LAKEPORT, Calif. – Local and federal officials offered an update on new health care coverage options for community members under the Affordable Care Act and explained how to apply at a Saturday forum.
Close to 100 people attended the forum – titled, “The Affordable Care Act: What's happened so far, what's happening and what's coming next” – held at the Lakeport Senior Center on Saturday afternoon.
Congressman Mike Thompson, whose office organized the event, was unable to attend due to having what his district representative Brad Onorato called “minor” surgery in San Francisco on Jan. 21.
Onorato read a statement from Thompson, who said the demand for the health care coverage offered through the Affordable Care Act has been “through the roof.”
The new rules are meant to ensure that more people have health care by establishing fairer premiums, limiting out-of-pocket costs, stopping coverage caps and denial of coverage due for preexisting conditions, preventing people from being rendered uninsurable and ending the practice of charging women more for the same care as men.
“We all know that reforming our health care system is an ongoing process,” Thompson's statement said, noting that while the law is not perfect, it's “an important first step.”
Panelists during the hour-and-a-half-long meeting included Herb Schultz, US Department of Health and Human Services Region IX director; Eliot Enriquez of the Redwood Community Health Coalition; and Lake County Social Services Director Carol Huchingson.
There also were tables with information and counselors who could guide people through the enrollment process.
Schultz said the Affordable Care Act is seeking to expand health care coverage to 40 million people across the United States.
To date, nine million people have signed up for private health insurance through the new marketplace, learned they're eligible for Medicaid or renewed Medicaid coverage, he said.
The six-month enrollment period is under way, and people have until March 31 to sign up. The next enrollment won't be until October, Schultz explained.
Schultz said national health care spending growth is at its slowest rate now in 30 years, with the rate having already dropped 1.5 percent on adult rates.
He assured people who have Medicare that their health coverage won't be affected.
One area of the law that Schultz addressed related to small businesses. He said there has been a lot of misinformation – and not enough outreach to correct it – about how the law applies to them.
If a business has less than 50 full-time equivalents – a full-time equivalent is defined as working 30 hours or more per week – it is exempt from the requirement to provide health care coverage, he said.
He said 96 percent of small businesses nationwide are exempt based on that staffing level rule, with 99 percent of California's small businesses being exempt.
However, small businesses may decide they wish to provide the coverage anyway, he said.
Schultz also noted that small businesses providing health care coverage to employees are provided tax breaks, with businesses able to enroll in the marketplace year round.
The new rules have expanded Medi-Cal coverage to adults ages 19 through 64 with income up to 138 percent of the federal poverty level, Schultz said. That equals $15,856 per year for individuals or nearly $33,000 a year for a family of four.
In addition, in the Covered California marketplace, advanced subsidized coverage is available for individuals with annual adjusted gross incomes of between $16,000 and $46,000, or $33,000 to $92,000 a year for families, he said.
The essential health benefits cover 10 areas, Schultz said: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, lab services, preventive and wellness services, chronic disease management and pediatric services, which extend up to age 21 and include oral and vision.
He would also tell community members during the meeting that the new rules will prevent people from having to be impoverished to be eligible for Medi-Cal coverage. “That will not happen anymore.”
Enriquez went over the Covered California Web site, www.coveredca.com , which translates into 13 different languages.
He recommended that people start by using the shop/compare tool, which asks basic information about the individual applying and their household.
Enriquez emphasized that people must sign up by March 31, otherwise they must wait until October for the next chance to sign up and may have to pay a fine on their income tax.
There are three ways to enroll, Enriquez said: call Covered California at 800-300-1506 and use a landline if possible, as the process takes a while; enroll online at www.coveredca.com ; or call Lake County Social Services at 800-628-5288.
The health care coverage available in Lake County through the marketplace is provided by Anthem Blue Cross and Blue Shield of California, Enriquez said.
The basic requirements for getting health care coverage include being a US citizen or national, and not being incarcerated, he said.
There are four levels of coverage: bronze, the least expensive, offers 60 percent cost coverage from insurance companies and 40 percent from the buyer; silver, which has a 70-30 split; gold, with an 80-20 split; and platinum, the most expensive, with has 90 percent insurance coverage with 10 percent paid by the buyer. Enriquez said the lower-priced plans have more out-of-pocket costs.
Huchingson said that the new “MAGI” – or modified adjusted gross income – Medi-Cal coverage that is available does not count child support and veterans income, and there is no asset test, meaning they don't look at vehicles, bank and retirement accounts, and life insurance when deciding eligibility.
She said eligibility determination is based solely on residency, citizenship and income.
“We've done a lot here locally to prepare for the implementation of the Affordable Care Act,” Huchingson said.
That includes hiring additional staff, assembling a team to implement it locally, creating numerous new policies and procedures, and having staff undergo extensive training, according to Huchingson.
“We're a part of the 'no wrong door' policy,” she said, meaning that all agencies involved can help people enroll.
Social Services can help community members enroll whether they qualify for the subsidized or unsubsidized health care coverage, she said.
“Any member of the public can contact us and we can help you select a plan that's right for you,” she said.
Since open enrollment began Oct. 1, Social Services has processed 750 health care coverage applications, Huchingson said, with the majority of them coming through in December.
Social Services can be reached at 707-995-4200 or 800-628-5288.
Email Elizabeth Larson at email@example.com . Follow her on Twitter, @ERLarson, or Lake County News, @LakeCoNews.