“Covered California” is California’s exchange for health care — part of implementation of the Affordable Care Act (ACA).
The ACA, passed in 2010, was a monumental victory in our century-long struggle to build a comprehensive, fair, and efficient health care system in the United States. And on October first, the long-awaited process of offering coverage to the uninsured began at last. Millions of people responded, providing dramatic evidence of both the need and the public support for this new law.
However, as is all too clear, the struggle is far from over. Not only is the ACA itself only a first step, it has served to catalyze increasingly vitriolic and rigid opposition, culminating in the recent shutdown of the federal government and the threat of government default by those seeking to prevent the United States from ensuring health care as a right rather than a commodity.
Less visibly, the opposition has also succeeded in undermining the implementation of the ACA. Twenty-four states have refused to expand Medicaid, leaving over 5 million poor childless adults without coverage—assuming they would be covered by Medicaid, the ACA does not offer them subsidies in the new exchanges. Twenty-seven states have refused to establish exchanges, and seven have opted for “partnership” exchanges, requiring the federal government to establish and manage 34 state exchanges and without the necessary resources—thanks to Congressional refusal to appropriate funds—to assume this completely unexpected responsibility. The resulting “glitches” in the opening of the new exchanges are hardly surprising.
California, on the other hand, has benefited from highly progressive leadership: our exchange—Covered California—has been authorized to bargain for the best price and quality in selecting plans for the exchange, and to uses its market power—in collaboration with other public plans and private payers as well—to drive more fundamental payment and delivery changes in our system. In its first two weeks, Covered California had almost 1.6 million unique visits to its website and over 100,000 calls, and started almost 100,000 applications.
California’s success is absolutely essential to the larger struggle for reform. We absolutely must show that “government” is capable of producing desperately needed services and doing so not simply more equitably but more efficiently than the private market.
The central need, as Alex Briscoe pointed out, is to ensure maximum enrollment in both Covered California and in Medi-Cal. There are 5.6 million uninsured people eligible for coverage in Covered California—2.6 million of whom are eligible for subsidies. There are 1.4 million newly eligible for Medi-Cal, and 2.5 million already eligible but not enrolled. Help is urgently needed to tell people about the new opportunities for coverage and how to apply.
Deborah LeVeen, PhD
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