BILL ANALYSIS Ó
SB 972
Page 1
Date of Hearing: June 10, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
SB 972 (Torres) - As Amended: May 6, 2014
SENATE VOTE : 33-0
SUBJECT : California Health Benefit Exchange: board: membership.
SUMMARY : Adds new areas of expertise that qualify a potential
member to serve on the California Health Benefit Exchange
(Exchange, also known as Covered California) Board. These areas
of expertise include: 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.
EXISTING LAW :
1)Requires, under the federal Patient Protection and Affordable
Care Act (ACA), each state, by January 1, 2014, to establish a
health benefit exchange that makes qualified health plans
(QHPs) available to qualified individuals and qualified
employers, or, if a state chooses not to establish an
exchange, requires the federal government to establish one for
the state. Federal law establishes requirements for an
exchange, for health plans participating in an exchange, and
who is eligible to receive coverage in the exchange.
2)Establishes in state government the Exchange as an independent
public entity not affiliated with an agency or department.
3)Requires the Exchange 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 by the Senate Committee on Rules, and one by the
Speaker of the Assembly. Requires the Secretary of the
California Health and Human Services Agency or his or her
designee to serve as a voting member.
4)Requires each person appointed to the Covered California Board
to have demonstrated and acknowledged expertise in at least
two of the following areas:
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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 Board's composition reflects the communities of
California.
7)Contains broad prohibitions on Board members having any
affiliation with health plans and insurers, agents and
brokers, health care providers, health facilities, and health
industry trade associations.
FISCAL EFFECT : None
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, as Covered
California works to improve its customer service, website,
marketing, and outreach to consumers, additional expertise on
the Board will be helpful. The author indicates that Covered
California is working on several problems, including: a) long
wait time for callers into the hotline; b) frequently
abandoned calls to the hotline; c) confusing presentation of
materials to consumers on the website; and d) underrepresented
Latino enrollment. The author writes that the purpose of this
bill is to help diversify the expertise of the Exchange Board
so that as improvements are worked on, individuals with
expertise in these areas will be eligible to serve on the
Board.
2)BACKGROUND .
a) Covered California Launch. Covered California's first
open enrollment period ran from October 1, 2013, through
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March 31, 2014. The pace of enrollment gradually increased
over the six months of open enrollment. The table below
provides data on the number of individuals who enrolled
(with plan selection) for the total six month open
enrollment period, with an additional 15 days for
completion of applications.
----------------------------------------------------------
| | Total |% of Total | Total | % of Total |
| | Enrolled | 1/1/14 | Enrolled | 4/15/14 |
| | 1/1/14 | | 4/15/14 | |
|---------+-----------+-----------+-----------+------------|
|White |179,615 | 43.7% | 386,501 | 35.4% |
| | | | | |
|---------+-----------+-----------+-----------+------------|
|Asian | 92,142 | 22.4% | 230,352 | 21.1% |
|---------+-----------+-----------+-----------+------------|
|Latino | 74,090 | 18% | 305,106 | 28% |
|---------+-----------+-----------+-----------+------------|
|Black/Afr| 10,867 | 2.6% | 30,774 | 2.8% |
|ican | | | | |
|American | | | | |
|---------+-----------+-----------+-----------+------------|
|Other | 38,253 | 9% | 121,875 | 11.2% |
|---------+-----------+-----------+-----------+------------|
|Total |410,967 | |1,090,60 | |
| | | | 8 | |
|---------+-----------+-----------+-----------+------------|
|Unknown | | | 305,321 | |
|---------+-----------+-----------+-----------+------------|
| | | |1,395,92 | |
| | | | 9 | |
----------------------------------------------------------
After the first three months' experience showed an
underrepresentation of Latinos in the enrollment numbers,
Covered California increased Latino-targeted and Spanish
language marketing efforts by $4.5 million. A targeted
on-the-ground strategy was developed in collaboration with
Covered California's community partners to create
face-to-face opportunities for enrollment, particularly in
Latino communities in Los Angeles, the Inland Empire, and
the Central and San Joaquin valleys. The number of
certified enrollment counselors, which was only 772 at the
start of open enrollment, increased to 5,598 by the end of
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open enrollment. Final enrollment figures show that
certified enrollment counselors were especially effective
for Latinos: 20% of Latinos signed up through a certified
enrollment counselor, compared with 9% of total enrollees.
b) California HealthCare Foundation (CHCF) reports. An
April 2014 report published by CHCF provides an analysis of
early consumer enrollment experiences. The report found
that many consumers were unaware that in-person enrollment
assistance was available and some enrollees were surprised
by how much documentation was needed and found it to be
difficult. 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.
