BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                            



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                                    THIRD READING


          Bill No:  SB 972
          Author:   Torres (D)
          Amended:  5/6/14
          Vote:     21

           
           SENATE HEALTH COMMITTEE  :  6-1, 4/30/14
          AYES:  Hernandez, De León, DeSaulnier, Evans, Monning, Wolk
          NOES:  Morrell
          NO VOTE RECORDED:  Beall, Nielsen


           SUBJECT  :    California Health Benefit Exchange:  board:   
          membership

           SOURCE  :     Author


           DIGEST  :    This bill expands the criteria for serving on the  
          California Health Benefit Exchange (Covered California) Board by  
          adding marketing of health insurance products, information  
          technology system management, management information systems,  
          and enrollment counseling assistance with priority to cultural  
          and linguistic competency, to the list of areas of expertise  
          that are acceptable for appointment.

           ANALYSIS  :    
            
          Existing law:

          1. Establishes Covered California an independent public entity  
             not affiliated with an agency or department.

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          2. Requires Covered California to be governed by an executive  
             board, consisting of five members who are residents of  
             California.  Of the members of the Board, two are appointed  
             by the Governor, one appointed by the Senate Committee on  
             Rules, and one appointed by the Speaker of the Assembly.  The  
             Secretary of the California Health and Human Services or  
             his/her designee serves as a voting, ex officio member.

          3. Requires Covered California Board members, other than the ex  
             officio member, to be appointed for a term of four years,  
             except for the initial appointments of the Speaker and Rules  
             Committee which are two and five years, respectively.   
             Requires appointments made after January 2, 2011, by the  
             Governor to be subject to confirmation by the Senate.

          4. Requires each person appointed to the Covered California  
             Board to have demonstrated and acknowledged expertise in at  
             least two of the following areas:

             A.    Individual health care coverage;

             B.    Small employer health care coverage;

             C.    Health benefits plan administration;

             D.    Health care finance;

             E.    Administering a public or private health care delivery  
                system; and

             F.    Purchasing health plan coverage.

          5. Requires appointing authorities to consider the expertise of  
             other members of the Covered California Board and attempt to  
             make appointments so that the Board's composition reflects a  
             diversity of expertise.

          6. Requires appointing authorities to take into consideration  
             the cultural, ethnic, and geographical diversity of the state  
             so that the Covered California Board's composition reflects  
             the communities of California.

          7. Prohibits Covered California Board members or staff from  
             being employed by, a consultant to, a member of the Board of  

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             Directors of, affiliated with, or otherwise a representative  
             of, a carrier or other insurer, an agent or broker, a health  
             care provider, or a health care facility or health clinic  
             while serving on the Board or on the staff of Covered  
             California.  Prohibits a member of the Board or of the staff  
             of Covered California from being a member, a Board member, or  
             an employee of a trade association of carriers, health  
             facilities, health clinics, or health care providers while  
             serving on the Board or on the staff of Covered California.   
             Prohibits a member of the Covered California Board or of the  
             staff of Covered California from being a health care provider  
             unless he/she receives no compensation for rendering services  
             as a health care provider and does not have an ownership  
             interest in a professional health care practice.

          This bill adds four news areas of expertise to the list of  
          required demonstrated and acknowledged expertise for Board  
          members:

          1. Marketing of health insurance products;

          2. Information technology system management;

          3. Management information systems; and

          4. Enrollment counseling assistance, with priority to cultural  
             and linguistic competency.

           Background
           
           CHCF Report  .  An April 2014 report published by the California  
          HealthCare Foundation on Consumers' and Enrollment Counselors'  
          Experiences with Covered California provides an analysis of  
          early consumer enrollment experiences associated with the more  
          than two million Californians who have signed up for health  
          insurance or applied for Medi-Cal through Covered California.   
          Researchers conducted interviews and focus groups during a few  
          weeks in February 2014 with a diverse group of users, including  
          participants applying online, by telephone, or in person.  The  
          goal of the research is to identify areas for improvement in the  
          application process.

          Among the key findings were that many consumers were unaware  
          that in-person enrollment assistance was available, some  

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          enrollees were surprised by how much documentation was needed  
          and found it to be difficult. The burden delayed successful  
          completion of the process for many people, especially Medi-Cal  
          applicants, and Covered California's online chat feature did not  
          work for anyone surveyed.  Specific to the Latino population  
          were concerns about immigration problems and losing their home  
          to Medi-Cal.  According to the report, the detailed questions  
          about family members, even those not applying for coverage,  
          unsettled some Latino consumers and made them worry they could  
          face problems with immigration.  Also, some Latino consumers had  
          heard Medi-Cal could take their home if they enrolled in the  
          program.  Many Vietnamese and Mandarin speaking consumers could  
          not enroll online in their primary language, which was  
          frustrating because some preferred to enroll online.  They had  
          to rely on an English proficient family member or apply in  
          person with a Certified Enrollment Counselor (CECs) or agent who  
          could speak their primary language.  Additionally, CECs did not  
          feel well trained and said they had limited ability to help  
          Medi-Cal applicants.  A new dedicated call center line for CECs  
          was helping, but many felt on their own to figure out complex  
          enrollment problems.  Many also had limited experience with  
          Medi-Cal and felt they could do little to help clients.  Since  
          the research was conducted in February, Covered California hired  
          350 additional service center employees, increased bilingual  
          Spanish speaking staff, increased online chat resources,  
          including Spanish chat, and is expanding telephone line  
          capacity, posting qualified health plan applications in Spanish,  
          Chinese, Vietnamese, and Korean on the Web site, adding consumer  
          information including searchable Frequently Asked Questions,  
          requiring agents and CECs to complete annual recertification  
          training, and creating a dedicated help line for Certified  
          Insurance Agents.
           
          Board diversity  .  The author's office has submitted an article  
          written by California State Controller John Chiang published in  
          the Corporate Governance Advisor March/April of 2010 called  
          Strength in Diversity:  The Changing Boardroom.  In the article,  
          which focuses on corporate diversity for investment strategies,  
          the Controller writes that he asked the CalPERS Board to  
          commission a study on board diversity in an effort to find  
          empirical evidence that different combinations of talent can  
          lead to increased shareowner value.  According to the article,  
          the report indicates that companies without ethnic minorities  
          and women on their boards eventually may be at a competitive  

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          disadvantage and have under-performing share value.

           Prior legislation
           
          SB 900 (Alquist, Chapter 659, Statutes of 2010), and AB 1602  
          (Perez, Chapter 655, Statutes of 2010), established Covered  
          California.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  No   Local:  
           No

           SUPPORT  :   (Verified  5/9/14)

          California Primary Care Association
          Latino Coalition for a Healthy California


           ARGUMENTS IN SUPPORT  :    The California Primary Care Association  
          writes in support that California implemented perhaps the most  
          successful Affordable Care Act outreach and enrollment program  
          in the nation, however, Covered California's activities were not  
          without fault.  Early efforts to enroll the large uninsured  
          Latino population into Medi-Cal or Covered California were  
          largely ineffective because of shortcomings in marketing,  
          enrollment assistance, and numerous other oversights related to  
          cultural and linguistic competence.  The Latino Coalition for a  
          Healthy California writes that this bill is a step in the right  
          direction and will help improve the customer service and  
          enrollment experience.


          JL:d  5/12/14   Senate Floor Analyses 

                           SUPPORT/OPPOSITION:  SEE ABOVE

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