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New Survey Shows the Affordable Care Act Has Dramatically Reduced California’s Uninsured Rate

  • Seventy-two percent of California’s previously uninsured gained coverage since the Affordable Care Act went into effect.
  • The majority of the recently insured say their experience with their current Covered California plan has been positive.
  • Nearly half of the remaining uninsured are unaware of the financial help available only through Covered California.


SACRAMENTO, Calif. — Covered California Executive Director Peter V. Lee said a survey released Thursday by the Kaiser Family Foundation titled “A Final Look:  California’s Previously Uninsured After the ACA’s Third Open Enrollment Period” provides a compelling picture of how the Patient Protection and Affordable Care Act is changing the lives of millions of Californians.
The survey found that 72 percent of California’s previously uninsured population has gained health coverage since the Affordable Care Act went into effect. That share is up from 58 percent of Californians who became insured after the launch of Covered California and the Medi-Cal expansion in 2014.
“California has made great strides over the past three years, with consumers getting coverage under the Affordable Care Act, getting better employer-based coverage and benefiting from a competitive market that has cut California’s uninsured rate to 8.1 percent,” Lee said. “We know we have more to do to assure that all eligible Californians are able to get the affordable, quality care they deserve, but we should pause to appreciate the progress made in three short years."
The survey found that recently insured consumers are getting access to quality care:
Seventy-seven percent say their health needs are being met, which is up from 49 percent in the first survey conducted before the launch of the Affordable Care Act and Covered California’s first open-enrollment period.
Seventy-six percent are satisfied with their choice of primary care doctors.
Seventy percent say their experience with their current Covered California health care plan has been positive.
Additionally, recently insured consumers say that their new health care coverage is a good value and that the coverage makes them feel more financially secure.
Sixty-five percent say health insurance is worth the cost, which is up from 58 percent in the first survey conducted before Covered California’s first open-enrollment period.
Forty-two percent report feeling more financially secure with health insurance provided by Covered California, which is higher than those who have employer-sponsored insurance.
The survey also showed the importance of continuing to spread the word about the financial help available only to Covered California consumers, as 76 percent of the remaining uninsured said they would be likely to get insurance in the future, if they could buy it for less than they thought. However, only 49 percent of the remaining uninsured said they were aware of the available financial assistance.
“This financial help is allowing nearly 200,000 Covered California consumers to pay less than $25 per month for their coverage, and 759,000 consumers to pay less than $100 per month,” Lee said. “Consumers need to know there is money on the table to help them protect themselves and their family.”
Lee noted that some elements of the survey underscored that further work is needed to ensure affordability of Covered California plans – 47 percent of respondents said they lack insurance because it is too expensive. The report also underscored the need to continue to reach out to underserved communities who remain uninsured, especially the Latino community. Of critical importance is allaying the Latino community’s fears that purchasing insurance through Covered California or accessing Medi-Cal will not affect their or their family’s immigration status.
“We want everyone to know that when you apply for health insurance through a health insurance marketplace like Covered California, all of your information is kept private and secure,” Lee said. “It will not be shared with or used by any immigration agency to enforce immigration laws. All information you submit is used strictly to determine your eligibility for health insurance programs available under the Affordable Care Act.”
The new Kaiser Family Foundation study reinforces Covered California’s own data that suggests consumers move through different coverage options, such as employer-based coverage, Medi-Cal and Covered California. This is the new reality of creating the fabric of coverage in California and nationwide.    
Covered California’s next open-enrollment period begins Nov. 1 and runs through Jan. 31, 2017. In the meantime, special enrollment for those who experience a change in life circumstances, such as moving, getting married or having a baby, continues year-round.
For more information on Covered California’s special-enrollment period, and to find out who is eligible, visit www.CoveredCA.com/individuals-and-families/getting-covered/special-enrollment. Medi-Cal enrollment and Covered California for Small Business enrollment also continue year-round.
About Covered California
Covered California is the state’s marketplace for the federal Patient Protection and Affordable Care Act. Covered California, in partnership with the California Department of Health Care Services, helps individuals determine whether they are eligible for premium assistance that is available on a sliding-scale basis to reduce insurance costs or whether they are eligible for low-cost or no-cost Medi-Cal. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget.

