Covered California

Covered California is at risk if the Affordable Care act is repealed.
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Californians are able to shop for, compare, sign-up, and renew health care coverage through Covered California, the state’s health insurance marketplace established under the Affordable Care Act. Consumers now have new tools to sign up for plans and get the best possible value.

Through Covered California, the Affordable Care Act offers four transformational benefits California consumers didn’t have before:

  • The right to coverage regardless of pre-existing conditions;
  • Financial assistance on a sliding scale to better afford coverage;
  • Standardized benefits for easy comparison and security in coverage;
  • Bargaining power that has already limited premium increases to half of previous years.

Health Access was proud to lead efforts to pass the first-in-the-nation bill to establish a robust Exchange under the ACA, an “active purchaser” with the ability to negotiate the best value for California consumers and with strong conflict-of-interest provisions so that the health industry isn’t on both sides of the bargaining table.

After one year of open enrollment over 1 million Californians took advantage of the new coverage options–and many did so in spite of start-up and capacity issues. We are pleased that Covered California listened well to advocates’ and other stakeholders’ feeedback and trained more on-the ground enrollment counselors; beefed up website capacity; and increased its call center staffing to reduce wait times.

But there’s more to do. Too many Californians, even those eligible for subsidies or Medi-Cal, remain uninsured. All around us and now for no good reason, people are living sicker, dying younger, or one emergency away from financial ruin. For every person we don’t enroll, California leaves money in Washington, DC, resources we can use to boost our economy or create more efficient health care delivery systems.

Although California has surpassed its original enrollment goals, an indicator of the overwhelming demand for affordable coverage, the enrollment process does not work as well as it should. As with any new venture, some glitches could be expected in the roll out of Covered California. The need to ramp up to the scale sufficient to California’s size and diversity presents additional issues, many as yet unresolved. Still other issues require thoughtful re-examination of the enrollment process itself. These challenges and goals include:

  • A smoother, glitch-free website experience, in English and Spanish and supporting materials in other languages.
  • Covered California call center and health plans have the capacity to answer inquiries quickly, by the standard of 80% in 30 seconds.
  • Real-time and improved communication with consumers, so they know the status of their Medi-Cal or Covered California application and are not left in the dark for months. Improved communications throughout the year to educate consumers about their rights, benefits, and  options.
  • More community enrollment counselors, aided by enhanced and reformed reimbursement streams and improved certification procedures and training.
  • A more concerted campaign to educate and enroll harder-to-reach populations, including Latino and other communities with limited English proficiency.
  • Better auto-enrollment systems to help people transition between types of coverage, reducing churn between public and private coverage as well as different sources of public coverage, and maximizing enrollment in a multi-payer system, especially during “special enrollment” season.
  • Better tools to help consumers select plans and make comparisons beyond price, including improved quality ratings, and an accurate provider search tool as well as drug formulary comparison.
  • Clarity for consumers about what they are buying: higher standards for network adequacy and no more confusing “co-insurance” options.
  • Streamlined connections and the ability to easily sign up for family dental and vision coverage, other benefits and services, including voter registration.
  • Improved information technology systems to support Medi-Cal and Covered California, and make all these processes work smoothly.

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Health Access Analysis