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Revamped Covered California Campaign Seeks Greater Minority Enrollment

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In the six months following the end of the first Affordable Care Act enrollment period, officials with the Covered California insurance exchange analyzed data to revise strategies aimed at removing more Californians from the ranks of the uninsured. The result of the analysis is Covered California's 2015 Community Outreach Campaign, a multi-pronged effort that will employ more than 200 community-based organizations, or Navigators, to work within their constituencies to provide personalized enrollment assistance.

Many of the Navigator groups represent African-Americans, Asians and Latinos, groups Covered California is hoping to enroll in greater numbers beginning in mid-November. The community outreach effort that includes $14.6 million in Navigator grants is being launched in conjunction with a $46 million advertising campaign that is heavily focused on minorities.

The combination of targeted advertising through minority media outlets and community partnerships is key to increased participation according to Covered California Executive Director Peter Lee.

"We are getting ready to roll out the implementation of the Affordable Care Act, building on the experience of last year's first open enrollment to seek to get every Californian covered," Lee said. "To do this we want to build on the partnerships we developed a year ago that made California the leader in the nation in expanding coverage of the Affordable Care Act.

"During the first open enrollment period, more than three million Californians got coverage either through Covered California or were newly covered through Medi-Cal. In California we've reduced the rate of uninsured from 22-percent to 11-percent. That's good news but it's not enough," Lee said. "We want to keep working together in every community in the state until every Californian gets insurance and keeps it. We are optimistic we will be well on that path during the second round of open enrollment."

Lee's optimism isn't shared by everyone. Critics of the initial six-month open enrollment effort claim Covered California did not do enough to target minorities, African-Americans in particular.

Forty-five-percent of the new advertising budget will be spent targeting Latinos, who represent 40-percent of California's population, but were underrepresented among new health insurance enrollees.

A nine-percent advertising allocation has been set aside for African-Americans, who comprise six-percent of the state's population, but were similarly underrepresented among enrollees.

From October 2013 through March 2014, 1.4 million Californians signed up for coverage. With nearly 31,000 signing up, African-Americans represented only 2.2-percent of new enrollees.

"We're looking at other data to see where we did a great job or not so great of a job," Lee said. "Within Covered California about five-percent of subsidy-eligible people are African-American. About four-percent of our enrollment was African-American. But we still want to lean in and double down.  If you look at the Navigator grants we specifically looked out and said who can we add who is anchored in the African-American community that can show they know that community and can reach out effectively and bolster education and enrollment efforts?"

Dr. Brownell Payne, whose Los Angeles-based Crenshaw Health Partners organization received $300,000 in Navigator funding, says the raw enrollment numbers may not give an accurate picture of African-American participation because they don't factor in enrollment in Medi-Cal, California's low-income health coverage assistance program.

"When we talk about enrollment among African-Americans, we're not just talking about Covered California, we're talking about Medi-Cal," Payne said. "Where we operate a significant portion of our community has Medi-Cal. So while the Covered California numbers may have been lower, the Medi-Cal numbers have been huge. With every insurance enrollment we make in the African-American community we will enroll two to three people in Medi-Cal because a lot of people didn't know that they were eligible."

"We invested heavily in reaching the African-American community and the data we have shows that we did a pretty good job," Lee said. "Among the previously uninsured, whether they get it through Covered California or Medi-Cal or through a job, about 61-percent of the previously uninsured got insurance, whether you're African-American, Latino, Asian or White."

The new marketing campaign that includes television, online, radio and print advertising is specifically designed to attract more minority participation by increasing awareness.

One challenge for Covered California and its partner organizations is how to convince African-Americans to sign up for coverage despite reportedly high-levels of awareness about the Affordable Care Act and the Covered California insurance exchange.

