Joe Raedle/Getty Images)

The state’s health insurance exchange, Covered California, announced Thursday morning the plans and premiums that will be available to people statewide to millions of Californians.

And what everyone wants to know is: how much will it cost. Experts had warned of “rate shock,” that premiums might skyrocket for all kinds of reasons. That has not happened.

Covered California says that individuals will pay an average premium of $321 per month for a “silver” plan. (More on silver plans below.) Many people will be eligible for subsidies to reduce that cost further.

Across the state, people who had been working toward this day seemed to heave a collective sigh of relief.

“This is a home run for consumers in every region of California,” said Peter Lee, executive director of Covered California, in a release to reporters. “Californians should be proud of how not only health plans in this state, but doctors, medical groups and hospitals have stepped up — creating a market that will allow millions of consumers to enroll in affordably priced products.”

The plans on the exchange are required to offer a standard set of comprehensive benefits. It’s hard to compare premiums next year to what’s in place this year, since there is no standard set of benefits at present. Covered California chose as the best comparison the average premium for a small business plan. The rates in Covered California range from 2 percent above to 29 percent below that benchmark.

“It’s nice to have a good news day in California,” said Daniel Zingale, senior vice president of The California Endowment. “It turns out there’s power in numbers when it comes to … health plans.”

13 Plans Selected for the Insurance Exchange

The selected plans and premiums are still subject to review by state regulators. Covered California has picked 13 plans, including Anthem Blue Cross, Blue Shield of California, Health Net and Kaiser as well as many regional plans and some country-sponsored health plans. Those include Alameda Alliance for Health, Chinese Community Health Plan, Contra Costa Health Services, L.A. Care Health Plan, Molina Helathcare, Sharp Health Paln, Valley Health Plan, Vnetura County Health Care Plan and Western Health Advantage.  You can look up your own region and see what plans and premiums you can choose from.

The “silver” plan mentioned above is in the middle. It has the same standard set of benefits as the other plans, and has a $2,000 annual deductible. Still, preventive care and some other services are outside the deductible — people would pay only a co-pay when they see the doctor.

When setting an individual’s premium, insurance plans in the exchange may look at only three factors: age, where you live and family size. Insurance companies may no longer use your health condition or your health history to set premiums. People may no longer be turned down for pre-existing conditions.

Subsidies are available for people making from 138 to 400 percent of the federal poverty level – or about $15,500 to $45,000 for an individual.

Breakdown on Premiums, Before and After Subsidy

Covered California provided tables of average rates for a 21-year-old and a 40-year-old single person. For the 21-year-old buying the most affordable silver plan, the premium is $216 per month. But depending on income, the 21-year-old may get a subsidy, making the price that person would pay range from $44 per month to $216 per month.

The premium for a 40-year-old buying the most affordable silver plan will be $276. But depending on the subsidy, that 40-year-old will pay from $40 to the full $276.

Starting this fall, people will be able to go online and look up plans and rates across the board for themselves or their families.

“Everything will be quite standardized and literally charted out,” said Betsy Imholz, special projects director for Consumers Union. “So you can look across lines and compare plans.”

On average, people in the larger metropolitan areas in California will be able to choose from among five different plans. Covered California says that even in rural areas where options have typically been sparse, people will have two or three health plans to choose from.

“We were particularly concerned about Californians in rural parts of the state,” Zingale said. “So it’s a relief to see that they will have doctors, hospitals and health benefits available in those areas.”

But not everyone was delighted. Jay Nelson is a 33-year-old attorney who lives with his wife and three children in Oakland. Nelson does not have employer-based insurance, although his firm is looking into options. He has been unable to afford insurance for his family. Nelson said he was disappointed the premiums were not cheaper.

“We’re exactly in that income level that is essentially uninsurable,” he said. “We make too much money to qualify for any help, but we don’t make enough money to pay for this … comfortably.”

