MAUREEN CAVANAUGH: Our top story on Midday Edition, a new survey on the effects of the affordable care act show that it has been successful in signing up more than half of the uninsured in California. But it has come at a price. The state insurance commissioner says that health insurance rates have increased from twenty-two to over 80% across the board in California. At a news conference today, officials with covered California announced that health insurance rates will only increase 4% next year. So there is good news and not so good news in the evaluations of the first few months of the ACA in California. I would like to welcome my guests. Jan Spencley is the Executive Director of San Diegans for Healthcare Coverage. Jan, it is good to see you. JAN SPENCLEY: Nice to see you too, Maureen. MAUREEN CAVANAUGH: This survey by the Kaiser family foundation is largely good news for supporters of Covered California. How does the information stack up against your hope is for the plan? JAN SPENCLEY: Actually it stacks up pretty well. I don't think we saw too many surprises in the survey. We did expect that Latinos would lag, but did better than we expected. MAUREEN CAVANAUGH: It says six out of ten uninsured Californians were able to find coverage. JAN SPENCLEY: I thought it was seven out of ten, actually seven out of ten of those that actually got the information that got contacted. I thought that was pretty good, because that meant that board was getting out. It is pretty challenging, there was a lot of misinformation out there at first, I think that people forget that. But I think the word got out. MAUREEN CAVANAUGH: The uninsured find coverage through Medi-Cal expansions? JAN SPENCLEY: I believe 58% did, in California. 58% got Medi-Cal coverage and 42% got other coverage. MAUREEN CAVANAUGH: And so that is the difference between private insurance sign-ups? JAN SPENCLEY: 25% of the uninsured enrolled in Medi-Cal, I should put it that way, that was the largest group of those uninsured previously. MAUREEN CAVANAUGH: And about 9% went to private insurers. JAN SPENCLEY: Right, Covered California. Another large group went to employer coverage, because they found jobs. MAUREEN CAVANAUGH: Exactly, good point, employer coverage is still the biggest coverage in California, most people still get insurance coverage through work. JAN SPENCLEY: Yes they do. MAUREEN CAVANAUGH: Even though the Covered California website did not have as much trouble as the national healthcare.gov website, people did not report being happy with it in this particular survey. What kinds of trouble did you hear about? JAN SPENCLEY: It was a new system, it was a new untested system, it came up quickly. There were a lot of problems, and slowly but surely they were being resolved, but we experience bombs throughout. Nobody expected that many people to access the system at that one time. Another thing that people don't realize, everyone waited until the last minute. Every single deadline, they waited until the last minute, and that overloaded the system. So we would be asking people these do not do that again, because it made getting you help hard, but it also overloaded the system. MAUREEN CAVANAUGH: I also want to ask you about outreach, because in this outreach, most people said, those who did sign up, that someone helped them enroll. Is that one of the things that we have discovered in this assessment, that the person-to-person enrollment help sort of essential? JAN SPENCLEY: I've actually believe it is essential, because even the people who enrolled themselves, they are calling us after the fact, calling and trying to get help after the fact, because they did not upload what they were supposed to, or they did not understand it entirely. Ask somebody to help, there are so many people to help. MAUREEN CAVANAUGH: As you look at what you personally, with San Diegans for Healthcare Coverage, did in the days and months before the deadline last spring, how are you assessing how you handled that? JAN SPENCLEY: I am assessing that we needed to be a little more firm, a little more systematic in terms of how we handled calls. People were desperate, so we had the phones ringing off of the hook. We didn't have to do a lot of outreach, we just answer the phone. There were people scrambling for coverage, so we were answering the phone and helping people over the phone to ask them if they had already started their application. What we are assessing now, we don't expect the same thing, we don't expect the same push this time for people to come in, because that though hanging fruit, as the report indicates, they enrolled. MAUREEN CAVANAUGH: Why was it so difficult, again coming back to the report, for people to compare plans or find out if they were eligible for Medi-Cal or subsidies? It seems that people had a real difficulty trying to make decisions that the people who developed the website and develop the plan were trying to say here, you have all of this choice, and yet people could not seem to figure it out. JAN SPENCLEY: I think in the beginning ñ I don't think could boil it down to any one thing ñ if people were doing it on their own, it was challenging to compare plans. I think that if people were looking for where is my doctor, that was a little challenging. That is what a lot of people were looking for, what is the difference between these plans, they did not understand that all