Results from a University of Chicago tracking survey show that in May and June 2013, prior to the first enrollment period, awareness of the Covered California insurance exchange among African-Americans was less than 10-percent. By February 2014, the enrollment mid-point, African-American awareness had risen above 80-percent due to advertising and marketing efforts. The survey also reported more than 50-percent of African-Americans had medium to high levels of exposure to the advertising campaign.

Based on the results, Covered California concluded, on average, 40-percent of consumers with high levels of exposure enrolled in a health insurance plan.

Yet, despite higher than average levels of exposure and awareness, African-Americans represented only 2.2-percent of the 1.4 million Californians signing up for coverage during the initial six-month enrollment period.

Payne says misinformation is another factor that may be preventing African-Americans from signing up in greater numbers.

"There are a lot of barriers in the African-American community, and unfortunately part of those barriers are old myths," Payne said. "We had a lot of Brothers and Sisters come up and say, 'We're not going to enroll in Obamacare because they put a chip in your wrist and they can track you for the rest of your life.'"

Conspiracy theories aside, Payne and other Navigator organizations will have to deal with more practical issues like communicating the merits of insurance to people who have never participated in the health care system or whose first insurance policy began last year.

"Part of our purpose in running the ads is to remind people who are not used to having insurance not to cancel because they didn't use it because insurance is there in case really bad stuff happens, as well as for preventive care," Lee said.

"We also  have a lot of people who have been used to relying on the county. So they say, 'Why should I enroll? I might get a $95 penalty, but i'll just go to the county," Payne said. "But what they don't understand is that penalty will increase every year. And the worst possible penalty of not having coverage is if you get in an accident and you don't have coverage."

When the new enrollment period begins November 15, organizers will have only three months to sign-up new enrollees and convince those currently covered to renew or make changes to their existing plans.

Both Payne  and Lee are optimistic about enrollment prospects and point to the strategy of relying on grassroots partnerships as a primary component.

"In the African-American community they trust us and we're in the community moving things forward," Payne said. "Now it is a matter of them gaining trust in the system. A big part of gaining that trust is in-person enrollment. In our center they can sit down and talk to us and gain the trust.

“We've taken care of the low-hanging fruit," Payne said. “ but there are huge numbers in the African-American community who qualify for subsidized enrollment, so we expect the enrollment numbers to be much higher than they were before.

New Report: Covered California’s Big Enrollment Numbers Mask Problems

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Serious Issues Hampered Outreach to Limited-English Californians

BERKELEY, CALIFORNIA – Covered California, the state health insurance exchange created under the Affordable Care Act, deserves credit for strong enrollment numbers in its first year but must act to correct serious deficiencies in its outreach and enrollment efforts, a new report finds. The Greenlining Institute study, Covered California’s First Year: Strong Enrollment Numbers Mask Serious Gaps, to be released June 26, follows up on Greenlining’s 2011 analysis of changes facing Covered California, iHealth: How to Ensure the Health Benefit Exchange Reaches all Californians.

“Covered California exceeded expectations for enrollment and did many things right,” said report co-author Jordan Medina, Greenlining Institute Health Policy Fellow. “But when we spoke to enrollment counselors and educators, we found real problems. Millions of Californians do not speak English well, but materials in other languages were often in short supply or simply nonexistent, and some of what did exist was badly translated.”

Key findings of the report, based on interviews with staff at outreach and education grantee organizations and certified enrollment counselors in Los Angeles and Fresno Counties as well as surveys filled out by ordinary Californians, include:

#The demographics of those who enrolled in private insurance plans roughly mirrored the demographics of those eligible, but Californians with limited English proficiency were seriously underrepresented. Eighty percent of enrollees in private insurance plans spoke English as their primary language, even though 40 percent of those eligible for coverage were limited-English proficiency individuals.
#Educators and enrollment counselors consistently cited problems with cultural and linguistic issues. Covered California’s website was fully functional only in English and Spanish (with the Spanish section coming online late), some materials were poorly translated and hard to understand, and translated materials that did exist were often in short supply. Educators and counselors described having to either create their own materials (in violation of rules) or having to give out English language materials and hope that “someone would be able to translate it for them.”
#As Greenlining had predicted in iHealth, lack of high-speed Internet access was a problem in some communities.
#To improve its performance next year, Covered California must:

*expand on the elements that worked, including social media outreach and the network of certified enrollment counselors;
*make sure all outreach and enrollment materials are translated into the 13 most widely spoken languages in California;
*hire a director of diversity and cultural competency to ensure that all communities are targeted appropriately, cultural and linguistic issues are dealt with, and that translations are understandable for the target population; and
*make sure outreach and enrollment activities are better coordinated and seamless, and that those doing this crucial work get adequate funding to do their jobs properly.

-PRESS RELEASE-

Housing for Vets and Public Access Top Ballot – Will Voters Turn Out?

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Updated nonpartisan website guides voters this primary season

SAN FRANCISCO — On June 3, California voters will cast ballots that will impact housing for veterans and public access to government meetings and records. They’ll also choose the top two candidates for a handful of offices including governor, lieutenant governor, attorney general and others. The newly updated nonpartisan California Choices (www.californiachoices.org), a clearinghouse for state voter information, is available to help walk voters through the process.

“If the 2012 primary is any indication, voter turnout could be low—even historically low,” said F. Noel Perry, the founder of the nonpartisan nonprofit organization, Next 10, which presents California Choices in partnership with the Institute of Governmental Studies at the University of California, Berkeley. “We hope that providing voters with clear, concise information will encourage them to get to the polls.”

California Choices examines the two statewide propositions – Prop. 41 and 42 – that are on the ballot this June, providing information about the measures in a highly accessible, one-stop-shop format. Prop. 41 would authorize $600 million in bonds to provide multi-family housing to homeless and at-risk veterans. Prop. 42 would require local governments to comply with state laws providing access to public meetings and records.

The site’s “Endorsements” table shows how nearly 20 groups of all political stripes would vote on both ballot initiatives. The interactive site also allows users to save their votes using the new “My Votes” feature. Voters can then access their voting preferences at any time from another device, including from a smart phone at the polling place. Users can also share their votes with family and friends via email or Facebook.

“Low voter turnout is very simply bad for our democracy. We’re arming Californians with information so that they can become more engaged in the political process,” said Jack Citrin, Director of the Institute of Governmental Studies at UC Berkeley.

-PRESS RELEASE-

Greenlining Urges California Public Utilities Commission: Don’t OK Comcast/Time Warner Deal

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SAN FRANCISCO – In a protest being filed today with the California Public Utilities Commission, The Greenlining Institute urges the CPUC not to approve the proposed acquisition of Time Warner Cable by Comcast, arguing that the proposed merger would not be in the public interest.

“This deal poses a real threat to low-income customers, whom Comcast has shown no interest in serving,” said Greenlining Institute Energy and Telecommunications Policy Director Stephanie Chen. Key points in Greenlining’s protest include:

  • Time Warner is one of the few cable companies that treats serving low-income customers as a meaningful part of its business model, rather than just a compliance obligation. The merger would eliminate Time Warner and deliver most of its customers to Comcast.
  • Time Warner has committed to providing LifeLine service for its low-income telephone customers, while Comcast has not (telephone issues are at the heart of CPUC’s jurisdiction over the proposed merger).
  • The proposed deal promises to reduce competition in the Los Angeles-area market, threatening increased prices and lower service quality, while providing no economic benefits to residential customers (despite substantial cost savings for the merged company).
  • The Commission should investigate the proposed new company’s commitment to diversity, given Comcast’s half-hearted record in this area.

“We believe there are strong reasons for the Commission to say ‘no’ to this deal, and we’ll be bringing up additional concerns with the FCC when the time comes,” Chen said.