Bacchi acknowledged that while the Covered California premiums are generally “positive news,” that’s not the case for everyone. “The reality is that there are some people who will pay more than they currently pay. That’s because the Affordable Care Act requires increased benefits and it also imposes less cost sharing on the enrollee through deductibles and co-pays.”

Plans and premiums for Covered California’s small business exchange are expected to be announced in June, and a major education and outreach campaign will launch this summer.

(Fred/Flickr)

For you wonks out there, Kaiser Health News has a fascinating Friday afternoon read for you.

In a piece titled “Bloggers See Own Reflections in Oregon Medicaid Study,” reporter Jordan Rau describes how this week’s news about Oregon’s Medicaid Experiment quickly became “a Rorschach test for how partisans and health policy wonks view the health care law.”

To quickly recap, in a New England Journal of Medicine study researchers analyzed how 10,000 people who won Medicaid coverage have fared since they gained insurance. The highlights were: no apparent affect on physical health; rates of depression 30 percent lower than those without coverage; catastrophic out-of-pocket medical expenses essentially eliminated.

In his piece, Rau publishes excerpts from seven blogs, each with a different take on the study’s highly nuanced results. But he closes with something I hadn’t seen elsewhere: a view of the experiment by someone who says he was one of the winners of the Medicaid coverage. Rau found the post on the blog Robert’s Stochastic thoughts.

Here’s the post in its entirety:

I am one of the winners in the Oregon lottery [winners could get Medicaid]. Going from no insurance to insurance is very confusing. When you have no money every health question starts with “would I rather live with this problem and have electricity, or treat this problem and keep my milk in a cooler for a month or so?” Stepping back into healthcare was like hopping on a merry-go-round. The doctor wanted to do test after test to come up with baselines for me, and I had a hard time showing up at the lab, I hadn’t been going to the doctor to find out new things about what was wrong with me. A huge part of living without insurance is not thinking about your high blood pressure damaging your kidneys. It takes a while to change that. It took me 6 months to change my level of co-operation with my doctor, and she said I was faster than many. Most people got into the groove about their 2nd physical. Then we had year-to-year values for blood tests and weight and blood pressure. Those numbers getting better helped. I lost 40 pounds the first year, regained 15, and lost another 10 the next year. Now my doctor wants me to try for another 10 pound loss. I have gone from 3 blood pressure medicines to 1, and that’s at a half dose. This whole time my blood pressure stayed the same, but dropping 2 pills and keeping the same score is a health upgrade. My blood sugar is still pre-diabetic, but diabetes is a progressive disease. If you keep your blood sugar at the same level for 2 years, you are making progress with managing diabetes. The study would have found me to make no progress, but my doctor thinks I have improved.

The last point is that diabetes and cholesterol are both food-based diseases. The Oregon Medicaid project enrolled very poor adults, I think the income cutoff was much lower than the SNAP benefit limit. So none of us have access to unlimited fresh fruit and low fat meat. We still eat nothing but carbs for most meals.

The mental health benefits are enormous. Changing how you eat and exercise is hard for everyone, but most people can throw a bit of money at the problem and grease their way. With no money for better food, no money for good shoes to go on walks, no rain gear, no walkman for listening to music as a distraction while walking, change is harder.

What I would like to see is a study that shows the changes in these measurements over a 2 year period for people who have insurance. People with insurance for the last 20 years are not always improving their health, either.

So much in this post touches on the tough policy issues we’re facing today: health is about so much more than health care; it’s really hard to change habits and even harder if you’re poor; how mental health affects health. But that last line is really a zinger.

By Kelley Weiss, CHCF Center for Health Reporting

Tax credits for small businesses offering health insurance have been available since the health law was passed in 2010. (Photo/Getty Images)

With less than a year to go before the full rollout of Obamacare, many business owners are still scratching their heads over what it will mean for them.

In fact, most still wrongly believe they’ll have to offer health insurance to their employees, according to a recent eHealth survey. While businesses with 50 or more full time employees will have to pay a $2,000 penalty per worker if they do not offer health insurance, there is no penalty for smaller businesses.

