is a health insurance marketplace in the U.S. state of California established under the federal Patient Protection and Affordable Care Act (ACA). The exchange enables eligible individuals and small businesses to purchase private health insurance at federally subsidized rates. It is administered by an independent agency of the California government.
California was the first state in the United States to establish a health insurance market. The California State Health Benefits Exchange was established in September 2010 when then-Governor Arnold Schwarzenegger signed the Assembly Act 1602 (“California Patient Protection and Affordable Care Act” ), John Perez, Speaker of the General Assembly, and Senate Bill 900 (Bill 900) enacted by State Senator Elaine Alquist. Organizations such as the California Taxpayers Association and the California Chamber of Commerce and Anthem Blue Cross opposed the bill in whole or in part, but Schwarzenegger made Obamacare in California a priority.
The program was named “California Coverage” in October 2012. Efforts to educate potential registrants about Covered California began in 2013, including $37 million in grants to 48 organizations. Enrollment began on October 1, 2013; During the first month of operation, 35,364 people enrolled in a health plan offered by Covered California, exceeding the number of people enrolled through the Federal Exchange website ( HealthCare. gov ). As of November 2013, more than 360,000 people have completed their applications.
By the end of the first open recruitment period in April 2014, approximately 1.4 million people had been recruited in Covered California; in addition, an additional 1.1 million had signed up for Medicaid ( California Medicaid, conducted as part of the ACA). extension), extended through the Covered California web portal. During the second open recruitment period that began in November 2014, Covered California was aiming to recruit an additional 500,000 people. The California Medical Association and other professional organizations pledge to work with Covered California to promote enrollment. In addition, the U.S. Department of Homeland Security and immigrant rights groups seek to assure potential applicants that any personal information disclosed to Covered California will not be related to U.S. Immigration and Customs Enforcement.
By the end of the second regular open registration period in February 2015, there were 474,000 potential new registrants. Announced that a special admissions application would be held between February 2015 and April 2015 to reduce the tax penalty for the 600,000 Californians who were required to pay taxes in 2014 for being uninsured in 2014.
There are four different options. Each option will determine the amount the consumer will pay.
- Bronze: On average, the health plan pays 60% of covered medical expenses; consumers pay 40%.
- Silver: On average, the health plan pays 70% of covered medical costs; consumers pay 30%.
- Gold: On average, the health plan pays 80% of covered medical expenses; consumers pay 20%.
- Platinum: On average, the health plan pays 90% of covered medical expenses; consumers pay 10%.
- Minimum Coverage Plan (Worst Case): This is another option if the consumer is under 30 and cannot afford other plans. It covers three visits with no out-of-pocket costs and free preventive benefits. The service will be billed in full until the consumer spends $8,150. At that time, the medical plan will fully cover these services.
Essential Health Benefits
Because coverage of California is part of the Affordable Care Act, insurance companies must provide consumers with some basic health benefits. Here is a list of some services:
- Outpatient service
- Urgent/Urgent Care
- Hospital Nursing Services
- Maternal and Newborn Care
- Mental Health and Substance Abuse Services
- Rehabilitation Services
- Laboratory Services
- Preventive health care
- Pediatric Services
This is not required in a health plan. All health insurance plans that cover California offer pediatric dental care. Adults can opt for supplemental dental care in their plan.
This is not required in a health plan. Covered California provides vision care for children, but not for adults. However, Covered California will partner with certain companies to provide vision care directly to adults.
Governance, People and Budget
The Board of Directors covering the State of California consists of five members: the Secretary of the Board of Directors of the California Department of Health and Human Services or his or her designated voter, ex officio member; two members by the Governor; one by the Senate Rules Committee; and one by the Assembly Speaker. All board members serve four-year terms.
The current first and current permanent executive director is Peter V. Lee. The current Board of Directors includes CA HHS Secretary Dr. Mark Ghaly and Chairman Paul Fearer, Jerry Fleming, Dr. Sandra Hernandez, and Art Torres.
The staff had 1,230 mandated positions in 2014-15. Covered California receives no funding from state taxes; it has received $1.1 billion in federal funding as of January 2014 but needs to be self-sufficient by January 2015. Estimated personnel expenditure for the fiscal year 2014-15 is $108 million. Covered California is projected to have a multi-million dollar deficit in fiscal 2015.
The 2015-2016 fiscal year was the last year Covered California used federal agency funds. The government provided about $100 million in funding that year. After that year, Covered California gradually reduced spending to save money. In 2015, it proposed a budget of $332.9 million, leaving a reserve of $194 million. The actual budget adopted is approximately $335 million. For 2016, the proposed budget was $308 million, a decrease of $28 million from the previous year. The actual budget adopted is $320.9 million. For the fiscal year 2017-2018, the proposed budget is $313.9 million.
Covered California is unique in the ACA marketplace is actively leveraging its “active purchase” negotiating power to bargain, lower premiums, regulate benefit design, and demand improved quality and fairness. This contrasts with many other state exchanges that do not have the ability to “select contract”, which must offer all eligible products offered by insurance companies. Of particular note to consumers, standardized benefits reduce complexity and consumer confusion, allow consumers to make apples-to-apples comparisons, and encourage head-to-head price competition to lower premiums.