Covered CA Board Meeting November 19, 2015: Highlights for Consumer Advocates

This week’s Covered California Board meeting, the last for 2015, focused on the Covered CA bus tour and related OE3 campaigns; early results from Open Enrollment 3 or OE3; how the Section 1332 waiver (an option within the Affordable Care Act to waive certain ACA provisions to demonstrate a new principle or model at the state level for how to achieve the same goals but through different means) stakeholder process will work and parameters for proposals; and the certification process and priorities for 2017 Qualified Health Plans (QHPs).

Covered CA Bus Tour and Related OE3 Campaigns

As noted by Covered CA director Peter Lee in his opening remarks, Covered CA’s marketing and advertising strategies are heavily guided by research and analytics—and OE3 is no different.

Familiarity with the ACA and Covered CA has vastly improved in recent years—and this is true across communities of color, suggesting that more targeted marketing efforts are paying off.  Though Covered CA has spent millions on ads, the fact is that news coverage still has the bigger payoff.

One reason for this year’s emphasis on the availability of premium subsidies is the discouraging finding that awareness of the penalty for not carrying insurance (84%) is quite a bit stronger than awareness of financial help (64%). This is important because the premium subsidies really are the #1 reason to purchase coverage.

Ad campaigns have also focused on the new dental benefit available through Covered—for its own sake but also as a new hook to drive traffic to Covered CA. About 15% are signing up for dental coverage. California is about average in the percentage of adults who have visited a dentist in the last year (67%, based on 2012 data).

All told, Covered CA has 590 storefronts—thanks to consumer advocates for making a case for these. We were right—that people really value face-to-face interaction in their enrollment process.

Recent improvements to the Shop and Compare tool, specifically around transparency of final costs to the consumer are paying off.

The Covered CA bus tour, stopping in 42 communities, focused on spotlighting iconic buildings around the state and use of the “Enroll Now” spotlight has helped drive consumers to the enrollment website.

Early Results from Open Enrollment 3 or OE3

Though data are tentative, 34,000 Californians have enrolled thus far—about 2,000 a day. Noting that so many wait to the last minute, the real test of effectiveness will be the first two weeks of December for the Jan. 1 effective date and the last weeks in January for the final Jan. 31 deadline.

Even Lee will admit there is room for improvement on call center wait times, especially for the Certified Application Counselors and agents, who have faced waits up to an hour. From October to November the wait time for the regular line has doubled to 4 minutes. Efforts are underway to do more rollover calls.

Section 1332 Waiver Stakeholder Process and Guidelines

Lee shared the guidelines and a few cautions about the Section 1332 waiver opportunity. First, the general guidelines:

  • It cannot add to the federal deficit
  • It requires state legislation
  • It has a 5 year timeframe (learn more here)

One key question is whether a 1332 waiver is required to make the improvements California seeks. So much of what Covered CA is doing, especially as an active purchaser, is actually independent of any Section 1332 waiver. And because of that, we have tremendous latitude and flexibility to do as we see fit to address state priorities for reform.

With that background, those contemplating a Section 1332 waiver should ask…

  • How the proposal will address CC mission: to increase the number of insured Californians, improve health care quality, lower costs, and reduce health disparities through an innovative, competitive marketplace that empowers consumers to choose the health plan and providers that give them the best value.
  • Does it achieve cost savings? It should not add liabilities to the state general fund.

The stakeholder process will run from Jan-April 2016 with next steps to be decided in the summer.

Public comments on Section 1332 waiver angles touched on general themes of lingering affordability issues despite subsidies; the need to address churning and difficulties with the transition from Medi-Cal to Covered CA, and of course Health4All adults, specifically the proposal (now part of SB 10-Lara) to allow adults and others not eligible for Medi-Cal to purchase coverage through Covered CA with their own money. Beth Capell, speaking for Health Access, asks the Board and stakeholders to be mindful of tight legislative timeframes–that if a stakeholder process really goes through June, and without a Covered California board meeting in July, it would be too late to get a bill passed to submit a waiver this year.

Certification Process and Priorities for 2017 Qualified Health Plans

The discussion on plan designs for 2017 was more of a preview of items for full discussion in January 2016 with final Board action by February. For the year 2017 we can anticipate substantive changes on plan designs and triple aim (or quadruple aim) goals on cost, quality, better care, and equity. Much of the legwork for these changes has been done in the Quality Subcommittee of the Quality and Plan Management Advisory Committee-see their Powerpoint presentations for helpful background.

Looking ahead to 2017, the general expectation is for plans to emphasize preventive care; strategies to control costs; and benefit changes that align with value and improve outcomes. They should also offer a range of meaningful choices for consumers along with strategies to retain members.

For CPEHN (California Pan-Ethnic Health Network), Health Access, and many other advocates the 2017 plan designs present an unprecedented opportunity for Covered CA to use its contracting power to reduce disparities. This starts with the QHPs collecting all the necessary data to establish benchmarks and show reduction in disparities over time. Over time transparency mechanisms like the Shop and Compare tool should display comparative data on how plans are doing to address disparities.

Other Issues: Continuing Issues with the Transition from Medi-Cal to Covered CA

As noted in comment letters to the Board by Western Center and Health Consumer Alliance among others, the transition of Medi-Cal enrollees into Covered CA is still shaky at best. Consumers do not yet have the ability to transfer from Medi-Cal to Covered CA plans without a gap in coverage, which contradicts the ACA goals for the continuum of coverage, says Cori Racela of NHELP-CA.  A key challenge in that transition from Medi-Cal to Covered CA, says Elizabeth Landsberg of Western Center on Law and Poverty, is you don’t have coverage until you pick a plan and pay your premium premium—this is not clear to enrollees in many circumstances. Covered CA should look for ways to simplify the process for these folks.

Coming Up Next for Covered CA

  • November 23 is the deadline for comments on the vision benefit RFP (find details here).
  • December 15, 2015 is the enrollment deadline for coverage effective Jan. 1.
  • There will be no December Board meeting, though December 17 will be held open in case there is a need for Board action. Advisory Groups will continue meeting, even in December.
  • January-April, 2016: Section 1332 waiver stakeholder process.