2013 Year In Review & Countdown to Coverage

HEALTH ACCESS UPDATE: Monday, December 30th, 2013




  * Actions for a Healthier California in the New Year:

  * Did You Sign-Up Already? Share Your Story So We Can Defend/Improve the Law

  * Contribute to Health Access To Help CA Seize The Opportunities  in The New Year

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The start of 2014 from now will begin the biggest transformation and improvement in health policy and health coverage in the history of the United States. Under the Affordable Care Act, millions of patients will have new consumer protections, and insurers will have a new set of rules to compete by, with prohibitions on denials for pre-existing conditions, and standards for basic benefits. In no state will these changes be more profound than California, which had the most acute issues in our health system including the biggest number (and one of the greatest percentages) or people who were uninsured. In particular, over a million Californians will be covered under a new expansion of health coverage under the Affordable Care Act on day one, and likely over two million by the end of the new year of 2014.

Covered California, the statewide marketplace for health coverage, reported over 450,000 Californians having picked a plan in the new marketplace to be ready to start January 1. If they pay their first premiums in time by January 6th, they’ll be covered starting on New Year’s Day. In addition, over 660,000 Californians in county-based Low-Income Health Programs will be shifted into full Medi-Cal coverage starting in January 1. Hundreds of thousands more have signed up for new Medi-Cal coverage, and more are expected for both Medi-Cal and Covered California, which has three more months for open enrollment. And these numbers don’t include the over 400,000 young adults up to age 26 now on their parents coverage.

Starting January, hundreds of thousands more Californians will be either newly covered, or have coverage that is cheaper or better than what they had before–and likely millions will be helped by the end of the new year. Californians have been more likely to be uninsured, more likely to not get on-the-job benefits, more likely not to afford coverage, and more likely to be denied for pre-existing conditions than the average American. But because California has some of the biggest problems in our health system, our state has appropriately been the most aggressive in taking advantage of the solutions offered by the Affordable Care Act.

The Affordable Care Act was passed at the federal level in 2010, but it was state actions leading up to and including in 2013 that will allow Californians to take advantage of the historic help in 2014. As 2013 ends, here’s a look back at the happenings in health care in California.

Ten Steps Forward for Health Care in California in 2013 

* Launch of Covered California: Our state was the first in the nation to establish a health exchange in 2010, but with California’s size and complexity, many were concerned it wasn’t enough time or expertise to set up something so big. The October deadline proved too high a bar for some states and the federal government (although with a little more time things seem to be improving)–and while’s California’s website wasn’t without glitches and delays, its systems managed to get hundreds of thousands of California enrolled, starting in October.

* Legislative Special Session: Even though they had passed a couple dozen bills to put in place the ACA’s consumer protections and systems changes, more legislative work was needed in 2013. The Governor and the state legislature convened a special session to expedite the final bills needed to implement health reform, showing the political leadership that has made reform advance in California.

* Insurance Market Reforms: The Legislature passed the historic reforms that prevented the denial of pre-existing conditions, and set the new rules for the insurers to play by. No longer can two people of the same age picking the same health plan be charged differently for whatever reason, from their gender to their health status.

* Medi-Cal Expansion: Special session legislation expanded the Medi-Cal program to 1.3 million more Californians (largely adults without children at home who at are or around the poverty level)–the biggest expansion since the creation of Medicare and Medicaid 45 years ago. It also made it easier to get on and stay on Medi-Cal coverage. It took additional steps than those required by federal law to expand coverage, for those on other human services, and for legal immigrants.

* Reallocation of County Safety-Net Dollars: The Governor insisted that the Medi-Cal coverage expansion be paid for by reallocating dollars that went to the county safety-net. In negotiations, counties and public hospitals got a formula that allowed them to keep some dollars depending on how the expansion goes–but not one that allows them to fully meet the needs of the remaining uninsured.

* Budget Includes Some Restorations, Including Dental Benefits: After years of budget crises and devastating cuts, the state budget including some restorations to key health and human services, including dental coverage for over three million Calfornian adults with Medi-Cal coverage, and augmented mental health benefits.

* Covered California Premiums Come In Lower Than Expected For Most: In general, health care costs are going up at the lowest rate in decades–but what consumers really want to know is what their premium is. Covered California made national news when it announced lower-than-expected premiums in May, even before people applied any subsidy or tax credit. For those currently coveraged, some did experience problematic premium spikes (an issue advocates continue to work on), but most got competitive rate and even a better deal, in either lower premiums, better coverage, or both. More work to do, but progress.

* Covered California Decides to Standardize Contract and Benefits: More than most states, California’s exchange has the ablility to negotiate for the best price and value. It used that power to standardize benefits (a defined set of benefits and cost-sharing for Platinum, Gold, Silver, Bronze levels across insurers), so consumers can make true apples-to-apples comparisons between plans. For all the complexities of our health system and the new law, this made the actual consumer experience simpler and more understandable.

* Low-Income Health Programs Top 660,000 Californians: Only a few states started their Medicaid expansion prior to 2014, and California’s was multiple times bigge than any other–even more than the 500,000 Californian originally projected when the plan was submitted for federal permission in 2010. Californians in 53 of 58 counties got coverage early, including a medical home providing primary and preventative care; California got billions in federal matching funds; and our heath system got an easier transition to health reform.

* Rebates and Rate Review Save California Consumers Money: California consumers saved hundreds of millions of dollars in premiums as a result of enforcing some of the new oversight tools in the ACA. Policyholders got rebates due to regulators’ enforcement of the medical loss ratio requirements, which ensure that over 80% of our premium dollars go to patient care, not administration and profit. Scrutiny under new rate reviews got insurers to reduce or roll back premium increases, showing the effectiveness of such regulatory oversight, but also the need to go further, as some insurers went ahead anyway with some rate hikes declared “unjustified.”

ACTIONS TO HELP: Here are three ways to make California healthier in the new year:

** If you or a friend or family member is uninsured, enroll at Covered California at www.coveredca.com.

** If you have already tried to sign up, and have a story to tell (positive or negative) about your experience, let us know. With your permission, Health Access would love to share your story, to defend the law’s new expansions and consumer protections, as well as to improve it and extend additional help to all who need it.

** If you want to support the ongoing work to implement and improve health reform here in California, consider a charitable contribution to Health Access before the end of the year. With your support, we can make historic progress, this year, in the cause of ensuring quality, affordable health care for all Californians—and lead the nation in going further.

From all of us at Health Access, may you have a happy and healthy new year!