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Dana Howard, Deputy Director of, 11/22/13

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HH: I’m pleased to welcome Dana Howard. Dana is the deputy director of Covered California, and an old news guy, and old television guy like me. Dana, welcome, good to talk to you.

DH: Thank you. It’s good to be here.

HH: Dana, I want to start with just facts. What’s the phone number for Covered California if someone wants to enroll?

DH: 800-300-1506. 800-300-1506 is the number to call for our service centers.

HH: Now Covered California is to enroll. What’s the Spanish language website?

DH: Well, you can get right to the Spanish language right from That is the place to go to.

HH: All right. Now how many non-Medicaid people have enrolled in Covered California as of today?

DH: We have really just close to 80,000 as of November 19th who have successfully selected a plan within Covered California.

HH: And by successfully selected a plan, what’s that mean?

DH: That means that they have chosen one of the eleven health care company plans here in California. So we have eleven health care insurance companies offering plans, multiple plans within California. And they have selected one of those companies to go with.

HH: Have they made a payment?

DH: No, the payments won’t come through for a couple more weeks. Right now, as soon as the person enrolls and selects a plan, then the health insurance company will send out an invoice to the consumer, and then the consumer will then send back a check to the health insurance company.

HH: And have the health insurance companies evidenced any problems in connecting with those who have selected them?

DH: No, not at all.

HH: So all 80,000 of those people, they will be getting a bill?

DH: Yes.

HH: All right. And they are guaranteed issuance as well?

DH: Yes.

HH: Now I received one note that you were supposed to send a binder along with the application. I don’t know what that means. Is that true?

DH: I don’t know what they’re speaking of.

HH: All right. Now of those eleven plans, how does the purchase break down? What is the most popular? What’s the least popular?

DH: I’d have to get out the actual numbers if you can hold on for a second, as far as that part goes.

HH: I sure can, yeah.

DH: But let me see if I can dig that up very quickly for you. We are looking at, where did that one go to? I don’t want to say somebody that is not true. The issuer that had the most enrollment was Anthem Blue Cross of California.

HH: And which of their plans is the most popular?

DH: Well, we don’t have that information. We just have which ones enrolled in a particular health insurance company.

HH: How many people have enrolled in Anthem?

DH: In Anthem in California, we have a total of 8,658.

HH: And what’s the least popular plan thus far?

DH: The plan with the least amount of enrollment at this time would be Valley Health Plan, and it has about 35 folks in there.

HH: Only 35 people?

DH: Uh-huh.

HH: All right, now how’s the website working?

DH: Oh, the website is working great. I mean, folks are coming along, obviously, and getting themselves enrolled without much issue.

HH: Does it go down at all?

DH: Well, we go, we take it down to shop and compare on the weekends sometimes to be able to do regular scheduled maintenance. And that’s why we’re not usually on Saturdays.

HH: All right, so is the Spanish website working as well?

DH: Yes. Everything is working as it should be.

HH: All right, let’s talk about the demographics. There was some news reports yesterday after the Covered California board of directors meeting on the demographics of those 80,000 who are enrolled to date. How do they break down by generational cohort?

DH: You mean, as far as age goes?

HH: Yeah.

DH: Well, that’s what’s some pretty good news. We do have in the age groups of 35 to 64, they are the largest number of people who are enrolling. But the really good news is that the folks who are in that young group, the what some people call young invincibles, 18-34, they are enrolling strongly, just a little bit ahead of what their proportion is in population to the state of California.

HH: So what are the raw numbers?

DH: So for 18-25, you’re looking at 2,344, for ages 26-34, 4,580. And so those are really strong numbers. It equals to roughly 23% of the state’s, as far as those who have enrolled in Covered California, and the state’s population in that same group of right around 21%.

HH: Can you march up the escalator for me and give me the specifics on the breakout by category, you know, above 30-35, you would have next, or 30-34?

DH: Okay, so ages 35-44 is 4,937. 45-54 is 6,865. 55-64 is 10,387.

HH: All right, so that is skewing a little bit on the older side. Do you have any breakdown by demographic in terms of ethnicity?

