Dive Brief:
- While Obamacare continues to take a beating amid the average 25% premium increases among benchmark ACA plans nationwide and critics arguing the marketplaces are unsustainable, Covered California's executive director is arguing his state proves success is possible.
- In a new Health Affairs blog, Peter Lee, Covered California executive director, lays out what policies he credits for the state's overall marketplace success, while conceding there have been bumps along the way.
- He argues that the lessons learned from California, as well as some other states and successful health plans, should help shape any upcoming efforts to refine the Affordable Care Act.
Dive Insight:
California has long served as an example, with other state and federal officials looking to it for indications on how to hold back premiums and otherwise improve consumers' value and experience.
Though the state has weathered challenges, they haven't exactly been like any other, and its successes are significant. These include cutting the state's uninsured rate in half from 2013 to 2015, having the healthiest risk pool, having ACA health plans that generally met or exceeded profit targets, having relatively low average rate increases, and financial stability without state or federal support.
Lee credits three main factors, with the first being its embrace of Medicaid expansion and the second being its decision to serve as an active purchaser that works directly with the plans it selects to help them "price right." The third major factor was its move to convert all individual market health coverage into compliant plans with a single risk pool.
In a nutshell, the state used all the tools at its disposal rather than working to undercut the ACA like many states where it has been less successful, Lee said.
The federal government has already shown its willingness to take a cue from California via its new “Simple Choice” plan designs that aim to highlight value and simplify plan comparisons, Lee noted, suggesting the state is indeed already a model for federal adaptation.