News Release

Date Posted

Covered California Releases Regional Analysis of Support Provided to Consumers Under the Affordable Care Act Compared to Changes Proposed in the American Health Care Act


  • Analysis shows lower-income Californians, particularly those who are older and live in high-cost areas, would be negatively impacted by the proposed changes.
  • Updated analysis using Congressional Budget Office findings and historic trends finds that premiums are likely to be 15 to 20 percent higher under the American Health Care Act.
  • Under the American Health Care Act, many Californians would need to spend more than a quarter of their income on health insurance premiums.

SACRAMENTO, Calif. — Covered California released a new analysis on Monday that goes into greater detail regarding how consumers could be impacted by the changes in financial assistance proposed under the American Health Care Act (AHCA).

The latest figures take into account the recent Congressional Budget Office (CBO) analysis and detail how consumers would be affected in all 19 of California’s rating regions for non-group coverage.

“We have made great progress in reducing California’s uninsured rate to a historic low of 7.1 percent,” said Covered California Executive Director Peter V. Lee. “The main reasons for that are that the financial assistance currently available helps many afford coverage, and for those not receiving subsidies we have kept premium increases to historically low levels. The current AHCA proposal would dramatically reduce financial assistance for most Californians while increasing costs for those who do not get help.”

The CBO examined the AHCA and determined that health insurance premiums would be 15 to 20 percent higher in 2018 and 2019 than they would have been under existing law. The amount of tax credits under the proposed legislation would be 60 percent of what is provided under the current law.

The result would be that some older Californians, particularly those who are lower-income and live in higher-cost areas, would see large increases in their costs, requiring them to spend a significant amount — or even their entire income — to maintain their health insurance coverage.

“The proposed changes to the subsidy structure would put coverage out of reach of many,” Lee said.

The examples below compare the financial help that consumers would receive in 2020 based on the current Patient Protection and Affordable Care Act (ACA) subsidies — which consider a consumer’s age, income, family size and where they live — to the proposed age-based-only subsidies of the AHCA.

For example, under the age-based subsidy structure, consumers purchasing the second-lowest-cost Silver plan would fare very differently depending on their income and where they live:
  • In Sacramento under the ACA, a 27-year-old earning $17,000 would pay 3.7 percent of her income toward health insurance premiums ($622 per year or $52 per month). By contrast, under the AHCA that individual would be asked to spend nearly 25 percent of her income on her health insurance premium, paying $4,036 per year or $336 per month.
  • In Kern County, a 62-year-old earning $30,000 a year would pay 8.3 percent of his income toward health insurance premiums ($2,494 per year or $208 per month under the ACA). If the AHCA were in effect, he would be asked to allocate more than 30 percent of his income to health insurance, paying $9,182 a year or $765 per month.
  • Finally, in Monterey County, a 62-year-old earning $17,000 would receive support under the ACA to limit her premium to 3.7 percent of her income ($622 per year or $52 per month). Yet under the AHCA, this consumer would have to spend 100 percent of her income on her premium and would still fall short of what it would take to purchase a plan that costs $17,873 per year, or $1,489 per month.
Covered California provided data for consumers aged 27, 40 and 62 years old who earn $17,000; $30,000; or $75,000 per year in each of California’s 19 rating regions. The premium projections estimated premiums and tax credits in 2020 under both the AHCA and ACA, using Covered California’s trend of a 7 percent average rate change during its first three years of operation to establish a “baseline” of what ACA coverage would cost.

Lee says the AHCA does address some of the gaps in our current health care system, such as providing needed financial assistance to those above 400 percent of the federal poverty level.

“The proposal addresses the real challenges for some Californians on the ‘cliff,’ of being at 400 percent of the federal poverty level. However, the proposal does not take into account what people earn or the cost of where they live. As a result, many of the most vulnerable Californians will be priced out of coverage under the proposed system,” Lee said. “The likely result is a smaller and less healthy risk pool, which would mean higher premiums for everyone in the individual market.”