DH: No, we do not.

HH: Do you have an enrollment total for those who enrolled via the Spanish portal?

DH: Well, we have for those who designated Spanish as their language, and right now, total individuals enrolled is 994.

HH: Only 994 thus far?

DH: Of people who designated Spanish as their primary language.

HH: Okay, and how old are they?

DH: We do not have that.

HH: All right, now in terms of the goal, I’m sure you guys had goals set at the beginning of the cycle. How many did you expect to have enrolled by this point versus those you actually do have enrolled?

DH: No, we do not have that kind of a goal set as far as week to week, day to day, month to month. Through the open enrollment period, we’re looking at somewhere between 465,000 is the projected enrollment, and then for the end of 2014, we projected enrollment is between one million and 1.4 million.

HH: So I want to understand that, Dana. So by the end of open season, when does that end?

DH: Open enrollment for this initial open enrollment period ends March 31st of 2013.

HH: And so your goal is, of ’14, you meant, I’m sure.

DH: Excuse me. ’14. 2014, yeah.

HH: Your goal is to have 465,000 people enrolled by March 31st of 2014?

DH: That’s correct.

HH: And you’ve got 80,000 thus far?

DH: Yes.

HH: What was the mix of the 465,000 by demographic? What’s the estimate there that you need to make this pool work?

DH: No, we do not have a figure as far as what we have to have in each particular demographic.

HH: You don’t have an actuarial projection of viability?

DH: No, not in the sense that this is what we have to have in order to make ourselves be able to be sustainable. We do have overall numbers as far as the pool goes. But we are not looking at what we need, people, well, this many people in this particular age, or this particular ethnicity, or this particular language or income, that says that this is what we’re going to have to have to be able to make this a sustainable product.

HH: So on the overall pool numbers, what are those?

DH: Just what I was saying, 400,000-650,000 is the projected enrollment.

HH: But you don’t have that breakup broken down by anything other than projected enrollment?

DH: No, we do not, not that we look at and say okay, this is what we’re going to have to have as far as demographics go.

HH: Of the 80,000, how many of those are going to qualify for subsidy?

DH: Ah, I see what your question is. Let me see if I can pull that chart for you. (pause) So of the individuals who enrolled and were subsidized, we have 4,852.

HH: That’s all? The rest of them are paying full freight?

DH: Yes, 25,978 are non-subsidized.

HH: But that doesn’t add up to 80,000

DH: Oh, I’m sorry, that was for the month of October. My apologies. We do not have those kinds of numbers for up to November 19th. So during the month of October, there were 30,830 people who enrolled, and that’s what we have all these numbers broken down for.

HH: Okay, and so that’s where the 25,000 are, non-subsidized.

DH: Yes.

HH: Just to go back and double check, when you told me that 8,658 had enrolled in Anthem Blue Cross, was that only in…

DH: That was for the month of October.

HH: Just the month of October?

DH: That was not of the 80,000.

HH: No not the 80,000?

DH: Yes, that was for the month of October.

HH: Do you have any update on the month thus far in November?

DH: No, we don’t.

HH: Okay, so that was just Anthem Blue Cross and Valley Health, 8,658 and 35 in the month of October.

DH: Correct.

HH: Great, perfect. Now backing up a little bit, when the board voted yesterday to not accept the President’s invitation to ask insurers to uncancel plans, was that a unanimous vote?

DH: Yes, it was.

HH: So Kim Belshe voted that way?

DH: Yes.

HH: Okay, I’m surprised by that, but I’m glad to get that out. All five of them said no, we’re not going to do it.

DH: That’s correct.

HH: All right, now I’ve been trying to get Peter Lee on the show. He’s been unavailable. Why is he unavailable to media generally?

DH: He is not unavailable to media generally. We had a news conference yesterday where he was answering questions from several dozen media who are both on the phone and in person.

HH: Yeah, but you know, sustained questions like this are not a press conference. Is he doing these sorts of interviews?

DH: He has done them, but he is on a really tight schedule.

HH: And of course, we’re across all of California.

DH: And that’s what I’m here for.

