Making Obamacare Work: California's Encouraging Start

In creating its health-benefit exchange under the Affordable Care Act, California has gotten off to an encouraging start
by | June 13, 2013
 

Put aside, for just a few minutes, whatever political rhetoric has infiltrated your airspace about the federal Affordable Care Act (ACA). Whatever you think of the health-reform law, it's coming, and with the clock ticking toward an Oct. 13, 2013, pre-enrollment deadline, some of the most important work for implementing "Obamacare" is going on now in the states.

As a member of the California Health Benefit Exchange Board, I've had a front-row seat for our state's efforts, and we're off to an encouraging start with our state exchange, branded as Covered California.

These state-level health benefit exchanges are the central, essential structural element of the ACA -- an effort to create a competitive, transparent health insurance marketplace for individual consumers in which price and quality for comparable products drive the purchase of those products. As of this writing, more than half of the states have opted to pass up on creating their own health exchanges, deferring their operation to the federal government. In my view, every state that relegates this decision to Washington reduces our chances of finding innovative solutions to controlling costs while improving health.

That's certainly what we've been trying to do in California. Our five-member health-exchange board adopted the ACA's mission of expanding health-insurance coverage, improving health-care quality, improving choice and value, and controlling rising costs. We've known from the start that the keys to our success would be contracting with affordable health plans, embarking on an effective outreach and marketing strategy, and executing a smooth, user-friendly enrollment process.

We issued a request for proposals statewide, inviting health plans to compete in one or more of 18 geographic regions across our sizable state. Thirty-three health plans responded. In an evaluation process driven by price, value, quality and provider-network adequacy, we selected 13 health plans to be on the selection panel for Covered California consumers. Moreover, four of the health plans were newcomers to the individual health-insurance market, one that suffers in choice and affordability compared to plans based on large- and small-group rates.

The most encouraging news: the rates we were able to negotiate. The prices that came in were far lower than the most dire, doomsday predictions, and even lower than actuarial and Government Accountability Office projections. In the most populous California regions, our 2014 individual market rates will be equal to or cheaper than 2013 small-group rates.

So we now have health-plan partners and provider networks that are ready, willing and able to provide a reasonably affordable product, and in a new, online, transparent marketplace for consumers. But with that Oct. 13 deadline approaching and the Jan. 1, 2014, open-enrollment and coverage start date not far behind, we still have much wood to chop. Over the next few years, we need to find and enroll as many as 5 million uninsured Californians who stand to benefit from Obamacare.

Our outreach and enrollment will be both "high tech" and "high-touch." Some Californians will choose the technology-friendly online shopping and enrollment route. Others will need more human, hands-on assistance to enroll. We are building infrastructure and readying ourselves for either approach.

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