SACRAMENTO, Calif. (AP) — After celebrating its enrollment numbers earlier this week, California's health-insurance exchange came under heavy criticism Thursday for its lackluster efforts to sign up Latinos and for continued paperwork problems that have left untold numbers of consumers in limbo.
Members of Covered California's board of directors also questioned some of the exchange's spending priorities. Specifically, they wondered whether millions of dollars planned for a ramped-up marketing and advertisement campaign was the right approach when consumer advocacy groups and insurance agents say systematic problems persist and are discouraging thousands of people from getting coverage.
Those groups cited continued long wait times on the exchange's three telephone call centers, numerous problems with the online enrollment site and multi-week lag times in getting policy paperwork transferred from the exchange to insurance companies.
"This is not a marketing issue. Awareness without access does not get you to where you want to be," said Deborah Lazaro, a certified insurance agent.
Lazaro told board members that major flaws continue with the Covered California website and said there was a lack of support for agents. For example, she said a hotline intended to enroll those who speak Chinese instead delivered a lengthy message in English, then switched to Spanish. The same was true for a call-in line for those who speak Korean, she said.
Another agent said a customer he helped enroll in mid-December still had no coverage because the insurance company had yet to receive the processed application from Covered California.
"We need help in the trenches," Lazaro said.
The meeting was the first for the board since new health insurance policies sold under the federal Affordable Care Act took effect Jan. 1.
Covered California Executive Director Peter Lee celebrated the headline number: about 625,000 people had signed up for an insurance plan between Oct. 1 and Jan. 15. But he also acknowledged steep challenges in enrolling Latinos, younger adults and in vastly improving customer service for consumers and those trying to enroll them.
Lee also acknowledged confusion over billing and paperwork exchanges between the state agency and private insurance companies.
"This has been a wild last three months," he said. "Many have had a less-than-ideal experience."
He said Covered California was in the process of hiring 350 additional call center employees, mostly in Fresno, and dedicating a phone line for insurance agents and certified enrollment counselors. Lee also announced hiring a new director of marketing and communications, and the hiring of former state Finance Director Ana Matosantos as a senior adviser to analyze the exchange's performance data. Covered California would not disclose the salaries of the new executives.
Additionally, the exchange will add bilingual staff, fix numerous problems with its Spanish-language website and expand the capacity of its service centers so callers don't receive a busy signal or get bumped off. It already has been addressing a glitch on its main website that in essence deterred families from signing up for pediatric dental care.
The board also was told about upcoming marketing and advertising campaigns funded by a new $155 million federal grant, an amount that is on top of the $910 million the exchange has received to date from the federal government.
The planned campaign would spend $4.5 million targeting Latinos and $5 million targeting young people. Both demographics are crucial to the exchange's success — Latinos because they make up a majority of California's uninsured population and young people because they are needed to balance out the older and less healthy people who are more costly to insure.
Enrollment for both groups has so far lagged behind the targets.
State Sen. Norma Torres, speaking on behalf of the legislative Latino Caucus, told the board that Latinos face numerous obstacles to enrolling, including a lack of in-person assistance in their communities. She said those obstacles in getting help to sign up for coverage are the problem, not a lack of marketing.
Latino lawmakers support the federal health care reforms, Torres said, but are alarmed at the low sign-up rates to date in their communities and urge the board to address the issue quickly.
"We need you to deliver on making those changes happen, not simply talk," she said.
Some members of Covered California's board of directors questioned whether spending millions of dollars on marketing is a good idea.
Board member Paul Fearer asked if the exchange's staff understood the disconnect with Latino and other minority communities enough to conclude that a pricey advertising campaign was the answer. For example, he said people who had never before had health insurance might not grasp a messaging effort focused on pre-existing conditions.
Fearer also said evidence to date suggests enrollment problems are largely caused by staffing, access to information and the capabilities of the website. He worried that if more people rushed to sign up for coverage without a corresponding improvement in Covered California's operations, the problems would only deepen.
"I'm somewhat worried that our solutions don't match the problem," Fearer said.
In response, Lee said he agreed that beefing up the marketing efforts was not the sole answer.