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California health insurance

The Golden State tops exchange enrollment, Medicaid signups

Do you wonder how you and your neighbors in California are doing healthwise? Looking for information on how political viewpoints have impacted the rollout of the Affordable Care Act in California?

If so, this brief summary will help you get a handle on the public health indicators and medical insurance coverage in The Golden State, a state that has embraced the ACA and whose lawmakers continue to push for increased access to healthcare.

California health ratings

America’s Health Rankings, compiled by the United Health Foundation, places California at 17th in its most recent rankings, which were completed in 2014. The state moved up four spots from 2013. A low rate of smoking and physical inactivity, as well as low infant mortality and low birthweight, ready availability of dentists and a low rate of preventable hospitalizations positively impacted the state’s ranking.

However, California faces health challenges that include high levels of air pollution, a moderate violent crime rate, a high percentage of uninsured and a large disparity in health status.

In a comparison of the 50 states and the District of Columbia, California is ranked 23rd by the Scorecard on State Health System Performance 2015. California ranked 29th in the 2009 analysis. The comparison is based on an overall health score, which rolls up health indicators in four categories, including health behaviors, clinical care, social and economic factors, and physical environment factors. See California’s Scorecard for the details.

The 2015 edition of Trust for America’s Health also evaluates a variety of public health indicators. Visit the site for Key Health Data About California.

Given California’s size and diversity, a statewide view might not provide the level of information you want. Get county-by-county health rankings for California, which were developed by the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.

California and the Affordable Care Act

The Affordable Care Act was signed into law in March 2010. California’s Congressional delegation voted along party lines. Both Democratic senators voted yes, as did 34 Democratic representatives. Nineteen Republican representatives voted “No.”

At the state level, legislators moved quickly to pass bills in support of a state-based marketplace – making California the first state to do so. Former Gov. Arnold Schwarzenegger, Republican, signed both the Assembly and Senate bills into law on September 30, 2010. Current Gov. Jerry Brown, a Democrat, called a special session in late 2012, enabling additional legislation to implement the ACA in California.

How has Obamacare helped California?

As noted above, California’s uninsured rate showed a significant decline following the 2014 ACA open enrollment period. A study by The Commonwealth Fund showed California’s uninsured rate dropping from 22 percent in July-September 2013 to 11 percent in April-June 2014. The Commonwealth Fund, along with a Gallup-Healthways poll and the Urban Institute’s Health Reform Monitoring Survey all show the national uninsured rate dropping to the 13-to-15 percent range.

California is among the 10 states with the biggest drop its uninsured rate since 2013. By mid-2015, the percentage of uninsured in California decreased 9.8 percentage points to 11.8 percent. However, the state’s percentage of uninsured is still higher than uninsured rate in other states that both expanded Medicaid and have a state-run exchange; the average uninsured rate for such states is 8.9 percent.

Californians’ enrollment in qualified health plans

Covered California reported that 1,414,668 individuals signed up for qualified health plans (QHPs) during the 2014 open enrollment period. Of that 1.4 million, about 1.1 million individuals paid their premiums and had their coverage take effect.

During the 2015 open enrollment period, 1,412,200 individuals selected QHPs through California’s health insurance exchange. By June, however, some had dropped coverage or failed to make their initial premium payments, and effectuated enrollment was 1,393,567. Of those remaining, 88.1 percent were in plans with advanced premium tax credits and 51.3 percent were receiving cost-sharing subsidies. Of any state, California’s exchange has the highest number of enrollees.

The 2016 open enrollment period brings forth a few changes to Covered California, including the hiring of 500 temporary call center workers and two new carriers. The 12 carriers that will offer 2016 coverage through California’s exchange include the following:

  • Anthem Blue Cross of California
  • Blue Shield of California
  • Chinese Community Health Plan
  • Health Net
  • Kaiser Permanente
  • A. Care Health Plan
  • Molina Healthcare
  • Oscar Health plan – new for 2016
  • Sharp Health Plan
  • United Healthcare – new for 2016
  • Valley Health Plan
  • Western Health Advantage

On average, the weighted average rate increase for Covered California plans in 2016 is 4 percent. When making the announcement, exchange officials told consumers that those who shopped around could potentially lower their premiums an average of 4.5 percent.

Covered California in May rolled out a cap on prescription costs that will be effective in 2016. This cap will be available to many consumers purchasing off-exchange plans as well.

Stand-alone dental coverage is also available through Covered California for 2016, and the five carriers offering plans include Access Dental Plan, Anthem Blue Cross, Delta Dental of California, Dental Health Services, and Premier Access.

