As open enrollment looms, officials reflect on the challenges ahead

As Covered California officials prepare for the upcoming open enrollment, they are learning from last year’s missteps and gearing up for new challenges ahead.

Enrollment kicks off Nov. 15. The goal is to keep 1.2 million people on board and enroll 500,000 more by its conclusion three months later.

“By many accounts, California was successful, but it was, often times, in spite of some very real barriers,” said Anthony Wright, the executive director of Health Access California, a consumer advocacy group. “We hope, with a year under our belt, we’ve resolved some of those issues and the second open enrollment will be smoother than the first.”

This week, Covered California executive director Peter Lee spoke of lessons learned during the previous enrollment, such as the need for more face-to-face counseling and call center staff. Adding more staff to its three call centers could help alleviate the long wait times that frustrated many consumers. California Healthline reported in March that about 33 percent of callers reported a busy signal when they called, and fewer than five percent of calls were answered within 30 seconds.

Not all technical issues will be resolved in time for the upcoming enrollment. For example, Health Access’ Wright would also like to see better usability for the exchange’s  trouble-plagued online provider directory, which was supposed to advise users which physicians participate in each of the exchange’s health plans. Along with increased accuracy – the directory was riddled with errors — Wright would like to see provider quality ratings to help consumers select the best available option when the directory goes live again, something that likely won’t happen before November.

One of the largest criticisms leveled at California’s exchange involves the state’s outreach in diverse communities. Even though Covered California reached its goals in each of the major racial categories, it far exceeded those benchmarks in some communities while just meeting them in others, Wright said.

In July, Covered California announced it would award $16.9 million in grants for education and outreach during the second open enrollment season, and was seeking organizations that provide outreach to the state’s diverse populations. And, this week, Covered California launched its 2014 outreach efforts with a $46 million advertising campaign focusing on TV commercials as well as print, radio and social media.

Still, it’s a challenging road ahead.

This series from California Health Journalism Fellow María G. Ortiz-Briones explores some of the barriers to enrollment in the Latino community, such as fear in mixed status families that their legal status would be shared with immigration officials. And, here’s a comprehensive Q&A with executive director Lee about lessons learned after “a rocky start with Latinos.”

Better communication in people’s native languages is important for diverse groups throughout the state, according to insurance agent Evette Tsang, who works with many Chinese Americans in the Sacramento area and beyond.

“The Latino community gets a lot of publicity, but for the Chinese community, there are also a lot of obstacles,” she said. “They can’t understand the letters. They get put aside and they don’t take any action.”

On a broader level, the marketing message this time around will emphasize the economic value of health coverage, and the financial security it brings, said Wright, who also serves an advisory role on Covered California’s marketing committee.

A powerful message is especially important since this year’s upcoming enrollment season will be half as long, time wise, and “twice as hard,” he said. That’s because the easiest to reach and most motivated consumers have already signed up.

Many of the remaining uninsured are people who have been uninsured for two years or longer. They may be people who may have gotten used to home remedies or perhaps acclimated to using the emergency room for care.

“They’re folks who are disconnected from the system,” Wright said. “How can we go from a culture of coping to a culture of coverage?”

The marketing campaign will stress that health coverage can prevent unexpected health bills or even bankruptcy, appealing to people’s need for financial security.

For consumers already enrolled in Covered California, open enrollment provides a chance to take a close look at plans and compare possible cost savings, Wright said.

“In the old world, people were not just locked out of health care because of preexisting conditions, but they were locked into their health plans,” he said. “In this new world, if you don’t think your health plan is giving you good service or a good deal, you can switch plans in open enrollment. You might want to take another look.”