Covered California November Board Meeting

December 6, 2016

On November 17, 2016, the Covered California Board convened its monthly Board meeting, the first since the presidential election. The Board agenda included expert panels to mark five years since Covered California was established, which were: “National and State Health Care Landscape and Trends” and “Improving Wellness, Population Health, and Consumer Engagement.” In addition to the expert panels, the Board received an update on 2017 open enrollment and considered several policy and action items as outlined below.

Click here for the Covered California Board Meeting Agenda for November 17, 2016.

Click here for the Meeting Materials for November 17, 2016.

Click here to watch the Board Meeting.

Executive Director’s Report

Peter V. Lee, Executive Director of Covered California, shared 2017 open enrollment data with the Board and public for the fourth Covered California open enrollment. Early 2017 data reveals that the 2017 enrollment period continues the trend of increasing consumer engagement and positive enrollment gains.

Data for open enrollment 2017:

• 44,885 individuals have selected health plans, as of November 15, 2016
• 3 million individuals are going through the annual renewal process
• 263,462 consumers have taken an active step toward 2017 enrollment

Executive Director Lee shared the following Covered California chart:

According to Executive Director Lee, Covered California recognizes that many consumers are likely nervous about open enrollment in light of the recent elections. For 2017, Covered California increased marketing strategies to encourage consumers to enroll. For example, Covered California created 820 more storefronts to encourage consumers to sign up. In addition, Executive Director Lee and staff adopted a ground-up approach to connect with the community by connecting with federally qualified clinics and community groups. Covered California also adopted a new helpline tool with an uber-style callback system; the tool allows consumers to easily and efficiently get answers to enrollment and coverage questions. Executive Director Lee acknowledged Covered California staff for their commitment to consumer engagement and accessibility.

Covered California Policy and Action Items

Click here for the Covered California Policy Items Presentation.

Individual Eligibility and Enrollment Regulations Emergency Readoption (Discussion)

Bahara Hosseini, Covered California Legal Department, introduced proposed changes in the emergency readoption of the individual eligibility and enrollment regulations for Board discussion. The draft regulation proposes to increase the allowable discrepancy threshold for annual income from 10% to 25%. This means that a difference between what the consumer reports as annual income and the federal income data available of up to 25% (plus or minus) will not trigger a finding of inconsistency or the need for the consumer to provide additional verification of income. Discrepancies above or below 25% will trigger a finding of inconsistency and the 95-day timeline for the consumer to show proof of income. The revised regulations will come up for action at the next Covered California Board meeting.

Enrollment Assistance Regulations (Action)

Drew Kyler, Covered California Branch Chief of the Outreach/Sales Division, shared revised Navigator Grant Program regulations for Board adoption. The revised regulations incorporate several changes adopted by the federally facilitated exchange that are optional for state exchanges, but staff-recommended as consumer-friendly improvements, including the policy that Covered California will continue to cover the costs of fingerprinting for Certified Enrollment Counselors (CECs) and provide training for CECs on consumer resources for tax advice or assistance. In addition, the revised regulations allow CECs to provide nominal gifts to consumers for purposes other than as an inducement for enrollment, providing the gift does not exceed a value equal to or greater than $15. Small gifts include a keychain, notepad or pen. Gifts of alcohol, tobacco or lottery tickets are prohibited.

Covered California Areas of Focus 2016/2017

Executive Director Lee highlighted the following Covered California areas of focus for 2016/2017:

• Planning for New Administration – Provide information on lessons learned from California to assist new Administration and Congress
• Medi-Cal Transition – Improve the process for those consumers no longer Medi-Cal eligible to transition to Covered California
• Special Enrollment Period Workgroup – Develop and implement plans to ensure the maximum valid enrollment during the Special Enrollment Period
• Consumer Experience – Improve the consumer journey
• Proving Ground – Serve as a proving ground for effective implementation of a consumer-centered health care marketplace
• Appeals – Continue to examine the appeals process for timeliness and streamlining

Dr. Ed Hernandez, California State Senator and Chair of the Senate Health Committee, attended the Board meeting and spoke to the Board and attendees about the potential for rollback of the Affordable Care Act (ACA) and impacts on California’s successful implementation. Senator Hernandez stated that “Health is a right and not a political football.” Senator Hernandez congratulated Covered California on the 1.3 million individuals enrolled in the exchange. Pointing out that California’s ACA implementation has been a huge success, the Senator warned that President-elect Trump’s threat to “repeal and replace” the ACA would destabilize a high-functioning health insurance market and return millions to the ranks of the uninsured. Senator Hernandez pledged collaboration and cooperation to work with the Board to ensure that California can protect its gains in coverage.

Expert Panel 1: National and State Health Care Landscape and Trends

This section highlights only a few of the key messages of the panel speakers. The full presentations and discussion can be viewed here.

