Currently, 89% of California workers are offered insurance through their employers, and 70% of those workers enroll, according
to the California HealthCare Foundation. The foundation also reports 25% of employers contribute less than 4% of payroll to
health benefits, but the top 25% contribute more than 15% of payroll. Ohman says shared responsibility embraces the role of health plans to be part of the solution, particularly with the day-to-day
realities of enrollment, issuing insurance cards and data collection, as well as systematically tackling the long-term problems,
such as how to cut the rising cost of healthcare and improve quality. Managed care's core strengths will be especially beneficial for the Medicaid population as more members gain coverage, according
to Daniel J. Hilferty, president and CEO of AmeriHealth Mercy and MHE Editorial Advisor. "It is imperative that the Medicaid
managed care plans are prepared to address continuity of care issues and to actively reach out to and case manage the members
on an individual basis," Hilferty says. "This population consists of high utilizers of healthcare services who often need
help using services appropriately to address their healthcare issues. If this population is managed well by getting the care
they need to manage their chronic disease and avoid hospitalizations, it's a win for everyone because the members get better
care, have a higher quality of life, and the states save money." As with any big change, those involved are concerned about negative consequences, such as residents relying too much on public
programs and opting out of employer coverage. Ohman says the governor's team is aware of crowd out (a large exodus of people
out of their employers' plans and into public plans or individual plans) and calls out specific responses to prevent it. "Crowd
out is something that we'll be watching closely to make sure there is no negative impact," he says. However, he is concerned about two other points: guaranteed issue threatening the strong individual market in California;
and the proposed 85% medical cost ratio. "Guaranteed issue in a broad conceptual way is a logical public policy," Ohman says. "Health plans are concerned, though,
that if you only go part way on the individual mandate and you don't, in fact, include all groups of the uninsured or if you
have enforcement mechanisms that really don't keep the people in the pool when they're healthy...then the net effect can be
an increase in the costs for the 1.7 million Californians who are currently in the individual market. And you could end up
with the perverse impact of actually reducing coverage." California's larger-than-average individual insurance market makes up more than half of the entire U.S. individual market.
A typical policy might cost $1,885, which is a third of the cost of a similar policy in New Jersey, for example. Ohman says
the distribution of premiums is "breathtaking," and that's why the health plans have an invested interest in preserving the
affordability of the individual market. That market segment is one of the avenues for covering the uninsured. In California, the rates are consistent with expected
use, and Ohman says about 12% of applicants are denied coverage. 
Christopher c. ohman: In his career, Chris Ohman has served as a senior executive of the commercial business unit for Blue
Shield of California and was also the founder of CapMetrics, a company that developed solvency ratings for medical groups.
He earned a bachelor's degree in economics and a master's degree in public administration.
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In the early 1990s, there was a movement against the practice of excluding people from insurance based on pre-existing medical
conditions. New Jersey, New Hampshire, Washington and other states passed laws to broaden coverage for people with pre-existing
conditions, and insurance carriers almost immediately began to lose money. The number of products shrunk, prices increased,
and enrollments dropped. Ohman says he does not want to see any of those consequences in California.
"Individual insurance is an affordable product for 1.7 million people, so there's a benefit, but it's hard to compete with
press stories about people who are struggling with a medical condition and their insurance," he says.
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