Obamacare

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

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Adequacy of Doctor Networks Key Issue for Covered California

Screenshot from CoveredCA.com, the website of Covered California.

Screenshot from CoveredCA.com, the website of Covered California.

Contract negotiations are about to begin for health insurance companies that want to sell plans next year through the state marketplace, Covered California. One area of scrutiny by the agency is sure to be adequacy of provider networks offered by insurers. 

“Insurers have gotten the message that there’s some consumer dissatisfaction out there.”
Last year, in order to keep premium costs down, insurance companies sold plans with a narrowed list of doctors for customers to choose from. The goal was to offer doctors and other providers more patients in exchange for a lower cost of providing services.

But many more people signed up for Covered California plans than had been anticipated, leaving perhaps too few doctors to see the patients. Many people scrambled to find a doctor. Complaints to the state show that some people were forced to leave a trusted specialist; some women in their third trimester of pregnancy found they’d have to switch to an unknown obstetrician for their birth. 

“It’s unfair and unrealistic,” said Betsy Imholz, an advocate with Consumers’ Union.
Continue reading

In Alameda County, Leaving Jail Doesn’t Have to Mean Losing Health Care

Rodrigo Salido, recently released from Santa Rita jail in Dublin, Calif., enrolls in Medi-Cal at Healthy Oakland clinic. (Courtesy: PBS NewsHour)

Rodrigo Salido, recently released from Santa Rita jail in Dublin, Calif., enrolls in Medi-Cal at Healthy Oakland clinic. (Courtesy: PBS NewsHour)

By Sarah Varney, Kaiser Health News and PBS NewsHour

It’s been two months since Rodrigo Salido left the maximum security wing at Santa Rita jail, about 40 miles east of San Francisco in Alameda County. It’s also been two months since Salido had medication for his bipolar disorder.

In Alameda County officials estimate 18,000 offenders in its two jails will now qualify for Medi-Cal.
A drug, Risperdal, prescribed by a jailhouse psychiatrist, had quelled Salido’s angry moods. “It helped me be more relaxed,” he said. “Not as much on the edge and feeling like everybody is out to get me.”

Now Salido, who served two years for burglary, assault and gang involvement, has no health insurance and until recently had few options for refilling his medication.

Many inmates leave county jails and state prisons with mental health problems and chronic physical ailments — and no health coverage. Because they typically are not custodial parents, ex-offenders have long been ineligible for a public health insurance program aimed at kids, mothers and the disabled. Continue reading

Obamacare Plans Illuminate High Cost of Going ‘Out of Network’

Consumers learn that in some cases there is no maximum on out-of-pocket costs if they see out-of-network providers. (Getty Images)

Consumers learn that in some cases there is no maximum on out-of-pocket costs if they see out-of-network providers. (Getty Images)

Editor’s note: This post is part of the ongoing Ask Emily column, a project of the nonprofit CHCF Center for Health Reporting. Reporter Emily Bazar answers consumer questions about Obamacare. In this issue, Bazar takes a look at the potential costs of visiting an out-of-network doctor or other provider. This is an issue anyone with health insurance should pay attention to.

Q: I learned today that the health “insurance” I purchased for my family through Covered California does not have ANY maximum out-of-pocket cost on out-of-network providers. … How is that even possible? Our family is now faced with potentially infinite costs that could wipe us out.

A: Let’s start with a quick refresher.

Consumer learns there is no maximum on what she must pay for out-of-network doctors she saw.

An out-of-pocket maximum is the most you would pay during the term of your health policy (usually one year) before your insurance begins paying 100 percent of covered medical services.

Deductibles, co-pays and other costs generally count toward your out-of-pocket maximum. Your monthly premiums don’t. Continue reading

Even With Obamacare, Many Latinos Still Seek Medical Care in Mexico

Dr. Cecilia Espinoza meets with her patient Irma Montalvo. Montalvo, a U.S. citizen, prefers to travel to Mexico for health care, even though she signed up for a health plan through Covered California (Heidi de Marco/KHN).