Small businesses can purchase competitively priced health insurance plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits. Covered California is an independent part of the state government whose job is to make the new market work for California’s consumers. It is overseen by a five-member board appointed by the Governor and the Legislature. For more information about Covered California, please visit www.CoveredCA.com.

Covered California Announces Rates and Plan Expansions for 2017

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  • Statewide weighted average increase is 13.2 percent
  • Three-year average increase of 7 percent is lower than pre-Affordable Care Act trends
  • Nearly 80 percent of consumers will pay less or see a rate bump of no more than 5 percent if they switch plans
  • Insurers are expanding to compete in new communities
  • New benefit changes help consumers save when they access
    health care



SACRAMENTO, Calif. — Covered California unveiled its rates for 2017 on Tuesday and announced that some health insurance plans will be expanding into new areas throughout the state to compete for consumers in California.

The statewide weighted average change will be 13.2 percent, up from approximately four percent in each of the last two years. However, most consumers will see a much smaller increase — or pay less next year — if they switch to another plan.

“Shopping is going to be more important this year than ever before,” Covered California Executive Director Peter V. Lee said. “Almost 80 percent of our consumers will either be able to pay less than they are paying now, or see their rates go up by no more than 5 percent, if they shop and buy the lowest-cost plan at their same benefit level. That’s the power of shopping.”

Downloadable comments from Executive Director Peter V. Lee (Video).

Lee said the opportunities to shop and save show that California has succeeded in building a competitive marketplace for health insurance, with rate increases that are still below trends in the individual market before the Affordable Care Act was passed.

“This is a new era of health care, where the consumer is in the driver’s seat with the power to look easily for a better deal, and where subsidies help absorb the impact of rate changes,” Lee said. “These options did not exist before the Affordable Care Act.”

Some consumers who choose to keep their plan will see a significant increase in their premium for 2017, while others will see a more modest increase, depending on where they live and what insurance plan they have. Consumers will begin receiving notices in October, when they will have an opportunity to review their new rates and change plans for their 2017 health coverage.

For many of those insured, the bulk of the premium increase will be absorbed by the subsidy paid by the government to help enrollees buy health insurance. Approximately 90 percent of Covered California enrollees get help to pay for their premiums. The average subsidy covers roughly 77 percent of the consumer’s monthly premium, and while premiums will rise, the subsidies will rise as well.

“Even though the average rate increase is larger this year than the last two years, the three-year average increase is 7 percent — substantially better than rate trends before the Affordable Care Act was enacted,” Lee said.



Lee said the average rate increase reflects the cost of medical care for consumers, not excessive profit.

“Under the new rules of the Affordable Care Act, insurers face strict limits on the amount of profit they can make selling health insurance,” Lee said. “So, while all plans are experiencing different cost pressures, we can be confident their rate increases are directly linked to health care costs, not administration or profit, which averaged 1.5 percent across our contracted plans.”

For consumers who get a tax credit to lower their costs — which is about 90 percent of those who sign up through Covered California — the amount they pay is impacted not only by the premium choice, but by changes in their tax credit. While the average rate increase is higher than past years, Covered California’s risk mix — the ratio of consumers who are healthy vs. sick — remains one of the best in the nation according to the Centers for Medicare and Medicaid Services (https://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/index.html).

