The Exchange’s Vision, Goals, Technology

The Board of the California Health Benefits Exchange met again this afternoon. The meeting began on a high note with the Board and the audience warmly welcoming the Exchange’s new Executive Director, Peter Lee. Mr. Lee’s first remarks including expressing joy at returning home to California and his excitement to work to make California’s Exchange a model for the rest of the country.

The many materials for the meeting are on the Exchange’s website. The most robust discussion at the meeting centered around a staff presentation about Exchange Design Options. The proposed program design goals were modified to reflect comments from stakeholders presented at the workgroup meeting. Thes “Program Design Goals” are:

  • “No Wrong Door” service system that provides consistent consumer experiences for all entry points
  • Culturally and linguistically appropriate oral and written communications which also ensure access for persons with disabilities\
  • Seamless and timely transition between health programs
  • Minimize consumer burden of establishing and maintaining eligibility
  • Ensure privacy and security of consumer information
  • Enable real-time eligibility determination
  • Ensure timely and accurate eligibility determination
  • Ensure transparency and accountability
  • Ensure no gaps in coverage
  • Enable consumers to make informed choices

Stakeholders expressed grave concerns that the rush to move forward in developing IT systems in order to have them operational in time may back the Board into policy decisions that have yet to be made. Chairwoman Diana Dooley assured everyone that the current work is simply to solicit a contractor to help in the crafting of a solicitation for the IT vendor in a way that reflects the goals of the Exchange, the requirements from the federal government, and technological feasibility.

Many stakeholders were also concerned about accountability in the context of so many state departments working together under shared IT systems. Our colleague Elizabeth Landsberg from WesternCenter on Law and Poverty proposed an alternative “Option #4” to those presented by the board, to better reflect the needs of consumers and other stakeholders.

A broader issue that came up as part of the discussion was the issue of the long term governance of health care eligibility, enrollment, and delivery in a world where more people are covered under more health care options.

Next, there was a discussion on the Exchange Vision, Mission, and Values. The consultant presented a few options for choosing, mixing, and/or matching that were the result of prior board discussions and a great deal of stakeholder input. This item will be acted on in the next board meeting, giving board members, the new Executive Director, and stakeholders more time to provide input. Health Access suggested including language that highlights benefits to consumers beyond a structured marketplace and better information, including subsidies to millions of Californians, and the bargaining power being no longer alone at the mercy of insurers. Also suggested was the inclusion of a broader goal expanding coverage, if not the explicit goal of mass enrollment on day one.
Lastly, the Board discussed the coordinated state response to the proposed federal rules on Exchanges. Comment periods on federal rulemaking are an opportunity for the state and other stakeholders to impact how the federal law is implemented. A number of stakeholders have spent innumerable hours combing through the “firehose” of regulations and providing comments to the Exchange Board as well as crafting their own comments. The deadline for comments was extended to October 31 but there are 4 other sets of comments due on that date as well. Advocates brought up a few areas of disagreement with the comments that the consultant drafted that they hoped to change, some of those include: areas where adverse selection may be problematic, a proposal to eliminate premium grace periods, requiring the Exchange (on top of employers) to verify citizenship, allowing multiple rate increases per year in the small group market, and the elimination of special enrollment periods. The board agreed to consider the additional stakeholder comments before finalizing the letter to the federal government.

We look forward to some decisions related to today’s discussions in the coming meetings. Also something to look forward to is the meeting schedule for 2012, which include meetings in Fresno, Los Angeles, and the Bay Area to enable more people to participate in this public process.

Health Access California promotes quality, affordable health care for all Californians.
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