Tuesday, November 29, 2016

Covered California in Changing Times

Elections matter and result in real change. While we cannot predict the future, we believe that Covered California can and should play an active role in both continuing to serve Californians and helping shape the future of health care for their benefit.

Five years ago, the Covered California Board of Directors set our course by establishing a mission that was anchored in expanding coverage for Californians by creating a consumer-centered marketplace. At the same time, the board said that we needed to be part of changing the way health care is delivered and accessed in our state — promoting the “triple aim” of better care, lower costs and improved health.

Today, with a new president and Congress about to take office, the prospect of change is on the horizon. Many questions are emerging about what the future holds for health care coverage and how it is delivered.    

Since day one, Covered California has been a learning organization, and over the past several months we have been looking ahead and planning for the certainty that we would be facing a new administration, whether it be Republican or Democratic.  

We began with an extensive study that Covered California released last summer that examined numerous scenarios that might be part of either a new Republican or Democratic administration and their potential impacts.

In November, two weeks after the election, Covered California brought together health experts with a range of perspectives to help our board consider the possible paths forward related to the future of health care in both the United States and California. 

Two panels explored in depth the state of health care reform implementation, the potential changes in the health care marketplaces and top issues that we as a nation need to consider such as promoting health equity, ensuring consumers are given tools to be active partners in choosing and getting the care they need, and recognizing the complex interactions between the many parts of the health care system. (The presentations are linked with the name of each speaker, and a summary of the day’s proceedings with references recommended can be found here.)

The first panel included John Bertko, one of the nation’s most prominent actuaries, who spoke about insurance trends in health care for 2017 and beyond, specifically focusing on policies that drive affordability. Larry Levitt, senior vice president for special initiatives from the Kaiser Family Foundation, walked through what has changed since the passage and implementation of the Patient Protection and Affordable Care Act in terms of the number of uninsured and potential changes to the law that may be debated by Congress. Sandra Hernandez, M.D., president and chief executive officer for the California Health Care Foundation, focused on the relation of health care to the broader Californian and national economies. The panel ended with a presentation from Ian Morrison, Ph.D., a noted health care futurist, who detailed the challenges ahead as the nation continues its path of evolving how our health care system should look in the future, especially considering the current political divide.

The second panel considered how to improve wellness, population health and consumer engagement. The panel included Karen Smith, M.D., M.P.H., director and state public health officer for the California Department of Public Health, who focused her presentation on the “triple aim.” Finally, Doris Peter, Ph.D., director of the Health Ratings Center at Consumer Reports, spoke about how to engage consumers in the process of affecting change and helping them “shop with their feet.”

Covered California will use this input as well as our own experiences as we seek to adapt to the changing environment. At the same time, we look forward to continuing our effort to share what we have learned, what has been proven to work, and what has not worked to help inform the discussions over the future of health care. 

Some of the lessons we have learned can and should provide important reference points for the discussions that will be forthcoming. These lessons include how Covered California:
·      Built a competitive marketplace that puts consumers in the driver’s seat, giving them a power that they did not previously have when it comes to the plans they pick and the providers they can access.
·      Developed patient-centered benefit designs that offer a good value for consumers and keep care affordable by including a wide variety of services not subject to the deductible.
·      Fostered a good risk mix by engaging and promoting access to primary care in robust and extensive marketing and community outreach with partners that include insurance agents and members of communities across the state that number in the tens of thousands.
·      Effectively managed the federal tax credits that have brought health coverage within reach of millions of Californians.
·      Established an infrastructure to examine patient data to evaluate the relationship between consumers’ income, benefit designs, health status and other factors on the quality of care and costs of services.  This Healthcare Evidence Initiative is just now collecting data to begin deep analysis. 
There has been a dramatic reduction in those without health insurance because of Covered California and the expansion of Medi-Cal (California’s Medicaid program). The latest data from the Centers for Disease Control and Prevention shows California’s uninsured rate has been slashed by nearly 10 points, from 17 percent in 2013 to 7.4 percent in the first half of 2016. 

We have also kept premium rate changes in the individual market moderate compared to the rest of the country and historical trends in California. We have built the healthiest risk pool in the nation, which means lower costs in federal tax credits and benefits for Californians who do not receive financial assistance. At the same time, Covered California has sought to partner with private employers and work with the health insurance companies we contract with to change the delivery system to promote quality care that is delivered cost effectively.

These are lessons and experiences that can extend well beyond our borders. They are relevant not just for federal and state policy, but for the employer-based and private health insurance markets as well.

Over the past four years, Covered California has become woven into the fabric of how health care is provided in the state, with nearly 3 million consumers benefiting from coverage for some portion of the past three years. Many of those consumers now have employer-based coverage. Many have lived for the first time without the fear that they would be turned away by a health plan because of having a pre-existing health condition. Many of those individuals — like those who now benefit from getting coverage through Medi-Cal — are the reason we have seen hospitals’ uncompensated care rates plummet.

Our work is not done and our mission is as vital today as it was when our board set our course five years ago. In the coming months our task will be twofold: We will focus on the here and now by making sure Californians get the best possible coverage and care they can through our programs; and, we will share our experiences with the new administration, Congress and policy leaders in California and nationally as we work to build upon what we have accomplished so far to foster a health care system that works for all Americans.