Highlights from Covered CA Board Meeting December 15, 2014

Today’s tight two-hour meeting featured a much anticipated presentation on benefit designs for 2016, an enrollment update, and a surprise announcement: that this meeting would be California Endowment Chief Executive Dr. Bob Ross’s last as a member of the Covered California Board.

Dr. Ross’s’ valuable contributions to the Board’s discussions since he was appointed by former Senator Pro Tem Darrell Steinberg (D-Sacramento) helped Covered CA get launched and moving in the right direction; Bob Ross has certainly made his mark on health care history in more ways than one, and will be missed.

The Landscape for New Plans and Benefit Designs for 2016

It’s a new day, and while insurers can still make money, but no longer on the wrong things (avoiding risk). If they want to compete, they will need to learn to compete over the right things, like keeping us healthy–and insurers that played such “risk selection” games by declining to enter the market in the first year, when the sickest signed up, don’t get full entry to cover the relatively healthier population later—much to United Healthcare’s consternation. Staff recommended that new entrants, with the important exceptions of Medi-Cal plans and plans serving areas with fewer plan choices, would still be barred from the marketplace. The Board will vote on whether to accept new entrants for 2016 at a subsequent meeting. What the staff recommended is “active purchasing” at its most active: Covered CA can be choosy about who can offer new products, in this case it will be plans that can serve areas with fewer plan choices. It also means that alternative benefit designs, which helped no one but those profiting from them, will only be permitted in the still negligible small group marketplace, the SHOP.

The board discussed new benefit designs for 2016. California has standardized benefit designs so that every health plan sells exactly the same copays, deductibles and other cost sharing—and the only difference is the premium, the network, the services the carrier offers—and of course, the brand name. In other states, a single health insurer can offer literally dozens of Silver products, to the considerable confusion of consumers and allowing health plans to pick their customers based on benefit design.

Much of the presentation was focused on the design of the Bronze and Silver products, the “workhorses of Covered CA,” as Health Access phrased it, and in much of this work the advocates needed to walk a fine line between wanting to convey the limitations of Bronze products which require the consumer, on average, to pay 40% of the cost of care. Bronze gives consumers a very low premium, sometimes as low as $1 a month, but then they pay lots when they need care.

By the new, less confusing standard recommended for Bronze plans, the deductible and maximum out of pocket will be set at $6,500 (the maximum out of pocket limit or, bear with us, “MOOP”). Consumers will pay a copay for up to three visits, which can be any combination of primary care, specialist, urgent care or mental health. The enrollee pays the entire cost of all other services, at the contracted rate, until he spends $6500 out of pocket. That means a consumer would pay $1800 or more for an MRI, hundreds of dollars for the third doctor visit, and thousands for an emergency room visits. Very few consumers spend $6,500 in a year so for many consumers, aside from the three doctor visits, they would pay every penny for their care—unless they got really sick.

One reason for Health Access’ keen interest in the proposed bronze product is the sad fact that in 2014, over 120,000 enrollees in Covered California picked a bronze product—but would have been eligible for a silver Cost Sharing Reduction product—with copays of less than $10 for a doctor visit and much better cost sharing generally. These Californians make less than $30,000 a year and yet bought a product with a deductible of $5,000—when they were eligible to buy something with a deductible as low as $75.

To make them easier to select, the silver plan options for those eligible for CSR (Cost Sharing Reduction) plans will be vastly simplified for 2016. CSRs are the much under-utilized discounts that lower the amount eligible consumers have to pay out of pocket for deductibles, coninsurance, and copayments. They were underutilized because they were hard to pick out from a line up of bewildering options. The new silver plans combine the copay and coinsurance plan designs into one design, reducing the number of CSR-qualified silver plans from six to three—much better.

After all is said and done, Covered CA enrollees selecting a plan in late 2015 for 2016 will have an easier time selecting the right plan—and, more importantly, they will know more precisely what they are buying and what it’s worth, even if it’s bare bones.

