Peter Lee is the executive director of the California Health Benefit Exchange, former CEO of Pacific Business Group on Health, and HHS Director of Delivery System Reform for the Obama Administration. Set to launch in 2014, the exchange is charged with enrolling Californians made eligible for new benefits under the Affordable Care Act, and creating a health insurance marketplace that will allow California consumers and small businesses to purchase plans at competitive rates through federal tax subsidies and credits.
There have been concerns about communities of color having access to the health exchange web portal. Is the board doing something to address the issue?
The plans of the exchange are framed first by recognizing that California is a phenomenally diverse state. Central to our mission, which is reflected in what the board approved this last meeting, is that we are committed to reaching out to everyone that is eligible for these programs regardless of their education level, their having or not having computer access, whether they live urban versus rural. All of our development work is based on that starting assumption. We’re here to serve all Californians, and we’re going to do that by having many ways that consumers can enroll in the Exchange, Medi-Cal, and Healthy Families. It’s important to note that at our last board meeting we adopted a mission and values statement, and the very first value the board thinks is core to achieve our mission of giving Californians access to affordable care is to make sure that we’re going to assure a consumerfriendly experience, recognizing their diverse cultural, language, and economic status. From there we will be exploring a whole range of new technologies. Which ones we end up using is still to be determined, but we’re going to be looking at the use of smartphone applications, kiosks, social media, texting, and (believe it or not) paper. We’ll be using a whole range of tools that are both 20th and 21rst century, and beyond.
What’s being done as far as outreach, informing people of the new benefits they’ll be eligible for?
We’re going to be doing an extensive outreach and education campaign. We haven’t done outreach (at this point) because the eligibility doesn’t take place until fall 2013. You don’t want to set up expectations today and have people say, “Oh, I get something, but it’s not available for two years?” So developing an education and outreach program will be based on the best science of when to you reach out to which populations based on when they can make an informed choice. The benefits of the subsidized coverage of the exchange and the expanded Medi-Cal benefits take effect January 2014. To bring up the absence of an outreach and education campaign is kind of silly. Under the Affordable Care Act, people have many new rights they did not have two years ago, such as the ability for parents to cover their children up to 26 years old. There have been good efforts to make that information known. And one of the things I’m heartened by is that the board of the exchange, specifically in its mission statement, held itself to be accountable for reducing health care disparities, for addressing health equity issues. We will be held accountable for making sure that communities of color, people that speak different languages, people with disabilities are front and center in who we are providing health care to and making our programs available to.
How will people track this accountability?
One of our values is that we should be measured not just by what we say, but by our results. And central to our results is how we have expanded health coverage and access. So we will have a whole range of metrics on what percentage of people who are eligible actually enroll, how we are doing with different target populations, how we are doing in urban versus rural areas. So, we will be a data-rich and transparent organization.
There are members appointed by the previous governor on the board, is there any concern about consensus?
I left the Obama administration to join the California health benefit exchange in part because I was so phenomenally impressed by the strength and diversity of perspectives of this board. It’s a strong and well-informed board. I’ve been at a number of board meetings, both in public and closed session, and it’s a board that’s working phenomenally well together that brings perspective and values to what is a very complex set of issues. So the climate that I can speak to, is the climate that I’ve witnessed at board meetings and otherwise, which is one that has been collegial, sleeves rolled up to wrestle with a tough issue.
There have been attempts to repeal the federal health care act. What would that mean for the California exchange if something were to happen to federal funding?
Our job at the exchange is to deal with the realities we have. We are implementing a federal law, we are also implementing a state law. And our charge is to be ready to help more than six million Californians get health insurance. The what-ifs out there raise all sorts of hypotheticals, but we are being distracted from making sure that we are going to be expanding coverage. I spent a lot of time in Washington looking at the what-ifs, whether it’s court case or electoral, and in some ways I think they aren’t worth spending a lot of time on, because this is the law of the land. We in California, across the political spectrum and range of stakeholders, are working together phenomenally well, recognizing that Californians don’t have the coverage they should have. And I’m confident that the spirit of collaboration and partnership that we’ve seen in standing up to the exchange would continue in California irrespective of what might happen at the national level.
Some critics have expressed concern over the exchange having an iron grip over the market.
The exchange will represent somewhere between 5 and 10 percent of the health care market. That is far from having an iron grip over anything. We look forward to helping create marketplace dynamics that will put consumers in the drivers’ seat. The charge and charter of the exchange is to enable consumers, those that are choosing health plans, doctors, hospitals, with the information and ability to make the choice that’s right for them. For many, many years we had a healthcare system that [in some ways] hasn’t put consumers in the center of it. The exchange is putting consumers in the center of health care. And that’s not an iron grip, that’s putting the right hand on the steering wheel.
Any thoughts on Senator Mark Leno’s, D-San Francisco, Single Payer Option bill?
I have no comment on that. I’m not familiar with the legislation. Our focus at the exchange is implementing a program which is moving California and the nation, as part of the Affordable Care Act, toward close-to universal coverage through market-based reforms that we think have enormous promise. Whether there are legislative efforts to dismantle exchanges or start single-payer options, I’ve got a day job and it’s a pretty big one and that’s what I’m focusing on.