Obamacare

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

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Obamacare: With One-Third of Californians Now on Medi-Cal, Can State Manage?

By Anna Gorman, Kaiser Health News

California is coming face to face with the reality of one of its biggest Obamacare successes: the explosion in Medi-Cal enrollment.

The numbers — 2.2 million enrollees since January — surprised health care experts and created unforeseen challenges for state officials. Altogether, there are now about 11 million Medi-Cal beneficiaries, constituting nearly 30 percent of the state’s population.

That has pushed the public insurance program into the spotlight, after nearly 50 years as a quiet mainstay of the state’s health care system, and it has raised concerns about California’s ability to meet the increased demand for health care.

Even as sign-ups continue, state health officials are struggling to figure out how to serve a staggering number of Medi-Cal beneficiaries while also improving their health and keeping costs down. Many are chronically ill and have gone without insurance or regular care for years, and some new enrollees have higher expectations than in the past.  Continue reading

On California Exchange, Only Kaiser’s Rates Will Go Down in 2015

Kaiser Permanente's lower rates on the California health exchange for 2015 may be meant to attract customers. (Ted Eytan/Flickr)

Kaiser Permanente’s lower rates on the California health exchange for 2015 may be meant to attract customers. (Ted Eytan/Flickr)

As all the other health insurers on California’s Obamacare exchange raise their rates for next year, Kaiser Permanente plans to lower them.

The Los Angeles Times reports that a new analysis by Citigroup shows Kaiser’s premiums dropping by 1.4 percent in 2015.

At the same time, the average premium across all plans on the Covered California exchange will rise 4.2 percent.

Citigroup health care analyst Carl McDonald told the Times he thinks Kaiser’s move is meant to draw customers: Continue reading

California’s 2015 Obamacare Premiums Will Increase Modestly

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

Screen shot from CoveredCA.com, the website of Covered California.

Officials with Covered California, the state’s Obamacare marketplace, say premiums will go up an average 4.2 percent statewide in 2015 for the 1.4 million Californians currently enrolled in insurance through the exchange.

Peter Lee, executive director of the agency, was clearly delighted. “This is good news for Californians,” he said, “and an example of how Covered California and the Affordable Care Act are working to make health insurance affordable.”

Lee said premiums would vary by people’s age and where they live in California. Californians will have a choice of plans from the state’s four major insurers: Anthem Blue Cross, Blue Shield, Kaiser and Health Net — as well as six regional players: Chinese Community Health Plan, L.A. Care, Molina Healthcare, Sharp Health Care, Valley Health Care and Western Health Advantage.

Lee said that for the million-plus people currently insured through the exchange:

  • 16 percent: will see rates remain stable or go down
  • 35 percent: will see premiums increase 1-5 percent
  • 36 percent: will see increases of 5-8 percent
  • 13 percent: will see increases over 8 percent, some as high as 15 percent

Continue reading

Survey: 3 Million Californians Newly Insured Under Obamacare

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 Anna Gorman, Kaiser Health News

A significant portion of previously uninsured Californians gained medical coverage through the nation’s health care law – about six in 10 during the state’s first open enrollment, according to a survey released Wednesday.

All told, about 3.4 million people who didn’t have health insurance before sign-ups began last fall are now covered, according to the survey by the Kaiser Family Foundation.

The largest share of the previously uninsured — 25 percent — enrolled through the state’s Medi-Cal program, which has long covered poor families but was expanded this year to include adults without children. Nine percent purchased private plans through the subsidized insurance marketplace, Covered California, which opened in October. And 12 percent became insured through their jobs, the researchers found. Continue reading

CA Insurance Commissioner: Insurers Fear Prop. 45, Will Keep Health Rates Low

(Getty Images)

(Getty Images)

A new analysis from the Department of Insurance confirms what has been reported since the Covered California exchange opened last October: Some people saw steep premium increases after the rollout of the Affordable Care Act.

According to the department’s analysis non-subsidy eligible individuals saw average increases ranging from 22 to 88 percent, depending on their age and where they lived. The review was done of all health plans — including those managed for the Department of Managed Health Care — and looked at premiums from California’s four largest carriers, Anthem Blue Cross, Kaiser, Blue Shield and Health Net.

The release appeared to be politically timed. Covered California’s rates for next year are due on Thursday, and the rumble is that new premiums will show only modest increases. Continue reading

‘Narrow Networks’ Frustrate Consumers in California and Nationwide

(Helen K/Flickr)

(Helen K/Flickr)

By Julie Appleby, Kaiser Health News

Marcia Perez of Palo Alto may live 2,000 miles Nancy Pippenger in Indiana, but the two women have the same complaint: Doctors who treated them last year won’t take their insurance now, even though they haven’t changed insurers.

“To try to find a doctor, I’m very limited. There aren’t a lot of names that pop up.”

“They said, ‘We take the old plan, but not the new one,’” says Perez, who is an attorney in Palo Alto.

In Plymouth, Ind., Pippenger got similar news from her longtime orthopedic surgeon, so she shelled out $300 from her own pocket to see him.

Both women unwittingly bought policies with limited networks of doctors and hospitals that provide little or no payment for care outside those networks. Such plans existed before the health law, but they’ve triggered a backlash as millions across the country start to use the coverage they signed up for this year through the new federal and state marketplaces. The policies’ limitations have come as a surprise to some enrollees used to broader job-based coverage or to plans they held before the law took effect. Continue reading

Critics Say Covered California Ill-Equipped to Help Former Foster Youth

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

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

Former foster youth lined up at Covered California’s last board meeting to complain about the hoops they have to jump through to enroll in Medi-Cal, the state’s health plan for the poor.

“Navigating adulthood is challenging enough, let alone trying to find insurance to cover your medical needs,” said Vanessa Hernandez, who spent 14 years in foster care. She says her younger brother tried twice to sign up online before he gave up.

“Currently the process is very unclear, it’s hard to navigate, and it’s not very accessible,” she said. Continue reading

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