With today being the ‘official’ wrap-up of Covered California’s first open enrollment period, it felt like the appropriate time to reflect and celebrate all the great work done by a diverse partnership of very committed officials, agencies, departments and community partners. It’s also a good time to start reflecting on what worked, and what can be done better as we start to gear up for the next enrollment period.
Covered California, and the Affordable Care Act overall, accomplished something huge in our nation’s history. To quote Vice President Biden, the Affordable Care Act is “a big [friggin] deal”. We know that over 7.5 million people have signed up for insurance across the nation through the federal and state exchanges. Over 1.2 million of those people enrolled in an exchange health plan here in California. Another 1.1 million low-income Californians enrolled in Medi-Cal thanks to the expansion. All told, today, there are millions more Californians covered by health insurance than there were just seven months ago.
By meeting its overall target numbers, Covered California accomplished a great feat. But we all know that this wasn’t without its challenges. Latino enrollment in particular, has been a sticking point for us. Latinos represent the largest uninsured group in our state, with almost 60% of the uninsured identifying as Latino. Yet, only about one-third of individuals who signed up for a health plan identified as Latino when they enrolled through March. While official numbers haven’t been released yet, we know there will still be work to do next fall when open enrollment re-opens.
When LCHC staff traveled around California for our Regional Network Meetings in September and October of 2013, we heard directly from our meeting participants the challenges that lay ahead. To a tee, it seems that our community partners saw many of the challenges before these trickled up to the Covered California team in Sacramento. Based on what we heard, and observed during our own on-the-ground education, here are some key lessons that may help inform future Latino-focused outreach efforts:
- Those in charge of setting the strategic direction and monitoring the operations of Covered California need to be able to decode what is going on in the target audiences. Not everything translates culturally, generationally, or linguistically.
- Assume the target population does not trust the government system and as a result will need multiple contacts before they finally enroll. Sharing the stories of successful enrollments and access to health care will go a long way in our community. “Seven touches and done” should be the mantra for the next enrollment period.
- Assume that many of those who need to sign up have never had health insurance. “No denials for preexisting conditions,” doesn’t mean as much if one has never had health coverage before.
- Health insurance is complicated. It can be hard for someone who has never had insurance to understand the acronyms and concepts that are barely understandable to those of us who have had insurance.
- We cannot underestimate the fear that mixed status families face when doing anything that can be perceived as a risk to family unity. The memo from ICE was a first step towards bridging the trust gap, but examples of mixed status families successfully enrolling eligible members will go a long way to decrease fear.
- Cost reimbursable contracts are not the best procurement vehicle when working with small community based organizations. Covered California understood the need to contract with trusted community organizations to outreach to targeted communities, but the procurement vehicle that helped fund this work was incongruent with the capacity of these small organizations to fiscally manage an environment with delayed payments for work already completed.
- The bottlenecks in the processes to certify enrollers was not anticipated. These certifications should be accelerated during the non-enrollment period to ensure an adequate pool of enrollers is available for the fall.
- There should be extensive technical assistance to help community groups work with the newly insured to navigate the system. Many have never had access to preventive care and have to be educated about shifting to doctors’ offices from the emergency room.
- While Medi-Cal is separate from Covered California, the stories we are hearing on the lag times to get coverage are unacceptable. The Medi-Cal horror stories tarnish Covered California as many do not distinguish between the two programs.
- A significant investment should be made in an Ombudsperson program that is not affiliated with any of the health plans to ensure that consumers are receiving the care they deserve.
- Covered California enrollment, service provision, and health outcomes should be evaluated to ensure that the whole system continuously improves.
The previous points are all a direct result of our interactions across California. As monumental as Covered California and the Affordable Care Act have been in terms of improving Latino health, there’s still room for improvement. We also can’t forget that there are many who contribute to our economy and to our communities that are simply ineligible for affordable health care.
In addition to working with Covered California to ensure that eligible people are enrolling in the Exchange, LCHC is also working hard to ensure that all Californians have access to affordable, culturally appropriate care, including those who are undocumented and currently ineligible for all but emergency care. We’re excited about our newest collaboration with The California Endowment, a statewide #Health4All billboard campaign. The campaign is intended to raise awareness of the remaining uninsured and hopefully spark conversation around the importance of prevention and health for all.