Jessica Altman took over in March as chief executive officer of Covered California, and even as she was settling into a new home in Sacramento she also was making the rounds with congressional leaders to drive home just how much Californians want access to health insurance.
The greatest barrier to getting it is all too often the cost, Altman said in her first interview with The Sacramento Bee, and nothing underscored that more than the record enrollment Covered California saw last year when new federal assistance in the American Rescue Plan slashed premiums for California enrollees by an average of 20%.
Enrollment in plans offered on California’s state-based marketplace surged to 1.8 million, according to Covered California records, an increase of more than 150,000 people.
Altman said she has to keep sharing the story that the financial help put in place under the American Rescue Plan is having an astounding effect for all Americans who rely on state and federal marketplaces to provide them with a lifeline when they or their family members are unexpectedly struck by illness and to get the preventative care that is so crucial to staying in good health. The federal subsidies were approved for only 2022 policies.
“Health care is core,” she said, “and being healthy is core to our ability to live happy and healthy lives and pursue the things that we want to pursue. It is also, within our society, a great equalizer if it’s used effectively and equitably in supporting people across our nation and in California.”
In other words, Altman said, Covered California’s work is not done when a consumer pays a premium.
“Our role as a marketplace does not end simply when people get covered,” she said. “It goes to what happens next. Is that health insurance providing the access that people need. Do they have the providers that they need? Are the providers providing high quality care that is actually delivering them better health outcomes? So this next phase of responsibility (is) not just access to coverage but access to quality, equitable care.”
A native Californian, Altman was the insurance commissioner for the state of Pennsylvania before she took the top job at Covered California. Altman takes the reins from Peter V. Lee, the founding leader of the marketplace since 2012.
She offered a glimpse into her key priorities during a question-and-answer session with The Sacramento Bee. We asked what her top priorities were as she started her tenure.
—Continuously improve the customer experience
The top priority is always going to be consumer-centric? How can Covered California, better serve customers that we have today, better reach the customers that we can have tomorrow, and better serve them in navigating our health care system, that can be all too complex.
One example: How can we better assist Californians as they transition between types of coverage — whether that’s from Medi-Cal to private insurers, from COBRA to a Covered California insurer, or between plans within Covered California or other types of transitions.
What are the outreach tools and the infrastructure that we have to identify these people at the time when they need us and to help them through those processes?
—Go deeper with diversity, equity and inclusion
Equity is built into our mission. It is something Covered California has always done. Are the providers providing high quality care that is actually delivering better health outcomes for all enrollees?
This next phase of responsibility is not just about access to coverage but access to quality, equitable care.
There are many things that we are doing through the equity lens, for example, our outreach to community-based organizations, our efforts to be embedded in different communities across California to provide customer service, our push to be known and understood across languages and across cultures, and our work to make sure that the providers that are in the network of the health plans that we contract with are diverse are culturally competent and are meeting the health care needs of all of our population.
—‘Our job doesn’t stop with coverage’
Our job doesn’t stop with coverage. It goes to quality.
Over the next coming years, we will be monitoring our health plans’ performance for six key measures of quality. We will have our health plans putting financial accountability on the table (paying penalties) if they do not meet the goals of those quality measures.
We are talking about things like: How many children that they cover are getting immunizations? How many adults are getting colorectal screenings that save lives at the appropriate age? How are they doing in monitoring blood sugar levels and hypertension among their population and improving it? These are the things that we know are the drivers of morbidity and mortality.
We will, by the way, be collecting and reviewing those measures not just holistically but also stratified by demographic factors like race and ethnicity to really make sure we are understanding any disparities.
Our equity work and our quality work are both the same and much more than one another. So what I mean by that is, health care quality is equity. Delivering on health care quality will help us deliver equitable outcomes.
—What makes you want to do this work?
I come from a family who has worked in health care and is steeped in health care. My father’s father was a primary care physician who I remember well, doing house calls even into his 80s with his black leather doctor’s bag and his stethoscope. My mother’s father was an obstetrician-gynecologist who provided women’s health services in a very different era.
And both my parents have worked in health care and had long careers in health care.
The issues hit close to home for me both because of watching my family members and loved ones give their lives and commitment to improving the health care of others and also (because) I have seen too many people I love experiencing health challenges. I have always been driven to public service, I have never worked anywhere other than in public service.