The data for all scenarios, in each of Covered California’s rating regions, can be found here: http://coveredca.com/news/pdfs/AHCA_ACA_comparison_chart.pdf.

Now that open enrollment has ended, Covered California is focused on its special-enrollment period. Consumers are eligible to sign up now if they experience changes in their life circumstances, such as losing their health care coverage, getting married, having a child or moving.

For more information on special-enrollment rules, visit: www.CoveredCA.com/individuals-and-families/getting-covered/special-enrollment.

Consumers who qualify for Medi-Cal may enroll through Covered California year round.

For more information, consumers should visit CoveredCA.com, where they can enroll online or get information about obtaining free, confidential in-person assistance in a variety of languages. They can find a certified enroller at a storefront in their area or have a certified enroller contact them through the “Help on Demand” feature.

Consumers can also enroll over the phone by calling Covered California at (800) 300-1506.

About Covered California
Covered California is the state’s health insurance marketplace, where Californians can find affordable, high-quality insurance from top insurance companies. Covered California is the only place where individuals who qualify can get financial assistance on a sliding scale to reduce premium costs. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Depending on their income, some consumers may qualify for the low-cost or no-cost Medi-Cal program.

Covered California is an independent part of the state government whose job is to make the health insurance marketplace 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 Wins National Public Relations Award for Enrollment and Outreach Efforts


  • Covered California was recognized for its bus tour promoting enrollment in health insurance across the state with community partners.
  • Outreach helped attract a good mix of insurance consumers to help keep premiums low.
  • The award was for the “Best in Public Sector” work in the industry.

SACRAMENTO, Calif. — Covered California’s outreach and earned media efforts to promote enrollment have been recognized by the prestigious PRWeek US Awards, which celebrate the best in public relations and public affairs work.  

Covered California, working in partnership with Ogilvy Public Relations, was recognized as the “2017 Best in Public Sector” awardee for the 2015–16 “Spotlight on Coverage” campaign and bus tour.

The campaign focused on reaching California's diverse communities and helped drive awareness and enrollment. The Spotlight on Coverage bus tour traveled 2,500 miles and included 42 stops in communities across the state.

“This award is not just for Covered California, but for the many community partners across the state who have worked with us to get the word out about affordable health coverage,” said Peter V. Lee, executive director of Covered California. “Attracting what actuaries call a good ‘risk mix’ requires strategic thinking and investment, and we are very proud to be recognized for the hard work involved in this outreach campaign.”

Covered California currently has about 1.3 million consumers enrolled in coverage through its exchange, and has one of the nation’s best “risk mixes,” the term actuaries use to indicate the ratio of younger and healthier consumers to those who may have chronic conditions or need more care.

Covered California’s initial analysis showed that the number of young adults signing up for 2017 coverage comprised a large proportion of its new enrollees for the second consecutive year.

Young adults in the crucial 18- to 34-year-old demographic accounted for an estimated 37 percent of this year’s plan selections, compared to 38 percent in the open-enrollment period for 2016, 34 percent for the open-enrollment period for 2015 and 29 percent for the open-enrollment period in 2014.

Lee credited supporters across the state with helping make the enrollment tour a success.

“We cannot do this work alone,” he said. “We’re grateful for the support we have from strong partners — government, business and nonprofit health advocates — who work with us to promote the importance of health insurance coverage.”

About Covered California
Covered California is the state’s health insurance marketplace, where Californians can find affordable, high-quality insurance from top insurance companies. Covered California is the only place where individuals who qualify can get financial assistance on a sliding scale to reduce premium costs. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Depending on their income, some consumers may qualify for the low-cost or no-cost Medi-Cal program.

