Hospitals In Focus

What the Nation Could Learn From ACA Health Coverage Expansion in California With Peter Lee


The ACA is starting a new era with President Biden at the helm of a new administration. We wanted to hear about what happens when a state not only fully embraces the ACA but keeps harmful regulations at bay that hurt marketplaces and patients. Chip is joined by the Executive Director of Covered California Peter Lee on the newest episode of Hospitals In Focus. The two discuss the basic tenets of the legislation, how and why California has been such a success at lowering its uninsured patient rate and what steps President Biden may take to encourage the hold out states to expand Medicaid.

Interested in learning more about Biden’s health agenda? Check out Building Biden’s Health Agenda with Chris Jennings and Doug Badger.

Announcer (00:05):
Welcome to Hospitals In Focus from the Federation of American Hospitals. Here’s your host Chip Kahn.

Chip Kahn (00:14):

Healthcare for all Americans has always been a high priority of the Federation members. The Federation in 2007, released our own coverage plan, the healthcare passport, and proudly joined in 2009 and 2010 with policy makers, opinion leaders and stakeholders who worked hard developing the Affordable Care Act. With the passage of the ACA, great progress was made in closing the coverage gaps, but the policies of the last administration were not kind to the coverage expansions envisioned in the 2010 legislation.

Chip Kahn (00:48):

The COVID crisis has further exposed issues of healthcare equity in our country. Health coverage gaps are now more obvious than ever, but despite this crying need, it was as if no one in the last administration was really listening. With President Biden at the helm, it is a new day and we’re grateful to have the leadership that is committed to improving on the ACA and using its framework as a vehicle to ensure coverage for all Americans.

Chip Kahn (01:17):

As we enter this new era for the ACA, today’s episode explores what’s possible when the law is fully embraced and we have the perfect guest to provide that perspective, Peter Lee, the Executive Director for Covered California. Thanks for joining us today, Peter.

Peter Lee (01:35):

Great to be with you, Chip.

Chip Kahn (01:37):

Peter, could we start off by helping our audience understand you and your background and how you got to Covered California?

Peter Lee (01:45):

Great. Well, first Chip, it’s great to be with you and thanks for you and the Federation’s work to get the Affordable Care Act passed and in place.

Peter Lee (01:55):

I’ve now been, believe it or not at Covered California for almost 10 years, which feels incredible. My path to here was somewhat of a wandering path of having been a consumer advocate. Many, many years ago, I cut my teeth as an activist on AIDS and HIV issues in the depths of the early days of the pandemic, which was one of the last huge pandemics before COVID we’ve had. After that though, I continued as a consumer advocate, then helped represent large employers running a group called the Pacific Business Group on Health, which I think is actually when we first met, when I was doing advocacy around quality, quality performance, quality measurement, from a purchaser perspective. From there though, I had the opportunity to work in the Obama administration to help implement the ACA looking at delivery system reform. Doing such things as drafting the national quality strategy that helped set up CMMI, the Center for Medicare and Medicaid Innovation.

Peter Lee (02:49):

I guess the thread that runs through all that is trying to actually be patient and consumer centric and recognizing that payment policy and tools make a difference to making that happen. Cover California has been a pretty great place to be to continue that work.

Chip Kahn (03:05):

Great. Peter, before we get into Covered California, let’s give our audience a sense for the framework that was envisioned in 2010. As you said, you were there at the very beginning. What did you all want to accomplish at that point to bring health coverage to everyone?

Peter Lee (03:22):

Firstly to note is the Affordable Care Act was a phenomenally important piece of legislation, biggest expansion of coverage since Medicare and Medicaid about 50 years ago, but it wasn’t a truly universal solution. It was a number of very, very big incremental steps to sort of have a better patchwork.

Peter Lee (03:45):

Number one, it said let’s expand Medicaid for low income people across America. In doing that, it thought at first that every single state would implement Medicaid. Subsequent Supreme Court case found actually states could opt out. We were surprised when that was the determination. So we now have about 15 states that didn’t expand Medicaid to the detriment of millions of people, in particular in states like Texas and Florida.

Peter Lee (04:12):

The other thing the Affordable Care Act did was provide financial subsidies for people that didn’t have employer coverage or Medicaid. Those are in marketplaces like Covered California. That’s financial health based on income. You’re given money, you pick the plan that’s right for you, you get more money to help you out if you make less money. It actually had a cliff 400% of poverty. So if you make more than $75,000, zero financial help. So another gap.

