California’s dual health insurance regulatory structure has evolved over the decades based on policy, political, and marketplace dynamics. Oversight of health coverage is divided between the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI), which have unique statutory histories, administrative structures, and legal frameworks. This dual structure contributes to consumer confusion, added government and insurance carrier administrative burdens, and difficulty in monitoring what is being bought and sold in the insurance marketplace.

The changes required by the federal Affordable Care Act (ACA) provide an opportunity to reexamine the state’s regulatory system. Under new federal standards, the ACA may narrow the differences between CDI- and DMHC-regulated health coverage.

CHCF held a Sacramento briefing to inform policymakers, stakeholders, and the public about health insurance regulation in California and the policies, structures, and responsibilities needed to implement the ACA in the state. A report presented at the briefing examined two potential options for health insurance regulatory reform in California: consolidating regulation into one state agency or institutionalizing coordination and consistency between the two agencies.

The presenters were:

• Patrick Johnston, president and CEO, California Association of Health Plans
• Deborah Kelch, president and CEO, Kelch Associates
• Maureen McKennan, acting deputy director, Plan and Provider Relations, California Department of Managed Health Care
• Marian Mulkey, director, Health Reform and Public Programs Initiative, CHCF
• Janice Rocco, deputy commissioner, Health Policy, California Department of Insurance
• Anthony Wright, executive director, Health Access

A recording of the event and the presentation slides are available below.