HH: All right, I’m just curious, can you commit him to talk to me next week at some point?

DH: I don’t know, because next week is a really heavy week, and on top of it is a holiday. So I can put in the request to him, but I don’t, I cannot offer you that guarantee.

HH: All right, Monday or Tuesday, just saying, we’ve got hundreds of Californians listening, and they can enroll across six markets. Now the tough stuff. What is your marketing budget?

DH: That is about, I have to go back and look at it again. I think it was $190 million dollars total. But I have to go back and look at it again.

HH: Of that, how much has been spent to date?

DH: I do not have that information. If I knew you were going to ask that, I’d have pulled those records so we’d have them. I don’t have that information off the top of my head.

HH: I mean, I can wait.

DH: Well, I can’t pull that right now. So I can’t just say I’m going to drop everything that I’m doing for the day to go pull this information. I’ll have other people go get that. So if you want to make it again next week…

HH: Okay, in the future…Perfect.

DH: And then we can, I can put in a request to get that kind of data for you. I’d be more than happy to do that.

HH: Perfect. Of the $190 million, how much has been spent to date?

DH: That’s what I’m saying, is I don’t know that number off the top of my head.

HH: You’ve got a guesstimate? I’m not holding you to it, but is it like 50%’s gone, or 100%? I mean, where are we on the range?

DH: I really don’t know the answer to that as far as where we are on us spending to date. It would be imprudent on my part to guess at that and have it be something that’s very much incorrect.

HH: Is there a spending plan? Is there a marketing plan that’s detailed?

DH: We certainly do.

HH: Has that been made available to the public?

DH: Well, as much as what can be. I mean, when you’re talking about marketing, you’re also talking about competitive bids and process, so we have in our, if you want to go online to our HBEX site, the government side, not the, but the HBEX, and you can click on board meetings there, click on meeting materials and go through those to pull what is a plan. But as far as…

HH: I’ll do that. Don’t worry about it. I’ll get that. What’s the website again?


HH: H as in Harold, B as in boy, E as in Edgar, X as in X, dot CA dot gov?

DH: That’s correct.

HH: And there’s board meetings and there’s the budget for marketing?

DH: Board meetings, and click on meeting materials, and you can go through those and look at what the marketing presentations have been over the past few months.

HH: Generally speaking, from the conversations you’ve been a party to, is Covered California happy with its outreach and its effective conversion of marketing dollars into enrollees?

DH: Well, you can look at where Covered California sits with its enrollment numbers, and see that it has been effective and continues to be. Can we do more? We most certainly can and will as far as reaching out to the demographics and populations who are best going to benefit from Covered California.

HH: But I mean, if you’d spent $190 million and you had 80,000 enrollees, that wouldn’t be effective.

DH: Well, yeah. No, $190 million dollars, if that’s what we had spent, and it was December 31st of 2014, and what we had was 80,000 enrollees, that would be disappointing.

HH: No, but I mean right now, if you’d spent $190 million right now and you had 80,000 enrollees, you’d be disappointed.

DH: But we haven’t spent all of our marketing budget.

HH: I know that, but I’m just getting at, if you’d spent $10 million dollars and you had 80,000 enrollees, I’m assuming you’re doing this on a sort of monthly basis, so I assume you’ve probably spent around $20 million dollars, right?

DH: Well, the end of, what’s going on in November is not the end all for enrollment. So we will be able to look at that question and give an honest answer by the end of the next enrollment period, because people right now, while they may indeed not have selected a plan, they, well certainly, are online. We’ve got 370,000 applications that have started. And so people just like all of us who have been in open enrollment periods with insurance that’s been provided by our employers, when it comes to open enrollment time, we will often go online, start an application, look around, go back, talk about it with our family members and figure out what is best, think about it, ponder it, and then come back on December 14th to select our plans and say this is it. And the deadline is December 14th or 15th. I mean, that’s what’s at stake here.

HH: Oh, sure. But I…in the world of advertising…

DH: So it’s not really accurate to try to go right now and say okay, this is what you have, is that money well spent? Well, of course it’s money well spent, because we’re trying to get out, get people enrolled, get them aware, get them educated, and that’s all part of the process.