Peter Lee (04:41):

The other thing it did that was huge in this area was totally reform insurance markets. Before the Affordable Care Act, in many ways, insurance companies won by either avoiding sick people, because why would you want a sick person, you’ve got to spend money on them, or avoiding paying for care. That was the business model of many large insurers. The Affordable Care Act threw that out and said, “Going forward, if you’re an insurer, number one, you got to take everybody.” So we hear a lot about no pre-existing condition bans. “Number two, we’re going to do something called risk adjustment. If you end up enrolling more sick people, the health plan that enrolls fewer sick people is going to give your plan more money.” So it actually kneecapped the economics of risk avoidance and saying, “We want an insurance system to be about people getting the right care when they need it, and insurance companies to be motivated to provide the right services rather than avoid providing care that’s needed.”

Peter Lee (05:42):

There’s a number of other changes to the insurance marketplace, but those are the core things. When I say it wasn’t totally universal, again, the intent of Medicaid expansion being a universal didn’t happen, 15 states didn’t expand, and it never embraced coverage for undocumented individuals, and it had a gap for the coverage for people who made more than say $75,000. But it was huge in terms of having mammoth impacts, depending on how it was implemented, in reducing the rate of the uninsured.

Chip Kahn (06:15):

Let’s get to implementation then, because one thing about California, which is often a leader in the country is that when you went there 10 years ago to lead Covered California, you had a big vision. Can you talk to us a bit about that vision and how you got it started? We’ll get in a moment to the goals.

Peter Lee (06:34):

First thing is, let me go back to the ancient days of the ACA. When we implemented it, we thought every state would have their own marketplace. We thought every state would want to expand Medicaid, and every state would say, “Boy, I want to control my destiny. I’m going to have a state-based marketplace.” 15 state-based marketplaces, it turns out the politics were such that many states stood on the sidelines.

Peter Lee (06:56):

The federal government administers marketplaces for even today about 35 states, about 15 states have state-based marketplaces, Covered California being one of them. California was the first state to pass legislation to establish a marketplace. It was set up as independent of the State of California, but part of the state. So we don’t report to the governor. I have a five member independent board. And the charge was to not only provide as much coverage as possible, but to try to address the underlying healthcare system. The ambition we had was to make higher quality healthcare available for all, and also to affect the entire healthcare system in California. It was a pretty big vision of not only making a marketplace work, but recognizing a marketplace is part of the broader healthcare system.

Chip Kahn (07:45):

What goals did you set for yourself in terms of coverage and how successful were you, or have they been in terms of being particularly consistent over the last 10 years?

Peter Lee (07:55):

Couple of things around coverage. One goal, and I’ll come back to each of these, was to actually have as many people covered as possible through Covered California and through the Medicaid expansion, but another goal was to have coverage that mattered as much as possible for consumers, and the third was to have true competition, but competition on consumer’s terms, not health plans terms. Let me talk about each of those if I could.

Peter Lee (08:25):

First, coverage: California has had the largest drop of the rate of uninsured in any state in the nation. We had 18% uninsured before the ACA; we’re now at about 7%. Phenomenally large drop. Much of that Medicaid expansion, but much of that Covered California. We now have about two million people enrolled in Covered California. But how’d we do that? We believe that the coverage itself matters.

Peter Lee (08:52):

An example of that and creating a competitive marketplace for consumers is we have standardized benefit designs in California. So when you’re picking a plan, whether it’s Kaiser or Anthem or Health Net, and you’re picking a silver tier, which many of your listeners know about, it’s an identical silver tier, identical. And in California at that silver tier, which is what most people buy, no outpatient care is subject to deductible. You go see a doctor; it’s covered, first dollar coverage That’s not the same in most of the nation. Most of the nation there’s essential health benefits standardized, but within those essential benefits, health plans can have variable benefit designs. That means consumers don’t know what they’re buying. California, they’re shopping apples to apples comparisons. It’s the price and the networks that they know make a difference, not the obscurity of what’s co-insurance and co-pays.

Peter Lee (09:49):

The third thing we did is we wanted to get health plans to compete to win. We had 11 health plans in our first year out. Before they put anything on the table, we let them know here’s the risk mix we think you’re going to get, so price right. Here’s how competitive it’s going to be. So you probably don’t want every single doctor or hospital in your network, because if you are a higher expense, consumers won’t pick you. What happened? We had huge enrollment that we supported with a lot of marketing dollars that originally was federal funding. We all got establishment grants.

