Obamacare

The Affordable Care Act takes full effect on January 1, 2014. Will California be ready?

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Latina Small Business Owner Enters the Insurance Marketplace

Under the Affordable Care Act Sandra Lopez, 41, owner of Las Fajitas in Newport Beach, obtained health insurance for the first time since arriving in the U.S. in 1990. (Heidi de Marco/Kaiser Health News).

Under the Affordable Care Act Sandra Lopez, 41, owner of Las Fajitas in Newport Beach, obtained health insurance for the first time since arriving in the U.S. in 1990. (Heidi de Marco/Kaiser Health News).

By Heidi de Marco, Kaiser Health News

Alongside one of Newport Beach’s canals, blocks from the beach, Sandra Lopez is finally living her idea of the American dream.

For years Lopez took home remedies or asked friends to bring her medicine from Mexico.
In 1996, six years after crossing the border from Mexico without papers, she began working at Las Fajitas, a popular Mexican restaurant as a cashier and cook. With the help of her boss, she received a work visa in 2001.

Eleven years after that, she bought the business – a bustling establishment where Lopez knows most customers by name. Mexican lanterns hang from the ceiling, and cheers from a soccer match on TV fill the room.

Lopez, now a legal resident, said the income from her small business fluctuates monthly. “People think that because you own a business, you have lots of money…that life is easy,” she said. “But it’s hard work and I have so many bills to pay.” Continue reading

Anthem Blue Cross Sued Over Covered California Doctor Networks

The Anthem Blue Cross headquarters in Woodland Hills, California. (David McNew/Getty Images)

The Anthem Blue Cross headquarters in Woodland Hills, California. (David McNew/Getty Images)

By Julie Appleby, Kaiser Health News

Statewide insurance giant Anthem Blue Cross misled “millions of enrollees” about whether their doctors and hospitals were participating in its new plans, and failed to disclose that many policies wouldn’t cover care outside its approved network, according to a class action lawsuit filed Tuesday.

As a result, many consumers are on the hook for thousands in medical bills, advocacy group says.

As a result, many consumers have been left on the hook for thousands of dollars in medical bills, and have been unable to see their longtime doctors, alleges the suit by Consumer Watchdog based in Santa Monica.

Anthem spokesman Darrel Ng declined to comment directly on the lawsuit. He said Anthem has agreed to pay the claims of those who received treatment from inaccurately listed doctors during the first three months of the year.

However, that policy would not be extended for enrollees who discovered after March 31 that their doctors had been incorrectly listed, he said. Continue reading

Nearly a Million People Backlogged in Medi-Cal Expansion

It's not clear when the backlog will be cleared. (Getty Images)

It’s not clear when the backlog will be cleared. (Getty Images)

By Helen Shen, Kaiser Health News

A massive backlog of Medi-Cal applications is well into its third month, and California officials have provided little information about how and when the largest such bottleneck in the nation might be cleared.

The California Department of Health Care Services in Sacramento first reported 800,000 pending applications in April. By May, that number had grown by 100,000 and has not budged much since. As the state works through older applications, new ones continue each day to enter the system, which has been plagued by computer glitches and inefficient procedures for verifying applicants’ personal information.

There are no estimates of processing times or how long delays will persist, though a state official said last month that new applications in May appeared to have slowed. Continue reading

Opposing Sides Testify Before State Committee over Insurance Proposition

Peter Lee, seen here in a 2012 photo, is the executive director of Covered California and testified Thursday before the joint legislative committee on health.

Peter Lee, seen here in a 2012 photo, is the executive director of Covered California and testified Thursday before the joint legislative committee on health.

State insurance commissioner Dave Jones is flatly rejecting accusations that a proposition on November’s ballot would undermine the implementation of the Affordable Care Act in California.

If passed by voters, Proposition 45 would give the commissioner the power to reject excessive rate hikes for health insurance –- and, he argues, keep health premiums affordable for consumers. Last month, Covered California, the state’s health insurance exchange, said the measure could compromise its operations, possibly causing delays in approving health plans before they are federally mandated to go on sale to consumers, or curtailing its own authority to negotiate the details of plans with insurers.

“These conclusions are fundamentally flawed,” Jones said on Wednesday, speaking before the state’s joint legislative committee on health. Continue reading

Hobby Lobby Decision Has Limited Impact in California

 Anti-abortion advocates rally in front of the Supreme Court awaiting the decision in Burwell v. Hobby Lobby Stores was announced Monday. (Chip Somodevilla/Getty Images)

Anti-abortion advocates rally in front of the Supreme Court awaiting the decision in Burwell v. Hobby Lobby Stores was announced Monday. (Chip Somodevilla/Getty Images)

Most women in California won’t be affected by Monday’s U.S. Supreme Court landmark decision in Sebelius v. Hobby Lobby. The Christian owners of the craft store chain challenged the Affordable Care Act’s requirement that companies provide contraception coverage to their employees. The Court ruled that closely-held, for-profit companies can opt out if they object on religious grounds.

But it’s not so easy in California. That’s because the ruling doesn’t apply to state laws. California has had the Women’s Contraceptive Equity Act on the books since 1999. It requires health insurance companies that cover prescription drugs to also cover birth control.

“For most workers in California, nothing will change,” says Maggie Crosby, attorney with the ACLU of Northern California. “Women should feel secure that if they have birth control coverage today, they will have it tomorrow.”

