California health exchange seeks to make buying insurance
a breeze
Published Tuesday, Jul. 17, 2012 - The Sacramento Bee
Peter V. Lee wants to make buying health insurance "as easy as buying a book
on Amazon."
He heads the nascent California Health Benefit Exchange, the cornerstone of
the state's effort to put in place the federal health care overhaul. Lee
envisions that 15 months from now, uninsured California residents will log onto
any computer to shop for health care the same way they purchase novels.
The poorest residents will receive Medi-Cal. Those above the poverty line
will find a menu of subsidized private options at different prices, from a
"platinum" plan with higher premiums but lower deductibles down to a "bronze"
selection that has lower premiums but requires the buyer to accept more risk.
All told, the exchange expects to connect about 2 million Californians with
health insurers by 2019. Starting in 2014, it will be California's vehicle to
deliver subsidized care to people who earn income up to four times the federal
poverty level, currently $92,200 for a family of four.
The largest share will be people who lack insurance now, though hundreds of
thousands who purchase health care on the open market or receive it through work
will also use the exchange, according to a simulation conducted by the UC
Berkeley Center for Labor Research and Education and the UCLA Center for Health
Policy Research.
None of it existed two years ago.
"We've been moving ahead full-throttle even before the Supreme Court
decision," Lee said, referring to the U.S. Supreme Court opinion last month that
upheld most of President Barack Obama's health care law. "This doesn't really
change things for us. It changes things in the eyes of others, who are now
saying, 'Wow, this exchange thing is going to be real.' "
California was the first state to establish a health care exchange after
Obama signed the Patient Protection and Affordable Care Act in March 2010.
Then-Gov. Arnold Schwarzenegger, who signed the state legislation, supported
universal health care and had tried to establish a California program along the
same lines in 2007, but could not overcome political opposition.
A state board of five high-powered appointees oversees the exchange,
including two former top Schwarzenegger aides, while Lee is responsible for
day-to-day operations. The exchange must tackle three major areas in the coming
months: attracting potential subscribers, building the enrollment system and
selecting the health insurers and the plans they will provide.
The exchange will target working poor and middle-class Californians who earn
too much to qualify for Medi-Cal but generally lack access to health coverage at
work. In the past, they may have found costs prohibitive on the private market
or been denied because they have high-risk medical problems.
The exchange is designed to help overcome those challenges. Under the new
federal law, insurers are required to accept all patients regardless of
pre-existing conditions. Federal subsidies are intended to reduce consumer costs
below market prices.
The most significant challenge will be attracting enough healthy consumers to
keep prices reasonable and provide enough income to health insurers. If the
exchange draws only high-cost patients, insurers could walk away.
"How many healthy people can we get in the purchasing pool to make the
economics work?" asked Susan Kennedy, an exchange board member who was
Schwarzenegger's chief of staff. "That's the $64 million question no one can
answer."
PR may include sitcoms
Recruiting those people starts with a massive public outreach campaign
next year. According to a new 124-page report, the exchange is considering
multiple fronts, including ads in English and Spanish, Facebook banners and
working with churches to distribute literature.
Also among the ideas: pitching popular television shows such as "Modern
Family" and "The Biggest Loser" to incorporate health care changes into their
story lines; recruiting Stevie Wonder as a pitchman; and hosting a "First Lady
Summit" with first lady Michelle Obama to focus on health care for all.
Under the health care law, Americans must sign up for insurance or pay a
penalty starting in 2014 – what the U.S. Supreme Court viewed as an allowable
tax in its 5-4 decision. Health care advocates describe the federal subsidies as
the carrot and the penalty as the stick in their effort to enroll consumers.
Diana S. Dooley, who serves on the exchange board as secretary of the
California Health and Human Services Agency, said she believes the federal
rebates will reduce cost concerns.
"We're doing a lot of work at the exchange to understand what motivates
people and what they're worried about," Dooley said. "We're finding a lot of
people want to have health insurance, but they simply can't afford it."
Under the federal law, all plans must provide 10 "essential benefits," which
include hospitalization, lab services, maternity care and prescription
drugs.
Health insurers have motivation to participate because they can increase
their customer base. But without knowing exactly who will sign up, they also
worry that only those who need expensive care will join the exchange.
"This is an important new channel to sell their product," said Marian Mulkey,
director of the Health Reform and Public Programs Initiative at the California
HealthCare Foundation. "But it doesn't mean they will all arrive with the same
enthusiasm, wanting to participate."
Charles Bacchi, executive vice president at the California Association of
Health Plans, said that in order to maintain reasonable risk pools, "it's
important that the exchange and outside marketplace look alike."
The health exchange is also charged with creating a voluntary insurance
program for small businesses, an attempt to give employers greater purchasing
power by consolidating their workers in one pool. Owners of businesses with 25
employees or fewer are generally eligible for federal tax credits.
But John Kabateck, National Federation of Independent Business California
executive director, remains skeptical about whether the exchange can reduce
costs for small businesses. Kabateck's national organization was the lead
plaintiff in the legal challenge decided by the Supreme Court.
"We have long advocated for increasing access options and healthy competition
for more affordable health care, but in this case the devil is in the details,"
Kabateck said. "Small businesses feel both uncertain and frankly confused about
the exchange."
Signups set in fall 2013
To ensure it can open its doors in January 2014 with as many consumers
as possible, the exchange plans to begin registering people in October 2013 with
a system that can make health care enrollment as easy as Lee's description of
buying books online.
The exchange last month awarded Accenture LLC a multiyear contract worth $359
million, including $183 million to develop and install a statewide enrollment
system over the next year.
The system has been the focus of health exchange discussions for the past
year, drawing interest from a who's who list of government contractors.
Accenture spent $226,000 between January 2011 and March 2012 on lobbying a
variety of state offices, including the Health and Human Services Agency, state
reports show.
Federal funds will mostly pay for the system, and the exchange asked the
Obama administration for a $196 million grant in June to finance the Accenture
deal and keep the exchange operational over the next year.
To pay for the health care changes, the federal act will generate money by
penalizing those who do not obtain insurance, imposing higher Medicare taxes on
upper-income earners, taxing high-priced employer-sponsored health care policies
and taxing different industries, from pharmaceuticals to indoor tanning.
It also counts on saving money from Medicare by reducing growth in provider
reimbursements and smaller payments to Medicare Advantage plans.
Health care advocates who celebrated the Supreme Court decision acknowledge
the federal program is not in the clear yet. The November elections loom large,
and Republicans have indicated they will seek to repeal health care changes if
they win the White House and Congress.
"The real risk to the exchange is the loss of the subsidies, which would be a
real attraction for millions of Californians," said Anthony Wright, executive
director of Health Access California, which advocates for low-income, uninsured
Californians. "The exchange could operate without those subsidies, but it
wouldn't be as attractive to as many people."
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