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Exchanges can learn from enrollment success in California


California matters. The state is very influential in many political, social and governmental issues. And when it comes to healthcare reform and health insurance exchanges, it has become a bellwether, serving as a barometer of success for other state and federal online marketplaces.

Why does California matter? For starters, the state has the largest population of subsidy-eligible consumers, and it accounted for 23 percent of all enrollment in the health insurance exchanges last year, according to a recent Health Affairs blog post.

"California is a giant state with a big and diverse uninsured population that has embraced the law, has political will, has money for outreach ... and has been out front implementing the Affordable Care Act," Drew Altman, CEO of the Kaiser Family Foundation, said at a briefing last month. "So both its successes and its challenges, they really matter for other states, and they really matter for the country."

What's more, California already has surpassed its own enrollment goal of signing up 580,000 consumers by March 31. As of mid-February, the online marketplace Covered California had enrolled almost 830,000, and 80 percent of those consumers already paid their first month's premium.

With only two more weeks left in the open enrollment season, "California has a solid foundation of enrollees and has made significant progress in reaching the state's uninsured population," Richard Scheffler, a professor of health economics and public policy at the University of California, Berkeley, wrote in the blog post. "The enrollment mix, affordability, access, and choice in California are sure to be carefully watched throughout 2014 as these and other health reform policies continue to unfold."

That's why California's exchange offers a template of sorts, indicating what steps state and federal officials should and shouldn't take in implementing their own marketplaces. And since many state exchanges still face technical glitches and other obstacles, they could benefit from exploring Covered California's strategies.

Minnesota's exchange, which still suffers from functionality and technical problems, could certainly learn a lesson or two from California. As could Maryland, whose exchange has faced such IT glitches that lawmakers are considering switching to the federal marketplace.

Of course, Covered California also has had to address its share of obstacles. Perhaps the biggest roadblock has been reaching out to Latinos, who make up 46 percent of the state's subsidy-eligible residents. Yet, only 18 percent of its enrollees were Latino at the end of last year. To boost Hispanic enrollment, state officials launched several campaigns specifically geared to this population, and Covered California also hired hundreds of new customer service workers, many of whom are bilingual. As a result of those efforts, Latinos now comprise 28 percent of all California exchange enrollees.

California officials still have a lot of work to do to reach out to the Hispanic population and motivate them to enroll in the exchange, but they've certainly made progress. I hope other states can find similar achievements in their exchange enrollment process. - Dina (@HealthPayer)