{{Short description|Health insurance marketplace in California, U.S.}} {{Infobox government agency | agency_name = Covered California | seal = | logo = Covered California logo.svg | formed = | jurisdiction = Health insurance marketplace for U.S. state of California | employees = | budget = | chief1_name = Jessica Altman | chief1_position = Executive Director | chief2_name = | chief2_position = | chief3_name = | chief3_position = | chief4_name = | chief4_position = | chief5_name = | chief5_position = | chief6_name = | chief6_position = | chief7_name = | chief7_position = | chief8_name = | chief8_position = | chief9_name = | chief9_position = | parent_department = | website = [http://coveredca.com coveredca.com] }}
'''Covered California''' is the health insurance marketplace in the U.S. state of California established under the federal Patient Protection and Affordable Care Act (ACA). The exchange enables eligible individuals and small businesses to purchase private health insurance coverage at federally subsidized rates. It is administered by an independent agency of the government of California.
==History== [[File:Gavin Newsom and Ann O'Leary in a Covered California PSA.ogg|thumb|California Governor Gavin Newsom and Chief of Staff Ann O'Leary in a public service announcement about Covered California in 2019.]] California was the first state in the U.S. to set up a health insurance marketplace.<ref name=Colliver2012>{{cite news |url= http://www.sfgate.com/health/article/Health-care-exchange-will-offer-policies-3675063.php |title=Health care exchange will offer policies |first=Victoria |last=Colliver |work=San Francisco Chronicle |date=November 12, 2012 |accessdate=April 16, 2015}}</ref><ref name="Haeder and Weimer 2013">{{cite journal|last1=Haeder|first1=Simon|last2=Weimer|first2=David|title=You Can't Make Me Do It: State Implementation of Insurance Exchanges under the Affordable Care Act|journal=Public Administration Review|volume=73|issue=s1|year=2013|pages=S34–S47|doi=10.1111/puar.12065}}</ref> The California Health Benefit Exchange was created in September 2010 when then-governor Arnold Schwarzenegger signed Assembly Bill 1602, (the "California Patient Protection and Affordable Care Act"),<ref name=AB1602>{{cite web|url=http://www.leginfo.ca.gov/pub/09-10/bill/asm/ab_1601-1650/ab_1602_bill_20100930_chaptered.html | title = AB 1602, Statutes of 2010, Chapter 655|accessdate=April 16, 2015}}</ref> by Assembly Speaker John Perez, and Senate Bill 900,<ref name=SB900>{{cite web|url=http://www.leginfo.ca.gov/pub/09-10/bill/sen/sb_0851-0900/sb_900_bill_20100930_chaptered.html| title = SB 900, Statutes of 2010, Chapter 659|accessdate=April 16, 2015}}</ref> by State Senator Elaine Alquist, into law.<ref>{{Cite web|last=|first=|date=|title=California Legislative Information|url=http://leginfo.legislature.ca.gov/|archive-url=|archive-date=|access-date=|website=California Legislative Information}}</ref> Organizations such as the California Taxpayers Association and California Chamber of Commerce and Anthem Blue Cross had opposed the bills in whole or in part, but Schwarzenegger had made Obamacare in California a priority.<ref name=Jewett2010>{{cite web|url=http://californiawatch.org/dailyreport/schwarzenegger-approves-new-health-exchanges-not-without-fight-5273|title=Schwarzenegger approves new health exchanges, but not without a fight|date=October 4, 2010|accessdate=April 16, 2015|archive-url=https://web.archive.org/web/20150417133024/http://californiawatch.org/dailyreport/schwarzenegger-approves-new-health-exchanges-not-without-fight-5273|archive-date=April 17, 2015|url-status=dead}}</ref>
The program was named "Covered California" in October 2012.<ref>{{cite news|first=Pauline|last=Bartolone| url=http://www.kpbs.org/news/2012/oct/30/covered-california-new-name-californias-health-ben/|title='Covered California' the New Name for California's Health Benefit Exchange|date=October 30, 2013|publisher=KPBS.org|accessdate=April 16, 2015}}</ref> Efforts to educate potential enrollees about Covered California began in 2013, including $37 million in grants to 48 organizations.<ref name=Gonzales2013>{{cite news|first=John M. |last=Gonzales|title=Health reform's hard sell: State's diverse middle class|url=http://www.dailynews.com/health/20130825/health-reforms-hard-sell-states-diverse-middle-class |work=Los Angeles Daily News |date=August 25, 2013|accessdate=April 16, 2015}}</ref> Enrollment started on October 1, 2013;<ref name=Kupfer2013>{{cite news|first=Dina|last=Kupfer|title=Enrollment for Covered California Opens Oct. 1|url=http://archive.news10.net/news/local/article/257571/2/Enrollment-for-Covered-California-opens-Oct-1|work=KXTV News|date=September 16, 2013|accessdate=April 16, 2015|url-status=dead|archiveurl=https://web.archive.org/web/20150417130102/http://archive.news10.net/news/local/article/257571/2/Enrollment-for-Covered-California-opens-Oct-1|archivedate=April 17, 2015}}</ref> during the first month of operation, 35,364 people enrolled in health plans offered through Covered California, more than were enrolled through the website for the federal exchange (HealthCare.gov) in the same period.