On November 15, the second annual open enrollment period begins for health coverage under the Affordable Care Act (ACA). This enrollment period, which runs through February 15, 2015, begins in an uncertain time for the ACA nationally, with midterm election results bringing greater possibility of legislative challenges to the law, and with the US Supreme Court granting review of King v. Burwell, which questions the validity of tax credits in the 34 states served by the federal marketplace.
Here in California, we’ve pushed ahead to deliver on the promise of the ACA by establishing a state marketplace and taking advantage of options in the federal law that go beyond the minimum requirements. These approaches are paying off.
In its ACA debut last year, California extended benefits to millions who previously hadn’t had access to affordable insurance, private or public. Covered California enrolled 1.3 million people, with most receiving federal tax credits to help pay their premiums. And because we accepted federal funds to expand Medicaid, California added 1.9 million people to the Medi-Cal rolls. As of last month, Medi-Cal enrollment topped 11 million, nearly one-third of the state’s population.
Covered California is one of only a few state marketplaces that negotiate premiums and other features with insurers before offering their plans to the public. In 2014, Covered California offered health plans from 11 companies, giving most individuals a choice of four or more health plans. Premiums for 2015 are, on average, 4.2% higher than this year, below the historical average increase, according to Covered California. The marketplace’s standardized benefit packages allow consumers to make apples-to-apples shopping comparisons. State law extends the benefits of this standardization to parts of the market outside Covered California.
There is much for Covered California to be proud of, but the hard work is not done. We’ve learned a lot from the first open enrollment that should guide our efforts going forward. Covered California has detailed many of these lessons in a self-appraisal released last month. There are numerous other opportunities for improvement.
We’ve learned, for example, that many individuals need help to complete the application, understand confusing jargon, evaluate their insurance options, and choose a health plan. During the first open enrollment period there were long wait times for help, which led consumers to grow frustrated and sometimes abandon the process. Covered California has taken steps to increase the capacity of its service center and IT systems, and to expand support provided by many partners, including certified insurance agents and assisters at community organizations and health providers.
We’ve also learned just how important it is to coordinate enrollment between Covered California and Medi-Cal, which is expanding at a rate that would challenge any system. The backlog of Medi-Cal applications peaked at 900,000 this year. While this logjam has been significantly reduced by the hard work of state and county staff who have found ways to move applicants through more quickly, some issues remain unresolved.
Getting individuals to renew coverage and stay enrolled is a new challenge now. Of course, coverage is only the first step, and we will learn more about what it means for people’s access to care. We should also understand how the ACA affects health care providers, including those serving millions of individuals in California who remain uninsured.
Sandra R. Hernández, MD, 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 cochaired San Francisco’s Universal Healthcare Council, which designed Healthy San Francisco. It was the first time a local government in the US attempted to provide health care for all of its constituents.
In February 2018, Sandra was appointed by Governor Jerry Brown to the Covered California board of directors. She also serves on the Betty Irene Moore School of Nursing Advisory Council at UC Davis and on the UC Regents Health Services Committee. Sandra is an assistant clinical professor at the UCSF School of Medicine. She practiced at San Francisco General Hospital in the HIV/AIDS Clinic from 1984 to 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.