discussion and final adoption at next month’s meeting.
The Long View
The board meeting ended with a review of the financial report for all of the activities in this start-up year, including the crafting of a major statewide marketing strategy, hiring and training the huge numbers of customer service representatives, credentialing all of the brokers/agents and community assisters, coordinating with county workers who would be taking all of the referrals from Covered CA for people eligible for Medi-Cal, negotiating with health plans regarding plan offerings and pricing, and the tremendous set up (and several subsequent additions and revisions) of the computer systems that support all these activities. While Covered CA operated with funding provided from the federal government for the start-up of our state-based exchange, the exchange will have to be self-supporting next year. That means that the ongoing costs to run the exchange will have to be assessed by a fee for each policy sold through the exchange. That will require Covered California to balance the need to make premium rates as affordable as possible to the public, while making the necessary investments in marketing, outreach, and customer service to get as many people enrolled. It was clear that this will be a future item for discussion as well.