Covered California is an independent part of the state government whose job is to make the health insurance marketplace 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 Releases Analysis of Support Provided to Consumers Under the Affordable Care Act and an Early Look at Consumer Impact of Changes Proposed in the American Health Care Act


  • Covered California enrollees benefited from $4.2 billion in subsidies to help them purchase health coverage and get care in 2016.
  • County data shows how tax credits help individuals throughout California purchase health insurance.
  • The average subsidy in 2016 was worth $5,300 per household and $3,500 per individual, but sizeable numbers of enrollees received more — with 12 percent of households receiving more than $10,000 per year to help them pay for coverage.
  • Initial review of proposed changes under the current American Health Care Act indicates big impacts, especially to older Californians and those who live in higher-cost areas.

SACRAMENTO, Calif. — Covered California released a new comprehensive analysis on Tuesday detailing the financial assistance available through the Affordable Care Act as well as a preliminary analysis of how changes proposed in federal law would affect enrollees.

The studies come one day after the Congressional Budget Office (CBO) reported that 24 million consumers could lose coverage under the proposed American Health Care Act (AHCA), which was introduced in the U.S. House of Representatives on March 6.

“We are deeply troubled by the CBO’s finding that the amount of support provided for consumers to buy health insurance in 2020 under proposed legislation would be only 60 percent of what is provided under current law,” said Covered California Executive Director Peter V. Lee. “While we are still doing an analysis of the aggregate effects of this law on our consumers, the likely effect of basing subsidies on age alone — rather than considering income and where an individual lives — is that it will make coverage unaffordable and in many cases, put coverage out of reach.”

Covered California released two documents on Tuesday: “Bringing Health Care Coverage Within Reach,” an in-depth analysis of Covered California enrollees and the subsidies they receive in 2016; and “Preliminary Analysis of Impacts to Consumers from Changes in Premium Subsidies and Cost Sharing Reductions Available Under the Proposed American Health Care Act.”

The first analysis shows Covered California households received an average of $5,300 per year in tax credits to help pay for the cost of their coverage in 2016. Additionally, 12 percent of Covered California households receive more than $10,000 per year and 16 percent of individuals receive more than $6,000 per year to help bring health care coverage within reach.

Approximately half of Covered California consumers are enrolled in “Enhanced Silver” plans, which give them the additional benefit of cost-sharing reductions that reduce their out-of-pocket expenses by an average of $1,500 per year.

“Health insurance can be expensive, and the financial assistance provided through Covered California helps consumers save money and brings that coverage within reach of millions,” Lee said. “As policy makers in Washington consider changes to our health care system, it is important that the impact on real individuals informs the debate in Washington, D.C. because we are seeing that many will be priced out of needed coverage.”

While the average effects are relatively clear and consistent with the CBO’s assessment that “the average subsidy under the legislation would be about 60 percent of the average subsidy under current law,” the effect on individuals in California and nationally will vary greatly.

The examples below compare the financial help that consumers receive now through the Affordable Care Act — which considers a consumer’s age, income, family size and where they live — to the newly proposed age-based-only subsidies of the AHCA. For example, under the age-based subsidy structure, consumers purchasing the second-lowest Silver plan would fare very differently depending on whether they live in Los Angeles or San Francisco:
  • In Los Angeles, a 27-year-old earning $17,000 a year would see similar net premiums: $55 per month under the proposed law compared to $52 per month under the current law. However, if that same individual lived in San Francisco, his or her new net premium would be four times higher — $199 per month —compared to $52 per month under the current law.
  • In Los Angeles, a 62-year-old earning $30,000 a year would see his or her net premium increase from $207 per month under the current law to $275 per month under the proposed law. If that person lived in San Francisco, his or her net premium would jump threefold from $209 per month to $668 per month.
“As many independent studies have shown, moving to age-based tax credits will hurt many of our consumers, particularly those older and lower- to middle-income consumers, and price them out of the market,” Lee said. “This would damage our risk mix and lead to higher premiums for everyone in the individual market, even those who do not purchase their insurance through Covered California.”

Covered California plans to conduct further analysis of the overall impact of proposed changes including all provisions contained in the American Health Care Act.

The county data used to prepare today’s analysis can be found here: http://hbex.coveredca.com/data-research/library/County_APTC_CSR_data.pdf.

