Author: Jeffrey Kho


Covered California May 2017 Board Meeting

On May 18, 2017, the Covered California board convened its monthly meeting. The board agenda included the Executive Director Report, Covered California policy items, and regulations background materials.

Click here for the Covered California board agenda for May 18, 2017.

Click here for the meeting materials for May 18, 2017.

Click here to watch the board meeting for May 18, 2017.

Executive Director Report

Peter V. Lee, Executive Director of Covered California, delivered the Executive Director Report, which included a federal update, overview of the federal market stabilization regulations, and American Health Care Act (AHCA) updates.

Executive Director Lee introduced “Real Stories of California.” The project looks beyond the analytical data for exchange enrollees to reveal the real-life impact of Covered California coverage. Click here to see the eye-opening project.

Click here (slides 10,11) for Covered California’s briefs informing the national debate on health reform.

On April 18, 2017, the federal Department of Health and Human Services (DHHS) finalized market stabilization regulations. Covered California commented on the final provisions. DHHS will reduce the open enrollment period to 45 days (Nov 1 – Dec 15) in 2018. Director Lee made clear that for 2018, California will maintain its current extended open enrollment period, as outlined in state law. He commented that under existing regulatory authority, state-based marketplaces (SBMs), such as Covered California, may supplement the open enrollment period with a special enrollment period (SEP) to help address operational complications caused by a shorter open enrollment period. Director Lee shared Covered California’s plan to engage policymakers and other stakeholders to consider appropriate adjustments for open enrollment for the 2019 coverage year. He stated that there are good reasons for consumers and for risk mix purposes to have enrollees covered for an entire year. Currently under Covered California’s extended open enrollment period, individuals enrolling in January are not covered for the entire year.

The federal rules altered the special enrollment process by adding pre-enrollment verification. Covered California informed DHHS of existing SEP pre-enrollment verification efforts to leverage electronic verifications. While final regulations do not require SBMs to create pre-enrollment verification, SBMs are encouraged to adopt the federally facilitated marketplace (FFM) process, as outlined in the regulations.

Under the federal regulations, DHHS will allow health plans to have -4/+2 percent variation in actuarial value of metal tier plans, instead of the current -/+2 percent variation in federal rules. In addition, certain Bronze level plans will be permitted to have a variation of -4/+5. SBMs are not required to make this change.

Executive Director Lee reviewed the past, present, and future state of the AHCA. On May 4, 2017, the House of Representatives passed the AHCA (HR 1628) without a Congressional Budget Office (CBO) report. At the Board Meeting, Director Lee informed the Board that on May 24, CBO will publish a score for the House-passed version of the AHCA. The Senate will probably draft their own version of an Affordable Care Act (ACA) repeal bill. If the Senate bill varies from the House bill, a conference committee will iron out the differences between both versions of the bill. The reconciled bill would be reintroduced to both chambers for a final vote. If approved by both chambers, the bill would be sent to the President for approval.

Covered California Policy and Action Items

Fiscal Year (FY) 2017-18 Proposed Budget and Quality Health Plan (QHP) Assessment Fee

Jim Lombard, Chief Financial Officer in the Covered California Financial Management Division, led the discussion of the 2017-18 proposed budget and QHP Assessment Fee. Lombard updated the Board and public on fiscal year 2016-2017:

CC FY 2016-17 Slide

FY 2017-18 Proposal Overview

Click here for the Covered California FY 2017-18 Proposed Budget.

Covered California proposes a budget of $314 million in FY 2017-18. Covered California predicts a stable market with a good risk mix among the 1.4 million actively enrolled consumers. Covered California will sustain the market by investing in marketing, outreach, and customer service. The budget prepares for uncertainty by entering the fiscal year with over $298 million in reserves to react to any changes in health care laws or policies. The budget reflects a commitment to delivering value to consumers and driving for better care and lower costs.

FY 2017-18 Proposed Expenditures

CC FY 2017-18 Proposed Expenditures

FY 2017-18 Budget Conclusion

According to Lombard, the budget is balanced for FY 2017-18. The forecast predicts an assessment rate of 4 percent for the individual market with the option to decrease in the future. At the Covered California Board Meeting on June 15, the Board will be asked to approve assessments for the 2018 plan year. Covered California proposes assessments for individual and dental market health plans at 4 percent of premium, and 5.2 percent of premium for Covered California for Small Business (CCSB). In addition, the Board will take final action to approve the Covered California FY 2017-18 Budget at $314 million.