Peter Lee (10:26):

Covered California has invested every year since then, literally tens of millions of dollars every single year in marketing. We are funded today out of user fees. It’s basically tied on health plans’ premiums, which adds about 3% to the premiums. But our 3%, which to give you a sense on our scale, we have a budget of about $400 million a year, we spend over a hundred million dollars on marketing every year. Why? Because doing that means healthier people sign up, it means premiums are lower because it’s on the overall risk mix of who signs up, and it means health plans boy, they compete like the dickens to be in Covered California, don’t want to leave.

Peter Lee (11:09):

Much of the nation saw health plans put their toe in the water of the individual market and realized they didn’t know what they were doing, lose billions of dollars and leave. And now they’re back in, and now they leave. California’s had the same 11 plans basically for seven years, since we opened our doors. We have consumers in essence, in the driver’s seat.

Peter Lee (11:31):

The last I want to note, we also have lower costs. Because we have a healthier risk mix, we have premiums that are about 20 to 25% lower than they would have been if you had the same risk mix the federal marketplace has, because we invest in marketing. That means not only to the people with subsidies benefit, but one of the rationales of the Affordable Care Act was I noted that subsidies don’t help people to make more than 400% of poverty, 75,000 a year, the theory was that we’d get enough people insured in the individual market that premiums would stay low for unsubsidized people that make too much.

Peter Lee (12:12):

That’s happened in California. We have 800,000 people un-subsidized, who buy in the individual market. In much of the nation, the individual market has disappeared. It’s become a high risk pool because individuals that don’t get subsidies have been priced out of coverage because health plans have not invested in marketing and nor has the federal government. So it’s been one of the things that we’ve had that virtuous cycle of good policy leading to good ends.

Chip Kahn (12:38):

From this experience that you’ve gained, Peter, in California, what further policies do you think are important that would help us achieve this kind of comprehensive coverage for all under the ACA framework and maybe help us in some other places as well as help you in furthering your efforts to expand coverage to maybe some of those people above 400% of poverty or others in California?

Peter Lee (13:08):

Two things. First, I want to be also clear that one of the reasons California was successful is not just that we did a good job, which we did, but the state as a whole implemented policies that were aligned with the Affordable Care Act. As a state, California outlawed short-term plans. Now short-term plans aren’t illegal under the Affordable Care Act, but they’re discouraged because they’re the old days of health insurance. You can turn away people who had pre-existing conditions, you can have lifetime limits, you can have crappy coverage and say, “Oh, it’s okay. It’s a short-term plan.” Those don’t exist in California as a matter of state law. That’s an example of a policy that was done so we have a better marketplace.

Peter Lee (13:52):

We’ve used all the tools, but many states have not. And under the recent Trump administration, they implemented policies to actually promote non-ACA compliant plans, to promote [inaudible 00:14:05] short-term plans in other states. California was able to hold those off. California also did two big things to while the Trump administration was in essence trying to kneecap the Affordable Care Act said, “Well, we’re going to try to go further.” Effective 2020, California did two things.

Peter Lee (14:23):

Number one, brought in state subsidies to compliment the federal subsidies. Now, they weren’t huge, but they actually provided some financial help to people that are middle-class Californians, who were not eligible for federal subsidies because they make too much money. We have over 50,000 Californians that make over 400% of poverty, but less than 600%, getting on average about $600 a month in state subsidies. They were spending huge portions of their income.

Peter Lee (14:53):

The other thing California did was implement a state penalty. I should have mentioned that at the outset. One of the things the ACA did at its outset was say, “If you can afford health insurance but choose not to get it, you’re going to pay a penalty.” Why? Because you’re deciding to go without insurance means, if you end up in a hospital, you’re going to be uncompensated care debt that we’re all going to pay. So a penalty makes economic sense. It was never politically popular.

Peter Lee (15:22):

That said, Governor Newsom bit the bullet, implemented the right policy in California. We saw in 2020, a year ago, which feels like 800 years in COVID time, a mammoth resurgence of new enrollment. These consumers in California said, “Huh, on the margins, I don’t have insurance, I pay a penalty. I get insurance, no penalty, I get a subsidy. I’ll get insurance.” So that was California implementing state policies to build on in some cases go beyond the ACA.

Peter Lee (15:54):

I’ve got to be clear that what we still need in California and nationally is the subsidies aren’t enough. As good as they are for lower income Americans who are trying to put food on the table, pay rent, et cetera, the financial help can and should be more. They are paying a larger percentage of their income than people with good employer-based coverage. There is a cliff out there nationally, and the Biden administration has proposed getting rid of the cliff and making the subsidies richer. Now to my mind, it makes the world of sense. The idea that you make less money, you get more financial help with your health insurance, makes the world of sense.