This is the latest analysis performed by Covered California that details how consumers are benefitting from the Affordable Care Act. Previous analyses include “Consumer and Market Implications of Affordable Care Act Repeal Without a Viable Replacement” and “Covered California Brings Health Care Within Reach and Shows How Consumers Can Save by Shopping.

Now that open enrollment has ended, Covered California is focused on its special-enrollment period. Consumers are eligible to sign up now if they experience changes in their life circumstances, such as losing their health care coverage, getting married, having a child or moving.

For more information on special-enrollment rules, visit: www.CoveredCA.com/individuals-and-families/getting-covered/special-enrollment.

Consumers who qualify for Medi-Cal may enroll through Covered California year round.

For more information, consumers should visit CoveredCA.com, where they can enroll online or get information about obtaining free, confidential in-person assistance in a variety of languages. They can find a certified enroller at a storefront in their area or have a certified enroller contact them through the “Help on Demand” feature.

Consumers can also enroll over the phone by calling Covered California at (800) 300-1506.

About Covered California
Covered California is the state’s health insurance marketplace, where Californians can find affordable, high-quality insurance from top insurance companies. Covered California is the only place where individuals who qualify can get financial assistance on a sliding scale to reduce premium costs. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Depending on their income, some consumers may qualify for the low-cost or no-cost Medi-Cal program.

Covered California is an independent part of the state government whose job is to make the health insurance marketplace 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.

Happy Valentine’s Day News for California: State Uninsured Rate Falls to a New Record Low


  • California’s uninsured rate drops to 7.1 percent.
  • Rate is down from 17 percent in 2013, before the Affordable Care Act.
  • California’s uninsured rate is falling faster than the national average.



SACRAMENTO, Calif. — A new survey from the Centers for Disease Control and Prevention (CDC) shows that California’s uninsured rate has fallen to a new record low of 7.1 percent, which is significantly lower than the 17 percent the CDC found in 2013.

“Covered California is proud to be part of the effort that is helping millions of people get the coverage and care they need,” said Covered California Executive Director Peter V. Lee. “From expanding Medi-Cal to launching a competitive state-based marketplace, California is empowering consumers and providing quality and value.”


The CDC survey, which covered January to September 2016, also showed a dramatic improvement when compared to national averages.

Prior to the Affordable Care Act, California’s uninsured rate for all ages was higher than the national average, 17 percent compared to 14.4 percent. Since that time, California has fallen below the national average and is dropping at a significantly faster pace. The CDC says the difference between the two rates was one percentage point at the end of 2015. The difference between the two rates has now increased to 1.7 percentage points, 7.1 percent in California compared to 8.8 percent nationally.



Covered California noted that this data does not include the recent open enrollment period that closed on Jan. 31 — during which more than 412,000 Californians signed up for coverage.

Now that open enrollment has ended, Covered California has begun new marketing focused on enrolling those who are eligible to sign up now due to changes in their life circumstances, such as losing their health care coverage, getting married, having a child or moving.

For more information on special-enrollment rules, visit: www.CoveredCA.com/individuals-and-families/getting-covered/special-enrollment.

Consumers who qualify for Medi-Cal may enroll through Covered California year round.

For more information, consumers should visit CoveredCA.com, where they can enroll online or get information about obtaining free, confidential in-person assistance in a variety of languages. They can find a certified enroller at a storefront in their area or have a certified enroller contact them through the “Help on Demand” feature.

Consumers can also enroll over the phone by calling Covered California at (800) 300-1506.

The full CDC survey can be viewed here: https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201702.pdf.

About Covered California
Covered California is the state’s health insurance marketplace, where Californians can find affordable, high-quality insurance from top insurance companies. Covered California is the only place where individuals who qualify can get financial assistance on a sliding scale to reduce premium costs. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Depending on their income, some consumers may qualify for the low-cost or no-cost Medi-Cal program.

