Calif. health care exchange at a glance

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California Health Insurance Exchange

(AP Photo)

(AP) — How many people are uninsured in California, and how many of those are projected to get insurance under the exchange?

There are different estimates of California’s uninsured. The California HealthCare Foundation estimates the state has about 7.1 million people without health insurance — or about one in five non-elderly Californians. The foundation projects that ratio is expected to fall to 1 in 10 by 2016 because of the Affordable Care Act.

The California Health Benefit Exchange, which goes by Covered California, estimates there are 5.6 million people without health insurance, or 16 percent of the population under age 65. Of that number, 4.6 million people are eligible for coverage under the Affordable Care Act and one million are ineligible because of their immigration status.

The exchange’s executive director, Peter Lee, has said a more realistic coverage figure by 2017 is closer to 2.3 million.

How many people in California are currently served by Medicaid, and how many more will be served with an expansion of Medicaid?

An estimated 8 million Californians are served by Medicaid, which is known as Medi-Cal.

An estimated 1.4 million more Californians are expected to be covered under expanded Medicaid provisions, according to a joint report released in January by the University of California, Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research.

The report estimates that as many as 510,000 who already are eligible for Medicaid but not yet enrolled are expected to join because of the federal law’s individual mandate and a simplified enrollment process.

How many small businesses are likely to take advantage of the health insurance offered through the California exchange?

Covered California estimates that 375,000 small businesses with 25 or fewer full-time employees making an average of less than $50,000 a year will be eligible to receive a 50 percent federal tax credit through a new program known as the Small Business Health Options Program. The program is aimed at helping small employers provide the type of health plans that generally have been available only to large employers.

How is the exchange going to be set up in California, and which agency will be responsible for overseeing it?

Established by legislation, Covered California is an independent public entity within state government with a five-member board, which is charged with creating the insurance marketplace in which individuals and small businesses will be able to compare and enroll in health plans.

Two members are appointed by the governor, one by the Senate, one by the Assembly. The Secretary of the Health and Human Services Agency serves as an ex-officio voting member of the board. Members serve four-year terms.

How far along is California in setting up an exchange, and do officials believe one will be ready to start enrolling people by the October deadline?

California was the first to authorize a state-run health insurance exchange after passage of the federal Affordable Care Act in 2010. State officials said that having control will allow California to custom-build a marketplace that caters to its large and diverse population. The federal government approved California’s plan to run its own health insurance market in January.

The exchange is in the process of negotiating contracts with health plans to offer “quality health benefit products online for individuals and small businesses.” It expects to have the web portal up in October, with coverage to start in 2014.

How much money has California received so far from the federal government to do the initial work in setting up an exchange?

Since September 2010, Covered California has been allocated $910.5 million in federal planning grants from the U.S. Department of Health and Human Services for implementation of the Affordable Care Act. That includes:

— A $1 million grant to establish the exchange board and recruit staff, analyze insurance markets, gather input, collect data on projected insurance markets and develop multiyear plans.

— A $39 million Level 1 Establishment grant supporting strategic, business and operational planning, including information technology analysis and system design/

— A $196.5 million Level 1.2 Establishment grant to support a wide variety of research, marketing, consultation, technology and management. It also included money for a customer service center.

In November 2012, Covered California submitted a Level 2 funding request to the federal government for $706 million to provide funding for 2013 and 2014. The government awarded $674 million of that request in January.

After 2014, the exchange must be self-supporting from fees paid by health plans and insurers participating in the exchange.

How will Californians access the exchange, and what kind of customer support will be offered?

The exchange is intended to make sure insurance companies compete fairly and offer quality products under the state’s rules. It will offer consumer support through:

— A website that provides standardized comparison information on qualified health plan benefit plans.

— A calculator for applicants to compare costs across plan options.

— A web-based portal to help link individuals to health coverage options.

— A toll-free consumer assistance hotline.

How many people will California’s exchange employ?

According to Covered California, the exchange will employ roughly 700 people by the time the portal is ready for launch. Another 500 seasonal employees also will be used.

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