Denise Robinson, 62, lost health insurance when she left teaching because… (Michael Robinson Chavez…)
Nearly every day, worried Californians call a Pacoima hotline asking what lies ahead in healthcare reform: Do I have to get private insurance? Will I lose my Medi-Cal? How much will it cost? When does it start?
"There's mass confusion already," said Katie Murphy, managing attorney at Neighborhood Legal Services of Los Angeles County, which runs the call line.
With the presidential election over and the nation's healthcare overhaul moving forward, California officials have less than a year to clear up widespread uncertainty about future medical coverage options.
"We are in our countdown period," said Peter Lee, executive director of Covered California, the state's new health insurance marketplace that opens in October 2013.
Under the federal law, the state-run exchange aims to fundamentally reshape the health insurance market by negotiating with insurers for the best rates and assisting consumers in choosing a plan. The exchange must also help millions of Californians figure out whether they qualify for an expansion of Medicaid, the government insurance for the poor, or federally subsidized private coverage.
Federal officials have a lot riding on the California effort. How the state's insurance exchange fares will be an important test of President Obama's healthcare law at a time when many Republican-led states are resisting implementation. California leaders also hope they can harness the purchasing power of the exchange to improve patient care and make healthcare more affordable.
All of that, however, depends on getting enough people — healthy and unhealthy, uninsured and insured — to enroll. If that doesn't happen, the state could lose billions in federal dollars and insurance premiums could soar. The task is daunting, given the size and diversity of California's population, said Paul Fearer, an exchange board member. "It's critical to get it right," he said.
But the exchange faces a fundamental communication dilemma, said Samuel Chu, board president of OneLA, an organization of churches, synagogues and nonprofit organizations. "They are trying to pitch a program that is not ready to enroll people."
Watching focus groups of consumers recently in San Diego and Sacramento underscored some of the challenges, Lee said. Only about 20% of those people had even heard of the exchange.
The state expects to enroll about 2 million additional residents in Medi-Cal, the state's version of Medicaid, and sign up another 2 million for subsidized private insurance.
Medi-Cal would be offered to people earning less than 138% of the federal poverty level. For example, a family of four making less than $31,810 would be eligible. Separately, federal insurance subsidies will be available to privately insured families earning up to about $93,000. Enrollment will begin in October 2013.
One of those who may be eligible for the help is Denise Robinson, 62, a former teacher and breast cancer survivor who has diabetes and severe back pain. Robinson, of Panorama City, lost her Kaiser Permanente coverage two years ago when she left teaching after 17 years because of an injury. Now, she can't afford to buy a policy on her own, she said.
She thinks the insurance exchange might help, but she isn't sure how. "I don't really understand it," she said. "I need this program."
Ann Miller, a small-business owner in Diamond Bar who provides insurance to her 15 employees, said she needs the program too. She hopes the exchange can offer some relief from rising premiums. She said her rates from Anthem Blue Cross jumped 21% earlier this year, and she and her husband pay $2,900 a month just for their family coverage. "These rate increases are outrageous," Miller said.
Like individuals, small businesses will be able to shop for coverage via the exchange, but whether they'll be able to get a better deal remains unclear. Some experts warn that average premiums in the exchange could rise because the health reform law requires improved benefits. But consumers could pay less in out-of-pocket medical costs because of the new requirements.
Historically, statewide public insurance programs have started slow. But under the Obama administration's reform plan state officials don't have the luxury of much time.
California officials plan to spend nearly $90 million next year on marketing and raising public awareness about the exchange. The proposed campaign calls for conventional advertising and grass-roots efforts at churches, schools and cultural events.
About half of California's 7 million uninsured are Latinos, according to the exchange. To reach those who are eligible for coverage, the state may sponsor professional and recreational soccer leagues and court bloggers popular with Latino mothers. Officials also may hit up Hollywood to get TV shows such as "Modern Family" or "Grey's Anatomy" to weave the health insurance expansion into their scripts.