California eagerly embraced the Affordable Care Act at it’s inception and was among the first to set up an exchange residents could use to purchase insurance. However, as with all programs, unexpected hurdles were thrown up which prompted changes to the rules concerning payment, transparency, and levels of care in the state. The new rules that were recently released will be phased in over seven years and have the support of key interest groups such as the California Hospital Association. Among the changes are a reduction in reimbursement payments for providers failing to meet minimum quality standards and greater openness about the negotiated rates between insurers and service providers. In addition, primary care doctors must be assigned to new plan enrollees within 30 days and insurers must help customers find lower price medications or discounts. What impact the new rules might have will not be fully understood for years, however, other states are keen to see how the changes play-out as they develop their own package of reforms to their own healthcare marketplaces.
See Ana B. Ibarra & David Gorn, California Insurance Marketplace Imposes New Quality, Cost Conditions On Plans, Kaiser Health News, April 8, 2016.
