One of California’s most substantial voices to weigh in on the consequences of repealing and replacing the Affordable Care Act wasn’t a consumer activist, politician or economist. It was the state’s health insurance exchange.
Almost immediately after Donald Trump was sworn in as President, Covered California started issuing a series of reports detailing how the state’s residents would either lose their insurance or be left with unaffordable options if the Affordable Care Act was repealed.
Some of the missives from Covered California provide examples of how federal budget cuts could impact the state, using reports from the Congressional Budget Office or insurance-related think tanks. Some are based on the exchange’s own research, or in conjunction with big accounting firms such as PwC, which is based in Los Angeles. All have been accompanied by blunt statements from Covered California Executive Director Peter V. Lee.
“California and the majority of markets across the nation are stable and working right now, but the possibility of changing the rules of the industry is threatening to upend markets and put consumers at risk,” Lee said in a statement Covered California issued in April.
The positions taken by Covered California are unique among the state-operated insurance exchanges.
“Covered California has really developed a databank and policy shop,” said Betsy Imholz, director of special projects for Consumers Union in San Francisco. Imholz added that most of the other exchanges have been focused primarily on service issues, such as responding to enrollee grievances.
“Covered California has the wherewithal to produce a lot of information,” said Anthony Wright, executive director of Health Access California, a Sacramento-based advocacy organization. Moreover, Wright said that Covered California has also made granular data publicly available, allowing his advocacy group to publicize the consequences of health care reform on a community level.
According to Wright, the exchange’s wherewithal is partly a function of Covered California’s size – with about 1.4 million enrollees it’s the largest state exchange in the country and it has the budget to perform such research and advocacy. But that mission is also related to its roots: Although funded initially with state and federal monies, Covered California is an independent operator separate from the state’s insurance regulators. Wright said that gives it a lot more latitude to take policy positions than its counterparts in other states.
Among the assertions that have been made in recent Covered California reports:
- Eliminating the cost-sharing reductions used to subsidize insurance costs for middle-income enrollees, premiums could rise by as much as 49 percent by 2018.
- Deductibles for a silver-level plan would rise from $2,500 to $7,350 for an individual and $14,700 for a family if the Better Care Reconciliation Act (the Senate version of the repeal bill) was signed into law.
- A 62-year-old in Monterey County earning $17,000 a year is currently paying 3.7 percent of their income toward insurance premiums. Under the American Health Care Act (the House version of the repeal and replace bill), their premiums would have risen to more than 100 percent of their income.
James Scullary, a Covered California spokesperson, called the steady stream of reports an educational effort. “We believe we must be constructively engaged in the process of exploring ways to improve our health care system so it works as well as it can for Californians and all Americans,” he said in an email.
Consumers Union has also used some of the data provided by Covered California, but to a lesser extent, according to Imholz.
But she observed that if “policymakers want to act on the facts and evidence,” the exchange is doing an excellent job “(telling) the public what the effects will be on California.”