Joe Mathews: If Obamacare flourishes anywhere, it’ll be San Diego

Supporters of Covered California hold signs during a promotional stop last month in San Jose, but it may be in San Diego where Obamacare has the most early success.
Supporters of Covered California hold signs during a promotional stop last month in San Jose, but it may be in San Diego where Obamacare has the most early success. The Associated Press

Will San Diego have America’s finest Obamacare?

Yes, it’s way too early for any verdicts about the Affordable Care Act, even in California, which has embraced this messy mashup of a law more rapidly than almost any other state. It may be that we’ll never be able to evaluate Obamacare coherently; it’s simply too complex and contradictory.

But if Obamacare is ever to fulfill its core promises – of bringing health coverage to those without, of innovating the health care business and of improving community health – I’d bet those promises get fulfilled in San Diego first.

Why does place matter in how a big federal law plays out?

Because the heart of Obamacare is the creation of healthy, competitive regional markets for health coverage. When you buy a health insurance plan in one of these markets – the so-called exchanges such as Covered California – you are not buying into a national or state plan but into a regional plan.

California is divided into 19 such regions. And in building its regional market, San Diego already holds a lead, as no other market in California has more insurance carriers offering plans. While some sections of Southern California lagged in health coverage enrollment, San Diego nearly tripled projections.

Those enrolling in San Diego can choose from among a broader, more diverse mix of high-quality health providers than what is available in less populous regions of California. The fact that San Diego County is all in one Obamacare region (Region 19) may make Obamacare less confusing than in greater Los Angeles or the Bay Area, which are divided up into multiple regional markets.

San Diego also is distinguished by how its providers have embraced Obamacare.

One of its two dominant local health providers, Sharp, set a tone by seizing on the Affordable Care Act more fervently than any other company in California. Most strikingly, Sharp, which is both a health care provider and an insurance plan, entered the individual market for health insurance plans with the advent of Obamacare. In its first year, it secured more than 10 percent of the Covered California plans sold in the San Diego market.

And when it comes to building a new, more technologically advanced health system in the future, San Diego is extraordinarily well positioned. Its regional economy combines strong research institutions with strong life science, pharmaceutical, software and communication industries, making it a potential leader in the emerging “mobile health” industry.

“If intelligent people work hard to take advantage of the distinctive combination of industries that are already thriving in San Diego,” said a recent article in the journal of UC San Diego’s Rady School of Management, “we can create relationships that will result in the technology innovation that the health care market needs.”

That may sound overly optimistic this weekend, as phone lines jam and websites crash with Californians trying to beat the Monday deadline to renew, add or change their health plan. But, at the very least, San Diegans should be able to find people to help them figure out Obamacare.

On one rainy weekday last week, I found a half-dozen different places with special services to help me with existing or new coverage. That evening, at a Sharp Health Plan office off Highway 163, I dropped by a free seminar that offered a warts-and-all explanation of the Affordable Care Act and the choices facing San Diegans.

Maybe it’s because it’s Christmastime, but the Sharp people – in a style reminiscent of “Miracle on 34th Street,” when the department store Santas send customers to competing stores – talked up the virtues of competitors’ health plans as well as their own. At the end, I was invited to attend a future “enrollment lab” where Sharp staffers with iPads would help me get online and navigate the website maze.

Navigating Obamacare is an unpleasant chore, but it might be a little less unpleasant in America’s Finest City.

Joe Mathews is California and innovation editor at Zócalo Public Square, for which he writes the Connecting California column.