Covered California is an independent part of the state government whose job is to make the health insurance marketplace 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 Finishes Fourth Open Enrollment With More Than 412,000 New Consumers and Strong Participation From Young Enrollees


  • New plan selections met enrollment projections for the fourth open-enrollment period.
  • Nearly 50,000 consumers signed up for health care coverage in the final two days before the Jan. 31 deadline.
  • Strong finish and overall enrollment are credited to effective work by Certified Insurance Agents and enrollers and robust television, digital, print and outdoor advertising that ran throughout the open-enrollment period.
  • The crucial demographic of young adults ages 18–34 accounted for 37 percent of enrollment, contributing to a healthy risk mix for 2017.

SACRAMENTO, Calif. — Covered California announced Monday that it finished the open-enrollment period with 412,105 new consumers signing up for health coverage.

“California met our projections, driven by the nearly 50,000 consumers who signed up for health insurance in the last two days of open enrollment,” Covered California Executive Director Peter V. Lee said. “This high number of sign-ups validates the surveying we did after the election. When consumers know they have a pathway to get health care made affordable by tax credits, they sign up.”

In addition to the strong pace of enrollment, Covered California’s initial analysis shows that the number of new young adults signing up for coverage comprised a large proportion of new enrollees for the second consecutive year.

Young adults in the crucial 18- to 34-year-old demographic accounted for an estimated 37 percent of this year’s plan selections, compared to 38 percent in the open-enrollment period for 2016, 34 percent for the open-enrollment period for 2015 and 29 percent for the open-enrollment period in 2014.

“Covered California is continuing to enroll consumers in large numbers and with a goodmix of younger and older, which helps keep rates down for everyone and keeps the entire individual market stable,” Lee said.

Lee said survey research conducted in December among potential enrollees showed that political uncertainty about the future of the Patient Protection and Affordable Care Act created some concern, but did not prevent individuals from enrolling. Instead, concerns about affordability remain top of mind, with some uninsured consumers still not understanding that financial help, or subsidies, are available to reduce the cost of health insurance.

“The demand for affordable health insurance remains very strong in California,” Lee said. “Reaching consumers where they are with the information they need is critical to attracting the enrollees we need to make competitive health insurance marketplaces work.”

While the rate of renewal from 2016 to 2017 will not be clear until March, when it is possible to reconcile paid premiums, Lee said there are early indications that consumers who enrolled in 2016 are continuing into 2017.

On Friday, the federal government reported enrollment and renewal figures for federal marketplace states. Using similar criteria, Covered California has enrolled more than 368,000 new consumers during the fourth open-enrollment period and continues to enroll 1.2 million consumers, for a total enrollment of more than 1.5 million people.

“Covered California continues to grow and make a difference in the lives of hundreds of thousands of people,” Lee said.

Now that open enrollment has ended, Covered California has begun new marketing focused on enrolling those who are eligible to sign up now due to changes in their life circumstances, such as losing their health care coverage, getting married, having a child or moving.

Special-enrollment marketing includes multicultural and multi-segment radio, digital and display advertising statewide.

For more information on special-enrollment rules, visit: www.CoveredCA.com/individuals-and-families/getting-covered/special-enrollment.

Consumers who qualify for Medi-Cal may enroll through Covered California year round.

For more information, consumers should visit CoveredCA.com, where they can enroll online or get information about obtaining free, confidential in-person assistance in a variety of languages. They can find a certified enroller at a storefront in their area or have a certified enroller contact them through the “Help on Demand” feature.

Consumers can also enroll over the phone by calling Covered California at (800) 300-1506.

About Covered California
Covered California is the state’s health insurance marketplace, where Californians can find affordable, high-quality insurance from top insurance companies. Covered California is the only place where individuals who qualify can get financial assistance on a sliding scale to reduce premium costs. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Depending on their income, some consumers may qualify for the low-cost or no-cost Medi-Cal program.

Covered California is an independent part of the state government whose job is to make the health insurance marketplace 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 Gives Consumers More Time to ‘Cross the Finish Line’ as It Prepares for Surge of Enrollment


  • Consumers must begin the application process by the end of Jan. 31 and complete their enrollment by the end of Feb. 4.
  • Thousands of Certified Insurance Agents and Community Enrollment Partners are ready to provide free and confidential in-person assistance.

