Monthly Archives: February 2014

Memo to Washington: Lessons Learned From California’s Obamacare Rollout

Certified specialist helps a consumer apply to Covered California at a free enrollment fair at Pasadena City College. (David McNew/Getty Images)

Certified specialist helps a consumer apply to Covered California at a free enrollment fair at Pasadena City College. (David McNew/Getty Images)

At the same time that California was releasing its latest enrollment numbers under Obamacare on Wednesday morning, advocates, experts and government officials at all levels gathered in Washington, D.C. to talk about … the Affordable Care Act in California.

Certainly, the rollout of Obamacare in the state has not been without its challenges and yet — California has 12 percent of the nation’s population and nearly 25 percent of all sign-ups nationwide. In addition to the more than 800,000 people currently enrolled in California, another 877,000 Californians are likely to be eligible for Medi-Cal. That’s on top of another 652,000 people who transitioned to Medi-Cal from the Low Income Health Program (more on that in a minute). That’s well over 2 million people total.

Diana Dooley, secretary of California’s Health and Human Services Agency, wasn’t about to gloat. “California is certainly not ready to put up a mission-accomplished banner,” she noted. But there was a lot of respect for California — and a desire to learn — from those in the room at the briefing. Continue reading

California Exceeds Its Target for Enrollment in Obamacare Plans

Peter Lee, executive director of Covered California. (Max Whitaker/Getty Images)

Peter Lee, executive director of Covered California. (Max Whitaker/Getty Images)

With six weeks left to go in the first open enrollment period in Covered California, the state’s health insurance marketplace, California has already exceeded its goal for the number of people it hoped to enroll into health care plans. As of February 15th, 828,638 people have signed up. The original goal had been 500,000-700,000 people by March 31. However, the state is still scrambling to get Latinos on board.

The rate of Latino enrollment showed signs of modest improvement in January. About 7 percent of people who enrolled in health plans through January 31 speak Spanish as their primary language. But the state is still far from mirroring the representation of Spanish speakers in California which is nearly 30 percent.

Overall, Latinos represent 21 percent of sign-ups through the end of January, while that demographic makes up nearly 50 percent of the state’s population. Continue reading

New Bill Would Extend Health Coverage to Undocumented Immigrants

(Getty Images)

(Getty Images)

Anna Gorman, Kaiser Health News

In a push to cover immigrants excluded from the nation’s health reform law, a California state senator has proposed legislation that would offer health insurance for all Californians, including those living here illegally.

The bill, SB 1005, would extend state-funded Medi-Cal to low-income immigrants who, because they are in the country without permission, are now eligible only for emergency and pregnancy coverage. It would also create a marketplace similar to Covered California to offer insurance policies to higher income immigrants who lack legal status.

It’s not clear how much the new coverage would cost or how the state would fund it.

Sen. Ricardo Lara, a Democrat who represents Long Beach and southeast Los Angeles, announced the proposed legislation at a press conference Friday. He said immigrants contribute to the California economy and deserve to have access to health insurance. Continue reading

How Covered California’s Outreach to Latinos Is Falling Short


While Covered California’s website is available in Spanish, the agency has a dramatic shortage of Spanish-speaking enrollment counselors. Many Spanish-speaking Californians say they prefer to enroll in person.

California may be leading the nation in its aim to enroll Latinos into health care plans under the Affordable Care Act, but sign-ups are falling far short of the goal. The state’s marketplace for health insurance, Covered California, is scrambling to fix problems with its marketing and outreach campaigns.

For starters, Spanish-speaking counselors are hard to come by. More of them are needed to address concerns of Latinos, who are wary of the health insurance system. Some are hesitant to sign up because they’re afraid undocumented family members will be discovered and then deported. Others aren’t sure it’s worth the money.

People like Larissa Bobadilla are trying to convince them that it’s okay.

