On behalf of the governing Board of the California Health
Benefit Exchange, recently named Covered California, I am pleased to present
our first annual report.Covered California is proud to be at the forefront
nationally in implementing the federal Patient Protection and Affordable Care
Act of 2010, the most significant health care reform since the enactment of
Medicare and Medicaid in 1965. The provisions of this new law that expand
health coverage to millions of Californians will take effect on January 1,
2014. We understand the importance of this task, and the challenges ahead. We
are also confident that we will get the job done.
Covered California’s progress and ultimate success are only
possible with the hard work and dedication of our staff working in partnership
with the Health and Human Services Agency, the Department of Health Care
Services, the Managed Risk Medical Insurance Board, the Department of Insurance
and the Department of Managed Health Care. Our partners extend beyond state
agencies. They include consumers, health plans and health providers, large and
small businesses, labor unions, community leaders and organizations,
philanthropic organizations, and many others who have come together to help
shape the vision and future of Covered California and the health care system in
California.
We are grateful to the Governor and the Legislature for their
strong support as Covered California prepares to create a new marketplace for
health coverage that will help millions of Californians and small businesses
secure the affordable, high-quality health insurance they need.
Peter V. Lee
Executive Director
Executive Summary
California was the first state in the nation to enact
legislation creating a Health Benefit Exchange following the passage of the
Patient Protection and Affordable Care Act.
In 2010, state law [Chapter 655, Statutes of 2010 (Perez)
and Chapter 659, Statutes of 2010 (Alquist)] was enacted to implement the
provisions of the Affordable Care Act and to “reduce the number of uninsured
Californians by creating an organized, transparent marketplace for Californians
to purchase affordable, quality health care coverage, to claim available tax
credits and cost-sharing subsidies, and to meet the personal responsibility
requirements imposed under the federal act.” These authorizing statutes also
call for strengthening the health care delivery system, guaranteeing the
availability of coverage to qualified individuals and small employers, and
requiring that health care service plans and insurers compete based on price, quality
and service rather than risk selection.
Since its creation, Covered California has begun building
the foundations that will be essential to the success of this new innovative
health coverage marketplace. In 2011, the Board of Covered California adopted
its vision, mission and values statement, setting the framework for doing
business with a primary focus being on making it easy and affordable for
Californians who are eligible to obtain health coverage.
Recognizing that California is unique among all states in terms
of its diversity, size and complexity, Covered California has worked closely
with the federal government to help facilitate smooth and effective implementation of the Affordable Care Act. Enrollment for new subsidized
coverage will begin on October 1, 2013 — 90 days in advance of when coverage
begins on January 1, 2014. At that time, Californians will have access to the online
Covered California portal to shop for health insurance coverage. Some will
learn they qualify for existing public insurance programs; others will qualify
for federal subsidies to offset the cost of their premiums for plans purchased
through Covered California.
Small business owners will have the same purchasing power as
large employers to shop for low-cost coverage for their employees, and many
small employers will qualify for federal tax credits to help offset coverage
costs. To be ready, Covered California’s tasks include:
- Selecting and certifying health plans by designating them as “Qualified Health Plans” for participation in the individual market and the Small Business Health Options Program (SHOP);
- Building the California Healthcare Eligibility, Enrollment and Retention System (CalHEERS), a consumer-friendly, Web-based portal designed to be the single streamlined resource for Californians to find out what health program they are eligible for, and to make buying health insurance as easy as possible. This stateof-the-art system will allow California consumers to compare health plans to make the purchase that best meets their individual or small business needs and receive federal subsidies if eligible;
- Launching marketing, outreach and education strategies to increase awareness and knowledge of Covered California’s coverage options for individuals and small businesses, with special attention to California’s diverse populations including, developing a grant-based program to facilitate community participation in outreach and education; and
- Building and supporting a wide spectrum of support to help consumers with questions, including service center staff, county workers, community-based assisters and agents, and many more to help explain insurance and coverage options under the Affordable Care Act so that consumers can get the help they need to make choices that best meet their health coverage needs.
When fully implemented in 2019 more than two million Californians
are projected to be receiving subsidized health coverage for themselves and their
families through Covered California. Another 2.1 million Californians are
expected to purchase coverage without subsidies through Covered California or
in the individual market. Ultimately, millions of Californians will obtain
health coverage as a result of the Affordable Care Act — a historic increase in
health care coverage.
In the months ahead, Covered California will be choosing health
plan offerings and begin testing the online enrollment portal. Grants will be
awarded to community organizations for public awareness efforts, and assisters
will be trained to understand Covered California enrollment offerings. In the
spring of 2013, Covered California will begin expanding the media campaign to
spread the word to millions of Californians about a new way to get affordable
health care — all leading up to pre-enrollment on October 1, 2013.[...]
