The Day One Challenge

In his comments at the annual Insure the Uninsured Conference (which we live-tweeted @healthaccess), Peter Lee, the director of the California Health Benefits Exchange, cited a goal of getting the maxmium number of people covered in 2014.

In my remarks on a panel, I supported those remarks, that we need millions of Californians enrolled on day one, January 1, 2014. In fact, it’s not just important, but imperative, that we have mass enrollment on day one.

* Clearly, we want Californians to get the benefits of coverage, so that as many people as possible don’t go uninsured, live sicker, die younger, and live one emergency away from financial ruin.
* There’s a financial imperative as well. The newly eligible will be paid for 100% by the federal government (whether for Medi-Cal or for subsidies in the Exchange). That means for every month Californians go unenrolled, that’s thousands, millions, hundreds of millions of dollars that are being left in Washington, DC–and not coming into our health system, and our California economy.
* Finally, in order for the Exchange to function, it needs mass enrollment. Those who sign up the quickest will likely be the sickest–those that value and need coverage the most. In order for the Exchange to have reasonable rates, it needs a pool of people that includes the healthy as well–a risk mix reflective of the state as a whole. The Exchange–and the market as a whole–benefits if it is bigger and broader, rather than smaller and sicker.
* Politically, we can better show the benefits of the law if more people take advantage of them, and we can be an example to those states who may not have seized the opportunities so readily.

But my other main point was that such a goal is doable. We can use these two years to create and enrollment and eligibility system that facilitates this goal. Between the Exchange and other state agencies, there is a process underway to set up the information technology to allow more easy enrollment.

We can create automatic and seamless mechanisms to get people enrolled. Health Access is sponsoring legislation in this regard: One, AB714(Atkins), would help identify and get 1-2 million Californians pre-enrolled prior to 2014, working with existing programs–from those with FamilyPACT to the parents of Healthy Families children to those screened for cancer through Every Woman Counts. Other legislation this year will explore “horizontal intergration” with other human service programs. Another bill, AB792(Bonilla), would help bring people to the door of the Exchange at the times in their life when they experience the life changes that lead to uninsurance: job loss, divorce, death in the family, graduation, etc.

These mechanisms won’t do the whole job by themselves–we’ll still need creative and expansive marketing, and significant “boots on the ground” to help people know about the options, select plans, etc. But together, getting millions of people enrolled on day one is acheiveable. We just have to make the commitments–this year–to do it.

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