December 2012 - Susman
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Health Care Exchange information

What will the Healthcare Exchange be?  What does it mean?

The Pacific Business Group on Health yesterday released the third and final installment of its comprehensive report on how to ensure that the people joining a health benefit exchange end up with the plan that works best for them.

“The whole notion of the Affordable Care Act and the establishment of the exchange is to improve the overall health care marketplace,” said Ted von Glahn, a senior director at PBGH, a not-for-profit business coalition focused on health care issues.

“If you don’t get it right when people are making those choices,” von Glahn said, “that would defeat the whole purpose of it.”

That’s one of the points of yesterday’s report, that health officials need to make sure that the choice of a health plan for consumers in the exchange becomes both a simple and well-informed decision.

The report, done in three installments, is based on a series of 2,100 interviews overall, conducted in 2012 with low-income participants chosen to mirror the demographic makeup of expected enrollees in the exchange in 2014.

Outside of premium cost, one of the most important factors to increase enrollment among participants is to make the process a simple one. The first recommendation of the report is to offer shortcuts to the choice of a health plan. That simple approach — basically nudging participants to consider common concerns — must be balanced by the flexibility to also present consumers with more detailed and in-depth information about their choices, von Glahn said. Basically, the approach is to simplify choices, but to be able to lay out the more complex components to choosing a plan, such as the level of varying deductible levels a consumer would pay, for instance.

“Because we know there are half a dozen things that stand out, that matter to people, so you want to nudge them to consider certain aspects,” von Glahn said. “But you don’t want to curtail their opinions or needs. You have to give people choices of what they want to choose.”

The cost calculator, for instance, will be an important component of the health plan selection process, von Glahn said.

 

Healthcare Reform in California

Lawmakers will need to move quickly to clear the way for Californians’ enrollment in a new state-run insurance market next fall in the run-up to the Affordable Care Act.

Lots changes happening, lots of changes every day.

When state lawmakers are sworn in Monday for the new legislative session, they will have little time to enjoy the pomp and circumstance.

Facing a federal deadline, the Legislature must move quickly to pass measures to implement President Obama’s healthcare law and revamp the state’s insurance market. New legislation will help extend coverage to millions of uninsured Californians and solidify the state’s reputation as a key laboratory for the federal law.

Legislative leaders have said they also want to overhaul environmental regulations, curb soaring tuition at public colleges, and tweak the state’s tax structure and ballot-initiative system.

But healthcare remains one of the largest and most immediate challenges.  Read on, this is important stuff.

The federal Affordable Care Act takes effect in January 2014, when most Americans face the requirement to buy health insurance or pay a penalty. State lawmakers must pass a series of rules to clear the way for enrollment in a new state-run insurance market next fall, including a requirement for insurers to cover consumers who have preexisting medical conditions and limits on how much they can charge based on age.

Gov. Jerry Brown is expected to call a special session of the Legislature next month — concurrent with the regular session — so healthcare bills that he signs can take effect within 90 days rather than the next year.

“It’s a very, very big undertaking to make the promise of the Affordable Care Act a reality,” said state Health and Human Services Secretary Diana Dooley. “We are working as hard and as fast as we can in a very complex area with a lot of conflicting information.”

As an early adopter of the Affordable Care Act, California has already laid much of the groundwork.

It was the first state to establish an insurance exchange after Congress passed the legislation in 2010. More than 30 other states have since sought federal help in enacting their own. Millions of Californians will be able to purchase coverage, with federal subsidies earmarked for families earning about $92,000 or less annually.

One of the most significant proposals will be an expansion of Medi-Cal, the state’s health insurance program for the poor. About 2 million low-income Californians would be newly eligible under the expansion, with the federal government subsidizing costs for the first three years. The state would then shoulder a portion of the bill.

According to a Kaiser Family Foundation study, the expansion could cost the state $6.3 billion over a decade, meaning a 1.7% increase in the amount California spends on Medi-Cal.

California got a head start on the effort by signing up more than 550,000 low-income people in a temporary program. They are expected to automatically move into Medi-Cal in 2014.

Lawmakers will also consider legislation that would create a health plan for people who cannot afford insurance on the open market but make too much money to qualify for Medi-Cal. The option, known as the Basic Health Plan, would provide coverage for individuals with incomes between 133% and 200% of the federal poverty level, or between $15,000 and $21,800 a year.

State Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee and author of the proposal, said the plan was needed to help California’s working poor. “I don’t think they should be choosing between putting food on the table and buying health insurance,” he said.

Insurers urged lawmakers to resist requirements that could make policies offered through the exchange unaffordable.

“We think the Affordable Care Act does much to get millions of people coverage, but new insurance taxes, costly benefit requirements and age pricing restrictions all have the potential of driving up costs,” said Nicole Evans, a spokeswoman for the California Assn. of Health Plans.

Healthcare advocates said it was critical for the Legislature to promote policies that would ensure a mix of healthy and sick policyholders to keep premiums affordable.

“It should be a goal of the state to have millions of people enrolled on Day 1,” said Anthony Wright, executive director of the consumer group Health Access California, “to bring in those federal dollars and make healthcare cheaper for everybody.”