The stakes are high in health care reform

We are in the countdown to a monumental change that will affect the lives of most every American in one way or another. In 308 days, health coverage through the Affordable Care Act begins for tens of millions of Americans, millions in California alone. In 216 days, the doors swing open for enrollment to start.

California’s Health Benefit Exchange—Covered California— will build and hold open the front door for Californians to obtain their health insurance starting October 1, 2013.

As Covered California prepares to open its online application and phone lines for business, some crucial decisions have still not been made. Why does this matter? For starters, the new federal law calls for states to offer families a first-class consumer experience. This is our best and possibly only chance to modernize paper-based and cumbersome enrollment arrangements, and move health care to the kind of customer service we experience using online banking, transportation, school, or shopping. Equally important, for Covered California and for the Affordable Care Act to succeed, early users need to be “satisfied customers.” Moms, Dads, young adults—whoever calls—must feel that they got what they needed and they got it conveniently.

Because so much is at stake with how the front door to Covered California is designed, consumer organizations have been working for many months with the California Health Benefit Exchange Board and the Brown Administration to get it right from the standpoint of families. Our organizations have provided recommendations for how to make sure the system works efficiently for consumers; that families are enrolled in real time rather than through a two-or three-step process during which they can fall through the cracks or become discouraged; that performance standards for how enrollment ought to work are set and monitored continuously; and that the Exchange step in if enrollment partners’ performance is sub-par.

In the end, the goal should be that every caller is able, in one step, to learn which insurance program suits them and to enroll themselves and all members of their family.

There are common sense solutions to achieve this goal, but they require a commitment to conduct business very differently and much more efficiently than is currently done.

There is a real risk, today, that the front door to health coverage in California will fall short of this goal. At its Board meeting last August, the California Health Benefit Exchange identified eight important elements for its automated enrollment system and said it would bring these items back at a future Board meeting. To date, no decisions have been made by the Board on these implementation questions. It is critical this happen because Covered California is considering transferring many callers to a subcontractor for enrollment, rather than handing them itself. Such a proposal needs more attention by the Board. If callers are transferred, it is likely they will not receive a one-stop, streamlined, first-class consumer experience, and this could hobble Covered California’s ability to be successful. The history of launching other new initiatives tells us that the public’s first impression of Covered California will have lasting effects.

Choices about how the front door to Covered California will work are among the most important the Board will make. The hourglass is running short on sand. Until these decisions are made, vendors responsible for building the IT components and for partnering with Covered California on various aspects of the enrollment job can’t prepare properly. But as urgent as the timing is, it is equally urgent that the Health Benefits Exchange Board with the Brown Administration make these choices based on what consumers want and expect. We’ve never had a more important opportunity to reform health care in this country. Working together, we’ve got to get it right—and now. We won’t get a second chance.