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California Health Benefit Exchange

October 5, 2011

Pat Powers, Acting Executive Director
California Health Benefit Exchange
Yolanda Richardson, Consultant
California Health Benefit Exchange
Peter Lee, Incoming Executive Director
California Health Benefit Exchange

Dear Ms. Powers, Ms. Richardson, and Mr. Lee:

Consumers Union, the advocacy arm of Consumer Reports, writes to offer a number of suggestions on standards for stakeholder engagement as the Exchange Board moves forward. We have appreciated the efforts to engage consumer interests, including Consumers Union, in the stakeholder process in a variety of ways, including soliciting feedback on proposed regulations and inviting Consumers Union to participate in the stakeholder workgroup on individual eligibility and enrollment.

The recent stakeholder consultant solicitation identifies a broad scope for the contractor:

The Contractor will conduct a thorough review of state and federal statutes, proposed federal regulations, and broad stakeholder feedback regarding the existing short-term stakeholder process. The Contractor will develop the framework, structure, goals, objectives, and specific approaches for the long-term stakeholder process which will be needed as the Exchange works towards full implementation of Exchange functions.

More particular guidance for the consultant’s approach and framework could amplify and improve upon the effectiveness of stakeholder engagement with the Exchange in the coming years. Through our experience as stakeholders over the past few months, we believe some concrete steps could best guide the process. Stakeholder engagement can leverage the expertise of stakeholders, support and enhance the hard work of staff, achieve broader investment in Board policies, and surface issues of confusion and agreement/disagreement before decisions have to be made. To that end, and based on our experience as stakeholders over the past several months, we suggest the following principles and practices be incorporated into guidance for the solicitation:

  • Convene in-person meetings whenever possible, providing the option for telephone access for those who cannot attend in-person. There was strong consensus from stakeholders at the in-person meeting of September 15th about how much more effective the group process was by meeting face-to-face and explicitly requested to continue with in-person meetings;
  • Promote and solicit communication between staff/board and stakeholders – initiate processes that provide two-way communication between staff/board and stakeholders. This would include sharing back to stakeholders information received by staff/board outside the regularly scheduled meetings. For example, if stakeholders are sharing information in writing beyond the calls, summarizing and sharing that information back to the stakeholder workgroups;
  • Provide transparency about staff decisions that are made when considering stakeholder comment and feedback. Staff solicits stakeholder feedback then makes certain decisions and recommendations to the Board. It would enhance stakeholders’ sense of “being heard” if staff explicitly informed Board members about stakeholder recommendations and articulated the reasons they either accept or reject them, as happens when federal agencies solicit and receive comments on proposed regulations;
  • Identify assumptions and provide opportunities for stakeholders to question or clarify those assumptions. For example, many assumptions were made in the proposals for design options that were not surfaced with, understood by or sufficiently discussed with stakeholders; and
  • Elicit stakeholder input on agenda and priority setting. Bringing in stakeholders early in the process would help staff surface and frame the issues about what is important to stakeholders and the Exchange. For example, in the individual eligibility and enrollment work group, consumer stakeholders raised concerns early in the process that the E&E group was confined to very discrete questions, rather than obtaining input on the big picture framework for design. In September, a number of consumer advocacy organizations sent a list of some of the important issues that stakeholders and staff should address together to help ensure that important policy decisions are being discussed.

We would be happy to discuss in more detail any of our concerns or suggestions. As you know, Consumers Union looks forward to continuing to work actively and productively with the Exchange Board and staff in the coming years to help California establish and implement a successful program that will be ready for consumers on January 1, 2014.

Julie Silas
Staff Attorney
Consumers Union
cc: Bobbi Wunsch, Consultant