Covered California

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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

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

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

California Health Secretary on ‘Disruptive Innovation’ of the ACA

Diana Dooley (right), Secretary of California's Health and Human Services Agency, talks with KQED's Lisa Aliferis about the Affordable Care Act at a New York Times conference at UCSF. (Michael Loccisano/Getty Images for New York Times)

Diana Dooley (right), Secretary of California’s Health and Human Services Agency, talks with KQED’s Lisa Aliferis about the Affordable Care Act at a New York Times conference at UCSF. (Michael Loccisano/Getty Images for New York Times)

Diana Dooley is head of California’s Department of Health and Human Services and — in that role — also serves as chair of the Covered California board.

So when the New York Times came to town last week and held its Health for Tomorrow conference at UCSF, organizers invited me to interview Dooley about how the Affordable Care Act is rolling out in California.

Yes, sign-ups during the first open enrollment were strong, but in no way was Dooley claiming victory. She joked that grading is happening on a curve. “We’re not absolutely good; we’re relatively good,” she said.

Four times during our 30-minute talk, Dooley spoke of the “jury being out” on whether the ACA will ultimately be a success. She referred to coverage expansion being just one leg of the ACA’s three-legged stool. The other legs include payment and delivery reform, as well as prevention and wellness. Continue reading

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

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

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