Obamacare takes turn for the worse in CA

As the Affordable Care Act and the Covered California health exchange enter their second year, Californians have begun to encounter fresh challenges and disappointments — a development that has pushed enrollment numbers below official targets. This year, signups are trailing last year’s numbers by some 200,000.

Although the slump in signups is not enough to derail Obamacare or California’s exchange, the figures have sparked concern — and confusion. “Covered California has 1.2 million people who renewed from 2014 or newly enrolled since mid-November,” the Los Angeles Times notes. “The state wants to hit 1.7 million by Feb. 15.”

One reason last year’s total makes for such a high hurdle relative to this year is because, out of those sign-ups, only 1.14 million, or 81 percent, ever submitted a payment. Still, Covered California set a goal of 1.7 million paid enrollees this year and it doesn’t appear it will reach that target, even if a last-minute surge materializes.

The explanation for why Covered California’s projections were apparently so wide of the mark will take time to emerge. As Investors Business Daily reports, about 85,000 paid enrollees from last year switched to Medi-Cal, bringing down the numbers a bit. Meanwhile, because California “hasn’t released information about the age of people signing up, it’s not clear if the shortfall is across the board or concentrated among young adults, which would be a negative for the exchange’s future.”

That’s because most young people need health care less often than older people, helping to reduce average costs.

Targeting Latinos

The Latino experience with Covered California also seems to be falling short of expectations. Overall, the Obama administration is on track to meet its overall goals for nationwide enrollment this year, which hinge on increasing the number of signups among America’s many uninsured Latinos.

But the picture in California reveals a stubborn set of challenges. As FiveThirtyEight observes, the most recent reported data show that, in the Golden State:

“50 percent of people determined eligible to purchase a plan were Latino. But among people who took the next step and actually chose a plan, the Latino percentage remained steady at 28.

“Last year saw a 30 percent increase in Latino enrollment during the final month of the enrollment period. If that trend holds this year, California could be on track to reduce the disproportionate share of its uninsured who are Latino. But with the undocumented representing 13 percent of the state’s uninsured, it could take new legislation, in the form of a new insurance stream for the undocumented or an act of Congress, to get the numbers where officials want them.”

Limited options

Latinos aren’t the only Californians whose participation in the health insurance exchange is critical. But across the state, limited plan choice is putting a damper on residents’ enthusiasm. As the Times reports that, taken together, “[T]he exchange’s four biggest health plans control 94.5 percent of the Obamacare market in California.”

And as The Daily Signal observes, in 22 Northern California counties, “[T]here are zip codes where there is only one choice of insurer,” with only one carrier available in the Monterey and Santa Cruz areas as well.

Blue Shield of California told The Daily Signal “it had to stop selling individual plans in areas where it didn’t have a contracted hospital nearby.” Blue Shield said “it offered doctors certain rates to keep the premiums low, but not enough doctors accepted those payment rates.”

According to The Daily Signal, Covered California believes 28,896 customers are stuck with one insurance carrier — “slightly more than 2 percent of the total exchange membership as of November 2014.”

Cost struggles

Perhaps the most prominent deficiency in California’s Obamacare coverage, however, has to do with the most expensive patients to cover. For patients with severe disabilities and chronic illnesses, Obamacare seemed to offer a reliable, guaranteed way to manage the costs of their treatment.

For officials, the new health care program promised something similar — a more truly affordable approach to those often sky-high costs. In California, however, the reality has been much different, as the Times confirms:

“The Obamacare program was designed to reduce medical costs by putting more of the nation’s 11 million most challenging and expensive patients into tightly managed care. 

“But the rollout in California — one of the first states spearheading the effort — has been marred by widespread confusion, enrollment glitches and a revolving door of health officials. Sixty percent of eligible patients have rejected the program, and state leaders are demanding to see financial savings in a year.”

All told, Covered California’s fortunes are still up in the air. Officials hoping to master the implementation of Obamacare through a smooth, robust California exchange will have to wait until next year, or longer.