The recommendation was also to minimize co-insurance, defined as the consumer’s share of the costs of a covered service, calculated in turn as a percent of the allowed amount for that service. Right now if you’re scratching your head, it’s because you are right to wonder what on Earth this could possibly cost.

The basic problem with coinsurance is that it cannot be predicted in advance—it’s one of the big unknowns in the cost sharing calculation. How much will you owe on co-insurance? Well, it depends on what the service costs—but who knows how much something costs, until maybe it’s too late and the bill comes in the mail. This is why Health Access and our partners are so keen on getting rid of it altogether–and at least limiting it to very specific circumstances.

Where the the Ad Hoc Group ‘s work left off is on the lingering problem of unmanageable cost sharing for certain specialty medications—the Sovaldi issue. This will be a top issue for the coming year’s benefit design process—if it is not addressed through legislation (more on that later).

Covered CA Executive Director Peter Lee’s report focused on an appropriately ambitious campaign to allay fears about immigration status of applicants. On this Lee did not mince words and so we repeat it here: Covered CA is a safe place to apply for affordable coverage, no matter where you or your family members came from or when you arrived. And, President Obama’s recent executive order will not change this. See Covered CA’s many fact sheets for messaging on this and specifics for outreach.

Obamacare Enrollment On Quick Pace As 1st Deadline Nears on Dec 15th!

Earlier today, Covered California hosted a press conference call, reporting that enrollment is moving ahead at a quick pace, with around 300,000 Californians enrolled or in the process of getting enrolled in new coverage, either in Medi-Cal or a private health insurance plan through Covered California.

As reported in the San Jose Mercury News and the Los Angeles Times, nearly 50,000 folks were newly enrolled in Covered California plans, out of 130,000 who were determined eligible and at some point in the process. An additional 160,000 newly applied for Medi-Cal, with 75% already enrolled, and the other 25% in process. These are all new enrollments, not folks renewing existing coverage.

The announcement highlighted that the first deadline of this second enrollment period is less than a week away, on December 15th. Consumers have until December 15th to sign up for coverage to start January 1. The full open enrollment period spans for three months, until February 15th.

Peter Lee highlighted the “ground up” outreach and marketing efforts, from 200 storefronts to a myriad of events around the state. There’s also some help from key leaders, including President Obama himself, raising these deadlines and reminding people to sign up, as he did earlier this week on one of the last episodes of The Colbert Report, in a segment called “To Health in a Handbasket.”

 

Remembering Lark Galloway-Gilliam and Ray Otake

In the last month, we at Health Access have been saddened to hear about the passing of two former board members, who were both true leaders and innovators in efforts to reform health care and extend coverage and care to California’s diverse communities.

Late last week, Lark Galloway-Gilliam, founder and Executive Director of Community Health Councils, Inc., passed away, following complications from a long-fought illness.

LarkGallowayGilliam

As the head of CHC for more than 25 years, Lark was a fierce and formidable champion for health equity in Los Angeles, in California, and across this country. She grew Community Health Councils into a powerhouse organization, addressing racial disparities, expanding coverage, and improving health–from advocating for the safety-net to fighting for increased access to care for the South-Central LA community to get King-Drew hospital re-opened next year, to a working statewide to improve outreach and enrollment into public health programs, from Healthy Families to Covered California more recently.

We will miss Lark and her spirit, and send our condolences to our friends and colleagues at Community Health Councils and throughout LA and California.

Not a month ago, we heard the shocking news of the passing of Ray Otake, Chief Technology Officer of Paras and Associates, who suffered a sudden emergency heart condition while attending a health care conference in Las Vegas.

RayOtake

Ray also served as Chief Information Officer for the Community Health Center Network, made up of the key community clinics in Alameda County. With Health Access California, Ray helped develop our work around video medical interpretation. With our former executive director Melinda Paras, he created the technical design for the shared video interpreter call center network – the Health Care Interpreter Network. Because of his work and the efforts it helped enable, many patients throughout California can now access care in a language they can understand–in multiple languages, with minimal wait times or scheduling hassles.