Dr. Cecilia Espinoza meets with her patient Irma Montalvo. Montalvo, a U.S. citizen, prefers to travel to Mexico for health care, even though she signed up for a health plan through Covered California (Heidi de Marco/KHN).

By Anna Gorman, Kaiser Health News

TIJUANA, Mexico – Irma Montalvo signed up for a health plan through Covered California, the state’s insurance marketplace, last month, getting coverage for the first time in eight years.

“To be honest, I like to come here better even if I have insurance.”
But when she needed treatment for a painful skin rash, Montalvo didn’t go to a doctor near her home in Chula Vista. Instead she drove to Mexico, about 16 miles south. Her doctor, Cecilia Espinoza, diagnosed her with shingles and prescribed medication to relieve pain and head off complications.

Montalvo, 64, said she comes to Tijuana in part because it costs just $15 to see the doctor. She can’t use her insurance for care outside California but it’s still cheaper because she doesn’t have to worry about a deductible. More important, she said, is that she feels comfortable with Espinoza.

“She listens to me,” said Montalvo, a U.S. citizen who was born in Mexico, said in Spanish. “I come here feeling really bad, and three days later I am better.” Continue reading

Obamacare in Jail: How San Francisco Policy Helps Inmates

A new law permits San Francisco Sheriff Department staff to enroll people into health plans. (Thomas Hawk/Flickr)

A new law permits San Francisco Sheriff Department staff to enroll people into health plans. (Thomas Hawk/Flickr)

The San Francisco Sheriff’s Department is implementing a new city law allowing its staff to enroll inmates into health insurance under the Affordable Care Act. Sheriff Ross Mirkarimi believes that making sure people have health coverage when they’re released will help prevent them from committing another crime and coming back.

“I believe that will go a long way to helping us improve public safety by using a public health strategy,” he said.

Health insurance sign-ups available to all inmates at the San Francisco county jail.

He estimates this will help save taxpayers millions of dollars.

One inmate – Sophia – recently requested help signing up for health insurance. Sophia, who asked that her last name not be used, was caught driving a stolen car in January and sentenced to three months in the county jail. She says that was because she stopped getting treatment for her substance abuse and mental health problems when her health insurance expired. Continue reading

Yes, California Leads in Obamacare — But the Marathon is Just Beginning

Screenshot from CoveredCA.com, the website of Covered California.

Screenshot from CoveredCA.com, the website of Covered California.

By Dan Diamond, California Healthline

Joel Ario says he meant it as a compliment.

It was January 2011, and Ario — the White House’s point man on exchanges at the time — was having dinner with Diana Dooley, California’s newly installed HHS secretary. And seeking to praise California, Ario told Dooley that her state had emerged as one of the nation’s “pace cars” when it came to implementing the Affordable Care Act.

The enrollment numbers are terrific, “but it’s too early to hang the Mission Accomplished banner.”
Dooley quickly corrected him, Ario recalled in an interview with California Healthline this week.

“[Dooley] told me, ‘Pace cars don’t actually win the race,’” Ario said. “‘We want to be the lead car.’”

Forty months later, California’s clearly pulled ahead of the pack. No state signed up more residents during Obamacare’s first open enrollment period, or grew its Medicaid rolls by a larger amount.

But not all glitters in the Golden State. While Covered California drove national enrollment — nearly one in five of all 8 million national ACA sign-ups went through the state’s insurance exchange — its faltering website and sometimes spotty service made for an occasionally bumpy ride. Continue reading

Despite Obamacare, Why Some Choose to Skip Health Insurance

Scott Belsha says he opted out of buying health insurance because he has never had it and has managed to stay healthy (Stephanie O'Neill/NPR).

Scott Belsha says he opted out of buying health insurance because he has never had it and has managed to stay healthy (Stephanie O’Neill/NPR).

By Stephanie O’Neill, NPR

Despite a surge in enrollment in the two weeks before the April 15 deadline to enroll for health insurance under the federal health law, many more Californians still haven’t signed up, and they’re unlikely to.

