In California, Health Care Marketplace Appears To Be Thriving

NPR's Ari Shapiro talks with Peter Lee, executive director of Covered California, about how state health care exchanges will work now that the AHCA has failed in Congress.

ARI SHAPIRO, HOST:

Now that the Republican plan to repeal the Affordable Care Act has failed, we're going to look at how Obamacare, as it's known, is doing in different states. In some parts of the country, insurers are pulling out of the marketplace. Prices are going up, and consumers don't have any choices. In other states, consumers have options, and the marketplace appears to be thriving. Today, we're going to talk about that scenario. Peter Lee runs California's health exchange, which is called Covered California. Welcome to the program.

PETER LEE: Great to be with you, Ari.

SHAPIRO: You've been a strong supporter of the Affordable Care Act from the beginning. You've said the message that Obamacare doesn't work is total spin and unanchored in reality. So how would you describe the reason that California has succeeded at implementing this law while other states have not?

LEE: Well, a couple things - first, it's working in most states. And, absolutely, it's working well in California, but we've focus a lot on a handful of states that are very rural that have troubles for a range of reasons in health care. And I think we need to remember that it's working for tens of millions of Americans across the country. And in California, it's working especially well because we make sure consumers know that subsidies are there to make health care affordable.

Now I'll tell you - last year, we spent a hundred million dollars on marketing. That's a lot of money, but that meant that last year the average Californian saw or heard about Covered California 56 times during open enrollment. You've got to tell people that it's available. You've got to sell insurance, and we've sold it and sold it well in California.

SHAPIRO: Now that you know the Affordable Care Act will remain in place for the foreseeable future, but without support from the federal government, what is your plan to keep the system working successfully in California?

LEE: Well, let's be really clear. The Affordable Care Act cannot work without fundamental support from the federal government. And really the next 60 days are to determine how well individual markets work across the nation because in the next 60 days the Trump administration and Congress will need to decide whether or not they allow many markets across the nation to have skyrocketing premiums or make the short-term policy decisions that will stabilize the market.

SHAPIRO: They've basically said their plan is to let the system fail - to let it, in Donald Trump's words, explode.

LEE: I don't think they've decided because I think that the reality is there's going to be plenty of finger pointing, but let's be clear - the finger pointing, whether you're pointing it at a Democrat or Republican, is because there will be millions of Americans without insurance. We need this administration and Congress to not allow millions of Americans to lose coverage or face 20, 30 percent price increases. And, again, I'm a lot more worried about other states than California, but even in California, the federal policies make a mammoth difference.

SHAPIRO: Ultimately, if some states, like California and Massachusetts, want to take steps to cover everybody and other states, like South Carolina or Wyoming, don't, what's wrong with that states' rights approach to policy?

LEE: Well, first, I think there's a lot to be said for a states' rights approach, but we need to be very clear that the secret sauce to the coverage expansion that's occurred is federal financial support. And so, you know, the attempt of the American Health Care Act was to restructure that.

SHAPIRO: The American Health Care Act - that's the Republican plan to replace the Affordable Care Act - Obamacare.

LEE: Yeah. That's off the table right now. What's on the table, though, is a structure that provides financial support to bring health care within reach to millions of Americans. Now, can California implement that differently than Alabama or Colorado? Yeah, and we have. And I think that we can continue to do that in a way that's responsive to California's regional differences, the diversity of our state. We're making it work for California. But, boy, I want Coloradans to make it work for people in Colorado, people in Alabama to make it work for them. That requires federal financial tools and a broad set of guidelines that each state can work within.

SHAPIRO: Peter Lee is the executive director of Covered California, the health insurance marketplace in California. Thanks for joining us.

LEE: Great to be with you, Ari. Thank you.

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