On several fronts, California Democrats have used the tail end of this political season to push for advances on their health care agenda — with mixed results. 

In Sacramento, they succeeded in passing legislation targeting health care cost sticker-shock after several recent misfires. “The unexpected charges come when patients are treated by an out-of-network provider at an in-network facility,” NPR explained. “After several failed attempts in recent years, the California legislature last week passed Assembly Bill 72, which aims to protect patients’ pocketbooks when they’re hit by these surprise bills. Gov. Jerry Brown has until the end of September to sign or veto the legislation. He is expected to sign it into law.”

“A 2015 Consumers Union survey suggests the surprise bill phenomenon is fairly common,” the station added. “It found nearly 1 in 4 Californians who’d had hospital visits or surgery in the prior two years reported receiving an unexpected bill from an out-of-network provider.”

Waiver wanted

In Washington, D.C., meanwhile, a who’s who of members of Congress hailing from California tried to flex their muscle around California’s unlikely request that the federal government allow unlawful and undocumented immigrants in state to access health benefits under Obamacare. “In a letter announced Wednesday, 37 members of California’s congressional delegation asked Treasury Secretary Jack Lew and Health and Human Services Secretary Sylvia Burwell to accept California’s request for a waiver that would allow the state to offer health care to an estimated 50,000 undocumented immigrants,” TPM reported. 

“The letter is just the latest in the fight to expand health care coverage to California’s undocumented population. In June, California Gov. Jerry Brown signed a bill passed by the state’s Legislature that allowed California’s undocumented population to buy their own health insurance on the state’s exchange, Covered California. However, a special federal waiver — a 1332 waiver — is needed before the state is allowed to enact its law.”

It hasn’t been clear whether President Obama could be moved to take action before the end of his term in office. He has already wound up under immense personal pressure to convince insurers to remain committed to the Affordable Care Act’s health care exchanges, despite a growing sense in industry that doing so will be harmful.

Unaffordable care

“With no lifeline coming from the divided Congress, Obama and his administration are redoubling their pleas for insurers to shore up the federal health care law and pushing uninsured Americans — especially younger ones — to sign up for coverage,” Politico observed. “The administration is nervously preparing for its final Obamacare open-enrollment season just a week before Election Day, amid a cascade of headlines about rising premiums, fleeing insurers and narrowing insurance options.”

“But six years after passage of Obama’s signature domestic achievement, the litany of woes afflicting the Obamacare marketplaces is formidable. Enrollment has plateaued at half of what was projected. Three major insurers have largely quit, citing big losses. Double-digit rate hikes are the norm for plans across the country. And roughly one in five Americans may find just one insurer selling plans in their area when they shop for 2017 coverage.”

At the same time, although California’s exchange program has been one of the biggest relative success stories for the ACA, the state’s health cost burden has continued to rise over time. A new study released by the University of California Los Angeles Center for Health Policy Research revealed that “spending is projected to total more than $367.5 billion in 2016, with about 71 percent covered by public funds when additional resources such as the Affordable Care Act subsidies and county spending are included,” according to U-T San Diego.

Indeed, California Democrats pushing the White House used the problem as ammunition for their own waiver goal, arguing before the press “that denying undocumented immigrants health care was only driving up the long-term costs of health care,” as TPM recalled. “Without insurance coverage, many immigrants have been forced to depend on emergency services to be treated.”

Expanding the exchange

Officials have set their sights on increasing enrollment by upping the public profile of the state exchange, which has struggled in years past to fully connect with potential customers. “There are 750,000 California residents without insurance that are eligible for Covered California,” according to CBS San Diego, with an estimated 2.2 million uninsured Californians eligible for subsidized coverage through either Covered California or Medi-Cal. According to the Los Angeles Times, the total population of uninsured Californians sat at around 4 million. “Of those, officials estimate that 1.4 million would qualify for Medi-Cal, the state’s Medicaid program for low-income residents.”

This time around, added the Times, an informal goal has been set to sign up 295,000 to 450,000 more residents over the three month enrollment period. “We want to make sure all uninsured Californians know that financial help is available to help people buy health insurance and that they can join thousands of Covered California consumers who are getting the care they need when they need it,” said exchange chief Peter Lee, as CBS San Diego noted.

Hoping to avoid service problems that plagued the exchange in previous enrollment periods, Covered California has also moved to staff up its telephone operators. “The scramble is on for up to 500 temporary call-center workers to answer questions and help enroll consumers,” the Sacramento Business Journal reported. “Virginia-based Faneuil Inc., in partnership with InSync Consulting Services in Roseville, won a $12 million contract for the business early this month.” Last year, however, the size of that contract hit $14 million.

Keeping subsidies central

Subsidized care has emerged as a centerpiece of Covered California’s effort to get and keep new enrollees. Officials believe that widespread public ignorance around subsidies has limited signups. “One of the biggest hurdles,” Lee told the Sacramento Bee, “is that more than a third – 36 percent – of uninsured Californians don’t realize they’re eligible for financial subsidies, according to a recent survey. That compared with 84 percent of uninsured who were aware of the existing federal tax penalty for going without health care coverage.”

But the vast majority of plans have already benefitted from subsidies. “Covered California has 1.3 million consumers, about 90 percent of whom receive subsidies to help cover their premiums,” the Times noted.