Editorial: State must ease sign-up for health coverage

Published: Friday, Mar. 1, 2013 - 12:00 am | Page 14A

The Affordable Care Act, also known as Obamacare, requires individuals to have health insurance starting in January 2014. Yet with just eight months to go before an October online launch to get people signed up, much remains to be done to revamp an enrollment system that is antiquated and heavy on paperwork.

By January 2014, Californians who currently don't get insurance through an employer or can't afford individual market insurance will be able to apply for coverage through the state. Depending on their income, individuals either will buy insurance in the state's exchange, called "Covered California," or get coverage from Medi-Cal, the joint state-federal insurance plan for lower-income people.

The process of accessing coverage should be as easy and burden-free as possible.

The old days of searching for paper pay stubs, bank statements, utility bills and other documents should be greatly reduced in this high-tech era, where states can check address, citizenship, employer and income information electronically and get people covered quickly – without in-person lines, crowds or 45-day delays.

Manual checks of paper documentation should, of course, be a fallback where electronic data does not match information provided by the individual or electronic data doesn't exist for that person on a key element.

Early on, Gov. Jerry Brown had proposed amendments that would have the state stick with the current outdated paper verification system. But Health and Human Services Secretary Diana Dooley told The Bee editorial board on Thursday that has changed with new federal guidance released Feb. 21. Dooley said California is committed to checking residency and income electronically as a first choice, and where that doesn't work, using the old paper system as a backup.

This needs to get settled quickly. Information technology experts need to know now how the governor and legislators want verification to work so they can program it in time for the October enrollment launch.

A California HealthCare Foundation-sponsored presentation, "Data Match: Streamlining Eligibility and Enrollment Under the Affordable Care Act," suggested that it is a waste of time and money to be manually collecting and checking paper documents for all individuals when information can easily be accessed electronically from state and federal sources. Electronic verification also is amazingly accurate, with very small numbers of errors and fraud. Assuring program integrity is extremely important.

The federal government is establishing a "Federal Data Hub" to coordinate information on citizenship, immigration status and federal tax information across several agencies – Homeland Security, Treasury, Internal Revenue, Social Security.

The state also has electronic databases for checking residency and income – from the Department of Motor Vehicles to state quarterly wage reports from the Employment and Development Department to tax filings from the Franchise Tax Board. The state already checks neighboring states – Nevada, Oregon and Arizona – to make sure people aren't double-dipping for public assistance programs.

But no electronic verification system can be effective for 100 percent of individuals. Paper backup in these cases still will be needed – as in cases where computer systems crash temporarily.

As we move to a culture of coverage – where individuals have to carry health insurance – we need to eliminate excessive bureaucracy and unnecessary complexity. It is time to move California's enrollment system into the 21st century.

If people are required to be covered, as they are under the Affordable Care Act, the process for getting coverage should be easy to understand and navigate, saving the state administrative costs, too.

The governor and Legislature need to get a sense of urgency about this, as the enrollment launch is a short eight months away.

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