-PRESS RELEASE-

Brown unveils conservative new budget proposal

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By James Carter
California Black Media

Despite $2.4 billion in unexpectedly higher revenues, California Governor Jerry Brown stressed spending restraint Tuesday when he detailed his revised state budget proposal.

According to Brown, the two-year tax revenue gains are offset by increased spending, specifically higher Medi-Cal costs and state worker retirement liabilities.

"We must follow a policy of restraint," Brown said. "Arguing with reality is a very chancy endeavor. The reality is the numbers that I've laid before you: Revenues are up a couple of billion but expenditures meet the revenues almost precisely. And that's the problem."

Last week a report from the Legislative Analyst's Office stated California is facing $340 billion in long-term costs that are not being adequately addressed. The largest percentage of those costs relate to a nearly $74 billion shortfall in the teacher pension fund. Because the contributions are mandated by state law they do not automatically adjust to ensure proper funding. If contributions are not increased, most estimates expect the fund to run out of money in approximately 30 years.

"People are concerned about young people getting what they need," Brown said. "To get what they need, they need teachers. Teachers get what they need by having pensions. The pension has to be paid for. There will only be pensions in 30 years if we start laying aside money."

Ongoing and uncertain healthcare costs are another major component of California's fiscal state.

Brown said that as people were being recruited to sign up for the federal Affordable Care Act, many people who previously were not participants in the health care system discovered they were eligible for Medi-Cal, the state's low-income healthcare program.

"30-percent of the people in California are now getting health coverage under our Medi-Cal program," Brown said. "That is a huge social commitment on the part of the taxpayers of California. I'm proud we did it but we have to take into account that it is growing. Since January the costs of this Medi-Cal enrollment has gone up $1 million. What are the unknown increases the next year and the year after that? That is why we have to be very careful with how we look at spending claims."

Brown's long-view approach to tackling California's economic troubles are winning some support from the other side of the aisle. Senate Republican Leader Bob Huff, R-Brea, is guardedly optimistic about the steps and directions Brown has taken with the budget.

"I think the governor outlined a fairly fiscally conservative budget, so he is trying to acknowledge and pay down debt," Huff said. "It's hard to call this an austere budget given that it's $12 billion more than last years' budget. But given the demand for so many programs up here I would have to say that the governor's drawn a pretty strong line of fiscal restraint."

The question is whether that strong fiscal line will be able to hold up under the intense pressure from outside groups and other legislators who want to see funding restored to programs and services cut during the recession and expenditures for new programs.

One such new program is Senate President pro Tem Darrell Steinberg's, D-Sacramento, proposal to expand transitional kindergarten statewide. The program, introduced as part of the Steinberg's Kindergarten Readiness Act, provides classes and a modified curriculum to four-year-olds who miss the cutoff date for kindergarten enrollment because their birthdays fall later in the year.

Advocates of the transitional kindergarten program site statistics and studies showing the improved academic outcomes among children who attend pre-school versus those who don't. While they may agree on the academic benefits, for opponents the clear consideration is cost. If fully funded Steinberg's program could cost an estimated $1.46 billion.

When asked about the transitional kindergarten proposal Tuesday, Brown, who previously warned lawmakers about using budget surpluses on new spending, showed no signs of support.

"A lot of people have various views on the education system," Brown said. "In California we have K through 12 and two years of community college. Some people say if we just get a sixteenth year everything will be hunky dory for the next 50 years. If that's true then some reallocation has to be made within that 15-year Prop 98 program."

Brown's fiscal conservatism combined with legislators looking to satisfy constituent groups seeking a larger slice of the economic pie could make for interesting debates leading to the June 15 budget deadline.

"The truth is there are many good ideas in health care in schooling in environment, in prison reform, in court expansion, but we only have so much money. we do live within the revenues given," Brown said. "This budget is my best cut at how to spend the money. This is taking a big bite out of our long-term obligations. The Legislature will now go over it and we'll have a good conversation about what we do."

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