We hadn’t seen Ray in a while, and we are sad we won’t again. He served on a HIPPA advisory board for us, and was the last person to hold the distinction of serving on both the Health Access California and Health Access Foundation boards. We send our condolence to our friends and colleagues at Paras and Associates, the Health Care Interpreter Network, and the safety-net community in general.

Both Lark and Ray were wonderful examples of California leadership on health issues, working for their communities and for the state as a whole. We salute their lives and their accomplishments.

New Legislative Session, New Momentum for #Health4All: SB4!

HEALTH ACCESS UPDATE
Thursday, December 4, 2014

NEW LEGISLATIVE SESSION STARTS WITH NEW MOMENTUM FOR #HEALTH4ALL

* Senator Ricardo Lara introduces SB4, with #Health4All intent language similar to last session’s SB1005 to extend coverage to remaining uninsured regardless of immigration status, in state-only Medi-Cal or a Covered California-like “mirror marketplace.” New momentum after President Obama’s immigration actions, which expands “deferred action” status to protect some undocumented immigrants from deportation–which California has long history and current policy of covering with state-funded Medi-Cal.

* Assemblyman Rob Bonta named the new chair of Assembly Health Committee, has also committed his support for #Health4All; Chairs of key Assembly fiscal committees include Assemblywoman Shirley Weber for Assembly Budget Committee and Assemblyman Tony Thurmond, for the Budget Subcommittee on Health and Human Services, and Assemblyman Jimmy Gomez of Assembly Appropriations Committee.

* HOLIDAY PARTY: YOU ARE INVITED to celebrate the holidays with Health Access and CPEHN, next Thursday, December 11th, from 4:30-7:30pm at the Waterfront Hotel in Jack London Square, Oakland. Please RSVP with sabbass@health-access.org.

Be a Member of Health Access To Help CA Win #Health4All in the New Year!
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Read Real-Time Updates on ACA Implementation on Twitter @HealthAccess!

On Monday, as California state legislators reconvened for a new two-year legislative session, Senator Ricardo Lara (Los Angeles) reintroduced a bill to extend help for affording coverage to all Californians, regardless of immigration status.

NEW BILL NUMBER: The bill, SB4(Lara), has the intent language of the previous session’s SB1005, which was to expand state-funded Medi-Cal for Californians under 138% (and children under 288%) of the federal poverty level, and create a “mirror marketplace” to offer the same plans and subsidies that Covered California offer for those above that income threshold. Health care, immigrant rights and community groups have rallied in favor of this approach, which passed the Senate Health Committee in the last legislative session.

PRESIDENT’S IMMIGRATION ACTIONS & CALIFORNIA HEALTH IMPACT: This approach has not just a new bill number but new momentum, after President Obama’s recent immigration announcement two weeks ago, which provides relief from deportation for hundreds of thousands of Californians. While the President’s order excludes these immigrants with “deferred action” status from federal health programs, California has a proud history and long-standing current policy to cover those immigrants with “deferred action” status who are at or below the poverty level in state-only Medi-Cal. California had recently already re-affirmed that “DREAM Act,” or DACA youth, were eligible for Medi-Cal if they met the income requirements, and the President’s order simply expands these categories, and thus those covered by Medi-Cal. This coverage won’t kick in immediately, since the process to get “deferred action” is being set-up by the federal government, but state policymakers would not need to take any additional action beyond existing policy.

In short, the President’s action not only reaffirms the notion that immigrants are important parts of our society and economy, it opens up California’s existing programs to provide additional help to the undocumented community, and creates momentum (and makes it cheaper) for the taking the additional step to cover all the remaining uninsured.

NEW ASSEMBLY CHAIRS: One notable and vocal supporter of the #Health4All campaign was Assemblyman Rob Bonta (Alameda), who is the new chair of the Assembly Health Committee.

Other relevant chairs named yesterday were of key fiscal committees: Assemblyman Jimmy Gomez (Los Angeles) will chair the Assembly Appropriations Committee, and Assemblywoman Shirley Weber (San Diego) will chair the Assembly Budget Committee, promoted from last year chairing the Budget Subcommittee on Health and Human Services–which will now be chaired by Assemblyman Tony Thurmond (Alameda). Health advocates look forward to working with all these members on a range of issues over the next few years.

