California health exchange board undergoes changes

SACRAMENTO, Calif. -- The board that oversaw the rollout of the Affordable Care Act in California is undergoing its first major turnover since the state-operated health insurance marketplace was established four years ago.

It's a shake-up that gives Gov. Jerry Brown increased clout on Covered California's five-member board of directors as it strives to reduce the number of uninsured people while tamping down overall health care costs.

Dr. Robert Ross, president and chief executive officer of The California Endowment, said he will resign at the end of the year, the same time terms expire for two members appointed by former Republican Gov. Arnold Schwarzenegger.

Those members are Susan Kennedy, a Democrat who worked as Schwarzenegger's chief of staff, and Kimberly Belshe, who served as Schwarzenegger's health and human services secretary. They have agreed to stay until replacements are named by Brown, a Democrat, so the board will temporarily drop to four but avoid losing a quorum.

Covered California generally has been regarded as a success, although the agency has been criticized for its lackluster sign-up of Latinos; the complexity of its enrollment system; and spotty customer service that included long call center wait times during the first round of open enrollment.

So far, the exchange has exceeded last year's insurance sign-ups during its first month of open enrollment and is on pace to beat its goal of enrolling 1.7 million people for private health coverage next year, including re-enrolling 1.1 million people.

California Health and Human Services Secretary Diana Dooley, who chairs the Covered California board, said the next board will have to make the delivery of health care work over the long run.

"We have to stay focused on the goal: better health, better care, lower costs," Dooley said in an interview.

For the first time next year, the exchange will send out tax forms like W-2s for people who received tax credits to help pay their premiums. The form is called a 1095-A, and must be sent out in a timely manner so it doesn't cause a delay for tax refunds.

As an active purchaser that negotiates benefits and prices with health plans, Covered California is considering expanding the pool of health plans sold on the exchange to increase competition in some ZIP codes that currently have only one provider. Those include certain rural areas as well as parts of Alameda and Monterey counties.

The exchange also has to coordinate with other state agencies at a time when several human service branches undergo their own leadership changes.

Dooley is leading a search to find replacements for California's Medi-Cal director and public health officer. Toby Douglas, director of the state Department of Health Care Services, and Ron Chapman, head of California's Public Health Department, both previously announced their departures.

Anthony Wright, executive director of Health Access California, a health care advocacy group, said the state embraced the federal changes early and that the board has been generally free of controversy.

Under the 2010 law establishing the California exchange, two members are to be appointed by the governor and one each by the Assembly and Senate. The secretary of the state Health and Human Services Agency serves automatically as a voting member.

"Maybe this is surprising for a board associated with Obamacare, but it hasn't been a particularly contentious board," Wright said. "Even with appointments from both Democratic and Republican politicians, there's been a consensus about not only implementing but wanting to take leadership on health reform."

Appointed by the Senate, Ross had a year left in his board term, but Dooley said he announced his early resignation because of a heavy work and travel schedule.

Board members must have specific health administration experience, but a new law broadened the qualifications to include informational technology experts, health insurance marketers and enrollment counselors skilled in reaching out to poor and minority Californians.

The bill initially sought to expand the board to seven members, but that provision was removed after opposition from lawmakers.

"With three board seats open, the governor and Senate now have an opportunity to implement SB972 in the way it was intended: by appointing a new majority to the board that is more representative of California's population, particularly those who need insurance," said Congresswoman-elect Norma Torres, a Democrat who authored the bill as a state senator.