When she was Pennsylvania’s insurance commissioner, Jessica Altman, a Democratic governor, often pushed against the political limits of healthcare policy in a state where Republicans control the legislature.
Despite the limitations of a divided government, Altman played a key role in persuading lawmakers to join Governor Tom Wolf in 2019, known as Pennsylvania’s state-run Affordable Care Act Marketplace, Penny. And she had a big hand in launching it as the first chairperson of its board in November 2020.
In March, Altman took control of the ACA insurance market in Covered California, Golden State, following the departure of Peter Lee, its first executive director. Altman will earn 450,000 annually.
To take on a new role, Altman, 33, has returned to his homeland, whose democratic leadership has supported extending health coverage to residents as much as possible. Covered California, founded shortly after the ACA passed in 2010, is the first state-run insurance exchange created under the new law. And the state has been an ardent supporter of the ACA’s Medicaid expansion.
However, Covered California relies on federal tax credits to make coverage more affordable for most of its entrants. The American Rescue Plan Act, passed by Congress last year, has helped increase enrollment in proposed plans in exchange for increasing the size of credits, sharply lowering premiums for enrollees and increasing financial support for many middle-class families. People can take credit in the form of reduced monthly premiums or wait until they pay their taxes.
The exchange estimates the extra dollars have reduced the average monthly premium cost of covered California entrants by 20% this year compared to 2021. And lower costs have helped push enrollments to a record 1.8 million this year. Nationally, the average premium cost for registrants in the marketplace decreased by 23%, and enrollment rose to 14.5 million, which is also a record.
But fiscal growth is set to end later this year, and Congress has not yet renewed it. California Gov. Gavin Newsom has proposed that the state use the surplus of its budget $ 304 million in subsidies if the federal government does not act, replacing only a portion of that federal increase.
Altman fears that without continued support, consumer spending will rise sharply and many people will abandon coverage. That’s why he says one of his first tasks is to pressure Congress to increase American Rescue Plan subsidies.
Altman arrived just as Covered California is pushing for commercial health plans to improve the quality of care for low-income and disadvantaged people and to address inequality.
The Marketplace board approved a new perennial initiative in February that would require a covered California health plan to submit data on the quality of care divided by race and ethnicity. A covered California fundraising plan will be needed if they fail to meet the criteria for care for childhood immunizations and certain health conditions – diabetes, hypertension, and colorectal cancer – which inequally affect people with disabilities.
In a recent interview, Altman discussed the new policy, as well as his pressure to increase federal premium subsidies. The interview has been edited for length and clarity.
Q: What is the biggest difference between healthcare politics and policy between California and Pennsylvania?
All you can achieve is to understand the potential art. Your political limitations, the limitations of your system, will show you what is possible. In Pennsylvania, you dream big and you work hard. I think that in the context of the political environment – with the unanimous support of a Republican legislature and a democratic governor – it is a great achievement to complete a transformation on a state-based basis.
In California, we have a marketplace that is developed in many ways. So, here, a wide set of his art is possible.
Q: What message do you want to give about the increased subsidies under the American Rescue Plan Act?
I came to this role after a record-breaking enrollment in California, which is true in many states due to increased subsidies. So, a really incredible effect when you look at the affordability available to Californians and Americans.
The flip side of this is that it means if they don’t continue. Before the American Rescue Plan, [federal] Subsidies have gone up to 400% of the federal poverty level [currently slightly over $54,000 a year for an individual and $111,000 for a family of four]. In California, people above that income level will see an average increase of $ 272 in their premiums per month. And then there are the lowest-income entrants in Covered California who will see the premium, on average, double, $ 131 per month. These are effects that are going to change people’s minds about whether they are covered or not or whether they are covered or not.
Q: What is the cutoff date for the decision to reflect the increased subsidy in 2023 premium?
Premiums are usually locked down in July. We will always try to move mountains when there is uncertainty. Basically, for me, the date we should think about is October, when we send a letter to the covered California registrar saying, “This will be your premium next year.”
Q: The way I read the quality and equity initiative approved by your board in February is that overall care and health equity have been combined. Is that right
Yes. It starts with a pretty basic principle that quality is equity – that if we improve quality, we improve equity.
Q: How will all the components of this initiative be integrated over time to improve equity in healthcare?
It’s really about capturing exactly what we cover, understanding what they’re feeling every day in their care, and trying to do better for everyone.
When we look at these poor healthcare sectors where we know the results vary by race and ethnicity and we work to raise the bar, we are going to help the population who feel worse health consequences on these basic measures.
And I don’t want to lose sight of the powerful data collection associated with systems, because fundamentally it starts with understanding at a really grainy level what the inequalities in our covered population are.
Q: What is your definition of success in tackling health equity issues with covered California Board approved measures?
One of the things you and I haven’t talked about in detail is the underlying financial implications of what we’re doing. And there’s a shared liability model, where insurers have money on the table if they don’t meet the 66 percent standard.
I would say the best definition of success is if our insurers don’t have to pay anything. Do I think that will happen now? I hope so, but maybe not. But that’s okay. It’s all about moving forward.
Q: If a health plan doesn’t pay anything because they’re meeting all the targets, what does that mean for consumers?
This means more children are being vaccinated. This means more people are getting their colorectal cancer screening, which means more colorectal cancers are being detected early and life is being saved. It really translates into better health and better results for people.
Jessica Altman is the daughter of Drew Altman, President and CEO of KFF. KHN is KFF’s editorially independent program.
The story was produced by KHN, which publishes the California Healthline, an editorially independent service of the California Health Care Foundation.
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