<ref name=Kardish2013>{{cite news |first=Chris |last=Kardish |title=State-Run Exchanges Signed Up More Than Healthcare.gov |url=http://www.govtech.com/federal/State-Run-Exchanges-Signed-Up-More-Than-Healthcaregov.html |work=Government Technology |date=November 4, 2013 |accessdate=April 16, 2015 |archive-url=https://web.archive.org/web/20141129042157/http://www.govtech.com/federal/State-Run-Exchanges-Signed-Up-More-Than-Healthcaregov.html |archive-date=November 29, 2014 |url-status=dead }}</ref> As of November 2013, over 360,000 people had completed applications.<ref name=Abram2013>{{cite news|first= Susan|last=Abram|title=Californians continue to enroll into Obamacare, but thousands will lose policies|url=http://www.dailynews.com/government-and-politics/20131121/californians-continue-to-enroll-into-obamacare-but-thousands-will-lose-policies |work=Los Angeles Daily News |date=November 21, 2013|accessdate=April 16, 2015}}</ref>
By the close of the first open enrollment period in April 2014, the number of people enrolled in Covered California was about 1.4 million; furthermore, another 1.1 million had signed up for Medi-Cal (California's Medicaid program, which was expanded as part of the ACA) through the Covered California web portal.<ref name=Colliver2014>{{cite news |url= http://blog.sfgate.com/chronrx/2014/04/17/covered-california-enrollment-numbers-surpass-goals/ |title=Covered California enrollment numbers surpass goals|first=Victoria |last=Colliver |work=San Francisco Chronicle |date=April 17, 2014|accessdate=April 16, 2015}}</ref><ref name=CC20140417>{{cite web |author=Covered California |title=Covered California's Historic First Open Enrollment Finishes with Projections Exceeded; Agents, Counselors, Community Organizations and County Workers Credited as Reason for High Enrollment in California (press release)|url=http://news.coveredca.com/2014/04/covered-californias-historic-first-open.html|date=April 17, 2014|accessdate=April 16, 2015}}</ref> In the second open enrollment period beginning in November 2014, Covered California's goal was to enroll 500,000 more people.<ref name=Abram2014a>{{cite news|first= Susan|last=Abram|title=Covered California, medical groups partner to push health insurance enrollment|url=http://www.dailynews.com/government-and-politics/20141202/covered-california-medical-groups-partner-to-push-health-insurance-enrollment |work=Los Angeles Daily News |date=December 2, 2014|accessdate=April 16, 2015}}</ref> The California Medical Association and other professional organizations pledged to work with Covered California to promote enrollments.<ref name=Abram2014a/> Furthermore, the United States Department of Homeland Security and immigrant rights groups tried to assure potential applicants that any personal information disclosed to Covered California would not be shared with U.S. Immigration and Customs Enforcement.<ref name=Abram2014b>{{cite news|first= Susan|last=Abram|title=Covered California works to ease deportation fears among Latinos|url=http://www.dailynews.com/government-and-politics/20141203/covered-california-works-to-ease-deportation-fears-among-latinos|work=Los Angeles Daily News |date=December 3, 2014|accessdate=April 16, 2015}}</ref>
There were 474,000 potential new enrollees by the end of the second regular open enrollment period in February 2015.<ref name=Abram2015>{{cite news|first= Susan|last=Abram|title=Covered California opens enrollment for uninsured who face tax penalties|url=http://www.dailynews.com/government-and-politics/20150220/covered-california-opens-enrollment-for-uninsured-who-face-tax-penalties|work=Los Angeles Daily News |date=February 20, 2015|accessdate=April 16, 2015}}</ref> It was announced that a special enrollment period would be held between February 2015 and April 2015 to reduce tax penalties in 2015 for 600,000 Californians who needed to pay a tax penalty in 2014 because they were uninsured.<ref name=Abram2015/>
== Coverage ==
=== Coverage levels === There are four options.<ref>{{Cite web|url=https://www.coveredca.com/individuals-and-families/getting-covered/coverage-basics/coverage-levels/|title=Coverage Levels|website=www.coveredca.com|language=en|access-date=2017-11-28}}</ref> Each will determine how much a consumer will pay. * '''Bronze level''': On average, the health plan pays 60% of covered health-care costs; the consumer pays 40%. * '''Silver level''': On average, the health plan pays 70% of covered health-care costs; the consumer pays 30%. * '''Gold level''': On average, the health plan pays 80% of covered health-care costs; the consumer pays 20%. * '''Platinum level''': On average, the health plan pays 90% of covered health-care costs; the consumer pays 10%. * '''Minimum coverage plan (worst-case scenario)''': If the consumer is under 30 and cannot afford the other plans, this is another option. It covers three visits with no out-of-pocket costs and free preventative benefits. The services will cost full price until the consumer spends $8,150. At that point, the services are covered completely by the health plan.