John Bertko, Chief Actuary at Covered California, compared California’s successes with the ACA to other states. According to Mr. Bertko, Covered California’s average rate increase for 2017 of 13.2% is well under the national average increase of 22%. In every Covered California region there are more than three insurers, compared to about 25% of counties in the country with only one insurer. In addition, Mr. Bertko mentioned that Covered California’s risk mix (percentage of high-risk patients) is 17% lower than the national average.

According to Mr. Bertko, many Californians are concerned about the January inauguration of President-elect Trump and his stated intention to repeal the ACA early in his first term. Mr. Bertko suggested calm and clarified that ACA coverage is protected for 2017. Mr. Bertko encouraged the Board and the public to plan for action with 2018 in mind. According to Mr. Bertko, possible issues for 2018 and beyond include increased rise of prescription drug prices; clarification on Simplified Employee Pension (SEP) Plan rules and Third Party Payment rules; and a need to monitor whether push for provider payment reform through Alternative Payment Methods (APMs) continues with the new Administration.

Larry Levitt, Kaiser Family Foundation (KFF) Senior Vice President for Special Initiatives, pointed out that 27 million people currently remain uninsured in the United States, and three million people are uninsured in California. Mr. Levitt explained that there are both eligible and ineligible individuals in the uninsured group. For example, unauthorized immigrants are ineligible for Medicaid coverage or for coverage and subsidies through exchanges. According to Mr. Levitt, 46% of those currently uninsured are eligible for health insurance. These eligible uninsured are not purchasing coverage primarily because of the cost. Mr. Levitt emphasized that uninsured individuals still need to be educated about the benefits of coverage and purchasing coverage through Covered California. Mr. Levitt discussed possible alternatives and compared ACA repeal proposals put forward by the President-elect and House Republicans as in the chart below.

Dr. Sandra Hernandez, President and Chief Executive Officer of the California Health Care Foundation, highlighted the substantial increases in coverage under the ACA.

Dr. Hernandez emphasized that California has always been innovative and forward-thinking, and those instincts will serve us well in these uncertain times.  Dr. Hernandez noted the extensive interrelationships between Medi-Cal and the private market and the need to evaluate the market impacts from any major shifts and changes in Medicaid at the federal level. She pointed out that health care is a major driver of the economy in California and nationally, and recommended understanding and highlighting the potential negative economic impacts from massive reductions in health care and health care spending. Dr. Hernandez also noted that California can look to state initiatives to reform the delivery system and our efforts to collaborate on the reforms across programs such as Medi-Cal, CalPERS and Covered California. The delivery system reforms can and should continue to be a focus, particularly strategies to better serve those who need the most services and can benefit the most from better integration and management of their care.

Dr. Ian Morrison, a noted author and futurist, offered that major changes to the ACA can be expected with the Trump election, including:

• Structural changes to the ACA, not just a name change
• The end of both individual and corporate mandates
• Establishing state high-risk pools for people with pre-existing health conditions
• Less federal subsidies for uninsured and Medicaid
• More state discretion for Medicaid spending

Panel 2: Improving Wellness, Population Health, and Consumer Engagement

Dr. Karen Smith, Director of the State Department of Public Health and State Public Health Officer, stated that different drivers of change will promote health equity and decrease health disparities. Drivers of change include expanding mandates, understanding the changing population, focusing on communities, and initiating new data and tools. Instead of health behavior or medical care being the best predictor for good health, research consistently shows underlying social determinants of health predict 20% to 50% of an individual’s health status. According to Dr. Smith, as a result of these findings, public health officials recognize that community-focused interventions can make the most effective, sustainable change.

Dr. Smith said that Let’s Get Healthy California focused on better care for individuals and better health for populations, with lower costs. Ultimately, the program focuses on the pursuit of health equity.

Dr. Smith shared the following image revealing the strategies and goals of Let’s Get Healthy California:

According to Dr. Smith, Covered California can be involved in population health through:

• Selecting priority areas and goals that parallel Let’s Get Healthy California
• Using data to gain a better understanding of health disparities
• Innovating with health equity in mind

Doris Peter, PhD, Director of the Consumer Reports Health Ratings Center, emphasized the importance of engaging the consumer in the health care industry. Consumer Reports (CR) is a nonprofit independent organization and enjoys consumer trust because of that independence. According to Dr. Peter, CR engages consumers by providing data-based comparisons, telling relatable stories and distributing health ratings. The Health Ratings Center mainly focuses on hospitals and medication, with hospital safety being a priority concern for consumers. Dr. Peter said that CR’s independence allows the organization to “tell it like it is.”

Chair of the Covered California Board, Secretary of Health and Human Services Diana Dooley shared, “It is not what you call it. It is what you are doing,” a sentiment that was repeated throughout the meeting. Secretary Dooley said that the ACA is just one approach to solving health care challenges, and there are other solutions. Covered California will look for opportunities to engage in the broader conversation. Secretary Dooley stated that Covered California’s main priority is to improve the health of all Californians; Covered California and partners need to collaborate and unite to pursue health equity, affordability and accessibility.