OTHER NEW EFFORTS OF NOTE: Health advocates are gearing up for other efforts as well. Another bill introduced Monday was SB33(Hernandez), to limit Medi-Cal estate recovery to long-term care. This revisits a bill topic vetoed last year, but which has been prioritized by numerous consumer and community groups, and will be pursued vigorously as a bill and in the budget process.

Also two weeks ago, several health, labor, health industry, and community groups joined forces to announce a campaign to save lives and prevent cancer by increasing California’s tobacco tax, now just 33rd in the nation, by $2–and using the money to increase funding and access in Medi-Cal, as well as cancer research, tobacco education and prevention, etc. The effort sought to win this increase either through the legislature, or on the 2016 ballot.

This winter, health care stakeholders are meeting in numerous workgroups around a new Medicaid waiver, which would determine the overall structure and financing for Medi-Cal for the next five years. This will also be a major focus for next year; We’ll post more information on the goals and the progress in a future update.

DHCS Stakeholder Advisory Committee Highlights

DHCS Director Toby Douglas began the Medi-Cal Stakeholders Advisory Committee noting it was his last, as he would be in the private sector at month’s end, and thanking his staff and the assembled stakeholders. The appreciation is mutual–we know the work has been tough, the resources limited, but it has been a pleasure to work with Toby. And we fully expect that the administrative processes and structures he’s put in place and broad vision he’s articulated for some of the delivery system reforms now underway will benefit many more and ultimately all Californians. 

So back to the meeting, to dig deep into issues impacting the most vulnerable Medi-Cal consumers (seniors, people with disabilities, or people living with mental illness or substance use disorders, for example) or to catch up on transformational processes, like waiver renewals, that have the potential to improve health outcomes or possibly extend care and coverage to the remaining uninsured.

Timely Access and Network Adequacy

SB964 brings dramatic changes to the timely access statute by standardizing health plan reporting, introducing an annual timeframe so that learning and correcting can happen from one year to the next; and separating the reporting processes for Medi-Cal and Covered CA. There will be a stakeholder process around this—starting in January.

Today we learned what a big deal it was to pass SB964; that DHCS had to staff up 10 times what they had in place to comply with the new access provisions; that a whole new division was needed for all the additional oversight. Bring it on: As more and more Californians gain coverage, some (like childless adults covered through the Medicaid expansion) for the first time; as providers and plans form themselves into new strategic configuration, it IS UNDOUBTEDLY important to ensure timely access to care.

The plans presented about what they were doing in terms of timely access and network adequacy (specifically Anthem, Inland Empire, Wellness, and CenCal Health), and we appreciated their frankness about their challenges in meeting the state’s current access standards, especially with specialists. At times the plans sounded as flummoxed as we are about rural provider shortages and related access issues, and telemedicine may not (or not yet) be all its’ cracked up to be to make up the difference. Maybe, suggested Toby, telehealth incentives could be built into bundled payment arrangements? Telehealth does have some potential to narrow gaps in access—and we would hope California with its high tech sector could be more in the forefront in this area.

Today we heard the plans are under a great deal of strain, from low rates to challenges finding all the needed providers. But that’s why it’ called managed care: If that means you have to contract outside the state border (as Anthem has) or contract with out of network providers, or pay for transport to a specialist (most plans do), that is what you must do.

Waiver Renewal Process and Workgroups

Most of the expert advisory groups have only had their first meeting, but already a few common themes or areas of interest have emerged:

  • The need to align metrics across providers, plans and delivery systems
  • Developing shared savings and accountable care arrangements to deliver better care
  • Behavioral health integration: it’s striking how this imperative runs across all of the groups.
  • Expanded workforce capacity
  • Maximizing federal financing  under waiver authority to achieve ‘triple aim’ and universal coverage goals.
  • Evaluation design: how else will we know whether these initiatives are working?

