After 10 years in the ACA hot seat, Covered California boss Peter Lee looks back and ahead.
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Covered California, however, went further, Lee told me. It established itself as an “active” exchange that setfor participating insurers to meet, in many cases more stringent than the ACA’s rules. ACA plans in California had to be standardized more stringently than the ACA required. California insurers must disclose every year the steps they’ve taken to reduce health disparities among ethnic, racial and income groups, to rein in high provider and drug prices and to meet other quality goals.Insurers may have balked at first, but they also came to understand that on California’s level playing field and given the state’s efforts to attract the largest coverage pool, they had a better chance to secure profits than in many other states.
After Jerry Brown took over as governor in 2011, the state expanded Medi-Cal, its Medicaid program, to take advantage of the ACA’s 100% federal subsidy for the expansion. California also established its own individual coverage marketplace instead of leaving the task of enrollment and marketing to the federal government, as 35 states did.Democrats slipped massive Obamacare improvements into the new pandemic rescue bill.
Those plans were cheaper than ACA-compliant plans but only superficially. They’re allowed to turn away applicants with preexisting medical conditions and to offer only limited benefits. Enrollees diagnosed with costly conditions or serious injuries often discover the coverage gaps too late.The Trump years were nerve-racking for Lee and Covered California. If Republicans had managed to repeal the ACA, as Trump and the GOP establishment aimed to do, “We had no Plan B,” Lee says.
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