A service of the California Health Care Foundation

One Year Later: What Worked for Covered Calif. and What To Expect in November

Oct. 1 was the one-year anniversary of California’s health insurance exchange under the Affordable Care Act. After some growing pains in the first year, officials are preparing to launch its second open enrollment period next month.

The exchange is “gearing up and building on the partnerships, community-based enrollment efforts and lessons learned from last year,” Covered California Executive Director Peter Lee wrote in a blog post marking the anniversary. Lee added, “We know this year will be harder. In three short months, we need to both renew coverage for more than a million Californians and reach out to the many who are eligible for coverage who have not signed up.”

The exchange’s second open enrollment period kicks off on Nov. 15 and will run until Feb. 15, 2015. What lessons are officials drawing on to streamline the process this fall? This edition of “Road to Reform” reviews the first open enrollment period and takes a look forward at the second.

Was Open Enrollment a Success?

Many say that the state’s exchange was overwhelmingly successful in its primary goal during the first open enrollment period: to extend health insurance to more Californians. Since the exchange launched last October, more than 3.4 million state residents have enrolled in coverage — including more than 1.3 million in private plans and about two million in Medi-Cal, the state’s Medicaid program. That’s far higher than enrollment in any other state, and it cut California’s uninsured rate in half.

Overall, Covered California ended up enrolling 42% of its projected eligible market. By comparison, if every state had kept up with California’s pace, national exchange enrollment would have topped 12 million.  (According to the Obama administration, exchange enrollment hit eight million, and 7.3 million enrollees had paid premiums as of September.)

The exchange also was able to be flexible and adapt to changes throughout the enrollment process. For example, after Latino enrollment lagged estimates, the exchange nearly doubled marketing aimed at that population in the first quarter of this year. As a result, the proportion of enrollees self-identifying as Latino went from 18% of all sign-ups in October through December to 32% in the first weeks of March.

Obstacles in Year One

Despite that apparent success, the exchange hit several road bumps along the way and continues to face some challenges.

Technical glitches: In its first days, Covered California’s website experienced some outages and technical glitches. Even as late as March, the flood of interest in Covered California caused wait times at the exchange’s call centers to exceed 40 minutes and slowed the website’s enrollment function.

Access problems: Even after obtaining a private health plan, some enrollees had trouble finding a doctor who accepted their new coverage, while others experienced coverage gaps or delays in when their insurance took effect.

Hundreds of complaints have been filed collectively against narrow provider networks in Anthem Blue Cross and Blue Shield of California exchange plans. Consumer Watchdog also has filed two lawsuits against Anthem and Blue Shield, alleging that the insurers misled consumers who enrolled in their health plans about the size of their provider networks. Covered California also has yet to post a comprehensive directory of physicians included in each exchange health plan, and there is no estimate for when that directory will be available.

Eligibility issues: Meanwhile, after signing up for private coverage, some enrollees later were switched into Medi-Cal after the exchange checked their incomes to verify eligibility for health coverage and subsidies. Exchange officials said that about 10,000 residents had their private coverage prematurely canceled after they were found to be eligible for Medi-Cal, resulting in a coverage gap. About 20,000 other enrollees experienced delays or confusion over their coverage after the exchange did not send their applications to insurers in a timely manner.

What To Expect in November

The exchange’s successes and challenges are shaping the marketplace during its second open enrollment period. James Scullary, a spokesperson for Covered California, said exchange officials acknowledge that open enrollment was “bumpy for some” and that the state wants “to make sure we get those things corrected and smoothed out so [enrollees] are getting the care they need and deserve.”

Health plan rates: Premiums remain fairly steady going into the exchange’s second open enrollment period, with an average rate increase of 4.2% and the same 10 insurers returning for year two. Meanwhile, subsidies for 2015 are likely to remain the same or be slightly higher than what were offered in 2014, which could help offset premium increases for some consumers.

Provider supply: Despite myriad concerns about health care access for consumers with exchange plans, a recent Los Angeles Times analysis found that insurers won’t be abandoning narrow provider networks in the exchange’s second open enrollment period. The Times found that while more than 80,000 providers will participate in exchange plans in 2015, many are only participating in one or two plans. Lee has said that the exchange will monitor the plans’ networks to ensure that they offer adequate access to care.

Outreach efforts: Meanwhile, the exchange plans to continue to reach out to Californians who have not yet signed up for health coverage — especially immigrant populations. Scullary told California Healthline that the exchange will launch more culturally focused marketing tactics as part of its overall enrollment campaign. The exchange is aiming to reach an additional 500,000 state residents. “We will have ads appearing in ethnic-specific media, and we plan to have a heavy presence on well-known television, radio, print and online outlets that are popular with Latinos, African Americans, Asians and Pacific Islanders,” Scullary said.

Scullary said the exchange also is considering increasing staffing to assist consumers through call centers and online chats. “We have also worked to improve the consumer experience by increasing the stability and capacity of our online enrollment portal,” he added.

Time will tell if the lessons learned during the exchange’s first year will smooth the road in its second year.

Around the Nation

Here’s what else is making news on the road to reform.

Veterans’ health: The Arizona Republic reports that advocacy group Concerned Veterans for America has launched a task force to propose significant changes to veterans’ health care in the U.S.

Medicare expenditures: Physician Kevin Schulman discusses whether health care reform has lowered Medicare spending.

Categories: Covered California, Road to Reform, The Health Law