Covered California users grateful but keenly aware of shortcomings

Oct. 01--Alain Datcher knows there's a sad truth about the newly minted Medi-Cal card he carries in his wallet. It opens a few doors, but only takes him so far.

"Even though I feel like I'm part of a network, it's a network that may not be adequate enough," the 25-year-old said recently. "It leaves me grateful, but it leads me to think of the what ifs."

Datcher, a former foster care youth, became eligible for Medi-Cal in January, when the Affordable Care Act allowed those like him to enroll in federally subsidized health plans through state health insurance exchanges. Datcher attempted to apply through Covered California and hit a wall.

"I was calling and calling and talking to different people," Datcher, a graduate student at Pepperdine University said. "You realize you have to call because the paperwork on the website is not complete enough. There's a lot of loopholes. When it came down to how to do it, there was so much confusion."

Datcher's experience navigating his way to health care was unique, because of his former foster care status. But his difficult enrollment process also illustrates some of the challenges many Americans experienced when the Affordable Care Act launched last October.

The 32 states that chose to participate marked a historic shift in the health care landscape unseen since Medicaid was introduced in 1965, academics said.

One of the largest enrollment campaigns in the nation, Covered California, introduced millions of state residents to the bronze, silver, gold and platinum level health plans and promised to reach out to everyone, including young adults, struggling single moms and contract workers who may have been uninsured because of cost.

But there were glitches, website shutdowns, and eventually, the federal government even postponed the employer mandate until the fall of 2015.

Some problems persist

Twelve months later some who applied for Medi-Cal still wonder if they are qualified. Former foster youth such as Datcher ran into application problems, and others say the care they receive is dismal because of lack of physicians in the network.

Yet considering those issues, last year's launch is still praised by some as an overall success when compared with other states and the federal government's own efforts. Some health care advocates are hopeful the next enrollment period which opens on Nov. 15 will be better as Covered California gears up for another first: renewals.

"I think we need to recognize that even though we had a huge number, we got that huge number in spite of the issues for consumers," said Anthony Wright, executive director for Health Access California, a statewide health care consumer advocacy coalition.

"There were long wait times, there were glitches, there weren't even enough people on the ground," he said. "We didn't have a Spanish-language website, we didn't have paper applications for several months."

Wright said even if only 200,000 who signed up were previously uninsured, the program was a success.

"There were significant issues and barriers, and yet Californians showed they wanted this coverage and options," he said.

Covered California managed to enroll more than a million of the 5.5 million uninsured who qualified. Of those, about 90 percent received subsidies to cover costs. Separately, more than 1.9 million used Covered California to enroll into Medi-Cal, the state's version of Medicaid.

Yet some concerns arose quickly. The California Medical Association became aware that physicians and their specialties were listed incorrectly in Covered California's directory. The directory was removed online indefinitely. In addition, tens of thousands who applied for Medi-Cal, are still waiting coverage months later.

Norma Torres, California state senator, D-Pomona, also was vocal about the state exchange's efforts to enroll Latinos during the first few months. She cited lack of diversity on the Covered California board and successfully introduced legislation to diversify the board. The bill has been signed by Gov. Jerry Brown and takes effect Jan. 1.

"Latinos are the state's largest and healthiest uninsured population," Torres said in an email last week. "Their enrollment is critical to keeping health insurance rates low. That is why I was appalled to learn that in addition to not having information translated, Covered California had also failed to hire a sufficient number of bilingual staff both on the phones and in the field. At the same time, their website and information technology system was constantly breaking down or experiencing delays. This led to a large backlog in the processing of consumer applications."

She credits the exchange with opening on Oct. 1, just as promised and its staff for its willingness to improve.

"This was a significant accomplishment considering that some other states were not able to do the same," she said. "Covered California's staff has also demonstrated a willingness to be flexible and make adjustments when necessary.

"The major difference between this year and last year is that Covered California now has a year of lessons learned to draw from."

Dana Howard, a spokesman for Covered California, agreed, saying there are plans in place to enhance the performance of the enrollment portal for those who qualify for Medi-Cal.

In addition, the exchange announced that more than $46 million will be spent on the advertising campaign and another $14.6 million toward funding community outreach.

"What we did do was go back and listen to what the consumers were saying, about how to do things better," he said. "Overall, everybody was impressed, but we can do better. We want to making sure we truly find a way to not just get the information out, but encourage an invite the Latino and African-American communities to take action. We believe that will come with one on one interaction."

Foster care youth

For some, those improvements may not come so quickly. The Affordable Care Act authorized states to use their Medicaid funding to extend health coverage to former foster care youth from the time they aged out of the system until they are 26 years of age. An estimated 5,000 state youth qualify and are eligible to apply for Medi-Cal on the Covered California site. But an important federal guideline says former foster care youth do not have to list income nor work history. Covered California kept demanding those answers.

"Our youth were not able to access the very program they were entitled to," said Taylor Dudley, staff attorney for Alliance for Children's Rights. "We very quickly told them not to go to Covered California."

Dudley said this is a population that could really benefit from a stable place to get medical care and also mental health services.

But instead of going through Covered California to complete applications, many such as Datcher went to the Los Angeles County Department of Social Services, where one employee is dedicated to helping them enroll.

"It's my understanding that Covered California is taking steps to creating a means to correcting it," Dudley said. While Covered California is a great option, it's not the only one."

Datcher had been in the foster care system since the age of 11. He said he had trouble paying for health care after he aged out of the system at 18, although California youth are now able to stay in the system until 21.

"I'm just imagining an 18 year old or 19 year old who doesn't have the resources," he said. "They have health care, but they have no way to know how to navigate it."

While Datcher experienced difficulties, others such as Keri Dempster, the process was easy but found the care to be insufficient.

Dempster, a northern Rancho Cucamonga resident, lost her job at the Ontario airport because of injury two years ago. She said she managed to apply for Medi-Cal last November, thought she had coverage in January, but couldn't see a doctor for the pain in her foot until June.

By then, she said, the pain had become excruciating. A quick foot X-ray showed no abnormalities. A physician's nurse gave her medication used by those with fibromyalgia. Dempster said she asked several times for a referral for a specialist but was denied.

"I felt like I was being treated with medication just to appease me," said Dempster, 50.

"This coverage is ridiculous. They don't allow you to have the very best care," she said.

"I've worked my whole life, never been on public assistance. It's degrading. It's really eye-opening, when I consider the fact that I've been in this pain in so long, and there's no solution. I'm supposed to be permanently disfigured."

Dempster said she is hoping to earn her MBA soon, and is looking forward to starting two part-time jobs. One of them offers insurance. She said she won't go through Covered California.

"It's really difficult because people don't have a voice, especially people who don't speak English," she said. "My suggestion is get a job and get better insurance."

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