HH: Dana, you know, it’s an interview, not a debate. I’m not trying to debate you. But I know what a cost per lead is, and everyone in advertising, television and radio knows what’s a cost per lead. And you’ve got, okay, 300,000 leads and 80,000 customers, maybe, if they actually pay the check, the invoices that they’re given, and there’ll be a fall off right there, so you’ve got a CPL in there somewhere. I’m just curious if you guys have projected what is an efficient CPL?

DH: Well, sure. We look at different strategies, and we look at different ways of determining value. But is that something that we just put out there so that folks can determine what it is that they’re going to submit for, in their competitive bid process to do either marketing for us or to do any other kinds of outreach? No. We don’t put that information out there. That’s not something that you would find any business saying okay, this is what we estimate as a good cost per lead, this is our target, this is our goal, and so that you put yourself at a disadvantage when you’re trying to negotiate contracts.

HH: Geez, I don’t know, in the public sector I’m familiar with, we always put that out. But I’m curious especially about your Spanish success of 994 enrollees over nearly two months, and I would think, I don’t know what your cost per lead there is, but we probably could have bought them a car at this point, maybe like the best health insurance in America at this point. But we’ll see. Last couple of questions, and I appreciate your time, and I appreciate that you will, you’ll come back with me on Monday or Tuesday, won’t you, when you’ve looked up the marketing budget?

DH: Give me a call and we’ll talk.

HH: I mean, that’s a commitment, isn’t it?

DH: Well, we haven’t scheduled that, yet, and I have not looked at my schedule, so…

HH: You’ve got to have 15 minutes sometime on Monday or Tuesday.

DH: Well, we’ve already spent more than 15 minutes here.

HH: All I want is 15 minutes with your marketing budget on Monday or Tuesday. I want to give you the chance. So you’ll commit that to me, right?

DH: So what we will do, if nothing else, I will have, I will make sure that we have, one of my staff make sure that it gets to you what are our dollars that are spent…

HH: Dana, Dana, the people of California are listening right now.

DH: I’m sure that they are, and I’m so glad that they are.

HH: And I’m a taxpayer, and…

DH: But what we are saying is that you’re trying to commit me to a time when I haven’t even looked at my calendar, yet.

HH: I know, but it’s Monday or Tuesday. It’s not like, you know, I’ll give you the whole day. Pick any time on…

DH: I know. I have serious projects that I have got, and meeting to which I have committed, and so what I will have to do is look at my calendar and be able to say is no more than I can tell you, well, you can tell me that next Friday, you’re going to have a spot open on your show.

HH: I actually, I can. I can give you a spot next Friday right now, because I keep…

DH: What time are you going to do that?

HH: I’ll be happy to do it at Noon next Friday.

DH: Great.

HH: Are you committed? Noon next Friday then?

DH: No, I am not committed to next Friday. But what I will do is look at my calendar and see if we can make sure that there’s a time that we can come back and talk with you.

HH: So you will come back and talk with me at some point?

DH: Oh, well certainly. We’re talking now.

HH: Next week about marketing budget? I don’t know what time, but next week, you’ll come back and talk to me sometime?

DH: Sure.

HH: Is that a yes?

DH: Oh, yes. Yes, next week, we can come back and talk?

HH: We, meaning Dana?

DH: Meaning me and you. We can come back and talk next week.

HH: Okay, perfect. Now last couple of questions having to do with the enrollment in the Spanish speaking people. You can’t enroll in Covered California if you’re undocumented, correct?

DH: I’m sorry?

HH: Undocumented Californians cannot enroll in Covered California, correct?

DH: Well, of course they cannot enroll in Covered California if they’re undocumented. That’s part of the rules. I thought we’d been over that.

HH: I know. That’s what I was confirming for the audience. I don’t, you know, I always get asked that question and I always tell them no, you have to be a legal resident of the United States in order to enroll in…

DH: Exactly. You cannot be incarcerated.

HH: No, you have to be a legal resident.

DH: And you cannot be incarcerated.

