News and culture through the lens of Southern California.
Hosted by A Martínez
Airs Weekdays 2 to 3 p.m.

Affordable Care Act: How has mandate's first year worked in California?

Pedestrians walk by a sign posted outside of a healthcare enrollment fair on March 18, 2014 in San Francisco, California.
Pedestrians walk by a sign posted outside of a healthcare enrollment fair on March 18, 2014 in San Francisco, California.
Justin Sullivan/Getty Images

Listen to story

Download this story 1MB

We're getting close to the second open enrollment period for people to buy health insurance under the Affordable Care Act, which starts next month. 

California is seen as a bellwether of the law's success.

SCPR's Health Care Correspondent Stephanie O’Neill explained how things have gone here during the law's first year to sign up. 

How many uninsured got Coverage in California?
This summer, the Kaiser Family Foundation issued findings from a large study that showed about 60 percent of formerly uninsured Californians now have health insurance. In real numbers, that comes to about 3.4 million Californians who gained insurance in 2014. That’s considered by just about everyone in the health policy world as a successful start.
Who are these newly insured?

They skew toward lower income Californians who qualified for the biggest subsidies.  About 1.4 million people signed up for plans through Covered California –which is the new state-run health insurance marketplace. Of those folks nearly 90 percent of them qualified for subsidies to reduce their monthly insurance premiums.  But the largest share of newly insured are covered through the state’s expanded Medi-Cal program.
We heard a lot through the year about the need for enrolling the state’s Latinos and young people. Let’s start with the Latino population – how well did California do in Latino enrollment?

To put it into perspective: Latinos make up almost 40 percent of California’s population.  At the close of open enrollment last spring, Latinos accounted for 28 percent of those who bought plans through Covered California and 38 percent of Medi-Cal sign-ups.  But health experts I’ve spoken with say that while those stats leave plenty of room for improvement, the state didn’t do too badly in enrolling Latinos especially when you take into account those who are here without legal residency.
What about getting younger Californians to enroll? They’re considered important to the success of the health law. 

Insurers want sign-ups from younger and healthier people to balance out the older and sicker consumers who typically need more health care services and, as such, are more costly to insure. So having a healthy mix of young customers provides the insurance companies with a more balanced risk pool that’s key to keeping costs steady. 
There is room for improvement here, too. Covered California’s data showed that about 29 percent of those who bought a health plan through the exchange were in this coveted 18-34-year old age category.  That’s pretty good as these “young invincibles” as they’re also called make up only about 25 percent of the total population in California.

What are some of the other enrollment challenges going forward in California?
Probably the biggest is how best to enroll the hard-to-reach people who remain uninsured.  One group consists of those who aren’t super low-income and don’t qualify for as much subsidy assistance.  Encouraging those folks is a harder sell compared to those who get almost free insurance. 
But the very hardest-to-reach are those who are homeless or mentally ill. These are people who will most likely qualify for free Medi-Cal coverage. What’s likely to happen with them is they’ll get signed up, but only when they get sick and show up at a hospital or health clinic for care.

Are Californians happy with the law?

That really depends on who you ask. If you were someone who in the past has been turned down for health insurance or lost it because you became sick and actually needed to use it, you’re very happy with the Affordable Care Act. You’re likely to be even happier if you qualify for subsidies that reduce the cost of your monthly premiums.

But if you’re someone who earns too much to qualify for a subsidy, you’re likely to be paying quite a bit more for your health insurance coverage today. The tradeoff is that your plan is more generous and provides you with consumer protections. But still, these higher costs are frustrating to many unsubsidized consumers I’ve spoken with - especially those who are healthy and really don’t seek much medical care. 

What about the cost of insurance – we’ve seen gigantic, double-digit increases in recent years?

This year we’ve seen a quite modest average rate increase of 4.2 percent statewide for those plans from companies that are selling both on and off the Covered California exchange.  But that number means nothing when it comes to your particular plan which may have gone down in price or it may have shot up as high as 15 percent, depending on who your insurer is and where you live.  So it’s imperative that everyone who is buying on the individual market spends a little time checking out the rates and making any necessary changes during open enrollment, which starts next month on November 15 and ends on February 15. 
What about those Californians who buy individual and family insurance? Are they happy with the plans they have?

Generally yes. That’s what the Kaiser Family Foundation survey I mentioned reported. But that could be because many people have yet to really use their coverage. Until they actually do, they won’t truly understand how much they must shell out for care in terms of deductibles and co-pays – which are in addition to their monthly premiums.   

You’ve reported quite a bit about narrow provider networks in these new plans. What’s happening with that issue?

That was sort of the ugly surprise for many who used their plans in 2014 . What many people found was that their policy did not cover their doctor or their hospital or other health care provider. This year has seen a definite narrowing of the provider networks offered in the individual and family market.

Making matters worse was that there was really no way for consumers to know who was on their plan and who wasn’t. A Covered California directory intended to provide that information wasn’t ready for prime time and had to be yanked. That’s one of the bigger issues that still needs to be resolved if the powers that be want to maintain the happiness level of consumers here in California.

Is it safe to say the health care law is here to stay?

I think so. There are a couple of court cases that are challenging the premium subsidies in states that don’t run their own exchange, like we do in California. But overall the political brouhaha that’s defined this discussion has subsided and that’s great news for consumers and health care reporters  as it allows us to see for ourselves, without the noise of politically-motivated bickering, what’s working and what’s not and what needs to be fixed.