New report: Covered California’s big enrollment numbers mask problems

Serious Issues Hampered Outreach to Limited-English Californians

Berkeley, Calif. – 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.