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CMA Capitol Insight: "Watching the Grass Grow"



September 30, 2013
Area(s) of Interest: Advocacy Health Care Reform 

CMA Capitol Insight is a biweekly column by veteran journalist Greg Lucas, reporting on the inner workings of the state Legislature.




“Watching the Grass Grow”


That’s the analogy used by Diane Dooley, Secretary of California’s mammoth Health and Human Services Agency, to describe the first months of implementation of the Affordable Care Act, which begins tomorrow, October 1. “It’s going to be like the start of a marathon, not a 100-yard dash,” she said. Dooley was speaking to a Sacramento health care conference on September 26. She later told Capitol Insight her point was that initially the number of enrollments or the number of calls the state health insurance exchange logs with questions about coverage isn’t a valid indicator of ultimate success. “We won’t know what’s really happening for a long time,” she said. What’s clear, though, is that as the deadline looms for deciding whether to buy coverage or be penalized, Covered California is getting a lot more attention. The state smorgasbord of insurance options has begun an awareness campaign in three small and moderate-sized markets: Chico/Redding, Sacramento and San Diego. A far more intensive statewide effort is now beginning. Just from the small market test run, phone calls to the exchange increased by 500 per day, Dooley said. And visits to the exchange’s website – www.coveredca.com – jumped by 15,000 per day. Will enough operators be standing by when the ad campaign hits Los Angeles? Covered California has said that by October 1 it will have 400 “Service Center representatives” on hand to “answer questions and enroll consumers in private health plans and Medi-Cal.”


“Like Political Season”


That’s Secretary Dooley’s analogy for the comprehensiveness of Covered California’s public awareness campaign of TV, print, radio, digital and social media announcements regarding the need for coverage and how to get it. “You’ll be so tired of all the Covered California ads you’re seeing, you can’t wait until the campaign is over,” Dooley said at the same September 26 conference. Between now and March 31, when open enrollment ends, Covered California is spending $45 million to get the word out. From April to the end of 2014, an additional $35 million (the $80 million comes from a one-time federal grant). There’s three phases to the outreach effort, which is being conducted in several languages. The first ads introduce the “new state of health” created by the Affordable Care Act. Says one brief TV spot: “Those who need financial assistance will get it and nobody will be denied because of a preexisting condition.” After that will come a bombardment of “enroll now” ads followed by messages centered on the theme of: “Better enroll quick or else because time is running out.” For more than 80 percent of Californians with health insurance, the months of messaging may seem a saturation bombing, as Dooley suggests. But for the 7 or so million Californians without coverage, it might be just enough. Although, to quote famed behavioral scientists The Grateful Dead: “You ain’t gonna learn what you don’t want to know.”


Our Friends to the North


By way of comparison, Oregon has an exchange like California’s. It’s called “Cover Oregon” and has a logo similar to Covered California except it’s a “C” and an “O” rather than California’s two upside down “C’s”. Like California, Cover Oregon calls itself a marketplace – “your place to buy health insurance.” And, like California, Cover Oregon is conducting an outreach campaign, except the price tag is $9.9 million and the messaging is a bit different than the Golden State. The Washington Post described Cover Oregon’s effort as the “world’s most twee Obamacare marketplace.” British in origin, “twee” is generally defined as “affectedly or excessively dainty, delicate, cute or quaint.” Cover Oregon’s “Long Live Oregonians” campaign has local songwriters like Laura Gibson and Matt Sheehy strumming and warbling about the “Oregon spirit” and how Oregonians “care for each one – every daughter and son.” Oregon sons and daughters singled out in Gibson’s 60-second ad, in which four cellists accompany her, are loggers, bakers, bankers, teachers, students and “indie rock bands.” Gibson artfully rhymes them. See how twee at www.coveroregon.com/creative/. Long live Oregonians!


Crazy for Check-offs


Lawmakers love tax check-offs. They passed seven bills relating to the voluntary contribution boxes, fixtures on state tax forms for 30 years. Gov. Brown has signed two of the seven. In one instance, the Democratic governor OK’d the legislation even though his own Department of Finance said the measure was “of limited value as there is nothing currently preventing California taxpayers from contributing directly to this cause if they so choose.” This year, lawmakers want to add three new check-offs to the existing 18 and keep some of the existing check-offs around longer. The list of check-offs, which support everything from breast cancer research to the Police Activities League, can be found at the top of Page 3 of California’s 540 tax form. For several years, space limits held the number of check-offs in check at a maximum of 15. New ones had to wait until existing ones expired. That’s five years for most – or sooner. A check-off is bounced from the tax form if it doesn’t generate $250,000 or more in annual contributions. But the increase in electronic filing and a redesign of the tax form have ended concerns over space. What were 15 climbed to 18 and now could be 21, depending how the governor acts on the remaining five check-off bills. The Franchise Tax Board says it can add another 12 to 15 check-offs before having to spend as much as $1 million to change its system to accommodate more. So far, Brown’s addition to the check-off list is the “Protect Our Coast and Oceans Fund,” which will pay for grants to groups conducting “innovative ‘adopt-a-beach’ programs.” Noted Brown’s Department of Finance: “It is not clear that a special preference should be given to the grants and programs supported by this tax check-off as compared to other organizations also dedicated to preserving and enhancing California’s coastal resources.” The California Arts Council, created in 1975 by Brown during his previous gubernatorial stint, had a check-off but lost its spot last year by failing a little under $85,000 short of the $250,000 annual minimum. The arts council has legislation before Brown to create a new check-off for itself called the “Keep Arts in Schools” Fund. An analysis of the bill says the new name is designed to create “improved marketability.” Brown also signed a bill allowing the Emergency Food Assistance Program to stay on the tax form an additional five years until 2019. Like Brown’s budget analysts, legislative policy staff routinely question the effectiveness of the check-offs. Among the arguments staff present in “opposition” to the check-offs is that 89,335 taxpayers in 2012 contributed a total of $4.7 million to the 18 check-offs, according to the tax board. In other words, less than 1 percent of the state’s 15 million taxpayers use the check-offs. This from a state so generous that it makes the most charitable contributions in the country – $17 billion worth, according to 2008 data compiled by the Chronicle of Philanthropy. Says a Senate Governance & Finance Committee analysis of one of this year’s check-off bills: “It is not clear that the tax check-off program, as currently administered, is an efficient and effective strategy to connect donors and charitable organizations.” Lawmakers appear to be listening to their policy consultants as intently as the governor listens to his Department of Finance on the issue.


Translation, Please


There ought to be a law against government-speak. Think how much easier to comprehend regulations and laws would be if written in straightforward English. Recently, the governor signed a bill that probably isn’t needed in the first place since it “clarifies” that something a previous piece of legislation might allow to happen, now can’t happen. The bill lets new car dealers sell “pre-owned vehicles” without replacing “brake friction materials.” In English: New car dealers won’t have to install new brake pads on used cars they buy and resell after 2014. Just a silly example but there’s an ugly side to all this obfuscation. George Carlin points out that Vietnam vets would have likely gotten more care sooner if the condition known as “shell shock” in World War I and “battle fatigue” in World War II was still called “shell shock” instead of “post-traumatic stress syndrome.”

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