Covered California Tackles Hot Topics in Sunny Los Angeles
By Linda Leu
As the rest of the state climbs out of a cold snap, the Covered California board of directors met in a packed room (and overflow rooms) in warm and sunny Los Angeles, at the headquarters of First Five LA.
The hottest news from Thursday's meeting was the approval of the federal Exchange Establishment grant, with California being granted $674 million dollars for the years 2013 and 2014 to "start up and stand up" the Exchange. (Afterwards, starting in 2015, the Exchange will be self-sufficient.) Health Access live-tweeted the press conference announcing this grant, as well as the entire meeting, using the hashtag #CoveredCA. In a related announcement, board member Dr. Bob Ross announced that The California Endowment would be granting at least $225 million dollars over the next several years toward the implementation of health reform in California.
Covered California director Peter Lee took pains to emphasize the importance of Los Angeles - a county bigger than the ten smallest states combined, one with significant diversity and 780,000 subsidy-eligible uninsured Californians.
Many members of the community turned out to speak with the Board in their first visit to Southern California. Many comments reflected the diversity of the region and the state, asking the Board to consider creating a website in all 13 Medi-Cal threshold languages, not just English and Spanish, and addressing additional language and cultural access issues. The board directed staff to look at the feasibility of doing this.
So many community members came to testify that the Board ran out of time for most of its packed scheduled agenda items. Discussion on Community Mobilization and outreach was postponed until the next meeting. Another discussion on the Service Center was put off until a webinar next week. They were able to have substantive discussion about Qualified Health Plans, specifically around a model contract that Covered California staff has developed and around a "bridge plan" for low-income consumers.
The model contract discussion touched on the realization of the concept of "active purchasing", where Covered California, as a purchaser representing a large number of consumers, can negotiate for better products. Among things that Covered California will be asking for in its contracting process are: Quality Improvement and Delivery System Reform, culturally and linguistically appropriate and consumer-friendly consumer communication, and clarity on costs through the use of a uniform subsidy calculator.
The Bridge plan is an idea that was first proposed by staff in the last Covered California Board meeting, which has returned today with more details. The basic idea behind the Bridge proposal is to make coverage more affordable and accessible for individuals on the lowest end of the income scale by contracting with Medi-Cal managed care plans to provide such coverage. The first part of this proposal is to include individuals between 138% and 200% of the federal poverty level who "churn" or move in and out of Medi-Cal eligibility as their income fluctuates. The second part of the plan, which would require federal permission, would be to make this available to all individuals up to 200% regardless of whether they were ever enrolled in Medi-Cal. The third part of the proposal would facilitate easier participation by Medi-Cal managed care plans.
Board member Kim Belshe, with others, expressed concern with staff's request to advocate with the federal government to move forward with the second proposal without further details. Secretary Dooley mentioned that getting the federal government to give California the needed "running room" may take advocacy, not just inquiry. After wrangling with language over a motion for staff direction, the Board simply decided to not take official action until staff brings back further details on this proposal. Board member Susan Kennedy noted that the Administration, which has already expressed support for the "bridge plan" idea, could advocate on the state's behalf for the "bridge plan" with the federal government, with or without Exchange action.
Chair Diana Dooley stated at the conclusion of the meeting that if the Covered California board were to hold another meeting in Los Angeles, they might have to make it a two-day meeting in order to accommodate all of the community participation.
Linda Leu is a health care policy analyst for Health Access California, a statewide health care consumer advocacy coalition of over 200 groups.