=== Essential health benefits === Since Covered California is a part of the Affordable Care Act, there are some essential health benefits that the insurance companies must offer to consumers. This is a list of a few services:<ref>{{Cite web|url=https://www.ehealthinsurance.com/obamacare/california|title=Obamacare in California Explained: A Complete Guide|website=www.ehealthinsurance.com|access-date=2017-11-28}}</ref> * Ambulatory services * Emergency/urgent care * Hospital care services * Maternity and newborn care * Mental health and substance abuse services * Prescription medication * Rehabilitation services * Laboratory services * Preventative and wellness care * Pediatric services
=== Dental care === This is not required in the health plan. All Covered California health insurance plans provide pediatric dental care. Adults have the option of choosing supplemental dental care services in their plan.<ref name="Coverage Basics">{{Cite web|url=https://www.coveredca.com/individuals-and-families/getting-covered/coverage-basics/|title=Coverage Basics|website=www.coveredca.com|language=en|access-date=2017-11-28}}</ref>
=== Vision care === This is not required in the health plan. Covered California provides vision care for children, but does not offer any for adults. However, Covered California will work with certain companies to offer vision care directly to the adults.<ref name="Coverage Basics"/>
==Governance, staff, and budget== Covered California is governed by a board composed of five members: the Secretary of the California Health and Human Services Agency or their designee as a voting, ex officio member; two members appointed by the Governor; one member appointed by the Senate Committee on Rules; and one member appointed by the Speaker of the Assembly.<ref name=Board>{{cite web |title=Board of Directors of the California Health Benefit Exchange|url=http://board.coveredca.com/ |accessdate=April 16, 2015}}</ref> All board members serve four-year terms.<ref name=Board/>
The first and current permanent executive director is Peter V. Lee. The current board includes CA HHS Secretary Dr. Mark Ghaly, chair, and Paul Fearer, Jerry Fleming, Dr. Sandra Hernandez, and Art Torres.<ref>{{Cite web|last=|first=|date=|title=Covered California website|url=https://board.coveredca.com/|archive-url=|archive-date=|access-date=|website=}}</ref>
The staff consists of 1,230 authorized positions in fiscal year 2014–15.<ref name=DOF>{{cite web|author=California Department of Finance|title=Salaries and Wages Information: 4800 California Health Benefit Exchange|url=http://dof.ca.gov/budget/historical/2015-16/salaries_and_wages/documents/4000.pdf|accessdate=April 16, 2015|url-status=dead|archiveurl=https://web.archive.org/web/20150417123637/http://dof.ca.gov/budget/historical/2015-16/salaries_and_wages/documents/4000.pdf|archivedate=April 17, 2015}}</ref> Covered California receives no funding from state taxes; as of January 2014, it had received $1.1 billion in federal funds, but needed to be self-supporting by January 2015.<ref name=Rauber2014>{{cite news|first= Chris |last=Rauber|title=Covered California gets $1 billion from feds|url=http://www.bizjournals.com/sanfrancisco/blog/2014/01/covered-california-tab-tops-1-billion.html|work=American City Business Journals |date=January 23, 2014|accessdate=April 16, 2015}}</ref> The estimated expenditures for personnel in fiscal year 2014-15 were $108 million.<ref name=DOF/> It is projected that in fiscal year 2015, that Covered California will have a multimillion-dollar deficit.<ref>{{cite news |last=Rauber |first=Chris |date=17 February 2015 |title=Covered California enrollment falls well short of 2015 goal |url=http://www.bizjournals.com/sanfrancisco/blog/2015/02/covered-california-enrollment-falls-well-short-of.html?page=all |newspaper=San Francisco Business Times |access-date=25 April 2015 }}<br/>{{cite news |agency=Associated Press |date=9 February 2014 |title=Covered California prepares for budget deficit |url=http://www.sfexaminer.com/sanfrancisco/covered-california-prepares-for-budget-deficit/Content?oid=2700643 |newspaper=San Francisco Chronicle |access-date=25 April 2015 }}<br/>{{cite news |first=Paul |last=Sisson |title=Health exchange projects deficit in 2015 |url=http://m.utsandiego.com/news/2013/dec/29/covered-california-deficit-2015/ |newspaper=San Diego Union Tribune |date=29 December 2013 |access-date=25 April 2015 }}</ref>