Another commonly misunderstood part of the health care law is the role of the tax code. John Gonzales [also with the Center for Health Reporting] has more details about how paying your taxes and Obamacare works. It’s the bedrock of enforcing the law and subsidizing premiums for people to buy insurance.

At an event about taxes and Obamacare, UCLA health care economist Dylan Roby gave a somewhat grim picture. He says widespread ignorance and varying degrees of hostility towards the health care law persist among business owners.

“Many of these employers, especially on the smaller level, are not that great about maintaining a relationship with the government,” Roby says.

Take, for example, the small business tax credits that have been available since 2010, when Obamacare passed. The U.S. Government Accountability Office last year estimated that less than 5 percent of eligible businesses have claimed the credit. This isn’t a big surprise to Larry Levitt of the Kaiser Family Foundation.

“It’s about as exciting as picking health insurance and doing your taxes and that’s what we’re combining here,” Levitt says.

These business owners are potentially leaving money on the table. If you’re a small business owner who has been offering health insurance at any point since 2010, you may qualify for a tax credit. You can file a revised tax return to collect it.

Another break for businesses trying to purchase health insurance for their workers could come from the new “marketplace” called Covered California.

This state-run exchange is supposed to even the playing field for small businesses that can pay almost 20 percent more than larger ones for health insurance. Currently a little under half of California’s small businesses offer health insurance to their employees.

On the flip side, those $2,000-per-employee penalties for large businesses that don’t offer health insurance start next year. But this will affect less than 5 percent of businesses. That’s because in California, and nationally, most businesses are considered small, meaning they have fewer than 50 employees.

Allan Zaremberg, head of the California Chamber of Commerce, says it’s a daunting task for businesses to keep the carrot and stick aspects of Obamacare straight.

“There is a heck of a lot of confusion about tax credits and costs and do I put him in the exchange or take the penalties,” Zaremberg says.

Allan says he’s not convinced the stick approach will work with businesses. He says they’ll be weighing if taking a couple thousand-dollar penalty per employee for not offering coverage would actually be cheaper.

“I’m not always sure that you can scare them with a monetary penalty. And certainly for a small employer there is none,” Zaremberg says.

Now the push is on to educate businesses about the potential benefits of Obamacare. USA Today and Kaiser Health News report that California has budgeted about $250 million to help consumers, including small businesses. But few experts are saying it’ll be easy.

The health care overhaul is “a big complicated piece of business,” President Obama told reporters during Tuesday’s news conference. (Alex Wong/Getty Images)

If you’re one of the millions of people confused about Obamacare, the president took a few minutes on Tuesday to reiterate his main messages about the federal health law.

“For the 85 to 90 percent of Americans who already have health insurance, they’re already experiencing most of the benefits of the Affordable Care Act even if they don’t know it,” the president said.

He called insurance “stronger, better, more secure,” for people than before the law’s passage. ”Full stop. That’s it. Now they don’t have to worry about anything else.”

President Obama specifically mentioned three benefits of the ACA already in place:

• Children can stay on their parents’ plan until age 26
• Your insurance company cannot drop you if you get sick
• You get free preventive care with no co-pay and no deductible (including many cancer screening tests)

The law also has banned lifetime caps on coverage. For people who have employer-based insurance or Medicare, most of the changes required by the law are already in place.

For people who do not have insurance — or who buy insurance for themselves or their families — “implementation issues” remain, the president said.

“… What we’re doing is we’re setting up a pool so that they can all pool together and get a better deal from insurance companies,” the president said. “And those who can’t afford it, we’re going to provide them with some subsidies. That’s it. I mean, that’s what’s left to implement because the other stuff’s been implemented, and it’s working fine.”

But the challenge in setting up that system is “still a big complicated piece of business,” he acknowledged.

A big complicated piece of business indeed.

