On Tuesday, California launched its version of Obamacare, with the official debut of the state’s insurance exchange Covered California.
Despite the shutdown of the federal government, the exchange is moving ahead, according to California Health and Human Services Secretary Diana Dooley, who spoke to Valley Public Radio Tuesday morning, prior to a launch event at Fresno State.
Dooley, who is a Hanford native, and was for many years an administrator at Children's Hospital Central California in Madera County, is also the Chair of the Covered California Board of Directors. She praised the state's effort as "a commitment to a culture of coverage," while saying much work still needs to be done.
Here's some highlights from our interview:
We asked Dooley how the federal budget standoff will effect the start of enrollment for Covered California:
"The funding for this is secure and the money is in the bank. We're ready to roll and we're funded through all of 2014. After that it will be funded through the premiums paid into the program. So from a practical effect, it [the government shutdown] is of no consequence."
Dooley says her staff has been working tirelessly to launch the exchange, but the work is not yet complete:
"Just as we thought as we couldn't move any faster, we moved into warp speed. This has been, while I say that for enrollment and changing the health care system is a marathon and not a sprint, it's certainly been a sprint for the last three and a half years."
Asked about some of the confusion surrounding the law, Dooley says that all health care related decisions are complex:
"Health care coverage generally is complex. Each of us that are lucky enough to have employer sponsored insurance knows that every year at open enrollment we sometimes need help from our human resources staff to go through the form and see what's available. That kind of support will also be provided to uninsured and to people who are purchasing on the exchange.
We asked Dooley what the biggest unknown will be as the sweeping changes to health care system begin to take place. While many have raised concerns about the mix of people who may sign up - worried that too many sick people, and not enough young, health people - may throw the Obamacare equation out-of-whack. Dooley downplayed those concerns, citing the rates from insurers that were lower than some expected:
"I think the mix of people who will join is one of the reason that people that worried that the insurance rates would be high. The insurance rates that we got from the plans when we negotiated, were well below that which was predicted, in part because there's a high level of confidence among the insurers, that the outreach is going to be effective and that people will want to be insured when they have the opportunity."
We asked Dooley to describe some of the essential features of the exchange, and what the plans offer:
The marketplace itself is very user-friendly. It's the first time people will be able to comparison shop and actually see what they're going to get. There are no hidden rules or gotchas. Everyone will see what their premium is, what they'll have to pay when they go to the doctor what their maximums are and that will be uniform across the plans, whether you're going to Kaiser or Blue Shield or Blue Cross or HealthNet.
One of the main differences and there are many is that there is an essential set of benefits. All of the plans will offer the same 10 basic benefits that include doctors visits, hospitalizations, and pharmacy, mental health and substance abuse disorders, all of that is in the basic set of benefits, and they will be tiered from bronze to silver to gold and platinum depending on how much you pay and how much the insurance pays. So you'll look at it and you'll see how much you'll need to use health care and how much you want to pay, if you want to pay a low premium, you might pay a higher deductible. If you have higher needs, you might want to have less out of pocket, so you'll pay more each month. All of that will be displayed in a way that you can shop and compare. You will also be able to see which doctors and hospitals are in the network of your plan, so if you choose one particular plan, you'll know which doctors and hospitals are available to get your care.
Throughout the 2008 presidential campaign and the 2009 debate over the health law, President Obama claimed, "If you like your health care plan, you can keep your health care plan." But that's not entirely correct, at least not for all people. Some individuals who have had privately purchased, high-deductible PPO health insurance plans have started to receive letters from their insurers notifying them that they will no longer have coverage after December 31. This is because their old plans don't comply with the requirements of the Affordable Care Act. We asked Dooley about these cases:
"There were several products in the marketplace that provided very little coverage, and many of these plans are what resulted in the medical bankruptcies, where people were paying a very small premium, and then they got sick or they had an injury, and they has a hospitalization and they end up with $30,000, $40,000, $50,000 in bills that they didn't think they had. And that is one of the things the Affordable Care Act addressed. They have 10 essential benefits, and every plan has to cover basic hospitalization, basic pharmacy, basic medical care that you would expect. So many people lived under the myth that they actually had coverage, but they do not. That won't be allowed and that's under the federal law, that if you buy a health plan, you are going to get coverage if you are sick or injured. So some of the companies that were selling very, very low priced but low benefit plans, can't offer those plans any longer. Some of them have left the marketplace and they won't be offering individual coverage. So we have plenty of very good, reputable, excellent providers that are available through the exchange and people will get what they pay for."
We also asked Dooley about the changing health care delivery landscape. In addition to helping to drive hospital consolidation, some physicians have claimed that the new law, by emphasizing so-called "bundled payments" to providers versus fee-for-service reimbursement, will result in fewer private practice physicians, and more physicians working for large hospital groups, or Accountable Care Organizations. Others, like Dr. John Henning Schumann, in a piece for NPR, say that the notion of having a relationship with a single doctor will become increasingly rare. Dooley says that this change is happening, but it isn't being driven by the law. Instead she says it's generational:
"I think that there is a confusion about the cause and effect. One thing doesn't cause the other. Much of the change in the delivery system is because medicine is changing itself. And there are significant difference between the way that younger doctors and the way older doctors have historically practiced. Almost no young doctors go out into a practice by themselves. They appreciate collegial involvement, they want to be a part of a group, they work in large organizations of medical groups, independent practice associations they're called, and there are many doctors working together. And there are many good things about the kind of collaboration that results from that. But the "Marcus Welby" visit at your home type of doctor does seem to be an issue of age and younger doctors are not choosing those kinds of practices, so they are driving that change that the Affordable Care Act accommodates. There is much better coordination of care and many private physicians provide excellent care and they always have and many people want to continue to have that type of care, and they will be able to. But there is a significant change going on that the Affordable Care Act recognizes rather than necessarily causes."
We also asked Dooley to look ahead several years, and talk about what a successful implementation of the Affordable Care Act will look like:
The Affordable Care Act, I call [it] a three legged stool. The first and the most important and the one we're talking about today is the coverage expansion. And if we can significantly reduce the number of people who don't have the security that comes from knowing that you are not just one injury or illness away from bankruptcy, that will be a huge advantage. But the other two parts of the act are also important and we are deploying in every way possible the tools that [the act] creates to both change the delivery system and the way we pay for care so that we are incentivizing wellness, and not just paying for treatment. Moving away from a fee for service basis, so that care is coordinated and you are treated early in an illness and your chronic conditions are managed in a way that are both higher quality and lower cost. And the third part of the ACA promotes individual responsibility and wellness and fitness, and we're seeing a major revolution throughout the private sector, businesses and local groups are sponsoring activities to better understand hypertension and obesity, exercise and nutrition... So there are many things about the Affordable Care Act that go well beyond the coverage expansion.