HH: Oh, and that’s an and. Okay. But my question, which I can’t find the answer to, and it’s just an honest question. If you’re a legal resident, but you have a dependent who’s not, are they going to be covered under a Covered California policy?

DH: If that person is claimed as a dependent on your taxes, you can go ahead and cover them. But if they are not a legal resident of California, they’re not going to be able to be covered.

HH: But that, I don’t want to, I want to be very clear, because I don’t want to misrepresent the plan. I didn’t think it was possible for an undocumented person in California to be covered by Covered California. I think you just said it is.

DH: No, I did not.

HH: Is it possible?

DH: Not to my knowledge. I don’t see how that would be possible. If you’re not a legal resident, you would have to have a Social Security number, and that’s part of the application process.

HH: Right. But if you came into the country and you are here legally, but your family members are not, or you married someone who’s not…

DH: All of the dependents who you are going to have covered under your policy must have Social Security numbers.

HH: And if they fill in the form, are those Social Security numbers checked as part of the enrollment process?

DH: It’s part of the application process.

HH: And who does that checking?

DH: It is electronic verification that is done between Covered California and the federal hub.

HH: So you guys are actually checking every Social Security number that comes in?

DH: Each one comes in and it goes out to verify that it is a valid Social Security number and it goes with the name that’s on there.

HH: And I’m wondering, because when I read the NPR story that you had low Spanish enrollment, I was wondering if perhaps people are afraid of just that, that their undocumented family members might be turned in by Covered California by virtue of the application?

DH: The application cannot be used for any kind of immigration enforcement.

HH: All right. That’s a good question. I didn’t know that. You’re absolutely certain about that?

DH: That’s what my understanding of the rules are.

HH: Is that by virtue of state law? Or is that by virtue of Covered California practice?

DH: I would have to go and get a legal opinion about that. I am not certain.

HH: I’d like to know that just for the purposes of making sure that we’re certain about that. Last set of questions, have you had any data leaks, any kind of breaches of security, any at all?

DH: No.

HH: Have you run a full test on the system?

DH: Yes.

HH: Can you guarantee that people who enter their information into the system that it is secure?

DH: I cannot guarantee anything like that. I mean, all the certain steps, the steps that are required by law, are taken. And we go above and beyond the security protocols to make sure. Now can some fluke thing happen that can somebody have access and decide that they’re going to, despite being fingerprinted, despite being background checked, can they go out and commit a crime? Well, certainly, people can.

HH: Edward Snowden took everything out of the NSA.

DH: So you’re not going to have somebody who has breached it. Information going in is not being transmitted back out. We are not having breaches in our security system.

HH: That you’re aware of.

DH: Nothing that we are aware of, no.

HH: Because Edward Snowden was completely cleared and he took it all from the NSA. How are you guys preventing that?

DH: Well, I can’t answer that question for you. I mean, that’s exactly what I was talking about. People will commit crimes. And you’re asking me how are we going to keep people from preventing crimes.

HH: Right. I’m actually going to background checks.

DH: And I don’t think there’s an answer to that. You’re talking about a social question.

HH: I’m talking about navigators and people who work for you, and how do you clear them into handling this data.

DH: They are all fingerprinted, and a background check through the Department of Justice has been done on them.

HH: And so that’s it? You do a fingerprint and you send it to California Department of Justice, and if nothing comes back, they’re good to go?

DH: Yes, a background check is done, fingerprinting is done, and so that is the security as far as making sure that these are legitimate people, these are people who do not have any significant criminal history.

HH: Oh, pause, what’s that mean?

DH: Well, so, if they come back and they’ve had a traffic violation, or they’ve had a misdemeanor arrest because there was something, for instance, that they did not maybe pay child support or anything like that, that’s not going to prevent them from being a certified enrollment counselor.

HH: Substance abuse prevent them from…

DH: But if it’s a fiduciary crime or a violent crime, or anything like that, no, they are not going to be allowed to become enrollment counselors.

HH: And who is doing the background checks?

DH: The Department of Justice.

HH: For all, how many people work for you guys?