It’s been three years since California became the first state in the country to pass legislation to set up a marketplace, now called Covered California. Covered California has been moving full steam ahead, but  the clock is ticking down rapidly to Oct.1 when the online marketplace must open for people to begin shopping for insurance. Coverage will start on Jan. 1, 2014.

“Glitches and bumps” ahead

The president was clear there’s still a long ahead. “And the last point I’ll make,” he said, “even if we do everything perfectly, there’ll still be, you know, glitches and bumps, and there’ll be stories that can be written that says, oh, look, this thing’s, you know, not working the way it’s supposed to, and this happened and that happened. And that’s pretty much true of every government program that’s ever been set up.”

The president’s remarks came on the same day that a new poll showed some troubling gaps in the public’s understanding of the law.

More than 40 percent of Americans are unaware that the ACA is still the “law of the land,” according to the poll conducted by the non-partisan Kaiser Family Foundation. And just under half of Americans say they so not understand how the law will affect themselves or their families.

Dr. Kathleen Clanon talks to patient Andrew Solis about keeping his HIV under control. Clanon worries her patients will have disruptions in their care if they don’t navigate the changes coming under federal health reform. (Mina Kim/KQED)

A major goal of the federal health care law is that millions of people who currently do not have health insurance will have improved access to care. But the massive overhaul is also expected to be widely disruptive, and doctors worry that many people with chronic illness could suffer during the changeover, as KQED’s Mina Kim details today on The California Report.

Kim tells the story of 33-year-old Andrew Solis who stopped taking HIV medications more than a year ago after becoming addicted to methamphetamine while in a “rocky relationship.” He resumed treatment at the Oakland Highland Hospital HIV clinic last October after ending the relationship.

Solis has been able to get back in to treatment fairly easily, Kiim reports. But changes coming under the Affordable Care Act could complicate care for clinic patients, says Kathleen Clanon, chief medical officer at Highland Hospital.

From Kim’s report:

“They are all poor basically. It’s been 15 years or so since HIV was really a disease in the U.S. of middle-class men. It’s been a disease of poverty in the U.S., really, for about 15 years now.”

Right now, low-income patients without insurance get their health care paid for by the federal Ryan White program which only covers HIV related care. In order for them to get the full benefits of the Affordable Care Act, they’ll need to move to a more traditional insurance-based care. For starters, they’ll have to first choose an insurance carrier and a primary care doctor and Clanon says, that won’t always be easy.

“Most of the information that goes to people about their choices and how they’re becoming insured is going to come by snail mail, and people who are low-income frequently don’t have stable addresses, and the majority of my patients don’t have regular access to the internet.”

If her patients don’t fill out the paperwork, they will be automatically assigned to a primary doctor — one that Clanon says is unlikely to have a specialty in HIV care. Or worse, she fears her patients won’t tell their new doctor that they’re infected, because of stigma surrounding people with the virus.

“I have a patient that I saw about a month ago, he needed to move in with his mom. However she was so afraid of him that she was making him eat in his room off paper plates that she would then throw away. So stigma will make it difficult for people to fix any weirdness that happens in terms of where they get assigned.”

And people with HIV, Clanon says, don’t have time to be away from treatment.

“Within a week, ten days, two weeks, if you stop taking your HIV medication, the virus comes back. And treatment interruptions are dangerous for people with HIV, they’re dangerous for their health, and they’re dangerous for our whole community because during that time that person is infectious to others.”

Still, the Affordable Care Act earmarks money to deal with all that paperwork. Covered California, the state’s new health insurance marketplace will soon announce grants totaling $49 million for education and outreach. Much of the money is expected to be awarded to community groups which have extensive networks in ethnic and low-income populations — the very people who might have the most trouble navigating the new system.

The primary goal of that outreach is simply to get people enrolled in a health insurance plan. But Dana Howard, a spokesman with Covered California says these “assisters” will also be charged with helping people directly. “Assisters are there to say, ‘Let’s figure out who you’re seeing. Let’s find a plan that has your network in there and find the one that has the best price,’” Howard described.

