Covered CA struggles through second enrollment

Covered California’s huge enrollment numbers boosted the national health care program, the Affordable Care Act, or Obamacare, during its first year. But the Covered CA health care exchange, the center of the system, has been sneezing through its crucial second open-enrollment period, which began on Nov. 15 and will end Feb. 15, 2015.

In a sign of how much of everyday life has been touched by the Affordable Care Act, a broad series of strains and stresses has emerged around Covered CA in recent months. To remain politically and financially sound, the exchange has grown increasingly concerned about posting robust enrollment and re-enrollment numbers.

And in sizing up its fortunes, attention has centered around everyone from immigrants to insurance agents, with some agents stiffed on payments. With dissatisfaction high among Californian customers — thanks in part to costs that can be hard to afford even with current subsidies in place — signup-boosting campaigns initiated by the exchange and its allies are poised to gear up.

Immigration hurdles

Sensing an opportunity for big new enrollments, exchange executives have begun to navigate the complex world of immigrants eligible for Covered CA. That landscape was remade overnight when President Obama announced his suite of executive decisions around the enforcement of immigration law. (Only 11 percent of Hispanics previously signed up for private policies through Obamacare.)

But concern and confusion have been widespread among immigrant families — some of which include members who are lawfully present and some who are not. As the Sacramento Business Journal reported, anyone who is an American citizen, or who is lawfully present in California, “is eligible for health insurance through Covered California,” regardless of whether “family members in their household reside here illegally. And some noncitizens or undocumented residents who are not eligible for Covered California may be eligible for limited coverage through Medi-Cal.”

In a statement, Covered CA executive director Peter Lee emphasized that applicants’ information “will not be shared with or used by any immigration agency to enforce immigration laws” — even if unlawfully present parents apply for their lawfully present children.

Polling badly

The public relations campaign for the state exchange has forged ahead despite stubborn problems at the polls, not only for Obamacare but for Covered CA itself. New polling by the Public Policy Institute of California revealed deep skepticism.

Respondents who said the exchange works well dropped 2 percentage points from May, while 39 percent said “it’s not working too well or not at all,” according to the Los Angeles Times. Meanwhile, 43 percent expressed an unfavorable view of the Affordable Care Act.

Given those numbers — with the challenges of open enrollment far from over — Covered CA’s targeting of immigrants has reflected its added incentive to grow enrollment among those whose opinion of the exchange has not yet soured.

High stakes

Covered CA executives have admitted the stakes are high. On the one hand, the exchange’s success — relative to failed exchanges in Oregon and other states, and exchanges contributing relatively small enrollment numbers — has made Covered CA more of a linchpin than a mere poster child for Obamacare implementation.

Toby Douglas, director of the Department of Health Care Services, has touted California’s biggest-in-the-nation decrease in the percentage of uninsured, as CalWatchdog previously reported. And in a reminder of the centrality of expanded Medicaid coverage to the Affordable Care Act, Douglas emphasized the significance of Medi-Cal signups.

On the other hand, California has struggled ineffectually to overcome a massive Medi-Cal backlog. In the ordeal’s latest episode, tens of thousands of terminations of coverage — a consequence of the new requirement under Obamacare that Medi-Cal recipients renew coverage — have become the focal point of litigation brought by health care activists.