"Covered California" Health Benefit Exchange Wraps Up Productive Year


Posted on 19 December 2012

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By Linda Leu

The Board of Directors of Covered California, the state's new Health Benefit Exchange, met yesterday in Sacramento to continue its work implementing a reformed healthcare market in compliance with the federal Affordable Care Act of 2010. The 15th and final Board meeting of 2012 wrapped up a productive year with little sign of slowing down as we race toward the January 1, 2014 mandate.

In his Executive Director's Report, Peter Lee reported that Covered California has had positive conversations with the federal government related to the state's Exchange Establishment grant request submitted last month. Covered California staff also reported on the progress of the development of the IT system, the California Healthcare Eligibility, Enrollment and Retention System (CalHEERS), and the Service Center. Regarding the establishment of Stakeholder Advisory Groups, Lee announced that the list of those chosen to serve on these groups will be announced on Friday.

The Board also heard a report back on some Marketing and Outreach research that was conducted. A total of 412 one-on-one interviews were conducted in 12 languages to assess knowledge and attitudes of consumers related to health reform, insurance, and an exchange. The results will inform a larger quantitative survey that will be conducted shortly.

Staff then made a presentation related to Qualified Health Plan contracting - the standards by which health insurers will sell plans on the Exchange. QHP bids will be released early next year in order to have contracts in place by summer. The Board discussed standardization of benefits, and the importance of clarity and transparency around out-of-network costs, especially with consumer confusion over coinsurance. There was a great deal of discussion surrounding the implications of not using the FairHealth Database to calculate out-of-network benefits. The Board voted to approve the staff recommendation.

Staff also presented a plan that would utilize and facilitate the use of local Medi-Cal Managed Care plans to provide more affordable coverage for individuals between 138% and 200% of the federal poverty level. This addresses some concerns held by some advocates that the Exchange will not be affordable enough for those at the lower end of eligibility. Comments about this proposal will be accepted until January 10, 2017 and the plan will be considered by the Board on January 17th.

The Board had agendized a panel on Health Disparities, but in the interest of giving the topic full discussion, this item will be moved to the January meeting, which will take place in Los Angeles. Before the next meeting, Covered California will be working with other state agencies to comment on federal regulations, including those related to multi-state plans. The state's comments will be posted online when they are ready for public comment.

As director Peter Lee noted, it was an eventful year at the Exchange - but it's 2013, with the start of enrollment in October, that will be the big coming out event for Covered California.


Linda Leu is a health care policy analyst for Health Access California, a statewide health care consumer advocacy coalition of over 200 groups.