Peter Lee (16:40):

Now I would note that that is the right policy to go as a nation. I think one of our national next big issues is how to make sure people with employer coverage have coverage that works for them. Maybe we’ll come to come back to that one in a minute, because that’s sort of a next step issue before all of us, I think. But an earlier step is going to be more people need more financial help. Healthcare is just too expensive. We need to address that.

Chip Kahn (17:10):

I think in the new legislation that’s being considered now to help with COVID, some of these subsidy issues are taken up and also the administration is proposing subsidizing for the newly unemployed, their COBRA for a time. But before we get to legislation though, or other action on the employer side, you mentioned a number of the obstacles, policies that came out of the Trump administration, which in a sense, degraded the ACA. Those were taken executively. The new administration has the option and actually has already taken some actions. What do you think are the key executive actions that need to be taken now so that the ACA within the bounds of what’s controlled by an administration and HHS can be everything that it could be?

Peter Lee (18:02):

Remember that President Trump ran in part on a repeal and replace platform. The Affordable Care Act was not repealed, was not replaced. Why? In substantial part because many Republican states expanded Medicaid. [inaudible 00:18:17] was working. Many Republican states saw as elements that made a lot of sense. What the Trump administration did do was take a raft of administrative actions that made the Affordable Care Act less effective in areas where they had, so to speak, dominion. That wasn’t in California.

Peter Lee (18:37):

The actions of stopping doing marketing is a great example. Look, we spend a hundred million dollars a year in marketing. The federal government went from spending over a hundred million dollars to spending nothing to promote enrollment. That’s going to change overnight. I’ll note that one of the very first actions of the Biden administration was to declare a special enrollment period. Their doors are wide open in all of their states that they serve and the federal marketplace states starting February 15th, going through May 15th. They’ve committed to spending $50 million for that special enrollment period. That’s a new day. That’s a really concrete example.

Peter Lee (19:18):

I’ve got a roster on or around my desk of 30 different sets of regulations that are different levels of horrendous to merely bad that I am certain the Biden administration is going to roll back. And the next year we’re going to see drumbeat of actions to roll those back, to stop promoting short-term plans, to have policies that promote consistency and true consumer protection. Those are going to be coming down the track. But what Trump could not get rid of is the funding for Medicaid expansion, could not get rid of the underlying premium tax credits, which make healthcare more affordable.

Peter Lee (19:58):

The money is the secret sauce of coverage expansion, and that was never taken away. We need some more of that sauce. I think that’s going to be the next big legislative act, which as you know, Chip, is part of the stimulus package to be a temporary increase in subsidies for a one or two year period, which many think, and I do, that those should be permanent though. But definitely it’s the right thing to do during a COVID pandemic.

Chip Kahn (20:24):

Well, hopefully that’s the first step.

Chip Kahn (20:26):

Let’s talk a little bit about the employer side. You bring that up. What do you think needs to be done on the employer coverage side to shore up that really important way that actually most Americans get their coverage?

Peter Lee (20:38):

That’s the thing that we often forget. It’s funny. I was part of the policy discussions, I think you were, when the ACA was being crafted and everyone probably remembers the whole thing about the Cadillac tax. The big worry was employers were giving benefits, which were too rich, and so we need to stop that because that’s encouraging consumers to use too much healthcare. I think in retrospect, we got it backwards. We don’t need a Cadillac tax; we need a Pinto tax, a tax on employers offering crappy coverage.

Peter Lee (21:12):

When look we at, and Chip, you’re absolutely right, the majority of Americans get coverage for their job. In California it’s about 50%. People under 65, get employer-based coverage, about one third, get Medicaid at this point, a bunch could cover California. Many people with employer coverage and particularly those represented by unions have really good coverage. The scope of benefits is really good, but for about a third people with employer coverage it is crappy coverage. It is very high deductible. It is not adjusted for people’s income, which means unlike in the Affordable Care Act, you make less money, you get more financial help with the premium. Most employers do not do that. They say, “Fine, whether you make $15,000 or $1.5 million, you pay a percentage of the premium.” Nothing to do with your income. That’s economically bonkers.