“They trust me,” says Bobadilla, a health outreach worker and enrollment counselor. She started working in Los Angeles 16 years ago as a promotora, a health educator. Now, the children of people she helped more than a decade ago are coming to her to find out what’s really going on with Obamacare. “The news gives a lot of information, (but) it confuses the people. They don’t know what is the truth.”

Many Latinos have never bought insurance before. So Bobadilla takes the time to explain what the benefits are and how they work, in their own language: Spanish.

Bobadilla is exactly the kind of person Covered California wants in the trenches. The trouble is, there aren’t nearly enough people like her out there. The state wanted to have 20,000 certified counselors ready to go when plans first went on sale in October. Yet today, it has just 4,000. Continue reading

Missteps in Covered California’s Marketing Campaign to Latinos

Screenshot from an early Covered California TV ad targeting Latinos. The on-screen text says people cannot be turned down for pre-existing conditions, but consultants say that is not a key selling point for Latinos.

Screen shot from an early Covered California TV ad targeting Latinos. The on-screen text says people cannot be turned down for  pre-existing conditions, but consultants say that is not a key selling point for Latinos.

It’s been decades since the advertising industry recognized the need to woo Hispanic consumers. Big companies saw the market potential and sank millions of dollars into ads. The most basic do’s and don’ts of marketing to Latinos in the U.S. have been understood for years.

“It’s not a cohesive campaign targeted to Hispanics.”   

So when California officials started thinking about how to persuade the state’s Latino population to enroll in health care plans, they should have had a blueprint of what to do. Instead, they made a series of mistakes.

“It’s not a cohesive campaign targeted to Hispanics,” says Bessie Ramirez of the Los Angeles-based Santiago Solutions Group, a Hispanic market research firm that has consulted for large health care clients like HealthNet, Cigna and Blue Cross.

“Frankly, it seems obvious that the launch of this program seemed to have actually turned a blind eye to what the needs of this particular consumer were,” she says. Continue reading

Study: No Job Loss from Soda Tax

(Getty Images)

(Getty Images)

Taxing sugar-sweetened beverages, such as soda, would have no negative effect on jobs, a new study shows. In fact, there would be a small increase, researchers estimate.

A team led by Lisa Powell, an economist at the University of Illinois at Chicago, analyzed the effect of a 20 percent tax on sugar-swettened beverages. That works out to a little more than a penny-per-ounce. They looked at the impact in two states: Illinois and California.

“Effectively we found that there was pretty much zero change in jobs, zero net effect,” Powell told me in an interview.  Continue reading

In Light of the Mammogram Study: Two Thoughts on Breast Cancer

(Getty Images)

(Getty Images)

More evidence is in this week that casts doubt on the value of mammograms. To recap: Canadian researchers followed nearly 90-thousand women since the 1980s. The women were randomly assigned to mammography or physical breast exam. Now 25 years later, the researchers say that roughly equal numbers of women in each group died of breast cancer — mammography, according to this study, is not affecting the death rate at all.

In addition, mammography comes with harms. More than 1 in 5 cancers found in the mammography group were not ones that pose a threat to women’s health, the researchers say. Doctors call this “overdiagnosis.” This is a problem because the treatments for cancer are aggressive — surgery, radiation therapy, chemotherapy — and can cause harms in and of themselves. “There is no question that there is an excess in the diagnosis of tumors that are not going to kill you,” Dr. Laura Esserman, head of the UC San Francisco breast care center, told me, “We all know this phenomenon exists, but this quantifies it.”

Those are the headlines. Thursday morning, KQED’s Forum got into more detail. I was particularly interested in two points the guests made. The first was about new approaches to screening and the second was about screening as distinguished from prevention. Continue reading

Homeless and Addicted — Then Overcoming Both


Julie “Jewels” Gates (from Berry Creek, Calif., left) and Elena Wilson (from Oroville, Calif., right) saw jail as a one of the few options for low-income people in Butte County to stop using drugs. (Ryder Diaz/KQED)

Editor’s Note: For over a year, we’ve been bringing you first-person stories about health. Now, we’re digging deeper. Each month, we’ll be exploring a different health issue and asking diverse community members across the state to share their own stories on that theme. It’s a project we’re calling “Vital Signs.”