Click for Español

SACRAMENTO, Calif. — Covered California announced it is giving consumers who attempt to enroll by the Jan. 31 deadline four more days to complete their enrollment.

“Experience tells us that people wait until the last day to sign up for health insurance, and we do not want to leave anyone behind,” said Covered California Executive Director Peter V. Lee. “Health care is so important, and people should not miss this opportunity to get coverage if they get caught up in a wave of last-minute shoppers.”

Between Feb. 1 and Feb. 4, consumers who started an application can complete the process with help from a Certified Insurance Agent, Service Center Representative or Community Enrollment Partner. Enrollment partners include Certified Enrollment Counselors, Certified Application Counselors and Plan-Based Enrollers. Those who finish their application by Feb. 4 will have their health care coverage start on March 1, 2017.

“Covered California is committed to helping all consumers cross the enrollment finish line,” Lee said. “Our top priority is making sure they have the time and help they need to find the Covered California health plan that works for them.”

Consumers interested in enrolling online can do so on CoveredCA.com. They can also get free and confidential in-person assistance, in a variety of languages, by clicking on “Free Local Help to Enroll.” They can find a nearby enroller or have a certified enroller contact them through the “Help on Demand” feature. Consumers can also enroll over the phone by calling Covered California at (800) 300-1506.

Covered California also stressed that financial assistance is available to help consumers pay for their coverage. The financial help allows 60 percent of consumers to get a Bronze plan for less than $10 per month, and 50 percent of consumers to get a Silver plan for less than $100 per month. Nearly nine out of every 10 Covered California enrollees receive some level of financial assistance.

“We will help people get across the finish line in the days following the deadline, but you must take steps to begin the process by today,” Lee said. “Covered California has partners who will make enrollment easier than you think, and with the financial help that is available it can be more affordable than you realize.”

Once open enrollment ends, consumers may sign up only if they experience a life-changing event such as losing their health care coverage, getting married, having a child or moving. Medi-Cal enrollment is year round.

About Covered California
Covered California is the state’s health insurance marketplace, where Californians can find affordable, high-quality insurance from top insurance companies. Covered California is the only place where individuals who qualify can get financial assistance on a sliding scale to reduce premium costs. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Depending on their income, some consumers may qualify for the low-cost or no-cost Medi-Cal program.

Covered California is an independent part of the state government whose job is to make the health insurance marketplace 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 Study Shows Rising Premiums and Hundreds of Millions Added to Federal Budget if Funding to Reduce Patients’ Cost-Sharing Changes


  • Eliminating direct federal funding for cost-sharing reductions for health plan enrollees would raise premiums by 16.6 percent in 2018 for Silver plan consumers.
  • Modeling suggests consumers who benefit from subsidies would shift to non-Silver plans.
  • Overall, the federal premium-subsidy funding for enrollees would rise by an amount significantly above the current cost-sharing reduction funding.
  • Enrollment in Covered California would rise slightly, while enrollment off exchange would decrease slightly, increasing the federal cost by approximately 29 percent for the same benefit to consumers.

SACRAMENTO, Calif. — A decision by federal officials to eliminate direct federal funding to reduce cost-sharing for more than 50 percent of consumers in Covered California would increase premiums substantially for Californians who buy health care in the individual market, while also resulting in higher costs for the federal government, according to new research commissioned by Covered California.

The study, “Evaluating the Potential Consequences of Terminating Direct Federal Cost- Sharing Reduction (CSR) Funding,” looked at what would happen to premiums and how consumers would react to those changes if instead of funding cost-sharing reductions through direct federal funding — as has been the case since 2014 — health plans were required to build the costs of such subsidies into their premiums. The study found that consumers in the individual market who are enrolled in Silver plans, both inside and outside of Covered California, would see their prices rise 16.6 percent.