Peter Lee (22:06):

One of the things I think we need to do as a nation is to potentially have something like a Pinto tax. Employers get a subsidy from the federal government to offer employer-base coverage. It is a tax-free form of compensation. Why are we giving that to employers that aren’t income adjusting their benefits for their employees and making sure that the coverage is robust enough to make a difference? I think we probably shouldn’t be.

Peter Lee (22:33):

I think the next generation of issues that either the Biden administration or the next will be looking at is employer coverage and making sure it’s meaningful and adjusted for income. The COVID pandemic has rightly put a fresh spotlight on issues of equity and disparities. The same people that are the frontline workers that have been hit hardest economically by the COVID recession, are those who are lower income people with worse employer-based coverage, because it’s not adjusted for their income. I think as we start looking at things through an equity lens, we’re going to rightly see a fresh look at some of the flaws of the employer-based coverage. Not for all people of the employer-based coverage; some people have great coverage, but a very significant portion have coverage that calls to question their ability to get care at the right time.

Chip Kahn (23:24):

Interesting concept. Obviously, if we think about the three legged stool or four legged stool here, I should say, we have public coverage, Medicare, Medicaid, we have the private individual market, we have the employer coverage that provides coverage to all Americans. Unfortunately I guess the fourth leg is for the uninsured; we do have protections when they go to the hospital, but we need to get them covered.

Peter Lee (23:50):

That’s right. A tip if I could. I think that the four legged stool so to speak of the coverage … Medicare and Medicaid, publicly funded. Employer coverage; about one third is federal tax dollars at play. The individual market is now mostly supported by federal tax credits, federal money in play. And the uninsured; it’s not only hospitals that are providing care they must provide, but it’s federally qualified health centers, which are paid for with federal dollars to provide coverage, not just in hospitals for outpatient care. In the end, healthcare is a public good that we need to make sure is publicly held account to.

Chip Kahn (24:37):

One leg of that stool is Medicaid. As we talked about it, the predominance of states, at least on the coast, expanded Medicaid but there’s some large states that didn’t. Do you think there’s anything we can do from a policy standpoint to further encourage those states or are they just part of the great political divide and we just have to wait and see over time whether attitudes evolve?

Peter Lee (25:05):

Well, I think two things. One of the things that I treasure about our nation is the balance of being states and a federal umbrella. I think it is as a nation unacceptable to say, “Oh sorry, these three million lower income people happen to live in Texas so they’re out of luck.” So what are the policy options? One is to sweeten the deal a little bit. So states will opt in to expand Medicaid. I think some states will.

Peter Lee (25:35):

One of the proposals is when the Affordable Care Act was launched, the first I think three years of Medicaid expansion, states paid zero for the expansion lives, proposals to bring that back. So now States can say, “Okay, I can start new as if I’d signed up at the beginning. Great proposal.” But if states don’t sign up with a carrot, I think the right thing to do is to work around them and say, “Fine, forget Medicaid. We’re going to have a marketplace option that is as meaningful as Medicaid so your low income people are not left without insurance.” The exact structure of that to be determined. That’s the sign of workarounds I think you’ll see what the Biden administration to address national coverage issues and not say, “We’re going to leave 15 states that don’t care, those residents to be uninsured.”

Chip Kahn (26:27):

As we head to the end here, Peter, obviously we have focused so appropriately on what I think is the first key to good healthcare, which is having healthcare coverage, but there are payment issues and other issues that are also involved in making healthcare work for Americans. What is from your standpoint, the next frontier in terms of health reform beyond just getting the people covered?

Peter Lee (26:53):

I love that question, Chip, because you and I have spent a lot of time together on the National Quality Coalition. It’s one of the things that Covered California done since day one. We have a expansive contract with our 11 health plans saying, “Your job isn’t just to give people an insurance card’ it’s to make sure people get the right care at the right time, depending on who they are, regardless of where they live.” We actually have performance incentives. We have what goes into our selecting, which plans can come into our marketplace. Unlike other states, we have said no to a number of health plans that say, “Hey, we want to play in California.” We said, “Sorry, we don’t want you.” We curate the market looking at a lens of quality, equity and value.

Peter Lee (27:38):

I think that really is the next frontier. When we look at how we have done as a nation, you know this well, you look at the six domains of quality the ILM laid out many years ago of is it safe, timely, effective, equitable, efficient, and patient-centered, as a nation we still aren’t doing that good of a job. That’s the next place we need to go to because getting coverage alone isn’t enough. In California, we measure our plans, and the good news is about 40% of our enrollees are very likely to get very good care. The bad news is most of them are in one healthcare delivery system, which is Kaiser Permanente, which has an integrated system that delivers very effective care for people with chronic illness, people not in that integrated delivery system, it’s rolling a dice whether they’re going to get the right care at the right time. That’s fundamentally unacceptable.