of the silver plans are the same, if it is a silver eighty-seven it is a silver eighty-seven. It is the provider networks that differ by plan, by carrier, Blue Cross versus HealthNet versus Blue Shield. I think there was some confusion with that, but the system is better now and we are anticipating it will be better yet in this coming open enrollment to allow them to compare. I think there is a lot of confusion with what messaging went to them initially. When they finished the application it said stop here, you went to Medi-Cal, I think that messaging is being improved now. MAUREEN CAVANAUGH: Another analysis of the Affordable Care Act rollout in California found that the anecdotal evidence about insurance company rates going up was right. Insurance Commissioner Dave Jones said rates jumped from 22% to 88% last year, and Commissioner Jones is on the line with us now, Dave Jones, welcome to the program. DAVE JONES: Good afternoon. MAUREEN CAVANAUGH: These rate hikes affected individual insurance plans. Do we know why the rates went up so dramatically? DAVE JONES: I think that the most important reason is that California, unlike thirty-five other states, does not have the authority to reject excessive health insurance rate hikes. Health insurers and HMOs are free to set rates as they please, and they do exactly that. I don't believe with the increase that occurred between 2013 and 2014 was related to new requirements for benefits under the afford a Blair act, because California has always had very strong benefit mandates, and most if not all Affordable Care Act benefits for already in place as of 2013, so that is not the reason that the rates jumped. We will continue to see rate increases into the future, unless we joined the thirty-five other states that have added to health care reform the authority to reject excessive rate hikes. Unfortunately, that is the missing piece of the Affordable Care Act. It's something that Senator Feinstein and President Obama tried to get into the law, but they were rebuffed by the health insurers in the HMO lobby. In November, voters in California will have a chance to correct that. There is a ballot measure, proposition forty-five, which will, if enacted by the voters, allow California to join the other thirty-five states that have this authority. MAUREEN CAVANAUGH: Let me stop you there, to break this down a little bit. At the time that people were signing up for Covered California, as they were seeing rates go up, what we were being told at the time was that the different requirements under Covered California was causing insurance plans to be reevaluated. There were things like preventative care being fermented, all of these bare-bones policies that hardly covered anything were being beefed up with better standards, and that was what was causing rates to go up, are you saying that is not the case? DAVE JONES: I'm saying that in 2013, the vast majority of individuals who had health insurance had good health insurance which complied with California's very strong benefit mandates, and we had already implemented Affordable Care Act requirements like eliminating gender rating, which is a practice of charging women more than men, requiring maternity coverage, autism coverage, this goes on, and on, and on. Benefit changes cannot explain what occurred. What occurred was the health insurers had the ability to set the rates where they would, and they did that. They pushed the pause button for 2015, I think they have done that in the face of a ballot measure. They don't want to create the same kind of a cry Anthem and Blue Cross made in 2009 when they jacked up rates 39%, and that resulted in the passage of the Affordable Care Act. MAUREEN CAVANAUGH: Commissioner Jones, were the higher rates mitigated by government subsidies? DAVE JONES: There is no question that the Affordable Care Act and Covered California is a good thing, I fully supported and I have been active in implementing it. A good thing about it, if your income is low enough, you get a premium paid for by federal taxpayers. So for those individuals who purchase health insurance through Covered California who are eligible for the premium credit which is funded by a federal tax credit, they did not feel the effect of the rate increases. It did mean that federal dollars had to be paid to offset that impact, but they got a good premium as good rate because of the subsidy, that is one of the positive things about the Affordable Care Act. But as a supporter of the Affordable Care Act someone who campaign for it and was active in implementing it and still strongly supports it, and what Covered California is doing, nonetheless we need to be clear eyed about what is missing in healthcare reform and things that we need to add to improve it. One of those is creating the authority to reject excessive health insurance rate hikes. MAUREEN CAVANAUGH: Which would be proposition forty-five, which you are obviously a strong supporter of. But isn't Covered California itself supposed to negotiate with insurers? DAVE JONES: The theory has not played out in practice. If you actually take a look at what has happened in the market, the market has become even more consolidated. The top four health insurers selling insurance in California now control almost 94% of the entire individual market policies sold through Covered California. The reality is, no one has sufficient