The waiver staff did an admirable job summing up some early thoughts from each expert workgroup:

  • The Housing/Shelter group: with strong consensus around the Whole Person care model, this group is digging into population and geographic priorities and evaluation criteria and metrics for success.
  • Plan/Provider Incentives Group: a key question for this group is how to distribute the risk—and how to align payments to manage that risk. This group, like several others, also hopes to align with national (for example NCQA) standards and all of the service categories.
  • DSRIP 2.0: in this go-round the DSRIP should be more focused on measureable outcomes and on the logistics, not to mention politics, around how to figure the non-federal share of financing in the delicate balancing act which is waiver budget neutrality.
  • The Workforce Development Workgroup, by no surprise, is looking at the need for more providers across the state, and specifically providers willing to serve the growing Medi-Cal population and prepared to deliver ‘whole person’ care. This group is also wisely looking also at future workforce needs.

Drug Medi-Cal Waiver Submitted to CMS, Nest Steps

Though the Drug Medi-Cal “Organized Delivery System Waiver” waiver has been submitted to CMS, DHCS is still taking input through the 120 days. Mari expects approval. This iteration, like the other waivers, is decidedly more ambitious encompassing the broad continuum of care: from individuals living with substance use disorders, to their families, the criminal justice system, and the system as a whole.

Rural Managed Care Expansion

Stakeholders voiced skepticism about readiness for this expansion, especially if the vision is as limited as it was described today: aimed at the same access as we saw under fee-for-service. Western Center’s Elizabeth Landsberg stated that we need to do more to make up for the hard fact that non emergency and non-medical transportation is not covered as a distinct benefit: “If the specialist is far away, these are low income people so we need to help them get there.”  Yes, that’s what managed care is supposed to be all about.

The anti-Obamacare message didn’t work in the West…

Republican political consultant Tony Quinn is no fan of the ACA, but even he thought that the anti-Obamacare focus of some of the Congressional campaigns here in California just weren’t credible and ultimately caused his party to lose opportunities to pick up seats. http://www.foxandhoundsdaily.com/2014/11/blow-nine-congressional-districts/

I thought it was strange that in Sacramento, where the most expensive House race in the country was waged, Congressman Doug Ose basically ran with a heavy emphasis on Washington, DC talking points bashing Obamacare, in a state where the ACA is working very well, thank you very much. I couldn’t imagine that this strategy could be that effective, given the real benefits being experienced on the ground. But glad to see I wasn’t the only one:

“Finally, there is the $19 million dollar campaign where the GOP outside groups did engage to the tune of $7 million, and managed to waste much of it.  This was Democratic Rep Ami Bera against former GOP Rep. Doug Ose in the Sacramento suburbs.  After two full weeks of counting late ballots Bera beat Ose by 1,432 votes out of 180,000 votes cast.

Republican spending on Ose’s behalf began in the early fall with a $900,000 television buy by Karl Rove’s Crossroads GPS hitting Bera for his support of Obamacare.  But the ads were cookie cutter spots that could have run anywhere, and were not tailored to California.

Obamacare is not the issue in California it is elsewhere for two reasons; Bera was not in Congress when it passed and Covered California, the Obamacare California exchange, has covered most people who lost their insurance under the initial plan.  Focusing on Obamacare in California was a huge waste of money, as the final results showed.”

Bottom line: The opponents who ran against Obamacare in California lost. And even Republican observers took notice.

The President’s Immigration Actions to Lead to a Healthier California

Statement by Anthony Wright, Executive Director of Health Access

Last night President Obama announced he would be taking executive actions to improve our immigration system, including providing many immigrant families in California and the nation with temporary relief from deportation.

REMOVING DEPORTATION DISRUPTIONS: President Obama’s order to allow immigrant families to stay together is a huge benefit to the health of California’s economy and our society. The threat of deportation for immigrant family members puts unhealthy stress on our residents and citizens, and has been disruptive to California families, schools, our communities and our economy. Fears of deportation of family members prevented many legally-residing Californians from seeking care and coverage. With this order, these families won’t have to think that seeking basic care might lead to the deportation of a loved one.