Peter Lee (28:36):

As a large purchaser, which we are, we’ll raise the bar for our health plans and saying, “You need to make sure you’re looking at equity. You need to make sure your diabetics are getting care on par with that of Kaiser. If not, we’re going to ship people off to Kaiser.” Now, obviously Kaiser’s not taken over the world. We have to be addressing the issues of subpar quality that is regardless of how you buy your healthcare, regardless of it’s in that Medicare, Medicaid, commercial, or individual market, for most Americans it’s crapshoot healthcare in that your chances of getting the right care at the right time, you’re flipping a coin. And that hasn’t shifted in the last 20 years.

Chip Kahn (29:22):

Peter, this conversation has just been so helpful and really covered, particularly with your last remarks, the entire span of healthcare issues. Before we completely close out, can you let us know where can people go to learn more about Covered California?

Peter Lee (29:38):

We actually publish a lot. We publish studies, we print results. You can go to coverageca.com, or the easier thing that we all do is Google us. Type in your search engine, policy reports Covered California. Our budget; Cover California budget. You want to see how we spent $440 million this year; we got an 80 page budget that lays it out in excruciating detail. We do that because at Covered California, one of the things we sort of have as a mantra, we are evidence-based and evidence generating. For our health plans; every one of them gives 100% of their claims data. We’re analyzing that right now to see are people with bronze plans, high deductible plans, actually getting the care they need, or are they avoiding it because it’s too hard to get past that deductible? That’s part of our job.

Peter Lee (30:28):

I welcome people following what we do. We’ll continue sharing it with you. We have a lot to learn from others, but we think that one of our jobs is to be a proving ground.

Chip Kahn (30:36):

Peter, so great to have you with us.

Peter Lee (30:38):

Great to be with you, Chip. Thanks for all you do, and thanks for the work of the Federation.

Speaker 1 (30:46):

Thanks for listening to Hospitals In Focus from the Federation of American Hospitals. Learn more at FAH.org. Follow the Federation on social media at FAA Hospitals, and follow Chip at Chip Kahn. Please rate, review and subscribe to Hospitals In Focus. Join us next time for more in-depth conversations with health care leaders.

Peter Lee, Executive Director, Covered California

Peter V. Lee is the first Executive Director for California’s health benefit exchange, “Covered California.” Having been confirmed unanimously by the exchange Board on August 23, 2011, Mr. Lee oversees the planning, development, ongoing administration and evaluation of Covered California and its efforts to improve the affordability and accessibility of quality health care for Californians.

California’s first health benefit exchange was established by the state in September 2010 to support the expansion of coverage enabled by the Affordable Care Act of 2010. As the first state to create a health benefit exchange following the passage of federal health care reform, it is charged with creating a new insurance marketplace where individuals and small businesses will be able to purchase competitively priced health care plans using federal tax subsidies and credits beginning in January 2014.

Prior to his current role as Executive Director of Covered California, Mr. Lee served as the Deputy Director for the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services (CMS) in Washington, D.C. where he lead initiatives to identify, test and support new models of care in Medicare and Medicaid; resulting in higher quality care while reducing costs.

Previously Mr. Lee was the Director of Delivery System Reform for the Office of Health Reform for the U.S. Department of Health and Human Services, where he coordinated delivery reform efforts for Secretary Kathleen Sebelius and assisted in the preparation of the National Quality Strategy. Before joining the Obama Administration, Mr. Lee served from 2000-2008 as the CEO and Executive Director for National Health Policy of the Pacific Business Group on Health (PBGH), one of the leading coalitions of private and public purchasers in the nation. Mr. Lee also served as the Executive Director of the Center for Health Care Rights, a consumer advocacy organization based in Los Angeles from 1995-2000, and was the former Director of Programs for the National AIDS Network.

Prior to his work in public service, Mr. Lee was a practicing attorney in Los Angeles.

A native Californian, Mr. Lee holds a Juris Doctorate from the University of Southern California and a Bachelor of Arts from the University of California, Berkeley.

The [goal of Covered CA] was to, not only, provide as much coverage as possible, but to try to address the underlying health care system. The ambition we had was the make higher quality health care available to all and also to effect the entire health care system in California.

Peter Lee
Executive Director, Covered California