Regulation Amendments

Drew Kyler, Deputy Director for Outreach and Sales Division, requested Board approval to amend the following regulations:

  • Plan-Based Enroller Program Regulations – Approved
  • Certified Application Counselor Program Regulation – Approved
  • Enrollment Assistance Permanent Regulations Amendment – Approved
  • Medi-Cal Managed Care Enrollment Assistance Program – Approved

The regulations, amendments, and program changes are aimed at streamlining the entity application for alignment with the new program portal efficiencies.

Updated Board Calendar

June 15, 2017
July 20, 2017 (possibly no meeting this month)
August 17, 2017
September, 2017 (no meeting this month)
October 5, 2017
November 16, 2017
December 21, 2017 (possibly no meeting this month)

ITUP Re-Tools 21st Annual ITUP Statewide Conference in the Wake of Threats to Health Reform

Following the Presidential election of 2016, ITUP quickly worked to reshape its upcoming statewide conference scheduled for February 6-7, 2017 in Sacramento. The conference will focus on the risks, threats and challenges to California’s health reform progress as the newly elected President and Congress consider federal action to amend, repeal and/or replace the federal Affordable Care Act. The conference will bring health care leaders and experts together to share information, compare strategies and explore the options for the state to do all that will be needed to preserve and continue to advance health reform in California. (more…)

ITUP Announces Dates and Locations for 2016 Regional Workgroups

ITUP will be hosting its 2016 series of California regional workgroups from October to December (schedule below). ITUP conducts health-policy research and serves as an independent convener bringing together health care leaders around the state to build common understanding on issues and policies affecting the health of Californians.

ITUP regional workgroups facilitate constructive dialogue, problem solving and identification of workable solutions to educate and inform state and local policymakers.

Workgroup findings inform ITUP’s analytical work and future convenings, including the annual ITUP statewide conference held each February in Sacramento.This year, the workgroups will discuss region-specific opportunities and challenges related to the following:

  • Three years of expanded coverage under the federal Affordable Care Act (ACA);
  • Implementation of California’s Section 1115 federal Medicaid waiver, Medi-Cal 2020; and
  • State and local efforts to better integrate and improve the delivery of behavioral health services (mental health and substance use disorder treatment services).

In addition, this year, ITUP’s new Executive Director, Deborah Reidy Kelch, will share the vision and direction for ITUP going forward.

Please join us and be part of the conversation! ITUP will send a finalized agenda to participants prior to each workgroup.

Region Date and Time  Location
Los Angeles Health Collaborative July 27, 2016
12:00 pm – 2:00 pm
The California Endowment, Los Angeles
Bay Area (registration) October 5, 2016
12:00 pm – 2:00 pm
The California Endowment, Oakland Conference Center
Central Valley (registration) October 20, 2016
11:30 am – 1:30 pm
The California Endowment, Fresno
North Central (registration) October 21, 2016
1:30 pm – 3:30 pm
Insure the Uninsured Project, Sacramento Office
Orange County (registration) October 26, 2016
12:30 pm – 2:30 pm
Coalition of Orange County Community Health Centers
San Diego (registration) October 28, 2016
12:00 m – 2:00 pm
Alliance Healthcare Foundation
North Rural, Mendocino (registration) November 1, 2016
12:00 pm – 2:00 pm
Mendocino County Executive Offices
North Rural, Humboldt (registration) November 2, 2016
12:00 pm – 2:00 pm
Humboldt Area Foundation
North Rural – Shasta (registration) November 3, 2016
12:00 pm – 2:00 pm
Health Alliance of Northern California
Inland Empire (registration) December 1, 2016
12:00 pm – 2:00 pm
Inland Empire Health Plan
Los Angeles Health Collaborative December 14, 2016
2:30 pm – 4:30 pm
The California Endowment, Los Angeles
Central Coast TBD TBD

Save the Date: 21st Annual ITUP Conference

21st Conference Save the Date

Join us in Sacramento on the evening of February 6, 2017 for the 21st Annual Insure the Uninsured Project Networking and Awards Dinner.

The 2017 Annual ITUP Conference will be held on February 7th, 2017 at the Sacramento Convention Center. This year’s conference will celebrate 3 years of ACA implementation and forge a path for the work remaining. The ITUP Conference will also consider the 2016 Presidential Election results and the political ramifications for reform leaders.