DH: The Department of Justice does the background checks.

HH: No, but I mean how many people work for Covered California?

DH: I think we’re at about 500 now within headquarters, and a thousand total.

HH: So the Department of Justice has done 1,500 background checks?

DH: They probably have done more, because that doesn’t include the enrollment counselors that are doing the fingerprinting, having fingerprints and background checks done.

HH: How many enrollment counselors are there?

DH: I don’t know off the top of my head.

HH: Can you give me…

DH: I do know that it’s somewhere around 1,400 right now, but I don’t know the exact number.

HH: So 1,500 full time, 1,400 employment counselors or counselors. What are we paying a counselor?

DH: Enrollment counselors are not paid directly. The enrollment entity for which they work is paid $58 dollars per successful enrollment.

HH: Wow, I didn’t know that. There’s a bounty on enrollment?

DH: There is not a bounty on enrollment. The enrollment entities are paid $58 dollars per successful enrollment.

HH: Wow. Dana, that is news to me. When did that policy get adopted?

DH: That has always been.

HH: Are other states using that policy?

DH: I am not certain what other states are doing, but Covered California does allow enrollment entities to be paid $58 dollars per successful enrollment.

HH: And how many enrollment entities are there?

DH: I’m not certain right now. I’d have to look that up, but the enrollment counselors work for the enrollment entities.

HH: Are there more than five or fewer than 10?

DH: Oh, yes. There are more than ten. I just don’t have the number right now?

HH: More than 50? Just give us a sense of…

DH: I unfortunately do not know that number off the top of my head, and so I’d have to go and look to make sure what the current status is of enrollment entities.

HH: So all those enrollment entities are sending the Department of Justice people who work for them, and the Department of Justice is doing a background check in real time to get back to them?

DH: Yes, and an enrollment counselor will have to go through and have a background check done and a fingerprinting done. That is according to state law to be able to successfully enroll people.

HH: And who gets the report from the Department of Justice?

DH: Covered California does.

HH: I mean, who at Covered California? Is there like a head of security?

DH: No, there is, there is a, within our own department here, an office that handles the processing of the enrollment counselors and the enrollment entities.

HH: And who’s the individual in charge of that office?

DH: Well, I am not going to give that person’s name out over the phone.

HH: It’s public…

DH: If you would like to, if you want to speak with them, you can put in a request to me, and we will be able to talk about whatever questions you might have for that person.

HH: But that’s got to be public information, Dana.

DH: So why would be do…

HH: I mean, I know who the Office of Personnel Management Deputy Director for Security is. I can get it out of my federal directory right here. It’s public information. I ran the OPM. People knew I was the general counsel.

DH: I can appreciate that, but unfortunately, that is not what we do here. That is not our policy to give out individual names of individual employees here and put it…

HH: But that’s a senior level person. That’s a political appointee selected by Peter Lee.

DH: No, it isn’t. Well, we do not disclose that in a public forum like this.

HH: All right, well, what I’m getting at, then…

DH: So again, Hugh, if you’d really like to know…

HH: …without the name…

DH: …we can set up a time and we can talk about that.

HH: No, that’s fine. You’re not going to tell me. What’s the background of that individual to be conducting overview of DOJ background reports?

DH: That, I do not know, but most certainly, we can forward to you the class certification for the positions that would be looking at that.

HH: What level of scrutiny are they giving the DOJ report?

DH: Mr. Hewitt, we are at the end of the time that we had prescribed to do this. This was supposed to be a 10-15 minute, and we are now up to a half an hour.

HH: Yeah, we are. But I mean, it’s important stuff.

DH: So I’ve really got to go, because I have other commitments that I have, must meet, and other reporters…

HH: I understand, and I’ll let you go. Can you, though, commit one more time, you will talk with me on air again next week sometime for at least 15 minutes about marketing and security?

DH: Well, I will talk to you on air next week. I will not say at least 15 minutes. That will be about the max that we will be able to talk. But we can definitely talk next week.

HH: I look forward to it. Thank you so much, Dana.

DH: All righty. Goodbye now.

HH: Bye.

End of interview.


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