Other reasons for rate increases include:
  • A one-year adjustment due to the end of a funding mechanism in the Affordable Care Act known as reinsurance, which was designed to moderate rate increases during the first three years when exchanges were being established. The American Academy of Actuaries estimates this will add between 4 percent and 7 percent to premiums for 2017.
  • Special enrollment by some consumers who may be enrolling in health insurance only after they become sick or need care, which seems to have had a significant impact on rates for two insurance plans.
  • The rising cost of health care, especially specialty drugs.
  • Pent-up demand for health care now being accessed by those who were locked out of the health care system before the Affordable Care Act was enacted.
Lee said Covered California is working to address some of these issues on multiple fronts. The exchange is aggressively marketing to attract healthy consumers year-round, and it is working to ensure special enrollment is available only to those who meet qualifying circumstances. It is also sampling the special enrollment population to better understand how to make any further improvements needed.

“We work hard to build a robust exchange that drives competition by attracting as many consumers as possible,” Lee said. “Now, consistent with the vision of the Affordable Care Act, we will redouble our efforts to make sure our consumers and potential consumers understand the importance of signing up during open enrollment and remaining covered throughout the year.”

Lee said Covered California’s 11 health insurers are competing across the state for its 1.4 million members.

“The sheer number of enrollees and their overall health means consumers in the individual market are benefiting from competition,” Lee said.

Below is the complete list of the companies selected for the 2017 exchange:
  • Anthem Blue Cross of California
  • Blue Shield of California
  • Chinese Community Health Plan
  • Health Net
  • Kaiser Permanente
  • L.A. Care Health Plan
  • Molina Healthcare
  • Oscar Health Plan of California
  • Sharp Health Plan
  • Valley Health Plan
  • Western Health Advantage
Rate details by pricing regions can be found in “Covered California’s Health Insurance Companies and Plan Rates for 2017,” posted online at: http://coveredca.com/news/pdfs/CoveredCA-2017-rate-booklet.pdf

The preliminary rates are subject to a 60-day public comment period and regulatory review by the California Department of Managed Health Care. In addition, the California Department of Insurance will review Health Net’s EPO.

Some insurance carriers will be increasing their coverage areas in 2017:
  • Oscar will be entering the market in San Francisco, Santa Clara and San Mateo counties.
  • Molina will expand into Orange County.
  • Kaiser will be available in Santa Cruz County.
With the expansion of its current carriers, almost all consumers (92.6 percent) will be able to choose from three or more carriers, and all will have at least two to select from.

In addition, more than 93 percent of hospitals in California will be available through at least one Covered California health insurance company in 2017, and 74 percent will be available in three or more plans.

Covered California also is improving its patient-centered benefit designs by increasing a consumer’s access to care by reducing the number of services that are subject to a consumer’s deductible. 

Starting in 2017, consumers in Silver 70 plans will save as much as $55 on an urgent care visit and $10 on a primary care visit. In addition, consumers in Silver, Gold and Platinum plans will pay a flat copay for emergency room visits without having to satisfy a deductible, which could save them thousands of dollars.

These improvements build on features already in place that ensure most outpatient services in Silver, Gold and Platinum plans are not subject to a deductible, including primary care visits, specialist visits, lab tests, X-rays and imaging. In addition, some Enhanced Silver plans have little or no deductible and very low copays, such as $3 for an office visit. Even consumers in Covered California’s most affordable Bronze plans are allowed to see their doctor or a specialist three times before the visits are subject to the deductible.

In addition, the contract with health insurers for 2017 ensures consumers select or are provisionally assigned a primary care physician within 60 days of effectuation so they have an established source of care.

“Health care reform isn’t just about making insurance affordable, it’s about doing things to make it easier for consumers to get the right care at the right time,” Lee said.

In May, the Centers for Disease Control and Prevention announced that California’s uninsured rate had fallen to 8.1 percent at the end of 2015, down from 17 percent at the end of 2013, right before the Affordable Care Act began offering coverage.

“We can all be very proud of the extraordinary gains we have made in reducing California’s uninsured rate to a historic low,” Lee said.

About Covered California
Covered California is the state’s marketplace for the federal Patient Protection and Affordable Care Act. Covered California, in partnership with the California Department of Health Care Services, helps individuals determine whether they are eligible for premium assistance that is available on a sliding-scale basis to reduce insurance costs or whether they are eligible for low-cost or no-cost Medi-Cal. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Small businesses can purchase competitively priced health insurance plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits.

