Higher Profile Coming to Exchange

by David Gorn

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California's health benefit exchange is nearing its move into the mainstream public spotlight -- but there is a lot of work still ahead, according to experts who gathered in Sacramento yesterday for a roundtable discussion of the exchange.

Yesterday's symposium, called "Covered California: The Challenges and Opportunities of California's Health Benefit Exchange," was presented by the University of Southern California's Price School of Public Policy and the USC Schaeffer Center for Health Policy and Economics and Quintiles.

Assembly member Richard Pan (D-Sacramento) acknowledged that creation of the exchange has helped place California at the head of the health care reform pack, but he said that leadership role doesn't change the 2014 deadline that's looming for health care reform and the exchange.

"California is a leader when compared to other states, but despite being a leader," Pan said, putting up both hands in a shrug, "well, there certainly is a lot to get done." If California really is leading the way, and its effort still has so far to go, Pan said, "Honestly, I don't know how other states are coping," he said.

The exchange not only is creating a health insurance marketplace, but in the next 10 months needs to choose its participating health plans, develop a small-business exchange, develop an assisters program, unveil a web portal eligibility system and other IT efforts, as well as launch an ambitious media and outreach campaign with the goal of making the Covered California brand as ubiquitous as Kool-Aid in California.

Several details, particularly concerning the individual health insurance market, need to be solved in the legislative special session, Pan said. "We do know there will be some people left out [of coverage, even with the exchange]," Pan said, "but we'll have to figure that out later. This is an ongoing process, so we'll change things as they play out, it's an ongoing evolution."

Health care reform as a whole is a work in progress, like the exchange, said Bob Kocher, a partner at venture capital firm Venrock and a former consultant to President Obama on health policy.

Kocher said there has been one constant in the changing American landscape of health care in the past decade -- its rising cost.

"We've seen premiums go up by 100% in every single state over the past 10 years," Kocher said. "We spend more on health care in America than the Chinese spend on everything. That is, the amount of money spent here, the percentage of the GDP, is bigger than the entire Chinese domestic economy."

That spending might make some sense, he said, if the health outcomes in the U.S. were markedly different from every other country -- but they're not. "We are delivering outcomes on a par with Cuba," he said. "If we were living longer and better, OK, but we're not getting our money's worth."

The establishment of health benefit exchanges in California and other states won't solve that problem, he said, but they could promote a number of things to move health care momentum in the right direction.

"What is so interesting and hopeful about a health benefit exchange," Kocher said, "is that you'll have more plans and more types of plans, with greater information," so people can actually see the differences between plans and make intelligent choices about what kind of coverage they want, he said.

"I'm excited that we're going to be talking about products," he said. "Health insurance is the most expensive thing you buy every year, so you should be able to shop for it."

That could put California on the cusp of a new paradigm, he said, where the patients might be able to affect a lot of the spending in health care, through their choices.

That rang true for Peter Lee, executive director of the exchange. Lee spoke at yesterday's symposium, as well as addressing a Tuesday conference sponsored by the Insure the Uninsured Project.

"What's important here is not just what happens in 2014, but what happens in 2015 and beyond," Lee said. "We are creating a new health care system for America."


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