California earns top marks as a model of how health care insurance exchanges can be run, according to a Brookings Institution analysis released Thursday.
The report compared California’s state-run marketplace, Covered California, with health care exchanges under the Affordable Care Act in four other states: Florida, Michigan, North Carolina and Texas. Some states, like California, embraced the mandatory health program, while Texas and Florida actively opposed it, the study noted.
The report, initiated before last year’s presidential election, sought to identify why certain states under the mandatory health program have succeeded in creating a competitive marketplace for health plans and how less successful states might improve.
California, which dropped its uninsured rate from 17.2 percent to 8.1 over four years, was deemed the “most successful” of the five states studied. The report attributed that to several factors: Covered California’s ability to “somewhat aggressively” negotiate premiums with insurers; its insistence on consistent benefit offerings among all insurers; a large and stable number of insurers – 11 – offering plans; and a large network of “navigators” (community groups and individuals who helped enrollees sign up).
The study was released as congressional Republicans debate how to implement President Donald Trump’s plan to “repeal and replace” the mandatory health insurance plan known as Obamacare.
“Whether you’re doing repeal-and-replace or a single-payer system, you need competition among hospitals and doctors in local markets (to ensure) good outcomes. That is really being missed in the debate in Washington, D.C.,” said Micah Weinberg, president of the Bay Area Council Economic Institute, who helped analyze California’s experience. “We’re not focusing on the competition among providers, which is most important in creating positive outcomes.”
Competition among insurers, hospitals and health providers was cited as a primary factor in whether insurance companies were able to stay financially whole and keep consumer premiums affordable, the study noted. But even in states like California, premium costs varied from region to region.
Weinberg said current proposals to replace the federal health program – such as by allowing insurers to cross state lines and issuing Medicare funds to states as block grants – are missing the bigger, critical point. “Those are almost accounting gimmicks that don’t get at the underlying issues that are significant in determining whether people have access to high-quality health care at an affordable price,” Weinberg said. “I hope people can see past the politics, which are terrible right now, to learn the lessons of California’s success.”