Covered California is an independent part of the state government whose job is to make the new market work for California’s consumers. It is overseen by a five-member board appointed by the Governor and the Legislature. For more information about Covered California, please visit www.CoveredCA.com.

New Survey Shows California's Uninsured Rate Falls to Another Record Low

SACRAMENTO, Calif. — A new survey from the Centers for Disease Control and Prevention (CDC) revealed that California’s uninsured rate had fallen to 8.1 percent at the end of 2015, a full percentage point lower than the national uninsured rate of 9.1 percent.

Covered California Announces Agreement With Eyemed Vision Care

EyeMed Vision Care Is the Second Vision Carrier Chosen to Showcase Its Offerings on CoveredCA.com

SACRAMENTO, Calif. — Covered California now has a second pathway to vision plans under an agreement with EyeMed Vision Care.

“We’re excited EyeMed is on board to offer another vision care path for consumers to choose from,” Covered California Executive Director Peter V. Lee said. “EyeMed Vision Care is a proven leader in the vision service community, and we believe it will bring added value to consumers shopping at CoveredCA.com.”

Beginning today, visitors to CoveredCA.com can access EyeMed Vision Care via a link, which will take the consumer to EyeMed Vision Care’s website. Once there, consumers will work directly with EyeMed Vision Care to shop for vision benefits and see what coverage options are best for their situation.

“EyeMed is pleased to join CoveredCA.com and provide a pathway for Californians shopping for vision coverage,” EyeMed Vision Care President Lukas Ruecker said. “Whether it’s our wide choice of providers, exam technology or eyewear solutions, we look forward to providing consumers access to digital, 21st-century tools they need to navigate their choices with confidence.”

As part of the agreement with Covered California, EyeMed Vision Care will conduct annual consumer surveys to ensure a positive consumer experience. In addition, EyeMed Vision Care will provide quarterly enrollment reports to Covered California based on those who have accessed EyeMed Vision Care through CoveredCA.com.

Covered California is committed to providing access to a wide range of options for consumers and serving as a one-stop shopping location for all their health care needs. In addition to the health plans offered through the exchange, Covered California also has dental options available. The addition of EyeMed Vision Care to the Covered California platform creates one more option for consumers.
Adult vision care is not an essential health benefit under the Patient Protection and Affordable Care Act, and coverage is handled directly through EyeMed Vision Care. Vision services for children are an essential health benefit and are included in all health plans purchased through Covered California. Enrollment with EyeMed Vision Care into vision plans is available year-round, and there are no open enrollment dates.

The link to EyeMed Vision Care from CoveredCA.com can be found here: www.CoveredCA.com/individuals-and-families/getting-covered/vision.

About Covered California
Covered California is the state’s marketplace for the federal Patient Protection and Affordable Care Act. Covered California, in partnership with the California Department of Health Care Services, was charged with creating a new health insurance marketplace in which individuals and small businesses can get access to affordable health insurance plans. Covered California helps individuals determine whether they are eligible for premium assistance that is available on a sliding-scale basis to reduce insurance costs or whether they are eligible for low-cost or no-cost Medi-Cal. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Small businesses can purchase competitively priced health insurance plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits.


Covered California is an independent part of the state government whose job is to make the new market work for California’s consumers. It is overseen by a five-member board appointed by the Governor and the Legislature. For more information about Covered California, please visit www.CoveredCA.com.

Covered California’s Board Adopts Prescriptions for A Better Health Care System

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New Contract Changes for 2017 Require Health Plans to Focus on Quality and Delivering the Right Care at the Right Time for All Who Have Coverage

SACRAMENTO, Calif. — Covered California announced Thursday that its board adopted significant new changes to its contracts with health insurers as part of its prescription to take health care reform to the next level. The new contract provisions, which will cover the years 2017-2019, will advance ongoing efforts by health insurance companies, hospitals and care providers to ensure that patients receive quality health care.

