By the numbers, Peter V. Lee has some reason to crow while the feds are eating crow. The executive director of Covered California can be pleased that, as of mid-November, nearly a third of all Americans who signed up under the new healthcare law were Californians. But it's not over yet: The state's success with the young and with Latinos is not a slam dunk. As California goes, so goes this national experiment, most experts say. But Lee, whose last job was working for Medicare and Medicaid in D.C., doesn't seem to be feeling the pressure.
What's the launch been like, after so much planning?
I told my staff it is a marathon but right now it is a sprint. I was in Fresno, San Diego, Long Beach, Santa Ana. The interest and support we're seeing are so at odds from the national news coverage, which is all about glitches and terminations. That's not what I hear.
Drew Altman, head of the Kaiser Family Foundation, told me the Affordable Care Act is ripe for death by anecdote.
I think we'll have salvation by anecdote. I was talking to our customer service staff and one of my people almost started crying, saying, "I want to thank you both for giving me a job but also, my family has been denied coverage because of a preexisting condition." Those aren't the anecdotes you're hearing. You're hearing that the price is going up.
Why aren't we hearing the positive ones?
Every time we share numbers, we share real people's anecdotes as well. Starting in January, you will never see an actor in any of our materials. It's going to be real people.
I'm not Pollyanna, [but] people are grateful, they're telling their friends. Some people are seeing price bumps and I wish that weren't the case, but the fact is we are enrolling thousands of people every single day.
Last week, Covered California decided it wouldn't extend a year's grace to people who found their policies, which they liked, had been canceled.
The board decided not to kick that can down the road. [We are] converting from plans that often put [people] at risk even though they had coverage. For some people, the prices went up for pretty good coverage, and the board wrestled with that. That was going to happen no matter what.
Are they getting better coverage?
Some are and some aren't. There's a chunk whose rates are going up. They fall in two categories. I call one the airbag group. That's like, you may not want an airbag in your car, but we think airbags are important. You may not want prescription drug or hospitalization coverage; we think you should.
[Second], about 200,000 Californians with pretty good coverage [also have their] rates going up, because we are changing the health insurance marketplace.
But they can shop around. In the new world, you can never be denied. Now you have lifetime assurance of affordable care. The [ACA policies] are trying to get us out of the old version of health insurance, which was gotchas and hidden designs.
California's online rollout works better than the feds'. Did you put the touch on some Palo Alto buddies?
[Laughs.] Couple of things. Three years ago, the Republican governor and Democratic Legislature said we're going to make this thing work, and we've been working on [it] ever since. We designed our [website], and we didn't put it out to bid — we put it out publicly for comments, from health plans, consumer advocates, major vendors.
Another reason: We have 11 health plans throughout the state. Those 11 on average have 36 different standard benefit products.
[Washington] thought maybe 10 states would not do their own exchanges. It wasn't clear until a year ago that 34 would not. The federal government [exchange] has 186 different health plans, each with 86 different products. That means the federal website has about 16,000 different products that they have to manage, coordinate and help consumers choose among. It's a much more complex process.
The states [that] decided not to run their own exchanges played politics with their citizens. And now we're sadly seeing the results.
Have the feds asked for advice?
We have had almost weekly calls with very senior people in the administration to talk about what our strategy has been, what's working. Covered California dotcom is a project of Covered California and the California Department of Health Care Services. That means if there's a tough decision, [the DHCS chief] and I can make it and we can move on. We have very good command and control. One thing that's challenging the federal government is that it does not have those processes.
What makes you so optimistic?
We're seeing enrollment increasing every day. It's about what people are telling their friends, neighbors and families.
Literally, for millions of Californians, this is an answer to a prayer. I think it's transformative.
You've been criticized for being too rosy.
I don't think we are. The facts are 2.6 million Californians are going to get a federal subsidy to help with their plans. The facts are 1.4 million are newly eligible for Medi-Cal. The facts are, no one can be turned away. I don't call that rosy, I call that "Dragnet" — just the facts, ma'am.
Are you really able to handle the demand you want to generate?
Absolutely. We're adding people to take calls. More important, [more] enrollment is going to be happening in communities [with in-person advisors; the federal program calls them navigators.] Go to "find help near you" [online] and put in a ZIP Code and find certified enrollment counselors. We always anticipated that 80% of the enrollment would be with the human touch. Health insurance is confusing, especially if you've never had it before, so in-person assistance is vital. And we feel good about our cadre of partners in every community in the state.
Your father and uncle — California physicians — fought for Medicare in the 1960s. Did you grow up understanding the effect of insurance on healthcare?
When I really got a sense of that was in the early days of the AIDS epidemic. In the early '80s, when I was 25, I did not feel young and immortal. I was seeing my friends dying and being denied healthcare coverage day after day. We talk about "young immortals" — if you're a man of my age, when we were 25, we did not feel immortal. We felt lucky to be alive.
What are the demographics for Covered California so far?
I expected what I call one-touch people, people who have preexisting conditions: You tell them once [coverage will be available] and they flock to get insurance. I was surprised and encouraged [by] people between 21 and 30; their [numbers are] very close to the percentage in the population.
But there are very few Latinos.
We're doing huge marketing. We've got billboards in East L.A.; we've got big buys with Univision and Telemundo and Spanish-language radio. [Those] low numbers didn't really surprise us because most enrollment that first month was not [in person] in communities. We now have thousands of certified enrollment counselors to help people; 60% speak Spanish. We had focus groups who worked with Spanish-speaking applications; we've done an end-to-end refresh of [the application]. I'm very confident the rates of Spanish-speaking applicants will go up dramatically.
Colorado launched some humorous ads in dubious taste targeted at young immortals.
We may change, but we have not gone the humor route, even for young immortals. Our market testing [found], yeah, that's kind of funny, but health insurance is a really serious matter.
One of our ads shows a young parent looking in the back seat at the kids in his car after he drives by an auto accident. Another shows a mountain biker going head over heels and ending up in the hospital. Young immortals aren't going to be roped into getting coverage; they're going to say, "You know, I am a spill over my handlebars away from being $20,000 in debt."
This interview was edited and excerpted from taped transcripts.
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