Political fight boils on health care

California is in the forefront of the nation’s new health care insurance reforms and is following its own drummer,  such as when it decided not to go along with the president’s call to give certain policyholders a year-long delay from being kicked off dubious health insurance plans.

But the political forces surrounding the Affordable Care Act in California are profound and are all but certain to play a role in campaigns, including the potential reelection of California’s powerful insurance commissioner and whether Californians will approve a high-stakes initiative to regulate health insurers’ rates.

“It feels like we’re having a conversation about the pre-nup after the wedding,” Micah Weinberg, with the public policy advocacy group the Bay Area Council, testified before the board.”

Skepticism fueled by partisanship  is strong in California about the ACA, even though a majority of the state’s uninsured say the hope to obtain coverage, according to one survey. Eight out 10 Republicans don’t like the ACA, six out of 10 Democrats do.

“Californians are evenly split and deeply divided along party lines on federal health care reform,” said Mark Baldassare, president and CEO of the Public Policy Institute of California, which commissioned the survey. “While public awareness of the state’s effort is high, there is room for improvement among those in need of health insurance.”

PPIC’s Mark Baldassare

The survey noted that those who are likely to vote next year viewed the ACA more negatively than Californians overall, about 51 percent to 42 percent — which could be a critical factor in next year’s elections.

In November, the board of directors of Covered California, the state’s new online portal for health insurance   purchasing, unanimously decided against permitting insurers a year, or even three-month, reprieve from canceling plans not up to reform standards.

The board said the delay would only prove confusing to the  public. “It feels like we’re having a conversation about the pre-nup after the wedding,” Micah Weinberg, with the public policy advocacy group the Bay Area Council, testified before the board. California isn’t alone: It now joins eight other states not following the president’s request.

Uncooperative plans — meaning those insurance policies deemed substandard or otherwise lacking by officials — that were obtained after health care reform was signed into law in 2010 will be canceled at the end of this year, little more than three weeks away.

Health care reforms are likely to play out in the 2014 race for insurance commissioner, who supports regulating health insurers’ rates.

The decision by the board highlights the divide in jurisdiction over this issue. Insurance Commissioner Dave Jones, a proponent of the ACA, has been critical of the cancellation notices and wanted the board to approve a delay.

Jones said the board’s decision was “both surprising and disappointing.” He has argued the federal law doesn’t require policyholders be kicked off plans not up to ACA standards, but that insurers lobbied Covered California for this rule.

Insurance Commissioner Dave Jones

“People who receive such cancellation notices, should have time to figure out what makes the most sense for their families and not be subject to December 31, 2013 cancellation,” Jones wrote to the board and Chair Diana Dooley. Insurance Commissioner Dave Jones

Jones urged eleven health insurers selling plans in the exchange to be released from their contract with Covered California, which requires the cancellations. Exchange officials say the requirement is needed to develop a broad enough pool of consumers.

Recently the commissioner was successful in ordering two health insurance giants, Anthem Blue Cross and Blue Shield of California, to delay the mandate for thousands of non-grandfathered policyholders at risk of being kicked of their plans.

“Look, we’ve already required… two of the largest health insurers to extend their policies into the first quarter of this next year,” Jones said. “It wouldn’t have been confusing. It would’ve provided additional opportunity for people to stay on their policies, make decisions that are correct for them. I think [consumers] think it’s patronizing that that decision gets made by someone else for them ”

The governor has not taken a stand on whether to support the one-year delay, and instead has counseled caution.

Jones is on the same page as President Obama, but contrary to where state officials have settled on the issue. Gov. Jerry Brown was not definite on where he stood on the delay, noting at a recent public appearance that California is going its own way.

“We’re following our own path here to implement the Affordable Care Act and we’re going to do it in the best way we can. We understand a lot of people are concerned about this,” Brown said. “But you can be sure we’re going to be very careful to both be sensitive to all the potential customers… and also the financial viability going forward, so the rates are attractive not just for this year but for many years to come.”

The insurance commissioner has oversight over homeowner, auto and other insurance products, stemming from  a 1988 voter-approved, consumer-backed ballot initiative, Proposition 103.

An initiative to allow the same regulatory authority over health insurance rates qualified for the ballot next year. The new measure was crafted by Consumer Watchdog, which includes activists who successfully pushed for the 1988 measure, a change that Jones has long supported.

As a member of the Assembly and chair of the health committee, Jones was known for stressing the need for rate regulation on the health care industry.

If voters approve the 2014 ballot initiative, whoever holds the post of California’s insurance commissioner will have authority on whether insurers’ rates in the exchange can go up or down. On that same ballot, Jones’ position is up for reelection and he already faces one contender opposed to the ACA.

Meanwhile, Brown, who also faces reelection next years sees the complexities of the issue. “We’re going to do it the right way. Our program is working, with uncertainties,” Brown said. But, he added, “There are unknowns out there that give me a great deal of concern.”