CALIFORNIA’S CURRENT POLICY: While the President’s order continues to exclude undocumented immigrants from federal health benefits, including even those granted deferred action, California has the ability, the history, and the decency to include these Californians in our health coverage and care programs, under existing law. In effect, this means that the President’s actions expand health coverage to those low-income working families, under California’s existing Medi-Cal program, allowing them to get more cost-efficient primary and preventive care, rather than just at the emergency room.

While the exclusion from federal benefits stands, immigrants with “deferred action” status who are at or below the poverty level will be able to get Medi-Cal coverage as an entitlement under existing California law–and this should include those provided relief under the President’s order. California has long covered certain immigrant populations excluded by the federal government, including recent legal immigrants (under the “5-year bar”), refugees (and other “people residing under the color of law”) and recently DREAM ACT students (and others under “deferred action”). The President’s executive order thus expands those eligible for state Medi-Cal, effectively a continuation of these commitments.

PROUD OF CALIFORNIA LEADERSHIP: While Congress has dithered and delayed, California should be proud to lead in efforts to include immigrants in our society, and in our health system. In California, we know our society and economy are better when all children can get educated; our roads are safer when everybody is able to go through the testing process to get a driver’s license; and we know that health care system is stronger when everyone is included. Californians should be proud that our existing state laws already provide health coverage to many of these immigrant families granted deferred action–and should take the modest additional steps to provide coverage for all Californians, regardless of immigration status. This is another way California can again lead the nation on immigration issues.

NEXT STEP SHOULD BE #HEALTH4ALL: We applaud the foresight of Governor Brown and the Legislature in extending Medi-Cal, including state-funded Medi-Cal for immigrant populations that will now include those granted administrative relief.  We therefore urge the Governor and Legislature to take the next step to cover all Californians, which is now even more achievable that the remaining gaps in eligibility are even smaller.

As the President has reaffirmed, our undocumented friends and neighbors are crucial parts of our economy and community–they should be fully included in our health system as well. We strongly support state and county level proposals to extend health coverage to all Californians, regardless of immigration status–building on SB1005 (Lara), introduced earlier this year and various efforts to expand coverage at the county level in the coming year. When and where Congress fails to act, California can and should lead. Our health system is stronger and more effective for everybody when everybody is included, when we provide cost-effective primary and preventive care up front and not just expensive treatment, often too late, in the emergency room.

Covered California Board Meeting Update

Today, the Covered California Board met for a public meeting that began around 1:30pm and ended at about 3:30pm. With open enrollment underway, much of the discussion at today’s Board meeting centered on outreach and enrollment efforts, including the recent Covered California Bus Tour, enrollment thus far and what enrollment will look like this year as we integrate the renewal process for the first time. The just released DMHC audit of Anthem Blue Cross and Blue Shield of California was also a highlight of today’s discussion.

Renewal and Enrollment – The Covered California Bus Tour started on Monday, November 10th in Sacramento, traveled through northern, central and southern California cities, and hit its final destination in Redding on November 18th. Peter shared a story of a woman named Diana whom he met during the Bus Tour in Fresno. Diana lost her employer based coverage over a year ago and went uncovered for quite some time because she thought the process would be hard. She had been feeling sick for awhile until she finally signed up for coverage. Shortly after she signed up, she had a doctor visit where she found out that she had a very aggressive form of uterine cancer. She is now better and credits Covered California for saving her life.

Peter shared that as of November 18th (in just four days) close to 70,000 people have been determined eligible for coverage. Last year, it took two weeks to get this many people enrolled, said Peter. This year, it took just four days to reach this number. This is a testament to the outreach, enrollment and education efforts thus far; consumers are informed, ready to sign up and there are knowledgeable agents, county eligibility workers and organizations ready to help them. With respect to the renewal process, Covered California sent renewal notices in October. Consumers have 30 days to shop and choose coverage before Covered California renews their coverage automatically. Those who were automatically renewed will be able to change plans through the end of open enrollment on February 15, 2015. Consumer advocates weighed in during this segment of the meeting, asking that more be done to improve the accuracy of notices and confusing nature in which duplicate notices are sent to consumers with conflicting and/or confusing information. As for the Covered California website, it has been re-launched, said Peter, and is cleaner, flows better and the English Spanish translations have been improved. that are going out to consumers.

