By being the first state to form an Exchange following the passage of the Affordable Care Act, California demonstrated considerable leadership.Â
The Exchange Board and staff have been hard at work putting all the necessary pieces in place to ensure people can get coverage beginning Jan. 1, 2014. But, the decisions the exchange leadership makes in the next year could determine its ultimate success.
The exchange must implement a well-executed marketing campaign to make sure customers are aware of this new health care marketplace. The enrollment system must be seamless, efficient and user-friendly so customers face no barriers to purchasing coverage. But, at its very heart, it must offer highly attractive and affordable products (i.e., health plans) that will drive a few million Californians to buy coverage through the exchange.
The exchange board is on the cusp of making one of its most important decisions — selection of and contracting with the health plans that will be available to enrollees through the exchange.
Defining the requirements for a health plan to be considered as a qualified health plan (QHP) is the first step in this process, followed by the actual selection of plans that will offer coverage in the Exchange.
The standards for QHPs should result in consumers having choices in health plans. They should initially rely upon California’s existing, robust consumer protections, require state licensure and use national quality standards to ensure patients receive quality care.
The Board has indicated that it intends to selectively contract with health plans that have become QHPs.Â Under this policy, the most cost-effective, timely and consistent approach in selecting health plans is to ensure that any health plan or insurer applying to offer coverage must meet the consumer protections, quality and legal standards in California law and regulation.Â This provides the exchange with the greatest flexibility to contract with health plans while ensuring exchange customers benefit from the state’s regulatory oversight and standards.
California has some of the most extensive health plan regulations in the country, offering important consumer protections — all of which the exchange can rely upon when selecting health plans for the exchange. For example, regulators’ review of rate filings, laws requiring robust networks of providers and rules surrounding timely access to providers are some of the consumer protections plans already meet.
Also, aligning exchange criteria with current regulatory and legal standards will offer consistency between health plan policies offered through the exchange and those sold commercially, which is required through the Affordable Care Act.
California health plans have kept pace with the ever-changing medical care needs of the Golden State’s diverse population by developing a wide array of plans and benefits.
Today, they are the backbone of the state’s medical care system and essential to its safety net for those in need. Together, all the state’s health plans provide comprehensive coverage for about two out of every three Californians.
The potential of the California Health Benefit Exchange is great — millions of Californians will have the opportunity to use a government subsidy to purchase health coverage through this new exchange marketplace.
California health plans are a key partner for the exchange to create a successful marketplace, and it is vital that they draw upon our extensive experience in attracting consumers amid a highly competitive marketplace in order to reach the shared goal of providing high-quality, affordable health care to millions of additional Californians.