As one headline put it, “Health Care Site is Doing Better,” something one would say of a child still in bed with a fever. But even before December 1, when everything was supposed to be fixed, the federal health care website remained troubled. This news came from the New York Times, which was willing to cut the President Obama some slack on his “incorrect promise.” As the federal debacle rolled out, some were countering that state health exchanges and their websites, particularly California’s, were “a bright spot in Obamacare signups.” That is something of a stretch.
According to this report, the California exchange and site are about more than getting the uninsured to sign up. It’s all about “health equity,” that is “reducing the increased burdens of illness experienced by select populations relative to others.” California exchange bosses “want to make sure that one racial group doesn’t have a higher rate of infant mortality than another, for example, or that women don’t die disproportionately of certain illnesses.” How they would do this remains to be seen, and disparities between groups are the rule rather than the exception. And another problem is looming.
In the pursuit of health equity, exchange bosses want “to collect and use data on a raft of sensitive customer information, from race and ethnicity to sexual orientation and gender identity.” This may run afoul of privacy laws, and the actual policy on collecting the data “has yet to be developed.”
In late November Covered California threw a sign-up party at the Sacramento Convention Center. Some 1,500 people showed up, with 300 “assisters” ready to lend a hand. Only ten people signed up and it remained unclear if any had actually paid and been issued a policy. The upbeat report on Covered California estimated that fewer than 80,000 had signed up statewide. A journalist’s trial telephone sign-up raised questions about security and tactics.
Also in November Covered California bosses voted to continue canceling more than 1 million plans that individuals had selected as best meeting their needs, but which the Affordable Care Act nixes. Covered California also opposed President Obama’s plan to extend existing health plans. So Covered California, like its federal counterpart, first does harm. That’s not much of a bright spot.