Many people are uninterested, confused or skeptical.

Scott Belsha, from Long Beach, Calif., falls in the skeptical category.

“I’ve been consumed with living my life, and I’m fortunate to be healthy,” he says. He works as a musician and carpenter, and he’s never had health insurance. His parents, who own a small business, always paid cash for medical care, most of which they were able to get from a doctor friend.

“I haven’t ever been to the hospital or broken a bone,” he says. “But I’m 34, and I should probably start thinking about it.” Continue reading

Waiting For Medi-Cal To Kick In

Teresa Martinez, 62, works as a hairdresser at a Koreatown hair salon. She earns about $10,000 per year and cannot afford to buy private health coverage (Photo by Heidi de Marco/KHN).

Teresa Martinez, 62, works as a hairdresser at a Koreatown hair salon. She earns about $10,000 per year and cannot afford to buy private health coverage (Photo by Heidi de Marco/KHN).

by Anna Gorman, KHN

For most of Teresa Martinez’s life, buying health insurance has been out of the question. She works at a Koreatown hair salon, earning about $10 per cut – not nearly enough to afford private coverage.

With a long list of ailments including dizziness, blurry vision and leg pain, she eagerly applied last year for a county program that would cover her for free until Obamacare set in.

“I thought at long last, I would be able to go to the doctor and get what I need,” said Martinez, 62, who lives in East Los Angeles. “I was so excited. But that was short lived.”

The state has 45 days to process the Medi-Cal applications but it often takes longer and the waiting period varies — sometimes widely — by county.

Without any explanation, Martinez received a denial letter from the Healthy Way Los Angeles, a temporary coverage program for low-income people. Later she applied for Medicaid — known as Medi-Cal in California — which was expanded under the Affordable Care Act to include people like Martinez without dependent children.

But a health clinic worker told her she may have to wait months for approval — and to hold off on appointments until she has her official card.

Nearly 2 million Californians have gained coverage with the expansion of the Medi-Cal program for poor and disabled people, including those who transitioned from temporary programs like Healthy Way LA. Continue reading

Expert: Millions More Uninsured Will Get Coverage in Next Three Years

Covered California application in Chinese.

Covered California application in Chinese.

Now that the final numbers from Covered California’s first open enrollment period are in, experts are already looking ahead to the next steps.

Nearly 1.4 million Californians have signed up for health care coverage through the exchange. Another 1.9 million are now covered by the expanded Medi-Cal program. That’s almost 3.5 million state residents.

And yet 5.8 million Californians remain uninsured.

Gerald Kominski, professor of Health Policy and Management and director of the UCLA Center for Health Policy Research, said these numbers are on target with early projections. Continue reading

Obamacare Opens Door for Some to Leave Jobs

Because Mike Smith of Long Beach was able to get insurance through the Affordable Care Act, he could retire from his job. (Stephanie O'Neill/KPCC)

Because Mike Smith of Long Beach was able to get insurance through the Affordable Care Act, he could retire from his job. (Stephanie O’Neill/KPCC)

By Stephanie O’Neill, KPCC

It’s just after noon on a recent weekday and Mike Smith, 64, of Long Beach is standing over his stove, gently mixing together a sizzling dish of bright green brussels sprouts with caramelized shallots.” Even people who don’t like brussels sprouts love this dish,” he says of the recipe he culled from the pages of Bon Appétit Magazine many years ago.

They were afraid if they tried to buy insurance on their own, an insurance company would reject them. And now that can’t happen.”
We’ve got organic shallots, organic brussels sprouts and organic apple cider vinegar,” Smith says as he stirs the ingredients. “I love the smell of the shallots, don’t you?”

Until recently, Smith had little time to to experiment in the kitchen, to practice guitar or to visit his elderly in-laws or his two-year-old grandchild.

Instead, he worked 11 hours a day, Monday through Friday and then half a day on Saturday, as a district manager for a national auto parts chain. Early retirement, while certainly appealing, wasn’t a viable option, as both he and his wife relied heavily on his job-provided health insurance. Continue reading