The California Association of Health Underwriters recently submitted comments to the Healthy California For All Commission regarding several health insurance policy areas that the state seeks to regulate. The stated goal of the Healthy California For All Commission is to “develop a plan for advancing progress toward achieving a health care delivery system for California that provides coverage and access through a unified financing system, including, but not limited to a single-payer financing system.” In their comments, CAHU made it clear that the association shares the Commission’s objective to ensure that all Californians have access to high quality, affordable healthcare and to improve transparency and stability in pricing, but still harbor strong concerns with some of the proposals that have been put forward.
CAHU cautioned against setting prices that healthcare providers can be paid. Instead, CAHU recommended that the Commission gather information on pricing, and suggest a price that would be deemed fair. This suggested price would provide significant pricing clarity for both consumers and plans when negotiating fair and appropriate payment. Additionally, instead of simply setting prices, CAHU proposed that the Commission require all doctors and facilities to use Medicare pricing as the reference point when they bill for services. The letter notes that such a reference-based pricing model has become widely used in the self-insured market and has reduced costs substantially.
CAHU recommended that the state strengthen the ACA by contending with the “family glitch,” a weak spot in the ACA structure that NAHU is also working on at the national level. This “glitch” happens often when small business employers, who are not required to provide health benefits, choose to offer health insurance to their employees, based on what they can afford. Currently, because a member of the household (the employee) is offered affordable health insurance through their employer, the “glitch” will not allow spouses and dependents access to ACA subsidies. As CAHU noted, this gap increases the number of uninsured, especially among children. Fix the family glitch by clarifying that employee eligibility for affordable coverage does not extend to family members if there is not an affordable employer contribution to dependent coverage.
In a rebuttal to the assertion that a single-payer approach to healthcare is the only path to equity and universal coverage, CAHU stated that the Golden State can take several actions that do not involve the establishment of a single-payer system in California. The association asserted that California has the most inclusive health coverage for low-income residents in the country, with undocumented young adults up to 26 and low-income adults 50 years of age older (regardless of immigration status) eligible for Medi-Cal. Between an expansion of Medi-Cal and extended premium tax credits on the Covered California state exchange, the uninsured gap can be closed without moving to single payer.
CAHU also mentioned that the one-size-fits-all approach of a single-payer system would fail to produce equal outcomes for residents, as it is specialized plans that fit the needs of the individual that are best. The association provides the example of the Chinese Community Health Insurance Coverage, which is a non-profit plan option for folks in the Bay Area offered through Covered California. CCHP’s enrollees receive a robust offering of personalized services in a way that is culturally competent and linguistically appropriate and with 60 percent of members identifying themselves as Chinese, this plan demonstrates an effective targeted model. CAHU made it clear that a single-payer system would eliminate these options.