Covered California, the Golden State’s health insurance marketplace, leaped into its open enrollment period at its headquarters in Sacramento on Thursday morning, commissioning a choreographer and dancers to depict how unexpected life events can leave people thankful they have medical coverage.
“Health insurance is … not about what you plan for,” said Peter V. Lee, Covered California’s executive director. “It’s about what you don’t plan for. One out of 10 of the people in Covered California will have health care costs over $5,000, most of which will be covered by insurance.”
In 2017, Lee said, roughly 22,000 of Covered California’s 1.4 million consumers had a dislocated, sprained or broken arm or shoulder, nearly 9,000 enrollees were treated for whiplash or back injuries, and more than 6,000 had broken ankles. These are a few statistics to illustrate how life changed in an instant for many Californians.
“Those are on the ‘small’ end” in terms of cost, Lee said. “Let’s take that up a notch: About 15,000 of our enrollees had health-care costs of over $50,000. Dozens have had claims over $1 million. And, yes, many of those are cancer....If you get cancer, you don’t want to be worrying about your mortgage or holding onto your house. You want to be worried about getting the best care possible, and that’s what good insurance provides: access to the best possible care.”
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The choreographer for Thursday’s dance routine, Rob Schultz, said that working on this project had brought his health-care journey full circle. In 2003, Schultz said, he learned he had a birth defect that left him susceptible to pancreatitis. It wasn’t a quick diagnosis, however.
“I got misdiagnosed three different times until I went to Cedars-Sinai,” said Schultz, a Detroit-area native who moved to Los Angeles to work in the entertainment industry. “My family flew out because the doctors didn’t know what was happening and my body was shutting down. They didn’t know whether I would make it.”
He was in the hospital for a month and lost more than 50 pounds, he said, and the bill was $285,000.
At the time, Schultz’s health insurance coverage all depended on whether he made enough income to qualify for coverage from his union, the Screen Actors Guild. That year, he did, he said, but in 2017, he didn’t.
“I wasn’t getting paid enough to get insurance, and I was freaking out,” Schultz said. “I checked into Covered California, and I didn’t know if I would even be considered. I applied and I got covered. The subsidy made it affordable.”
Lee said that nine out of every 10 Covered California enrollees qualify for a subsidy from the federal government that will help reduce their premiums. It’s vital, Lee said, that the population who receive subsidies include a large base of healthy people. Otherwise, costs go up for those who don’t get assistance with their premiums.
Covered California estimates that 1.1 million state residents are currently eligible for coverage but haven’t signed up, Lee said, and without big spending on marketing, his agency won’t attract the healthy risk pool that allows insurers to control payouts. Covered California will spend $40 million on television, radio and digital advertising, four times as much as the federal government will spend on advertising in its 34 marketplaces.
Covered California also asked Schultz and other choreographers to come up with dance routines that capture the spirit of one of the organization’s slogans: “Life can change in an instant.”
Every year, Lee embarks on a multi-day, multi-city bus tour where he hosts open enrollment kickoff events and uses the arts to promote health coverage. Schultz, who choreographed routines for both Los Angeles and Sacramento, said he usually sees moving images in his mind that he feels will tell a story.
The Sacramento routine starts in a parklike setting where a skateboarder has an unexpected fall and a young mother goes into labor, he said, and they end up going to the hospital at the same time.
“There’s this moment where it’s like, ‘Oh, gosh, what will happen?’” Schultz said. “Then we take them behind a curtain that represents the hospital, and through the number, they show the freedom of knowing that they’re covered. I don’t think people really understand sometimes that having insurance is a blessing. You don’t have to stress out. All that money doesn’t have to come out of your pocket.”
Insurance agent Bubi Gorgevich, with Health Markets in Citrus Heights, said his clients are often surprised by just how little they have to pay toward their premiums when they qualify for subsidies. Some enrollees pay nothing, Lee said, and others pay as little as $50 a month.
Gorgevich said he tries to help people understand that, when they don’t have health insurance, they and their family members are less likely to seek preventive care or to go to the doctor when they feel sick.
“Early detection of diseases helps survival,” he said “If you have people in your family … not getting coverage, they’re going to neglect doctor visits because they don’t have coverage, so there’s a ripple effect. It could lead to procedures that are very expensive, and people have to sell their houses, declare bankruptcy or do whatever it takes for them to survive.”
Even people with employer-based coverage don’t think they’re going to get sick until they get sick, Lee said, and that’s why Covered California’s marketing and advertising efforts encourage, remind and perhaps even harangue potential enrollees. Unless state residents lose their jobs or have another special life circumstance, they can sign up for coverage from Covered California only during open enrollment. It ends Jan. 15, but to ensure coverage begins on Jan. 1, consumers must sign up by Dec. 15.
California and nearly a dozen other states opted to create state-based health exchanges under the Patient Protection and Affordable Health Care Act, often referred to as Obamacare, that went into law in 2010. That act also mandated that insurers could not deny coverage to people with pre-existing conditions at no additional cost, and it defined what health benefits are considered essential as part of any policy.
Covered California has taken this concept a step further by ensuring that enrollees in its most popular plans do not have to pay any deductible fees when seeking outpatient services. In most employer-based plans, workers must annually pay deductibles totaling thousands of dollars before their insurance coverage starts.
“The last thing we want is to have insurance (plan designs) being a barrier to you getting the care you need when you need it,” Lee said. “That’s why every one of the health plans we offer have the same benefit designs that don’t play gotcha games with the coverage.”