The fiscal year 2015-2016 was the last year that Covered California used federal establishment funds. The government extended funding for that year and gave approximately $100 million. After that year, Covered California has gradually reduced expenses to save their funds. In 2015, it proposed a budget of $332.9 million, leaving $194 million in reserve funding.<ref>{{Cite web|url=http://board.coveredca.com/meetings/2015/5-21/2015-16-Covered-CA-Budget-Summary-FINAL.pdf|title=Proposed Fiscal Year 2015-2016 Budget}}</ref> The actual budget adopted was approximately $335 million. In 2016, the proposed budget was $308 million, which was $28 million less than the year before.<ref>{{Cite web|url=http://board.coveredca.com/meetings/2016/5-12/2016-17-CoveredCA-Proposed-Budget.pdf|title=Proposed Fiscal Year 2016-2017 Budget}}</ref> The actual budget adopted was $320.9 million. For the fiscal year of 2017–2018, the proposed budget is $313.9 million.<ref>{{Cite web|url=http://board.coveredca.com/meetings/2017/05-18/CoveredCA_2017-18_Proposed_Budget-4-15.pdf|title=Fiscal Year 2017-2018 Proposed Budget}}</ref>
== Active purchasing == Covered California is unique among ACA marketplaces in actively using its "active purchasing" negotiating power to bargain for lower premiums, standardize benefit designs, and require improvements in quality and equity. This is in contrast with many other state exchanges without "selective contracting" ability, which must offer all qualifying products offered by insurers. Of particular notice to consumers, the standardized benefits reduce complexity and consumer confusion, allow for apples-to-apples comparisons for consumers, and encourage head-to-head price competition to lower premiums.<ref>{{Cite web|last=Imholz|first=Elizabeth|date=|title=Healthcare By Design: Consumer-Centric Benefits for California's Individual Market|url=https://advocacy.consumerreports.org/wp-content/uploads/2017/07/Healthcare-By-Design-July-2017.pdf|archive-url=|archive-date=|access-date=|website=Consumer Reports}}</ref>
==Participating insurance providers== As of 2024, 12 insurance companies are participating in the individual and family exchange:<ref name="r188">{{cite web | title=Covered California’s Health Plans and Rates for 2024: More Affordability Support and Consumer Choices Will Shield Many From Rate Increase | website=Covered California™ | date=2023-07-25 | url=https://www.coveredca.com/newsroom/news-releases/2023/07/25/ | access-date=2024-06-11}}</ref> *Aetna *Anthem Blue Cross *Blue Shield of California *Chinese Community Health Plan *Health Net *Inland Empire Health Plan *Kaiser Permanente *L.A. Care Health Plan *Molina Healthcare *Sharp Health Plan *Valley Health Plan (part of the Santa Clara County Health System) *Western Health Advantage (partnership of Dignity Health Sacramento and NorthBay Healthcare)
==Impact==
=== Uninsured Rate === As of 2015 the uninsured rate in California was 8.1 percent, a 9.1 percent decrease from the rate prior to the implementation of the Affordable Care Act. Of the 5.4 million Californians who gained health insurance coverage during this period, 1.4 million received coverage through Covered California, and 4.1 million received coverage from the expansion of Medi-Cal.<ref name=":0">{{Cite web|url=https://www.brookings.edu/wp-content/uploads/2017/02/ca-aca-competitiveness.pdf|title=A Study of Affordable Care Act Competitiveness in California|author1=Weinberg, Micha |author2=Kallerman, Patrick |date=February 2017|website=Brookings Institution|access-date=28 November 2017}}</ref> The number of individuals covered through the exchange has not increased significantly from the 1.4 million who enrolled during Covered California's first open enrollment period in 2014. During later open enrollment periods, as some individuals chose plans through the exchange, others become eligible for Medi-Cal coverage or received coverage through an employer.<ref name=":0" /> A 2014 analysis estimated that "between 1.1 and 1.3 million people will be enrolled in Covered California with subsidies at any point in time" due to the churn rate.<ref name="Roby2014">{{cite journal|last1=Roby|first1=Dylan|last2=Jacobs|first2=Ken|last3=Watson|first3=Greg|last4=Bronshteyn|first4=Alla|last5=Graham-Squire|first5=Dave|last6=Keller|first6=Michelle|title=Health care reform in the US: an analysis of implementation of the Affordable Care Act in California|journal=BMC Health Services Research|volume=14|issue=Suppl 2|year=2014|pages=P103|issn=1472-6963|doi=10.1186/1472-6963-14-S2-P103|pmc=4122896 |doi-access=free }}</ref>
