The early signs for Obamacare in California look good. After a rocky start, more than 3.3 million residents have signed up for health coverage during the first open enrollment period. As of March 31, 1.2 million signed up for private health plans through Covered California, and 1.9 million were found likely eligible for Medi-Cal, with final determinations to be made by the counties. But even as California leads the nation in expanding coverage, there is much to be learned in preparation for this fall’s open enrollment, which will likely attract another deluge of first-time enrollees and renewals, as well as for Medi-Cal enrollment, which is ongoing.
You should read CHCF’s new report on the early experiences of highly motivated consumers, which can help map the improvements that are needed for ACA Enrollment Lap Two. This paragraph sums it up:
“Substantial knowledge gaps remained after enrollment. Even after completing the process, many participants were unclear about the relationship between Obamacare, Covered California, and Medi-Cal. A large number did not know they could receive in-person assistance to enroll. Many did not know Medi-Cal had been expanded and that they might now be eligible. Some did not know about the premium tax credits, and most were unaware they might have to pay back some of the financial assistance if they inaccurately reported their income or if their income changed. Some were unfamiliar with how insurance works. Most of these knowledge gaps remained after enrollment was complete — the enrollment process did not answer many of these questions for these consumers.”
It should not surprise us that consumers could not read the road signs that were put up to help them to coverage, regardless of whether they were written in English, Spanish, Mandarin, or Vietnamese. The terminology was baffling to thousands of applicants: ACA, Obamacare, Medicaid, Medi-Cal, premiums, subsidies, copays, deductibles, and out-of-pocket expenses. Each of these terms alone is hard for most people to understand. Together they caused a lot of confusion. Our report makes it clear that Covered California and its partners could shore up the consumer experience with clearer pathways and road signs to coverage.
The report also points to opportunities to speed the route to Medi-Cal coverage. Medi-Cal provides insurance to a growing share of Californians and is key to ensuring comprehensive coverage for low-income Californians. But the new road to Medi-Cal enrollment can be particularly winding. A better road map and more assistance is needed to support consumers through the process.
California is a multicultural and multilingual state, and all paths to coverage must have appropriate signage and language-appropriate tools and programs. In-person assistance is crucial to this effort, which is why enrollment counselors should have robust training and support. Keeping the newly insured enrolled will require that knowledge be deepened, complexities clearly explained, and processes simplified.
Dr. Sandra R. Hernández is president and CEO of the California Health Care Foundation. Prior to joining CHCF, Sandra was CEO of The San Francisco Foundation, which she led for 16 years. She previously served as director of public health for the City and County of San Francisco. She also co-chaired San Francisco’s Universal Healthcare Council, which designed Healthy San Francisco, an innovative health access program for the uninsured.
Sandra is an assistant clinical professor at the University of California, San Francisco, School of Medicine. She practiced at San Francisco General Hospital in the AIDS clinic from 1984 to 2016. She was appointed by Governor Jerry Brown to the Covered California board of directors in February 2018. She currently serves on the Betty Irene Moore School of Nursing Advisory Council at UC Davis and the UC Regents Committee on Health Services. Sandra served on the External Advisory Committee at the Stanford Center for Population Health Sciences in 2016. Sandra is a graduate of Yale University, the Tufts School of Medicine, and the certificate program for senior executives in state and local government at Harvard University’s John F. Kennedy School of Government.