“Covered California’s mission is not just getting patients health insurance; it’s about improving the quality of the health care delivery system,” Covered California Executive Director Peter V. Lee said. 

“We are creating a market that rewards quality over quantity and moves health reform forward in an impactful way.”

“Covered California is making it clear that we are about more than just getting consumers coverage, by ensuring they get the right care when they need it,” said California Health and Human Services Secretary and Covered California Board Chairwoman Diana Dooley. “We are proud of the hard work and extensive collaboration — which has been a hallmark of Covered California’s work — engaging with doctors, hospitals, health plans, consumer advocates, patients themselves and other stakeholders who are working together with us to improve quality and strengthen the health care delivery system for all Californians.”

The new contract provisions seek to address the challenges in our current health care system and provide concrete prescriptions for the future that will address both quality and costs, such as strengthening value-based, patient-centered benefit designs to improve access to primary care. In addition, Covered California uses core levers to promote better quality and lower costs, such as:
  • Requiring providers to meet quality standards without exception, to provide safe care for all, including various racial and ethnic groups.
  • Adopting payment strategies that support quality performance.
  • Adopting proven models of primary care and integrated delivery models.
  • Providing tools to help consumers make informed choices when selecting providers.

Specifically, the new contract includes the following initiatives.

Ensuring the Right Care at the Right Time, Every Time
Diagnosis:    
  • Many consumers do not have a primary care provider and do not know how to use the current fragmented and costly health care system.

Prescription: 
  • Plans will ensure all consumers either select or are provisionally assigned a primary care clinician within 30 days of effectuation into their plan, so they have an established source of care.
  • Covered California will encourage plans to promote enrollment in advanced models of primary care, including patient-centered medical homes and integrated health care models, such as accountable care organizations.
  • Plans will exchange data with providers so that physicians can be notified if their patients are hospitalized and can track trends and improve performance on chronic conditions, such as hypertension or diabetes.

Promoting and Rewarding Quality Care at the Best Value
Diagnosis:
  • The current health care system rewards providers based on the volume of care delivered, regardless of its quality or value.

Prescription:
  • Covered California will adopt a payment system for hospitals, such as the one employed by the Centers for Medicare and Medicaid Services (CMS), which, over time, will put at least 6 percent of reimbursement at risk or subject to a bonus payment based on quality performance.
  • Plans will be required to identify hospitals and providers that are outliers and deliver either poor-quality care or unwarranted high-cost care. Once these providers are identified, health plans will be expected to work with them to improve their care or to lower their costs, and, if they do not and do not provide justification, plans will exclude those hospitals from Covered California networks as early as 2019.
  • Plans will manage high-cost pharmaceuticals and help consumers better understand the effectiveness and costs of their drug treatments, as well as any alternatives.

Reducing Health Disparities and Promoting Health Equity
Diagnosis:
  • There are significant health disparities and problems with health equity, meaning that the care received by millions of Californians — and the health status of those Californians — varies because of their race, ethnicity or income.

Prescription:
  • Plans will be required to track health disparities among all their patients receiving care, identify trends in those disparities and reduce the disparities, beginning with four major conditions: diabetes, hypertension, asthma and depression.
  • Plans will develop programs to proactively identify and manage at-risk enrollees, with requirements to improve in targeted areas.

Giving Consumers Tools to Make the Best Choices for Themselves
Diagnosis:
  • Consumers do not have the tools they need to make an educated decision on picking a provider based on cost and quality, and there is a huge variation in costs for consumers.

Prescription:
  • Plans will be required to help consumers be active participants in their health care by providing tools to help consumers better understand their diagnoses and treatment options and understand their share of costs for medical services — based on the contracted costs of their plan.

“We are insisting on the best care and value for our consumers,” Lee said. “In the near term, keeping costs low is about making sure Covered California has a good mix of enrollees, but over the long term there must be system-wide efforts to lower costs and improve quality for all Californians.” 