2015 Workgroup Summaries

ITUP conducts a series of regional and statewide issue workgroups every year and provides executive summaries of all proceedings. These summaries provide an overview of the main topics of discussion, ranging from local enrollment success and challenges, local reform initiatives, and developing issues that stakeholders are grappling with.

Regional Workgroups

Statewide Issue Workgroups

Los Angeles Health Collaboratives

Insure the Uninsured Project’s Workgroups are supported by grants from the Blue Shield of California Foundation, The California Endowment, The California Community Foundation, The California Wellness Foundation, and the California HealthCare Foundation.

Online Symposium: The New Health Care Industry

The health care industry has undergone significant transformation, one of the most notable aspects being a wave of mergers and acquisitions that have led to an increase in market consolidation (a topic that was featured at this year’s ITUP conference). While the fact that these changes are happening is indisputable, it remains an area of hot debate as to how these changes will impact the sector in the long run. Proponents of consolidation suggest that it can achieve economies of scale that result in better care quality and innovation, while opponents believe that any potential savings obtained from consolidation are rarely passed on as either innovation or care quality improvement.

Health Affairs is holding a special online symposium on this topic, hot off of the heels of a conference titled The New Health Care Industry, held recently at the Solomon Center for Health Law and Policy at the Yale Law School. Over the next couple of days, they will be posting a number of articles looking at three key themes:

  • What is the effect of consolidation on innovation?
  • The risk on incompleteness in transformation
  • The proper law enforcement balance

Read symposium articles at the Health Affairs Blog website.

20th Annual Conference Materials Now Online

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Materials from the 20th Annual ITUP Conference are now available! Session notes, presentations, related articles, and photos are now available on the Conference webpage.

Conference Materials

Thank you to all that attended the 20th Annual ITUP Conference! We hope you enjoyed it as much as we did.

Opportunities for California Under Section 1332 of the Affordable Care Act

Section 1332 Opportunities Report Header

ITUP’s report, Opportunities for California Under Section 1332 of the Affordable Care Act, is now available.

California has made great progress implementing the Affordable Care Act (ACA), with 6 million people newly enrolled in either Medi-Cal or Covered California since December 2013. The state strives to improve the quality, outcomes and effectiveness of care and the performance of its safety net delivery systems with its recent renewal of its §1115 Medicaid waiver. Beginning in 2017, the ACA offers another major opportunity for states to meet these goals with a section 1332 waiver. These broad waivers would allow states the ability to waive several requirements of the ACA to create new and innovative models to improve and expand health coverage.

To create and finance a new coverage framework, a section 1332 waiver would allow states to waive four major planks of the ACA:

  1. The individual mandate to have health coverage
  2. The employer mandate to offer coverage
  3. The health benefit exchanges and the essential health benefits requirement
  4. The premium and cost-sharing subsidies available through the Exchanges.

The ACA requires that states’ section 1332 programs would have to exceed or be comparable to the law’s standard coverage framework in four ways, so the challenge for California is whether it can design reforms that exceed the following:

  1. The number of people covered
  2. The scope of health benefits
  3. Consumer affordability
  4. Containing the cost to the federal government.

In other words, a state’s section 1332 waiver can cover more people, and/or more services at a lower cost to individuals and equal or lower cost to the federal government. The ACA sets the floor or the minimum that states can use a section 1332 waiver to exceed.

States may not waive certain basic rights for all Americans – the many other insurance market reforms of the ACA, including its guaranteed issue requirement and prohibitions on increasing premiums for consumers with preexisting conditions. In addition, the lifetime and annual coverage limits, coverage of preventive care and dependents up to age 26 may not be subject to a waiver.

Under the ACA, California has made major strides to expand and improve health coverage for millions of Californians; the State could use a section 1332 waiver to align and advance program and delivery system reforms even further. The ACA largely built around the existing patchwork of health coverage programs that already existed. As a consequence, the landscape became more complicated and confusing for many consumers and providers, despite the expansion of health insurance and consumer protection. Can we use the waiver to make the system simpler and easier to navigate for Californians and their providers? The remainder of this brief explores some ways that California might design a section 1332 waiver to make health coverage more consumer-friendly, affordable, and supportive of payment and delivery system reforms that both improve health outcomes and slow the growth in health spending.

The full report can be downloaded here.

Press Release: Insure the Uninsured Project Selects Deborah Kelch as New Executive Director

SACRAMENTO, CA Insure the Uninsured Project (ITUP), a statewide policy institute focused on expanding and improving health care coverage in California, today announced the appointment of its new Executive Director, Deborah Reidy Kelch, M.P.P.A. of Elk Grove, CA.