California Medicaid/CHIP

California embraced Medicaid expansion in addition to implementing a state-run marketplace. Expanding Medicaid eligibility to include nearly all non-elderly adults with incomes at or below 138% of poverty is one of the ACA’s main strategies to reduce uninsured rates.

Between October 2013 and September 2014, California’s Medicaid enrollment increased by about 2.7 million people, or 31 percent. Total enrollment is about 11.3 million — about one-third of the state’s total population.

California Medicaid is called Medi-Cal and is the largest Medicaid program in the nation, covering 12.65 million people as of August 2015. Since 2013, Medi-Cal enrollment has increased 38 percent, the eleventh-highest enrollment change in the nation.

To learn more about California’s Medicaid program visit the California Department of Health Care Services. Note: California’s Children’s Health Insurance Program (CHIP) was previously known as Healthy Families. In 2013, California transitioned Health Families enrollees to Medi-Cal.

Does California have a high-risk pool?

Prior to the ACA’s reforms in the individual health insurance market, medical history was a factor in eligibility for private plans in nearly every state, including California.  Applicants with pre-existing conditions were often unable to buy individual plans in the private market, or if coverage was available it came with a higher premium or with exclusions on pre-existing conditions.

The California Major Risk Medical Insurance Board (MRMIB) was created in 1991 to provide a coverage option for people who were ineligible for coverage under a private plan because of medical history.

Under the ACA, all new health insurance policies became guaranteed issue starting on January 1, 2014. This change largely eliminated the need for high-risk pools, since pre-existing conditions are no longer a barrier to obtaining coverage.

The California Budget Act of 2014 included a provision for MRMIB to cease operations as of July 1, 2014. Most of the MRMIB insureds had already been able to obtain coverage through the exchange or expanded Medicaid, but remaining members were transitioned to the California Department of Health Care Services on July 1.

Medicare in the state of California

In 2015, California Medicare enrollment reached 5.6 million, about 14 percent of the state’s population. For comparison, 17 percent of the U.S. population is enrolled in Medicare. Eighty-five percent of California Medicare recipients qualify based on their age alone, while 15 percent are on Medicare as the result of a disability.

Medicare spends about $10,954 per enrollee each year in California, which is among the roughly 20 states where Medicare spends $10,000 or more per recipient. At $50.6 billion per year, the state ranks No. 1 in terms of overall Medicare spending.

Medicare Advantage plans offer additional benefits to Medicare-eligible individuals who want them. Medicare beneficiaries may select a Medicare Advantage instead of Original Medicare, and 42 percent of California’s Medicare beneficiaries make this selection. Nationwide, 32 percent of Medicare recipients are enrolled in Medicare Advantage plans.

About 37 percent of California Medicare beneficiaries are enrolled in Medicare Part D plans for stand-alone prescription drug coverage, compared with 43 percent nationwide.

Health reform legislation in California

Here’s a summary of legislative action regarding healthcare reform at the state level in California:

  • SB4 – The California Senate passed SB4 in early June 2015, the Assembly in September, and on October 9, 2015, Gov. Brown signed it into law. The legislation, renamed the Health for All Kids Act, focuses on Medi-Cal access for undocumented immigrant children under the age of 19. SBF will take effect in May 2016, and it has been estimated that 170,000 undocumented immigrant children will then become eligible for Medi-Cal based on their household income alone.
  • SB10 – This bill was introduced in 2015 and will be addressed in the 2016 legislative session. It would allow adults age 19 and older to enroll in Medi-Cal, regardless of immigration status, and would also allow those with incomes above the Medi-Cal threshold to purchase subsidized health plans through Covered California as long as HHS grants a waiver that allows them to do so.
  • AB1102 – Initially, the legislation was written to make pregnancy a qualifying event that would allow pregnant women a special enrollment period. The California Assembly passed AB1102 in June 2015 and was significantly revised in July. This bill, which is now inactive with the Senate, says that applicants that are rejected for coverage shall be directed to the California Major Risk Medical Insurance Program and/or Covered California for further assistance. MRMIP, Medi-Cal, and the Medi-Cal Access Program, which had its enrollment integrated into Covered California in October 2015, all have year-round enrollment for eligible applicants, including options for uninsured women who have become pregnant outside of open enrollment.
  • AB339 – Signed into law in October 2015, this bill applies to all non-grandfathered individual and small group plans in California. It limits the copayment for a 30-day supply of any medication to no more than $250. It takes effect January 1, 2017, and will last until January 1, 2020. For high-deductible health plans, the copay limit will apply after the deductible has been met.

Other California state-level health reform legislation includes: