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Standards Release a ‘Milestone’ for Exchange

Covered California, the state’s health benefit exchange, yesterday released its benefit standards outlining the basis for choosing qualified health plans that will participate in the exchange.

“This is another milestone for the exchange,” said Diana Dooley, secretary of the state Health and Human Services Agency. “We have a lot of hurdles to get over, we still have a lot to do, but this is another successful milestone toward the health care reform effort.”

Covered California also submitted an intention to file emergency regulations with the Office of Administrative Law last week, outlining its pediatric dental benefit policy. The exchange is expected to file those regulations Friday, according to Brandon Ross, staff counsel for Covered California.

The benefit standards will guide the exchange in selecting health plans to be included in the exchange.

“We are going to be an active purchaser,” Ross said, “and not everyone will be chosen, so it’s important to say, here are the standards we’re going to go by. Just so everyone knows that these are our standards and criteria, it creates a level playing field, so everyone knows where they stand.”

The California Association of Health Plans greeted the news with cautious approval. In a news release, president and CEO Patrick Johnston, said requiring the same benefits and deductibles for each category of health care coverage could reduce consumer confusion about the pricing of health insurance premiums.

But, Johnston said, CAHP is concerned that premiums might be affected by the setting of benefit standards, among other policies.

“New taxes, limits on geography-based pricing and age rating restrictions are all part of the Affordable Care Act that will drive up the cost of coverage for millions of consumers and employers,” Johnston said in the release.

“We will see in the coming months whether the standardized benefit designs adversely impact premiums or not,” he said.

Dooley was skeptical about tying premium increases to benefits standards.

“You can’t isolate one variable at this point, and say anything about the effect on premiums,” Dooley said. “There are lots of effects on premiums. We don’t know the effect of competition on premiums, for instance.”

Covered California yesterday officially unveiled its new website  — — as well as new information posted about the exchange.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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