She says the state law is still in full effect after Monday’s Supreme Court ruling. Continue reading

Hobby Lobby decision has limited impact on California

Most women in California won’t be affected by Monday’s U.S. Supreme Court landmark decision in Sebelius v. Hobby Lobby. The Christian owners of the craft store chain challenged the Affordable Care Act’s requirement that companies provide contraception coverage to their employees. The Court ruled that closely-held, for-profit companies can opt out if they object on religious grounds.

But it’s not so easy in California. That’s because the ruling doesn’t apply to state laws. And California has had the Women’s Contraceptive Equity Act on the books since 1999. It requires health insurance companies that cover prescription drugs to also cover birth control.

“For most workers in California, nothing will change,” says Maggie Crosby, attorney with the ACLU of Northern California. “Women should feel secure that if they have birth control coverage today, they will have it tomorrow.” Continue reading

Covered California Needs Better Outreach to Limited-English Speakers, Advocates Say

A report from Berkeley's Greenlining Institute called on Covered California to make its enrollment website available in more languages than English and Spanish.

A report from Berkeley’s Greenlining Institute called on Covered California to make its enrollment website available in more languages than English and Spanish.

Covered California may have had strong overall enrollment, but people who do not speak English as a first language are underrepresented in the state’s health insurance marketplace, according to an analysis from Berkeley’s Greenlining Institute.

The report relied on Covered California data, which showed that 20 percent of enrollees do not speak English as a primary language. That’s compared with 44 percent of Californians overall.

“We know California is a diverse state ethnically and linguistically,” said Jordan Medina, a health policy fellow with Greenlining and lead author of the study. “Moving forward, if the Affordable Care Act is going to work in California, we have to make sure those populations are represented in the health insurance marketplace.” Continue reading

Covered California Questions Health Insurance Initiative

Covered California executive director Peter Lee, seen here at a November, 2013, press conference. (Max Whittaker/Getty Images)

Covered California executive director Peter Lee, seen here at a November, 2013, press conference. (Max Whittaker/Getty Images)

UPDATE: June 20

KQED’s April Dembosky attended the Covered California board meeting Thursday afternoon where the board expressed concern that a voter initiative on the upcoming November ballot could compromise its authority. The initiative would give the state’s insurance commissioner the authority to reject excessive rate increases in health insurance premiums.  But Covered California already negotiates rates with insurance plans. How would the initiative, if passed, affect Covered California?

Covered California board member Susan Kennedy called on agency staff to conduct an intensive analysis of the initiative’s potential impact Covered California’s ability to operate — and to get it done soon.
Continue reading

6 Questions About Contraceptives, the ACA, and the Supreme Court

Customers entering a Hobby Lobby store in the San Francisco Bay Area community of Antioch. (Justin Sullivan/Getty Images).

Customers entering a Hobby Lobby store in the San Francisco Bay Area community of Antioch. The owners of the company are evangelical Christians and object, on religious grounds, to providing certain types of birth control. (Justin Sullivan/Getty Images).

By Julie Rovner, Kaiser Health News

One of the most watched issues before the Supreme Court this term may turn on the question of religious freedom. But it will also likely determine how women will be able to access a key provision of the Affordable Care Act – one seeking to guarantee no-cost prescription contraception in most health insurance plans.

The justices’ ruling on Sebelius v. Hobby Lobby Stores and Conestoga Wood Specialties Corp v. Sebelius, two cases that are being considered together, is expected by the end of this month. The court will decide whether those companies, and potentially all other for-profit companies, must abide by the so-called contraceptive mandate. It’s a complicated legal thicket, so here is some background.

1. What is the contraceptive mandate?

The health law requires that most insurance plans provide preventive care services without out-of-pocket expense to beneficiaries. The Obama administration included all contraceptives approved by the Food and Drug Administration as part of a package of preventive services for women. Continue reading

Obamacare No Help to Undocumented Immigrants

Morgan Smith, a registered nurse with the Redwood Empire Food Bank Diabetes Wellness Project, conducts free diabetes screenings once a month at the Graton Day Labor Center.  The center serves as a conduit between its members -- many of whom are undocumented -- and health organizations around the region. (Lisa Morehouse/KQED)

Morgan Smith, a registered nurse with the Redwood Empire Food Bank Diabetes Wellness Project, conducts free diabetes screenings once a month at the Graton Day Labor Center. The center serves as a conduit between its members — many of whom are undocumented — and health organizations around the region. (Lisa Morehouse/KQED)

By Lisa Morehouse

California may lead the nation in numbers of people signed up for health insurance under the Affordable Care Act, but there are still millions in the state without health insurance.

‘That leaves a lot of low-wage workers without any health care coverage.’
Some of the people most likely to remain uninsured are undocumented Californians. While they can buy health insurance with their own money, they are specifically excluded from receiving any benefits under the ACA. Community groups and non-profits in cities and towns across California work to fill in the gaps.

One of them is Graton, a small town in Sonoma County, about 20 miles west of Santa Rosa.

When I arrive at the Graton Day Labor Center a woman named Maria is standing behind a table filled with containers of homemade food. There’s oatmeal — with no added sugar, she tells me — tortillas and salsa, fish for tacos, and salad. Continue reading