Covered California pushes for better health care as federal spending cuts loom

Faced with expected federal spending cuts that threaten soundness coverage and falling childhood vaccination rates Monica Soni the chief diagnostic officer of Covered California has a lot on her plate and on her mind California s Affordable Care Act physical condition insurance exchange covers nearly million residents and of them receive federal subsidies that reduce their premiums A great number of middle-income households got subsidies for the first time after Congress expanded them in which helped generate a boom in enrollment in ACA exchanges nationwide From the original and enhanced subsidies Covered California enrollees as of now get a month on average lowering the average monthly out-of-pocket premium from to according to statistics from Covered California The subsidies are set to expire at the end of this year unless Congress renews them If they lapse enrollees would be on the hook to pay an average of a month more for physical condition insurance not counting any premium hikes in and beyond And those middle-income earners who did not qualify for subsidies before would lose all financial assistance a month on average which Soni fears could prompt them to drop out At the same time vaccination rates for children and under declined among of the Covered California healthcare plans subject to its new quality-of-care requirements Soni a Los Angeles native who came to Covered California in May oversees that initiative in which soundness plans must meet performance targets on blood pressure control diabetes management colorectal cancer screening and childhood vaccinations or pay a financial penalty Lack of access to such key aspects of care disproportionately affects underserved communities making Covered California s effort one of wellness equity as well Soni a Harvard-trained primary care healthcare provider who sees patients one day a week at an urgent care clinic in Los Angeles County s inhabitants safety net wellbeing system is familiar with the challenges those communities face Covered California stated in November that its wellness plans improved on three of the four measures in the first year of the scheme But childhood immunizations for those under declined by The decline is in line with a national trend which Soni attributed to post-pandemic mistrust of vaccines and more skepticism of the entire biological industry Majority of parents have heard at least one untrue announcement about measles or the vaccine for it and various don t know what to believe according to an April KFF poll Wellbeing plans improved on the other three measures but not enough to avoid penalties which yielded million The exchange is using that money to fund another effort Soni manages which helps Covered California households buy groceries and contributes to over savings accounts for children who get routine checkups and vaccines A few of the penalty money will also be used to endorsement primary care practices around California In addition to her bifurcated professional duties Soni is the mother of two young children ages and KFF Vitality News senior correspondent Bernard J Wolfson spoke with Soni about the impact of realizable federal cuts and the exchange s initiative to improve care for its enrollees This interview has been edited for length and clarity Dr Monica Soni worries about a decline in childhood vaccination rates and possible federal budget cuts that could lead to large-scale disenrollments Photo by Rich Pedroncelli For KFF Healthcare News Q Covered California has record enrollment of nearly million boosted by the expanded federal subsidies passed under the Biden administration which end after this year What if Congress does not renew them A Our estimates are that it will approach Californians who would drop coverage instantly We hear every day from our folks that they re really living on the margins Until they got a few of those subsidies they could not afford coverage As a primary care expert I am the one to treat folks who show up with preventable cancers because they were too afraid to think about what their out-of-pocket costs would be I don t want to go back to those days Q Congress is considering billions in cuts to Medicaid How would that affect Covered California and the state s population more broadly given that more than in Californians are on Medi-Cal the state s version of Medicaid A Those are our neighbors our friends Those are the people working in the restaurants we eat at Earlier cancer screenings better chronic ailment control lower maternal mortality more substance use disorder medicine We know that Medicaid saves lives We know it helps people live longer and better As a physician I would be hard-pressed to argue for rolling back anything that saves lives It would be very distressing to watch that come to California Q Why did Covered California undertake the Quality Transformation Initiative A We were incredibly prosperous at covering nearly million but frankly we didn t see improvements in quality and we continue to see gaps for certain populations in terms of outcomes So I think the question became much more imperative Are we getting our money s worth out of this coverage Are we making sure people are living longer and better and if not how do we up the ante to make sure they are Q There s a penalty for not meeting the targets but no bonuses for meeting them You meet the goals or else right A We don t say it like that but that is true And we didn t make it complicated It s only four measures It s things that as a primary care specialist I know are central that I take care of when I see people in my practice We announced get to the th percentile on these four measures and there s no dollars that you have to pay If you don t then we collect those funds Q And you use the penalty money to fund the grocery assistance and child savings accounts A That s exactly right We had this opportunity to think about what would we use these dollars for and how we truly make a difference in people s lives So we cold-called hundreds of people we sent surveys out to thousands of folks and what we heard overwhelmingly was how expensive it is to live in California that folks are making trade-offs between food and transportation between child care and food just impossible decisions Q You will put up to a child into those savings accounts right A That s right It s tied to doing those healthy behaviors going to child well visits and getting recommended vaccines We looked at the literature and once you get to even just in an account the likelihood of a kid going to a two- or four-year school increases significantly It s truly because they re hopeful about their future and it changes their path of upward mobility which we know changes their healthcare outcome Q Given the rise in vaccine skepticism are you worried that the new measles outbreak could grow A I am very concerned about it I was indeed reading a few posts from a physician colleague who trained decades earlier and was talking about all the diseases that my generation of physicians have never seen We don t authentically know how to diagnose and take care of a number of infectious diseases because they mostly have been eradicated or outbreaks have been really contained So I feel worried I ve been brushing off my old textbooks This article was produced by KFF Vitality News which publishes California Healthline an editorially independent arrangement of the California Fitness Care Foundation KFF Robustness News is a national newsroom that produces in-depth journalism about strength issues and is one of the core operating programs at KFF an independent source of wellness program research polling and journalism