In addition, since the calculation for Advanced Premium Tax Credits (APTC) is based on the cost of the second-lowest-priced Silver plan, any increase in premiums would also result in an increase in the amount of tax credits that help consumers pay for their premiums. The study found that eliminating cost-sharing reductions and requiring health plans to build the costs into premiums in 2018 would increase federal expenses by $221 million, or 29 percent, because the new amount of APTC would be significantly greater than what the government currently pays directly in cost-sharing.

“Covered California commissioned this report as part of our effort to plan for the future and provide concrete analysis of the real-world impacts of the policy alternatives being considered on consumers and the federal budget,” said Peter V. Lee, executive director of Covered California. “This report underscores the importance of making policy choices informed by evidence. Here the evidence is clear that changing the payment method for cost-sharing reductions would be a bad deal for the federal government and a bad deal for consumers who do not receive subsidies.”

Funding to reduce cost-sharing is one of the two ways that health care is made more affordable through federal financial assistance. The first way is to provide premium assistance in the form of a tax credit (the Advanced Premium Tax Credit), which eligible consumers receive in the form of a monthly reduction to the premium they would have paid for private insurance. Nationally about 85 percent of consumers with coverage through marketplaces receive the tax credit, and about 90 percent of consumers enrolled through Covered California receive this benefit.

Reducing cost-sharing lowers out-of-pocket costs for consumers once they are enrolled and getting care, with the size of the reduction based on the consumer’s income. The rationale behind reduced cost-sharing is the recognition that lower-income individuals would avoid needed care if faced with higher out-of-pocket costs, given their income.

Cost-sharing reductions are available to Covered California consumers who earn between 138 percent and 250 percent of the federal poverty level. These funds help lower-income enrollees increase their access to care by lowering their copays, coinsurance, deductibles and maximum out-of-pocket costs. For example, a consumer who enrolls in a typical Silver plan would pay $45 for a primary care visit, while a consumer with reduced cost-sharing could pay as little as $5. As of June 2016, more than 678,000 consumers — about 50 percent of total enrollment — were enrolled in a Covered California Silver plan with reduced cost-sharing.

The study, which was conducted by researchers from the University of California, Los Angeles, looked at the potential impact of the Department of Health and Human Services dropping the appeal of a 2014 lawsuit initiated by members of the U.S. House of Representatives.

This study is the first of its kind by a state-based exchange to examine the impact of such a move on consumers and on federal spending.

The study can be found here: http://coveredca.com/news/pdfs/CoveredCA_Consequences_of_Terminating_CSR.pdf.

Also on Thursday, Covered California released an analysis of repealing the Affordable Care Act without replacing it.

“This in-depth analysis underscores the importance of not having disruptions to the market that would cause imminent harm to consumers,” Lee said. “And it is also helping us look ahead to 2018 and beyond.”

The analysis can be viewed here:

http://coveredca.com/news/pdfs/Implications_of_Repeal_without_replacement.pdf.

For health coverage in 2017, Covered California is continuing open-enrollment efforts through Tuesday, Jan. 31.

Consumers interested in enrolling online can do so on CoveredCA.com. They can also get free and confidential in-person assistance, in a variety of languages, by clicking on “Free Local Help to Enroll.” They can find a nearby enroller or have a certified enroller contact them through the “Help on Demand” feature. Consumers can also enroll over the phone by calling Covered California at (800) 300-1506.

About Covered California
Covered California is the state’s health insurance marketplace, where Californians can find affordable, high-quality insurance from top insurance companies. Covered California is the only place where individuals who qualify can get financial assistance on a sliding scale to reduce premium costs. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Depending on their income, some consumers may qualify for the low-cost or no-cost Medi-Cal program.

In addition, small business owners can purchase affordable health insurance for their employees through Covered California for Small Business.

Covered California is an independent part of the state government whose job is to make the health insurance marketplace 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 Enrollment Continues at Strong Pace; New Research Suggests ACA News Coverage Is Not Deterring Consumers


  • More than 320,000 consumers have newly enrolled since Nov. 1 — a similar pace to last year.
  • Research conducted in December indicates the Affordable Care Act (ACA) debate at the national level is a concern for consumers, but is not keeping them from enrolling.
  • Affordability continues to be the main perceived barrier to getting coverage.
  • Most have a positive feeling about Covered California.

