OAKLAND -- The only thing harder than rolling out President Barack Obama's health care law is changing the health care industry culture, Covered California Executive Director Peter Lee said Thursday night at the Barbara Lee & Elihu Harris Lecture at Merritt College.

Despite exceeding expectations by enrolling 3.3 million Californians in Covered California's marketplace of insurance programs or Medi-Cal during its first six months, he said the initiative was "relatively succeeding" and "only just beginning."

"When we look back 10 years from now, we'll say, 'Can you imagine a day when we didn't have (universal) health care?'" Lee said.

Under President Obama's Affordable Care Act, also known as "Obamacare," 8 million Americans have signed up for coverage. In California, Covered California operates as an independent part of the state government tasked with guiding residents through the new health insurance marketplace. An open enrollment period ended on March 31: uninsured people who missed the deadline and do not experience a "qualified life event" allowing them to enroll will face a penalty of $95 or 1 percent of their income. The next open enrollment period begins Nov. 15 for coverage beginning Jan. 1.


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According to Lee, improving health care literacy remains Covered California's primary task. He said of the millions who signed up, there are still "millions who did not get across that line to get coverage." Citing statistics, like the 100,000 Californians who went bankrupt in 2013 due to medical bills, Lee said the tax penalty wasn't what the uninsured should fear, it was America's ongoing, enormous medical costs.

Dr. Coyness Ennix Jr., founder and past president of the Bay Area Society of Thoracic Surgeons, brought more than 30 years of experience as a thoracic surgeon to the discussion. He said the cost of his birth in Tennessee in 1942 totaled $7: a $3 deliver fee and a $4 clinic fee.

"But then things changed," Ennix said, citing historical, escalating medical costs and attributing them to less choice, less competition and the influence of hospital consolidation and the insurance industry.

"You've heard reasons the costs in the United States are so high, but the true reason is right under our noses. The U.S. consumers have had no centralized negotiation and no leverage to keep health care providers from charging whatever they want," he said.

Lee was quick to note that the health care law provisions require providers to spend 80 percent of collected premiums on health care, not executives' salaries. "ACA changes everything," he said. Even so, Lee's evaluation of Covered California as "relatively succeeding" means the program must continue to be selective in the health plans it offers, he said. Designing standardized benefits has eliminated "shell games" (hidden costs), but effective marketing will require ongoing agility. "Three months in, we saw we weren't reaching Latino and African-American communities. We expanded," Lee said.

Education through 250 grass-roots organizations will continue," he said.

"Enrollment is not as easy as buying a book on Amazon; it's more like doing taxes on TurboTax."

The new health care system's big data collecting will provide an accountability that Lee said would help Covered California spot problems and will ultimately lead to reduced costs. Connecting the health care expansion to the Rev. Martin Luther King Jr.'s belief that lack of adequate health care was an injustice, Lee said "We've taken a huge step to having a more just America. As Californians, folks across the state have helped make history."

During an audience Q&A, some people asked about improving outreach to African-American communities, informing released convicts about options available to them, and addressing cost differentials between insurers like Blue Shield of California and Kaiser Permanente. Lee said "the human touch" would be needed. Although 40 percent of enrollees used the online registry successfully, he said 60 percent of those enrolled relied on certified, licensed insurance people, enrollment counselors, grass-roots organizations, and county offices to explain and implement the new program.

The evening's most targeted question came from a health care worker, who asked, "Why should we believe Obamacare can eliminate a two-tier system where (others) have failed?"

Acknowledging he didn't always have great answers for great questions, Lee said health care literacy is critical to the success of the program. "Obamacare is the product of a lot of compromises," he admitted. "The ongoing continuity of care is what Covered California can push for."