The improvements were hailed by a wide variety of stakeholders, including CMS and the American Academy of Family Physicians (AAFP). 

“We applaud California’s focus on delivery system reform in the California health insurance exchange,” said Dr. Patrick Conway, CMS’s deputy administrator for innovation and quality and its chief medical officer. “Through payment incentives, innovative care delivery and improvement science, and transparent information, the public and private sector can collaborate to transform the health system to achieve better care, smarter spending and healthier people.”

“We applaud Covered California for their leadership in working to ensure that all Californians have an ongoing relationship with a primary care physician and that the care patients receive is truly coordinated across the continuum of services,” said Dr. Douglas E. Henley, executive vice president and CEO of AAFP. “Research has consistently shown that people who have access to a usual source of health care are in better health and have lower medical costs. This initiative will help make that vision a reality for Covered California beneficiaries because it values primary care and shifts payment toward paying for the quality of care and away from the number of services or procedures.”

The contract provisions were developed over the past year in conjunction with consumer advocates, health plans, clinicians, and other stakeholders and subject matter experts. See the fullsummary of the 2017 contract provisions and the slidespresented at the board meeting. In many cases, these improvements will benefit both Covered California members and consumers enrolled outside the exchange.

Covered California is required under both state and federal law to strengthen the health care delivery system; require that health plans improve health outcomes through effective case management, care coordination, chronic disease management and care compliance initiatives; and require health plans to reduce health and health care disparities.

In addition, Covered California will also make improvements to its patient-centered benefit design for 2017 plans. Benefits will be structured to remove financial barriers to consumers getting needed care and will include:
  • Making all outpatient care in Silver, Gold and Platinum plans not subject to any deductible.
  • Providing Bronze plan consumers three outpatient visits not subject to the deductible, in addition to the free preventive visits.
  • Protecting consumers from high specialty drug costs by limiting out-of-pocket costs.

For 2017, Covered California is proposing to build on this structure by lowering the out-of-pocket costs for primary care and urgent care. For more details, see the proposed 2017Standard Benefit Plan Designs and 2017Standard Benefit Plan Design Endnotes.

About Covered California
Covered California is the state’s marketplace for the federal Patient Protection and Affordable Care Act. Covered California, in partnership with the California Department of Health Care Services, was charged with creating a new health insurance marketplace in which individuals and small businesses can get access to affordable health insurance plans. Covered California helps individuals determine whether they are eligible for premium assistance that is available on a sliding-scale basis to reduce insurance costs or whether they are eligible for low-cost or no-cost Medi-Cal. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Small businesses can purchase competitively priced health insurance plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits.

Covered California is an independent part of the state government whose job is to make the new market work for California’s consumers. It is overseen by a five-member board appointed by the Governor and the Legislature. For more information about Covered California, please visit www.CoveredCA.com.

New Analysis Urges Shift to Patient-Centered Benefit Designs to Cut Costs and Help Consumers Get Care

Lessons Learned in California Can Help Avert a Collision Between Conflicting Reform Initiatives

SACRAMENTO, Calif. — A new analysis urges state-based marketplaces, the employer-sponsored insurance market and health insurance plans to take action and move toward plan benefit designs that put consumers first, and remove existing barriers to getting needed health care.

Covered California To Offer Consumers A Pathway To Vision Coverage

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Consumers Can Learn About Vision Coverage Offered by VSP Vision Care Beginning in Mid-February on CoveredCA.com

SACRAMENTO, Calif. — Covered California will offer consumers a pathway to vision plans under a new agreement with VSP Vision Care (VSP).

New Data Show How Covered California Spurs Competition Among Health Insurance Companies

Consumers Choose a Wider Variety of Plans as Pricing Drives the Market

SACRAMENTO, Calif. — Covered California released new enrollment data on Tuesday, which showed how the state’s healthy mix of enrollees and its aggressive negotiations with health insurance companies led to increased competition in the marketplace and better prices for consumers.