bargaining power when the health insurers control 94% of the market, when by law you have to buy their product, where there is no regulatory control on the price they set for the product. They are free to set it as they will. So we saw that in 2014 in the rates there, and I think we see it here again. The rates recently announced or the results of health insurance officials themselves deciding to push the pause button, because they do not want to create a public outcry. MAUREEN CAVANAUGH: Commissioner Dave Jones, thank you so much for joining us, I appreciate it. DAVE JONES: Thank you. MAUREEN CAVANAUGH: Just to reiterate, only today Covered California came out and said overall rates next year will only rise 4.5%, and some premiums will go down. Jan, 60% as we said have found healthcare coverage. But that leaves 40% uninsured, and there was terminology of the low hanging fruit being to 60%, what do you do to reach out to people who make up the 40% who remain uninsured? Who are they, how can we characterize them? Are they young, do they have language difficulties? JAN SPENCLEY: I think you will find that one, it is a higher proportion of Latinos. You'll find they are 62% Latino. MAUREEN CAVANAUGH: Why is that, do we know? JAN SPENCLEY: I think that the report itself spoke to a number of issues, language challenges being one of them, immigration status for a member of the family being another. This has long been an issue. If you have mixed status families, there is fear in the community about whether or not that will affect their change in immigration status. I think there are a lot of things we have to change. I think we need to change messaging. We did not spend a lot of time giving assurances to people. It is out there. We have gotten it from the government at all levels, but I don't think it has gone to the grassroots. MAUREEN CAVANAUGH: Reaching out to the Latino population who may have concerns about whether or not going into this plan might cause more trouble for themselves or family members down the line. What other populations remain unreached? JAN SPENCLEY: I would say employees, the working uninsured and their family members. That is a group that we have targeted, and have said we need to do better, we need to do better with employers in helping them understand the Affordable Care Act, how they can impact employee eligibility, and to get to those uninsured employees. MAUREEN CAVANAUGH: People who signed up through Covered California are going to getting letters soon, asking them about their status, what is that about? JAN SPENCLEY: They're going to be getting letters, actually they are going to be getting a series of letters. If you are already enrolled, it is part of the renewal process. As we understand it, there will be a series of letters, we will know about them in advance, so we will know what the consumers are getting, and it'll say we will renew you, or here is what you are eligible for next year, do you want to change that, or is your information different? So they will be getting that kind of letter, telling them how to get into their account, which is extremely important. Some people could not get in at the beginning, when the system was first up. I think that will be very helpful. MAUREEN CAVANAUGH: I think one of the interesting things that perhaps we are learning through this process, we talk about the uninsured in the 40%, we're not necessarily talking about a static group of people. A lot of people go in and out of insurance due to employment changes and other life changes, and that pool of people went up sometimes in a confusing situation. JAN SPENCLEY: Right, you have people that are persistently uninsured, for more than two years. I think if you look, that is not an insignificant number in that group in the survey. But that is the persistently uninsured. That is the least likely group to enroll, because they do not know how to use health insurance, how to access health insurance, and we've heard this a lot, they don't believe that they need it. I can't tell you how many times I've heard from people, I'm healthy. I used to be healthy, but I am now, but one day I wasn't and I spent a year being thankful I had health insurance. It is the unexpected that you need to prepare for. MAUREEN CAVANAUGH: I have to end it there. Thank you very much.
There's good news and not-so good news in new evaluations of the first few months of the Affordable Care Act in California.
A new survey on the effects of the Affordable Care Act show that it's been successful in signing up more than half of the uninsured in California. The Kaiser Family Foundation found that roughly 3.4 million previously uninsured Californians obtained health care coverage through Medi-Cal or Covered California.
But it's come at a price. California Insurance Commissioner Dave Jones says health insurance rates have increased from 22 percent to more than 80 percent overall in California since 2013.
Officials with Covered California announced Thursday that health insurance rates will not be rising that dramatically this year.
“The ‘average’ rate going up only 4.2 percent means that for some it will go up more and for some less, but all consumers now have the ability to shop. Consumers are not locked in to one plan; they can stay with their plan or change and can often find a lower-priced option,” Covered California Executive Peter Lee said in a statement.