=== Disparities in Access === As of 2017, 11 insurance companies offer plans through Covered California, however depending on the county in which an individual lives, the number of insurers can vary from two to seven.<ref>{{Cite journal|url=https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2016.0902|title=Consumers Buy Lower-Cost Plans On Covered California, Suggesting Exposure To Premium Increases Is Less Than Commonly Reported|author1=Gabel, Jon |author2=Arnold, Daniel |author3=Fulton, Brent |author4=Stromberg, Sam |author5=Green, Matthew |author6=Whitmore, Heidi |author7=Scheffler, Richard |date=January 2017|journal=Health Affairs|volume=36|issue=1|pages=8–15|doi=10.1377/hlthaff.2016.0902|pmid=28069841|access-date=29 November 2017|url-access=subscription}}</ref> A 2015 ''California Healthcare Foundation'' study found that the number of hospitals in an insurance network did not significantly affect the quality of care patients received.<ref>{{Cite web|url=http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20N/PDF%20NarrowNetworksLimitedChoice.pdf|title=Narrow Networks: Does Limited Choice of Hospitals Affect Quality in Covered California?|last=Spurlock|first=Bruce|date=October 2015|website=California Healthcare Foundation|access-date=29 November 2017|archive-url=https://web.archive.org/web/20151106173524/http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20N/PDF%20NarrowNetworksLimitedChoice.pdf|archive-date=6 November 2015|url-status=dead}}</ref> A study in the journal ''Health Affairs'' indicated that while hospital networks sold on the marketplace are narrower than their commercial counterparts, geographic access is similar, and the quality of care may even be better.<ref name="Haeder et al. 2015">{{cite journal|last1=Haeder|first1=Simon|last2=Weimer|first2=David|last3=Mukamel|first3=Dana|title=California Hospital Networks Are Narrower In Marketplace Than In Commercial Plans, But Access And Quality Are Similar|url=http://content.healthaffairs.org/content/34/5/741.abstract|journal=Health Affairs|volume=34|issue=5|year=2015|pages=741–748|doi=10.1377/hlthaff.2014.1406|pmid=25941274|doi-access=free|url-access=subscription}}</ref> However, a lack of healthcare provider options may weaken the leverage of insurance companies when negotiating prices, leading to higher premiums.<ref name=":0" />
== Controversy == In April 2025, an investigation by ''The Markup'' revealed that the Covered California website contained trackers that sent sensitive personal data that users entered on the website, including whether a user was blind, pregnant, transgender, or a possible victim of domestic abuse, to LinkedIn for over a year as part of a marketing campaign.<ref>{{Cite web |last=Apodaca |first=Tomas |last2=Lecher |first2=Colin |date=2025-04-28 |title=How California sent residents’ personal health data to LinkedIn – The Markup |url=https://themarkup.org/pixel-hunt/2025/04/28/how-california-sent-residents-personal-health-data-to-linkedin |url-status=live |archive-url=https://web.archive.org/web/20250621101221/https://themarkup.org/pixel-hunt/2025/04/28/how-california-sent-residents-personal-health-data-to-linkedin |archive-date=2025-06-21 |access-date=2025-06-23 |website=The Markup |publisher=CalMatters |language=en}}</ref>
==References== {{reflist|2}}
==Links== *{{official website|http://coveredca.com}}
{{PPACA}}
Category:Government of California California Category:Healthcare reform in California Category:Medicare and Medicaid (United States) Category:Welfare in California Category:Medical and health organizations based in California