By Stephanie McCrummen, Published: November 23, 2013


BREATHITT COUNTY, KY. — On the campaign trail, Senate Minority Leader Mitch McConnell was still blasting the new health-care law as unsalvageable. At the White House, President Obama was still apologizing for the botched federal Web site.

But in a state where the rollout has gone smoothly, and in a county that is one of the poorest and unhealthiest in the country, Courtney Lively has been busy signing people up: cashiers from the IGA grocery, clerks from the dollar store, workers from the lock factory, call-center agents, laid-off coal miners, KFC cooks, Chinese green-card holders in town to teach Appalachian students. Read more...

By Leesa Tori, Principal & Founder, The Tori Group

Not surprisingly, the last few weeks’ buzz was pretty loud from folks receiving cancellation notices on their health insurance policies. And why shouldn’t it have been? Wasn’t health care reform designed to make coverage more accessible, not less?

To turn down the volume on this, the Administration decided to permit plans on track for cancellation to exist for as long as another year, to help out folks who don’t want to contend with making a switch.  But here in California, it was decided that such an approach was missing the point. In fact it was referred to as “the tail wagging the dog,” where at best it would just put off for another year the inevitable cancellation of inferior health plans, and at worst jeopardize the delicate balance of repairing a broken health insurance system.

The plans that are being discontinued are generally part of the capricious, expensive, and not particularly pretty individual health insurance market – the slice of the population that does not have coverage through an employer or other group, either because it’s not offered or because what’s offered is not appealing. Sometimes from the self-employed contingent of the workforce, other times from small businesses not offering their own employee coverage, these folks have until now been a captive population with few choices, more often than not on the high-risk side of health insurance consumers. They’ve been between a rock and a hard place for a long time and have had to contend with raided benefits, increasing premiums, and rising deductibles. Policy cancellations seem like another slap in the face. Until one has all the facts.

These cancellations are happening for good reason. Many of the health insurance plans that are going away did not meet new minimum standards for health care plans under the ACA. Some lacked prescription drug coverage, while others didn’t provide maternity care or mental health benefits. These skimpy plans are being phased out, and good riddance to them, so that plans with robust, comprehensive offerings will be universally available.

We know that if healthy, low utilizers don’t enroll and only high utilizers do, our health insurance system will remain broken. Risk must be spread over populations of various levels of utilization. Ensuring that everyone enrolls, regardless of their health status, in a plan meeting minimum standards, is what’s going to make health insurance successful in the United States.

The good news is that folks are being offered new, better plans, either by their state health insurance exchanges or their insurance carriers. And many of those whose policy prices are going up are eligible for a share of the Federal set-aside of subsidies and tax credits. Prolonging the life of plans that need to be put to rest because they don’t meet new, minimum Federal standards stands in the way of everyone having the same basic health insurance coverage -- the only way to truly spread costs.

And for some, this is a bitter pill.

Because these new plans are more robust, they cost more. In fact, even some plans that are not being substantially enriched are increasing in price. This is the inescapable upshot of moving from a system where premium prices were determined by factors like health status, which kept a lot of people from being insured to begin with, to one where everyone gets to join the club. For these consumers, population statistics don’t ease the sting of writing a bigger check every month, which is why this is only the beginning of health care reform. Step one was to ensure that everyone could purchase coverage. Step two will be to improve delivery, lower costs, and identify new efficiencies.

What needs reiterating is that the individual plans in which many are enrolled are not being cancelled per se. Rather, they are being morphed into plans that meet basic requirements under the new rules of the ACA. No more bailing on mental health coverage, maternity plans, or prescription drugs. This way, with both the folks who have immediate need for these features, and folks who don’t (and may or may not in the future), paying into the pool, costs are spread around and insurance works the way it’s supposed to.

So long to the inferior plans and welcome to the new ones.  Now everyone has an equal chance for the same health care coverage (and for those who can afford to “buy-up,” go right ahead). The decision by California to stay the course and continue requiring the cancellation of noncompliant plans to keep everyone equally in the risk pool, was made not made lightly. Much heated and late-into-the-night discussion and debate surrounded how to continue moving California toward the goal of equal coverage for all. Washington had best interests at heart by allowing states to consider postponing cancellation of noncompliant health plans. But this approach only would have served to delay the inevitable. The plans would eventually have to be done away with. A 12-month extension would just present the same problem again in a year.

With health insurance coverage both required of and available to all Americans, the wealthiest country in the world is at last making sure one of the most basic of human needs is within the reach of every one of its citizens.

Access, Affordability, and Insurance Complexity Are Often Worse in the United States Compared to 10 Other Countries 

A 2013 survey conducted in 11 countries finds that U.S. adults are significantly more likely than their counterparts to forgo health care because of the cost, to have difficulty paying for care even when they have insurance, and to deal with time-consuming insurance issues. Read more...

One of the most important tasks that the state of California faced in preparation for the October 1 launch of its new Affordable Care Act health insurance exchange, Covered California, was training thousands of employees and stakeholders to ensure all Californians got the information they needed in a timely, accurate and consistent manner.

In order to ensure that training the remaining 40,000 or so people continues on course, The Tori Group has been tasked with developing Covered California University.

Using a corporate university model, The Tori Group partner Kathleen Solorio will head up the integration of multiple Covered California learning programs.

Covered California offers training, and in some cases, certification, to five primary groups involved in helping Californians get enrolled in health insurance. They include: 1) Covered California Service Center staff, 2) Certified Enrollment Counselors (in regional organizations), 3) health insurance agents and brokers, 4) health insurance plan-based enrollment staff, and 5) county workers enrolling Medi-Cal individuals and families.

While training for these five constituent groups has been developed and is currently being delivered, there is more work to be done to develop a formal training and information sharing structure. This includes standardizing processes to ensure uniformity across the various learning portals, where operations and practices will be centralized for consistency and greater efficiency.

The top-level objective is to make sure everyone, regardless of where Covered California touches their work, is provided accurate, timely, and consistent information so that in the end, all Californians get the best service possible to help them get the health insurance Covered California was created for.

Part of this challenge involves transitioning the three departments that house all Covered California training from launch to operational mode. These departments include a curriculum design center, an enterprise content management component and a learning management system where training information is stored and tracked.

Kathleen said, “It is exciting to be able to contribute to this project, and help ensure consistency among all components of Covered California training, so Californians get the best service possible from this groundbreaking program.  We need to make sure that each department, while it may be reaching out to different customers, is sure to provide consistent and accurate information about the program.”

It’s estimated that Covered California University will be fully operational early 2014.