A Substantive Second Meeting of the Exchange

The Board of the California Health Benefit Exchange met for the second time today, still short their 5th member, who has yet to be appointed by the Senate. For those who have not been following this closely, the Board currently consists of Kim Belshe and Susan Kennedy appointed by former Governor Schwarzenegger; Paul Fearer, appointed by Assembly Speaker John Perez; and Diana Dooley, Secretary of Health and Human Services, who was elected Chair at the last meeting. As usual, we live-tweeted the meeting at our Twitter account @healthaccess, at the hashtag #CaHEx. For those who missed it, here’s a summary below.

The first order of business was a report from the Interim Administrative Officer Pat Powers, who introduced herself, including her specific experience in the areas of small business and health care quality, and laid out the near and long term deliverables to be completed by staff. She cited the recruitment and hiring of an Executive Director and General Counsel, and the submission of the Exchange Planning Grant as the first priorities.

Ms. Powers devoted a significant portion of her report to opportunities for stakeholder participation. She mentioned opportunities such as public comment in meetings, a public comment form that allows written comment outside of the meetings, and plans to leverage technology to make the Board more accessible such as webcasting, and using the website and webinar. She also mentioned longer term goals to include stakeholders, including consumer groups, in workgroups. Kathleen Hamilton of the Children’s Partnership and the 100% Campaign spoke up on the importance of including stakeholder input early, in the form of workgroups or other similar venues, so that their expertise and knowledge of the needs of the community could be incorporated into staff recommendations prior to the recommendations being presented to the board for action. Ellen Wu of the California Pan Ethnic Health Network encouraged the board to translate meeting materials and materials on the website to make them accessible to all Californians, and asked the Board to designate a staff person or create a workgroup to ensure the needs of communities of color and limited English proficient individuals, who make up 66% of those eligible for the Exchange, are represented in its governance.

The Board then heard reports from the subcommittees that were created at the last meeting. The Search/Recruitment Committee (consisting of Diana Dooley and Paul Fearer) presented the Duty Statements for the Executive Director and General Counsel, and asked for Board approval of those as well as the proposal to contract with a recruiting entity. The board adopted the proposals with an amendment suggested in public comment by Elizabeth Landsberg of Western Center on Law and Poverty, which was that the ED have expertise not only in private market programs but also in public programs.

The Exchange Establishment Grant Subcommittee, consisting of only Kim Belshe, jokingly reported meeting “24-7” and achieving a “striking degree of unanimity”. Belshe has already begun working with Powers to delve deeper into the opportunities available through these federal grants. They reported attending an Exchange establishment meeting in Denver and having learned more about the grants, are planning to come to the Board at the next meeting to recommend action, potentially to change the level of grant the state applies for. The thinking is that rather than submit a long term Level II grant in September, the Board may submit a Level I grant in June, and take a little more time with the larger Level II grant that requires a four-year budget.

The remainder of the agenda consisted of 4 expert presentations on policy issues that will impact the exchange: An overview of the Individual and Small Group Markets, Projections of Potential Exchange Enrollment, the Small Business Health Options Program (SHOP), and the Basic Health Program Option. You can find the presentation materials on the Exchange website. (Speaking of which, there are a couple fake exchange websites out there that are run by agents and brokers, so look for the real thing at www.healthexchange.ca.gov)

The presentation about the Basic Health Program Option spurred a robust discussion about the impact a basic health program might have on the Exchange. A basic health program would take 95% of the funding that would have gone to providing subsidies to individual between 133% and 200% of the Federal Poverty Level, and use that money to provide alternative coverage that is intended to be more affordable. First and foremost, there is concern for the feasibility of “buying more for less” and whether this is possible. Secondly, many advocates expressed concern that this would mean taking a significant subset of people out of the exchange, and an even more significant portion of the heavily subsidized population (since subsidies are provided on a sliding scale, those with 133-200% will be receiving the highest subsidies) out of the Exchange, potentially harming both the purchasing power of the Exchange. There was discussion of what the impact of this would be on the risk mix of the Exchange, but without better data on the health status of individuals eligible for each option, it is difficult to draw concrete conclusions. SB703 (Hernandez) is a bill that would establish a Basic Health Program, and that is moving through the legislative process right now.

The California Health Care Foundation is sponsoring a briefing tomorrow May 12 at the Capitol at which they plan to reveal findings from their studies on the Basic Health Programs.

Also of note, the Low Income Health Programs, or county based Medi-Cal expansion programs that we have been advocating for along with our colleagues at Western Center on Law and Poverty and others, was mentioned several times as an important vehicle as early enrollment and a bellwether to learn from. Monitoring the implementation of the LIHPs will likely prove instructive for broader expansions in 2014, specifically by providing sample population characteristics such as health status of those who take up health care expansion, as well as providing lessons learned on eligibility and enrollment and other implementation mechanisms. Health Access has an organizing resource website about the LIHPs, to help Californians advocate for these LIHPs in their home county.

The Exchange Board will meet again on May 24, and that meeting will be webcast. More details to come.
Health Access California promotes quality, affordable health care for all Californians.
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