Since the research was conducted in February, Covered
California has 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
applications in Spanish, Chinese, Vietnamese, and Korean on
the website, adding consumer information including
searchable frequently asked questions, requiring agents and
enrollment counselors to complete annual recertification
training, and creating a dedicated help line for insurance
agents.
In May 2014, another report by CHCF examined the experience
of individuals enrolling for coverage through the Covered
California website. Researchers observed individuals
interacting with the Covered California website in February
2014 and recorded their reactions. The study found that
participants typically reacted positively to the homepage.
They described it as welcoming and were relieved that it
was not intimidating. As participants proceeded to use the
site, however, researchers saw these positive impressions
diminish. Participants struggled to use the site and
formed incorrect understandings of their options and
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eligibility. Of the 15 study participants, only one
enrolled in coverage, with individuals stymied by an
inability to enroll in Medi-Cal through the Covered
California site or confused by conflicting eligibility
messages.
The report found several key themes that created barriers to
enrollment through the website:
i) Understanding the meaning of questions and
denitions: participants frequently did not understand
what was being asked and were, therefore, unsure of how
to answer.
ii) Comprehending eligibility and next steps: after
submitting the application, participants were presented
with confusing information about eligibility
determination; they did not know how to, or feel
encouraged to, proceed to enrollment.
iii) Entering simple data: when inputting personal
information in data elds, participants usually knew the
answer but often had diculty entering the information.
iv) Understanding steps and sequence: participants had
limited understanding of intended steps, and they were
not adequately guided through the process.
v) Finding information and answers: participants often
could not nd the information they were looking for, and
help within the site did not provide adequate assistance.
vi) Comparing and choosing plans: participants
struggled to understand plan options, compare multiple
plans, and decide which plan was right for them.
In their response to the study, Covered California and the
Department of Health Care Services (DHCS) write that they
are committed to further improving the consumer-facing
website experience and will continue to work in partnership
with external stakeholders in this development.
3)SUPPORT . The Latino Coalition for a Healthy California
(LCHC), writes that it is concerned about underrepresentation
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of Latinos in Covered California plans. LCHC argues that this
bill offers an appropriate solution to help increase Covered
California's leadership to better interpret the nuances of
enrolling Latinos and other populations that may initially
show reluctance to sign up for coverage. The Western Center
on Law and Poverty, also in support, writes that this bill
will help Covered California have a board with the needed
expertise to reach limited English proficient communities.
The California Association of Health Underwriters (CAHU), also
in support, writes that technology challenges presented
enormous barriers during the open enrollment process and that
some technology issues remain unresolved. CAHU states that
having a future appointee with technology experience will
likely prove invaluable to smoothing Exchange operations.
CAHU also states having an appointee who understands the
challenges of servicing California's multi-cultural population
will benefit Exchange operations and the certified agents that
serve as trusted avenues to affordable coverage in those
communities.
4)PREVIOUS LEGISLATION . AB 1602 (John A. Pérez), Chapter 655,
Statutes of 2010, and SB 900 (Alquist), Chapter 659, Statutes
of 2010, established the Exchange and its powers and duties.
REGISTERED SUPPORT / OPPOSITION :
Support
California Association of Health Underwriters
California Latino Legislative Caucus
California Primary Care Association
Latino Coalition for a Healthy California
Service Employees International Union Local 1000
Western Center on Law and Poverty
Opposition
None on file.
Analysis Prepared by : Ben Russell / HEALTH / (916) 319-2097