Lisa Aliferis: There were 144,000 new enrollees in the first month of open enrollment that ended Monday (Dec. 15). Covered California has a goal of adding 500,000 people by Feb. 15, when open enrollment ends. This is in addition to renewing their current 1.2 million members.
Shafer: The renewal deadline is Sunday (Dec. 21) at midnight. What happens to those who miss that deadline?
Aliferis: If people miss the deadline, Covered California says they can reapply anytime until Feb. 15. The agency says they will release information on how many people renewed in January.
Shafer: It’s seems like yesterday that the launch of Obamacare was such a disaster. That overshadowed California’s effort. But looking back, remind us how that first year went.
Aliferis: Covered California worked remarkably well in comparison to healthcaregov. Yes, there were problems, but nothing like on the national scale.
Remember that Cov CA had sought to enroll 560,000 people. That was their conservative goal before open enrollment started in October, 2013. The agency ultimately more than doubled that number in enrollment.
But there were also challenges. Initially Covered California had very low enrollment from Latinos, who pre-ACA made up 60 percent of the uninsured. The agency was broadly criticized in January, then changed course and ended up with solid enrollment. Covered California says it is doing even more outreach to Latinos this year.
There continue to be problems around the so-called "narrow networks." Insurers negotiate lower rates with doctors in exchange for delivering higher volume. Insurers say that's what helps keep premiums low. The problem is that plenty of consumers signed up believing their own doctors to be in network, but then it turned out they weren't.
The Department of Managed Health Care investigated numerous consumer complaints and in November ruled that two major insurers, Blue Shield and Anthem Blue Cross, both violated state law because they listed doctors in their network, when they really weren't.
A new state law requires the Department of Managed Heatlh Care to more closely monitor the Covered California networks.
Shafer: The U.S. Supreme Court has agreed to hear another case challenging the Affordable Care Act. What exactly is the basis for this case, and what’s at stake in the outcome?
Aliferis: The case, King v. Burwell, challenges the very heart of the Affordable Care Act -- that is, the subsidies that help millions of people nationwide and in California afford their premiums.
At issue is a phrase in the law that says the subsidies are only available in exchanges run by a state. Supporters of ACA say it was not Congress' intent to exclude people in the three-dozen states that are using the federally-run marketplace healthcare.gov from subsidies.
If the Supreme Court decides that the letter of the law stands, millions of people in those three dozen states would lose their subsidies. They would no longer be subject to the individual mandate, since they would not have access to affordable health insurance. Most experts say that the ACA would be completely destabilized.
Under such a Supreme Court decision, Californians would still, under the law, be eligible for subsides, but if the whole Act falls apart, it doesn't make much difference.
Some experts do believe that if the Supreme Court rules to exclude people in healthcare.gov states from subsidies, that Congress will not let the Affordable Care Act collapse, that Congress would fix it. I'll leave it to viewers to decide if that's going to happen under a Republican controlled House and Senate in Washington.
Shafer: Last time Chief Justice John Roberts was the surprise swing vote in a 5-4 decision mostly upholding the ACA. There's a lot riding on a court that’s often hostile to the Administration.
Undocumented immigrants are explicitly banned from getting health coverage through the ACA. But here in California, a bill called “Health For All” would extend coverage to them. How would that work?
Aliferis: "Health for All" would do two things. It would expand Medi-Cal to undocumented immigrants who qualify by income. It would also create a "mirror" exchange – a separate health insurance marketplace with subsidies available – for undocumented immigrants.
This would be expensive and the bill died last year when no funding stream was identified. I'm told there's a lot of support among the legislative leadership for this bill, and that they will be talking about ideas for funding come January.