Despite enrollment glitches and consumer complaints over limited and hard-to-decipher health care provider networks, the first year of coverage under the Affordable Care Act has been positive in many ways for the San Diego health care community, according to experts and stakeholders.
“We have seen a decline in the number of patients that are self-pay with no insurance,” said Marc Reynolds, senior vice president for payer relations with Scripps Health System.
That situation is likely to improve for providers in 2015. According to Reynolds, Scripps will be in more insurers’ networks next year than in 2014, potentially expanding its access to more than 75% of Covered California participants.
Sharp HealthCare, which is both provider and insurer, saw a positive uptick from the ACA this year as well.
“Sharp Health Plan was very satisfied with its performance during the first year of open enrollment under Covered California,” said John Cihomsky, spokesperson for the organization.
As a new player in the individual insurance market in 2014, Sharp Health Plan captured more than 10% of Covered California enrollment in San Diego County. Cihomsky said his organization has high expectations for this next open enrollment period.
There is still room to grow for insurers. California’s rate of uninsured was cut in half from 22% of the population to 11% as a result of the first open enrollment period.
Rates Remain Steady for 2015
Although San Diego rates will increase more than rates in most other California counties, experts say consumers overall should be pleased. Rates and benefits of the plans sold through Covered California will remain fairly stable for 2015. On average, statewide increases in premium rates are 4.2%, according to Covered California.
San Diego’s rate increases are the second-highest next year, with a jump of 5.8%. Orange County’s rates will jump an average 6.3% — highest in the state.
The San Diego region has the largest number of insurance carriers in the state with nine companies selling plans through the exchange. Health Net had the greatest share of enrollees in 2014 with 32% of the market.
Health Net’s rate increase for 2015 is the largest in the region. The carrier is raising HMO rates by an average of 7.3% and its exclusive provider organization rates by an average of 7.8%, with its highest plan increase reaching 11%. At the same time, the insurer has the lowest-cost silver plan in the county — $295 for a 40-year-old without subsidies.
Only one plan, Kaiser Permanente — which last year captured 17% of the enrollment pie in San Diego — is lowering rates. Kaiser’s rates will drop by an average of 1.6% for 2015.
If enrollment for 2015 follows a similar path as this year, premium rates alone could have the biggest impact on consumers’ decisions.
“It was clear a lot of people made their choices based on premium prices,” said Carolina Coleman, research director for Insure the Uninsured, a Santa Monica-based health care advocacy group.
That, she said, led many consumers to face surprise medical bills. Helping them better understand the details of their health plans will be one of many outreach initiatives advocates and health care providers will focus on next year.
“Last year we tried to get as many people in as possible, which we needed to do. But we didn’t spend as much time talking with consumers about out-of-pocket costs, networks and formularies,” Coleman says.
Another part of the education process for those already covered is that while prices remain fairly stable across the board, they will change and vary by plan. Consumers who already have an insurance policy through Covered California might not get as good of a deal if they simply auto-enroll for 2015 and do not re-evaluate their plan choices.
Cost-sharing subsidies are available for the second-lowest priced silver plan. In San Diego, 60% of people who bought coverage through the exchange bought a silver plan. As plan prices shift, consumers’ subsidies can, too.
“I think that’s why it’s so important for everyone to take a look again this year,” said Craig Gussin of San Diego-based Auerbach & Gussin Insurance and Financial Services.
Coleman agreed. “We’re trying to drive the message home that consumers should rethink their options. Covered California will allow auto enrollment — while that’s good because we don’t want to lose people if they forget or don’t get around to it, it won’t allow them to evaluate choices that apply for the whole year.”
Reaching Out to New Populations
While 122,000 San Diegans bought insurance through Covered California in 2014, there were 380,000 uninsured people throughout the county prior to the law taking full effect, leaving much work to be done in bringing down the number of uninsured in the county.
In order to get more people covered, experts say a more nuanced and focused outreach approach is needed this year.
In many cases, emphasis will be placed on populations that have historically been difficult to reach — largely because of socioeconomics, language barriers and low literacy rates.
According to Leticia Cazares, director of outreach for San Ysidro Health Center, her organization and others throughout the region are targeting their messages this year “to make sure they are relevant and meet the needs and priorities of families.”
Latino families in particular are a large focus of outreach efforts in San Diego as they are throughout the state. “Covered California is quite aware they under performed with Latinos [this year] and they want to see changes,” said John Connolly, deputy director of Insure the Uninsured.
The exchange this week announced an investment of more than $46 million in TV, radio and social media advertisement for open enrollment, which will feature stories of people in local communities — many ethnic and historically underserved — who have benefited from the law. It also announced navigator grants to organizations throughout California, 11 of which are in San Diego. Many target Latino communities.
About 60% of the southern San Diego population is Latino, many of whom remain uninsured. This region includes San Ysidro, where Cazares’ organization is located, as well as the cities of Chula Vista and National City.
“Last year it was about general awareness,” Cazares said of outreach efforts. “We were building the plane as we were flying it, and not focused on any one topic or issue,” she said. “This year we need to be more targeted in our approach.”
To do that, she said, her organization has partnered with other organizations in the community. It also plans to conduct outreach at community colleges and team up with hospitals, business associations and chambers throughout the county.
Efforts will focus on dispelling myths and alleviating fears related to health reform and immigration.
“In San Diego, with the Latino community, it will be important to reinforce that when you sit with a navigator, your information is only used to sign you up for insurance and will not be shared with U.S. Immigration and Customs Enforcement. Getting that message out is important in the Latino community in San Diego,” Connolly said.
Many people also have misconceptions about Medi-Cal estate recovery, experts said. “Low-income families fear that if someone dies that they would lose their house,” Cazares said.
Helping people understand their health coverage options, the benefits of insurance coverage and increasing general health insurance literacy also will be a focus.
While there are many challenges still ahead, there’s much to feel optimistic about particularly with regard to costs, Connolly said. “California has seen pretty modest increases, which is good news for consumers.”