Next Steps for the Exchange

January 22, 2014

The State announced today that 1.7 million people enrolled in Covered California and Medi-Cal by Dec. 31, with an additional 125,000 Covered California enrollments by Jan. 15.

enrollment jan

These are fantastic results for just the first three months of enrollment; we are well on our way to meeting our goals. So what’s left on the agenda for open enrollment?

1.    Connect with individuals who started, but did not complete applications.

69.6% of people who started Covered California applications completed them by the end of 2013. This is probably a pretty good number, but that leaves over 300,000 people who considered getting coverage, but for whatever reason did not finish the application. Covered California should continue to reach out to these individuals, along with any applicants who did not enroll in a plan, to answer any unresolved questions and get the uninsured enrolled in coverage.

2.    Capture the Spanish speaking and Latino communities.

Only 5.5% of applicants speak Spanish. Yet 28.6% of Californians speak Spanish at home. Reportedly 18.7% of enrollees are Hispanic or Latino, however this question is optional on the application, thus the results leave out a sizable chunk (18%) of consumers.

Screenshot 2014-01-22 11.07.06

The press release issued by Covered California recognized an increase in interest among Latinos late in 2013, but acknowledged that we have a long way to go. Covered California and the State will need to work closely with Latino interest and advocacy organizations to capture this hard to reach population.

3.    Keep an eye on the enrollment of young people.

Everyone’s favorite topic: “Sure, lots of people are signing up, but are the millennials?!” Simply put, yes, in adequate numbers for now.

The success of the Exchange does depend on a balanced risk pool between the sick and the healthy. Since insurers can no longer refuse the sick, the young and old are used as proxies for relative health risk. Experts frequently state that a pool compromised of 40% individuals between the ages of 18-34 would satisfy insurers and keep premiums low. Fear-mongerers argue that any composition less than 40% young people would trigger a “death spiral” in which premiums would skyrocket and the remaining healthy individuals would drop out. But according to the Kaiser Family Foundation, if young people kept up pace with the 25% rate now, only a 1-2% increase in premiums would result in 2015. Hardly a death spiral, but worth keeping close tabs on.

4.    Recruit additional in-person assisters and enrollment entities.

The number of certified enrollment entities and counselors has not grown considerably since November. The state is well below its targeted 16,000 in-person assisters at just 3,427 (as of Jan. 11). Covered California should  recruit more organizations to become certified enrollment entities, particularly organizations that are not related to health, but are trusted in the community. (Think churches and schools.) Enrollment entities should train more of their staff and recruit new employees or volunteers to provide application assistance. We are all in this together, and need to step up collectively to enroll the uninsured.

5.    Take steps to encourage retention of insurers and recruit new carriers.

As expected, a vast majority (96%) of individuals enrolled in large health plans like Anthem Blue Cross, Blue Shield, Kaiser Permanente, and Health Net. Smaller regional plans such as Molina, Western Health Advantage, Contra Costa Health Plan, and Valley Health Plan accounted for less than 1% of enrollments each.

plans selected jan

California was fortunate enough to have 11 insurance companies opt to participate in the Exchange. We only want this number to increase with time, so that Californians have numerous options. If small local plans see no opportunity for profit or sustainability, they won’t participate. Covered California has to show carriers that the Exchange is a unique opportunity worthy of their interest (of course without steering customers). It is particularly important to recruit Medi-Cal managed care plans to participate, as this option is highly beneficial to consumers who shift between Medi-Cal and Exchange eligibility.