Click for Español

SACRAMENTO, Calif. — As of Monday, Jan. 23, 322,014 people have newly enrolled in a health plan through Covered California since Nov. 1, keeping pace with enrollment last year despite a measure of concern on the part of Californians about the future of the ACA.

“As we continue working to enroll consumers in Covered California, it’s heartening to see that they continue to place great faith in our brand and are getting the financial help essential to getting and keeping health coverage for those who need it,” Covered California Executive Director Peter V. Lee said. “While people are worried, the uncertainty is not preventing them from enrolling or renewing in coverage for 2017.”

The study, titled “An Integrated Quantitative and Qualitative Study on Post-Election Attitudes Toward Enrolling in and Renewing Health Insurance Coverage,” was conducted between Dec. 14, 2016, and Jan. 3, 2017, to evaluate whether to adjust Covered California’s marketing and outreach messaging. The qualitative and quantitative research, which included focus-group testing and an online survey of 500 respondents, was conducted by Greenberg Strategy, an Emeryville-based research and strategy consultancy with clients around the world.

Among the findings:
  • Concerns about affordability and costs rising far outweigh concerns about the future of the ACA.
  • Consumers say if they could afford coverage, they would sign up for it.
  • Ninety percent of consumers think subsidies will continue to be available in 2017.
  • The belief that the ACA will be cancelled is not associated with hesitation to enroll or renew.
The survey also found that while the affordability of health care remains a top concern among consumers, many still do not know that financial help is available to lower the costs of their premiums and care.

“Subsidies to help consumers buy health insurance on the exchange are critical to making coverage affordable to many people in California,” Lee said. “Because those subsidies are available, more than a million customers are able to buy health coverage they can afford.”

As of June 2016, policyholders have benefitted from an average of $440 per month in financial assistance, and nearly 90 percent of Covered California members receive some level of financial help.

“Consistent with what we have seen in the last four years, affordability is still the barrier, especially for those who remain uninsured,” Lee said. “Any policy changes coming from Washington D.C. need to continue to address consumers’ core concerns about affordability.”

According to the research, consumers have a lot of trust in the Covered California brand, with a “willingness to believe that California will save the day, and an openness to and trust in the idea that Covered California will be part of the solution.”
  • “Right now, I feel California is looking out for us, and we can’t trust what’s going on in D.C.” — Focus-group participant, uninsured.
  • “I don't think California will let us down. We moved here for a government that takes care of its people.” — Survey respondent, insured through Covered California.
Lee said consumers should not hesitate to enroll, and that Covered California is committed to keeping them informed of any changes that could affect them in the future.

“We recognize that the discussion in Washington can be unsettling, but those without insurance should not hesitate to enroll in coverage if they can afford it,” he said. “Purchasing insurance can give them access to health care almost immediately, which can be life-changing.”

The complete study can be found here: http://www.coveredca.com/news/pdfs/CC_Current_Sentiment_Topline_012417_FINAL.pdf.

Open enrollment continues through Jan. 31, 2017.

Consumers interested in enrolling online can do so on CoveredCA.com. They can also get free and confidential in-person assistance, in a variety of languages, by clicking on “Free Local Help to Enroll.” They can find a nearby enroller or have a certified enroller contact them through the “Help on Demand” feature. Consumers can also enroll over the phone by calling Covered California at (800) 300-1506.

About Covered California
Covered California is the state’s health insurance marketplace, where Californians can find affordable, high-quality insurance from top insurance companies. Covered California is the only place where individuals who qualify can get financial assistance on a sliding scale to reduce premium costs. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Depending on their income, some consumers may qualify for the low-cost or no-cost Medi-Cal program.

Covered California is an independent part of the state government whose job is to make the health insurance marketplace 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.