This month we look at the health needs of people who are homeless. Accurate statistics on homeless Californians are hard to get, but by some estimates roughly one in four people who are homeless abuse drugs. And homeless people face unique challenges when trying to quit.

Today we hear from Julie Gates and Elena Wilson. The two met seven years ago in Chico. Both women struggled with addiction and Gates, who goes by the nickname “Jewels,” sold drugs to support her own habit. In largely rural Butte County, it was hard for them to find treatment they could afford and were daunted by months-long waiting lists for help. Now clean and sober, the two women volunteer at the Hope Center in Oroville, giving back to the homeless community. They talk to one another about their journey.

By Julie Gates and Elena Wilson

ELENA WILSON: Jewels and I, there were periods of time we didn’t see each other but either at the lowest of out lows, and now, at the highest of our highs, God has brought our paths back together.

JULIE GATES: Absolutely.

WILSON: The last time I had seen her before I got clean, I was acutally kicking heroin in Chico. I was homeless. I was really, really sick. And I didn’t have any money and I couldn’t find any heroin. She went and bought me a pack of cigarettes and gave me a little bit of some methanphetamine to do with, to trade, or whatever. She said she’d try to find me some pills.

Continue reading

You’re Enrolled in an Obamacare Plan: Will Your Doctor Accept Your Insurance?

(Getty Images)

(Getty Images)

It’s been about six weeks since a half-million people saw their Covered California health insurance plan take effect. And in that time, those who have needed care have experienced the good, the bad and the ugly of finding a provider who will accept their insurance.

Let’s start with people who are dealing with some significant challenges.

I’ve been following Sue Kearney of Oakland. After confirming her doctors would take the insurance, she enrolled in an Anthem Blue Cross subsidized PPO plan with Covered California last fall. Then she scheduled appointments for early January. She has ongoing chronic health issues, and the thing she said she needs most is a colonoscopy.

But at her first appointment, she was told that the doctor did not accept any Covered California insurance. Ditto for the other doctors. Kearney set up a screen share with me, logged into her account and confirmed for me that doctors showed up as accepting her insurance, but the office said they didn’t when she called them. Ultimately, Kearney was referred to a specific customer service representative with Anthem Blue Cross to help her find an in-network doctor to perform her colonoscopy. I promised to check back in.

Continue reading

California Pharmacists Providing More Direct Care to Patients

Clinical pharmacist Diana Arouchanova worked with patient Diana Freedman’s physician to switch one of the medications that helped lower her blood pressure (Heidi de Marco/KHN)

Clinical pharmacist Diana Arouchanova worked with patient Diana Freedman’s physician to switch one of the medications that helped lower her blood pressure (Heidi de Marco/KHN)

Anna Gorman, Kaiser Health News

Jill Freedman felt like her heart was jumping out of her chest. She knew her blood pressure was too high and feared having a heart attack or a stroke.

“I was freaking out,” said Freedman, 55. “You get very emotional when you think you could drop dead at any moment.”

Her doctor doubled one of her medications, she said, but that only made her feel worse. So Freedman turned to the one person she knew she could count on — her pharmacist.

“We are the most overeducated and underutilized healthcare professional in the U.S.”   

“It was Diana who figured out what the problem was,” said Freedman, referring to her longtime pharmacist Diana Arouchanova. “Had she not been on top of what I’m going through, God knows how many more weeks this could have potentially gone on.”

Arouchanova, who owns Clinicare Pharmacy in Northridge, reviewed Freedman’s medications and realized that her problem stemmed from the dangerous combination of two prescriptions. She got the physician to change the medications and started checking Freedman’s blood pressure daily. Soon, it began to drop. Continue reading