One of the biggest challenges will be persuading the uninsured to sign up, particularly the healthy subscribers necessary to ensure that the program is financially viable. Lee said Covered California will devote much of its energy and resources to connecting with residents through paid advertising and community outreach.
The state health exchange previously hired Ogilvy Public Relations for $900,000 to work on an outreach plan. The Bee reported in July that ideas ranged from having First Lady Michelle Obama lead a California summit to asking television writers in Hollywood to draft story lines featuring subsidized health care options, the latter of which drew objections from GOP congressmen.
Despite the flak, Lee said Covered California isn't backing away from those ideas: "We want it talked about at the dinner table, in front of the TV, in barber shops."
Health insurers are concerned that the federal law limits their ability to charge significantly lower rates for young people than for older adults. Patrick Johnston of the California Association of Health Plans says older adults typically have health care costs five to seven times higher than young enrollees.
Johnston said health insurers are asking the Obama administration to allow greater discounts for young subscribers. Otherwise, he fears, healthy young adults will avoid signing up.
"What Congress did was take (pricing) out of math and science and move it into politics," Johnston said. "It's good for older people. But the effect will not only be on younger people, but the stability of the pool. It's a concern."
As recently as several weeks ago, Gov. Jerry Brown worried that Obama's overhaul might not survive the election. The governor vetoed bills that would have enshrined some of the most popular federal components in state law.
Obama's plan requires health insurers to cover people regardless of condition and prohibits higher premiums based on illness. That pencils out for insurers only if healthy people are mandated to buy coverage, as the federal plan requires under threat of financial penalty.
Brown feared that Obama-plan critic Mitt Romney might eliminate the mandate if elected president, leaving California insurers required under Senate Bill 961 and Assembly Bill 1461 to cover sick patients while healthy residents could avoid buying coverage.
While much of the health care action will take place at Covered California, the Legislature must still make several major decisions in a special legislative session in January.
Sen. Ed Hernandez, D-West Covina, chairman of the Senate Health Committee, said lawmakers must revisit the legislation that Brown vetoed to require insurers to cover all individuals regardless of medical condition and define how premiums are set.
He said the Legislature also has to consider how to extend Medi-Cal benefits to more people and whether to create an alternative basic health plan for low-income residents.
(c)2012 The Sacramento Bee (Sacramento, Calif.)
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