Howard Kahn, retired CEO of L.A. Care Health Plan and Chair of the ITUP Board stated, “The ITUP Board is delighted to welcome Deborah Kelch as ITUP’s Executive Director. Deborah has the deep knowledge, experience and collaborative spirit that has made ITUP the ‘go-to’ resource for policymakers and health leaders.”

Ms. Kelch is a respected health policy researcher and strategist with more than 30 years of experience analyzing and working to improve health care in California. Her professional experience includes 15 years as policy and fiscal staff to the California Legislature, including serving Chief Consultant to the Assembly Health Committee.

Ms. Kelch is the owner and principal of Kelch Associates, a health policy research and consulting firm providing independent analysis, technical assistance and strategic advice to state and legislative leaders implementing health care reform in California. Ms. Kelch has a B.A., in Political Science from UCLA and a Master in Public Policy and Administration from CSU Sacramento.

ITUP, currently based in Santa Monica, CA, conducts policy-focused research to educate policymakers, stakeholders and the media on public and private health care programs in the state. ITUP is a trusted resource, honest broker and successful convener of state and regional stakeholders across the health care community – payers, advocates, public and private providers, labor and small employers. ITUP promotes innovative approaches to advance access, preserve a viable health care safety net and improve health care delivery in California.

“I am honored to be chosen as ITUP’s executive director at this transformative time for health care in the state and the nation,” said Kelch. “ITUP embodies values I have embraced my entire career – fact-based decision-making, inclusive problem-solving and dedication to the needs of uninsured and underserved populations.”

“While California has made dramatic progress in addressing the problem of the uninsured, leading the country in implementing health reform, the original vision of ITUP is not yet fully achieved,” Kelch continued. “Millions of Californians are still without coverage and many who do have coverage face barriers of all kinds in accessing the health care resources they and their families need. I look forward to ensuring ITUP continues to be a thought leader, consensus-builder and valued resource as we confront these ongoing challenges.”

Ms. Kelch will replace Lucien Wulsin, ITUP’s founding Executive Director, who is retiring in mid-March after 45 years of exemplary service and statewide leadership. ITUP announced the selection of Ms. Kelch at its statewide conference held each year in Sacramento. This year’s event marks ITUP’s 20th anniversary, offering networking and educational programming for the state’s health care leaders and diverse stakeholders.

“I know Deborah will be a terrific leader taking ITUP into its next decade and facing the challenges of much better integrated care and reimbursement that rewards improved patient outcomes while completing the job of coverage for every Californian; she has the experience, dedication and passion that California needs” said Lucien Wulsin.

Download the press release (PDF)

Covered California: Consumers Still Have Through Feb. 6 to Finish Their Applications

From Covered California’s website:

SACRAMENTO, Calif. — With three days left for consumers to finish their applications for affordable, quality health care coverage through the Patient Protection and Affordable Care Act, Covered California announced that more than 425,000 consumers had made plan selections during its third open-enrollment period.

“In the last four days of open enrollment, nearly 100,000 consumers signed up for quality health care coverage,” Covered California Executive Director Peter V. Lee said. “Those who started an application still have time to finish the process and get the health care and the peace of mind they deserve.”

In addition to the strong enrollment, Covered California’s initial analysis shows that its new consumers got younger for a second consecutive year. The number of young adults in the crucial 18- to 34-year-old demographic has increased to 37 percent this year, compared with 29 percent during the first open-enrollment period.

“Even more important than the strong numbers of those enrolling is the fact that we appear to be continuing to attract a younger and healthy mix of consumers,” Lee said. “We continue to have a broad and healthy mix of those signing up for coverage — which has already been declared among the healthiest in the country — which means better rates and a more stable system, both for all of our enrollees, and for the entire individual health insurance marketplace in California.”

Covered California’s healthy risk mix has previously resulted in weighted average rate changes of 4.2 percent in 2015 and 4 percent in 2016, well below what consumers saw before the Affordable Care Act. In addition, because consumers can now shop and change plans during open enrollment, consumers who switched to the lowest-cost plan in their area could reduce their premiums by an average of 4.5 percent for 2016.

Covered California also announced that 1,149,000 consumers who were enrolled in 2015 had plan selections made for 2016. This compares to 944,000 consumers who were enrolled in 2014 and made plan selections for 2015. Later this year, Covered California will release data on how many of these returning consumers and new enrollees have paid for their coverage.”