Department of Managed Health Care Non-Routine Survey of Anthem Blue Cross and Blue Shield of California – Following complaints from consumers, in June of 2014 DMHC initiated a formal non-routine survey to assess the accuracy of the provider directories of two of Anthem Blue Cross and Blue Shield of California. The major findings of the survey were presented during today’s Board meeting. The survey confirmed what they had already known, she stated, which was that provider directories were inaccurate. DMHC has engaged in action with the plans to address the issue of inaccurate provider directories. In 6 months, DMHC will do another review to determine whether the plans have followed through on whoops my phone necessary corrective action. Covered California reviewed there own actions to address the issue–using their active purchasing power negotiating with the plans, educating doctors and providers about their issue, working with DMHC, etc.

The next Covered California will be held December 15th (new date!) and the Board plans to discuss Qualified Health Plan Recertification before they make final QHP Plan changes in January.

Affordable Care Act as a Tool for LGBT Equality and Wellness!

This blog post was written by Kate Burch, Network Director, California LGBT HHS Network

One of the projects that Health Access supports is the California Lesbian, Gay, Bisexual, and Transgender Health and Human Services Network, a coalition of organizations throughout the state working towards improving wellness in LGBT communities.

We are excited that open enrollment started on Saturday! The Affordable Care Act has cut the number of uninsured people in half in California, and that’s especially important for LGBT communities. LGBT people have a long history of being discriminated against, denied access to insurance, and refused medical care. We are more likely to be uninsured, and fear of discrimination makes us less likely to go to the doctor when we need to.

But the Affordable Care Act is changing all of that. The Affordable Care Act and Covered California are amazing tools for equality. Our families can get affordable health insurance right now. We can’t be discriminated against any more. We can’t be denied care or charged more just because of who we are.

The first step toward equality in health is getting covered. We are leading a statewide effort to get LGBT people enrolled, working with more than 12 LGBT organizations throughout the state to make sure that LGBT people can get their health insurance questions answered. Our #LGBTcovered website (http://www.californialgbthealth.org/lgbtcovered.html) lists office hours for organizations around the state that can answer LGBT-specific enrollment questions, and we will be holding enrollment events throughout the open enrollment period (November 15, 2014-February 15, 2015). We are also working with Out2Enroll (http://out2enroll.org/) to promote the national effort to increase the number of LGBT individuals and families with health insurance.

Websites, social media, and enrollment events are a great way to get the word out about open enrollment. We know, however, that the best way to improve health in all of our communities is one-on-one. So between November 15th and February 15th we urge all of you to talk to everyone you know to make sure they’re covered.

Getting On The Bus…

This Monday morning, Covered California is embarking on a nine-day, 21-city bus tour through the state to highlight the beginning of open enrollment to take advantage of new health insurance options and financial assistance to get covered.

I’m excited to be at the 8am launch in Sacramento at the State Capitol, and to get on the bus for at least a portion of the ride, tweeting and posting some thoughts during this week leading up to the first few days of open enrollment — a three-month window of time from Nov. 15 to Feb. 15 when Californians who need insurance cannot be turned away by health insurance companies and when many can get federal subsidies to dramatically lower their cost of coverage.

On the bus will be Peter Lee and other leaders of Covered California, and community partners and elected officials will make appearances at enrollment events and storefronts to encourage uninsured Californians to obtain health coverage during the open-enrollment period through Covered California.

The tour will include stops in Petaluma, Gilroy, Fresno, San Bernardino, Palm Springs, San Luis Obispo, Salinas, Chico and Redding, as well as stops in major cities such as Los Angeles, San Francisco and San Diego.

So we hope partners join in on the tour, and more importantly start to tell their communities about the opportunity for the peace of mind that comes with coverage.