Anthony Wright of Health Access, a statewide consumer advocacy group, was a bit more circumspect, saying, “that is the hope” when asked if assisters would help make sure people made it into a plan that includes their current doctor.

In the meantime, Dr. Clanon is moving ahead on her own, Kim reports. Two staff members at Highland’s HIV clinic are becoming experts in the Affordable Care Act. They’re also working with insurance plans to make sure that one of their HIV/AIDS doctors can be listed as a primary care provider.

Again, from Kim’s report:

Clanon says her clinic is ahead of the game, but she worries about clinics in rural areas or clinics with fewer resources. To help them along, Clanon’s been traveling up and down the state talking with other HIV providers about ways to prepare for health reform.

This post has been updated to include a quote and information from Dana Howard of Covered California. It also corrects the amount of money to be granted for education and outreach.

(Dale M. Moore/Flickr)

Perhaps the most popular provision of President Obama’s federal health law is that people cannot be turned down or charged a lot more because they are sick. Obamacare also reduces how much more older people can be charged for insurance.

But the president’s health law permits one group to be charged more — a lot more: smokers. States can allow health plans to charge tobacco users up to 50 percent more for their health insurance premiums.

The provision allowing for a “tobacco surcharge” was designed in part to encourage smokers to quit a habit that often leads to major illness.

The Centers for Disease Control puts the nation’s annual price tag for smoking at more than $190 billion in both medical care and lost productivity.

It’s that price tag that prompts some to support higher health care premiums for smokers. Micah Weinberg is a senior fellow with the Bay Area Council, which researches public policy issues that affect businesses and the local economy. While he says caution is needed to avoid premiums so high that they are unaffordable to smokers, ”I think that we need to make sure that there is a strong financial disincentive for people to smoke.”

But critics say the smokers’ surcharge is discriminatory and goes against the spirit of federal health reform.

It can also negate the benefits of subsidies offered under the federal health care law, says Karen Pollitz, a senior fellow with the Kaiser Family Foundation .

For example, a low-income person buying a $6,000 policy who qualified for a subsidy might see the price of the annual policy drop to $3,000, Pollitz says. But “the tobacco surcharge would knock it back up to $6,000 again.”

That was the finding of a study published last summer by the Institute for Health Policy Solutions in Washington, D.C. Smoking rates both in California and nationally are highest among lower-income people –- who often must juggle several jobs to support themselves and their families. The resulting stress, Rick Curtis, president of IHPS says, makes breaking the tobacco addiction even harder.

“For somebody who is totally hooked after many years, and older – and those kinds of people often do need more medical care, they have emphysema and so forth – they have two bad choices: go without health insurance and be impoverished that way, or get health insurance and be impoverished,” he said.

That argument resonates in Sacramento where Assemblyman Richard Pan (D-Sacramento) has written legislation that would make California among the first states to ban higher premiums for smokers under the Affordable Care Act. He believes providing smokers with affordable health insurance is a better way to help them kick the habit.

“It does not make sense to have smokers being uninsured,” says Pan, who is also a practicing pediatrician. ”We want smokers to actually have health care coverage. … [T]hrough having health care coverage they’ll have access to smoking cessation treatment” as well as health care in general.

Weinberg calls effort by California to ban higher premiums for smokers misguided, especially when based on findings that those smokers are disproportionately poor.

“We have this very paternalistic attitude about lower-income folks that I think is inappropriate and particularly inappropriate in this context,” he says. “Because if we eliminate the financial incentive not to smoke we’re going to create an environment in which more people do smoke.“

Weinberg’s concerns aside, Pan’s bill faces little opposition –- not from cigarette companies, anti-smoking groups or anti-cancer advocates.

Officials at the American Lung Association’s California branch said in a statement that because smoking is so hard to quit, it’s essential to provide tobacco users with affordable health insurance, rather than make them pay more for it.

(Vic: Flickr)

Federal tax credits designed to make health insurance more affordable, starting next year, will help nearly 3 million Californians buy health insurance, according to a study issued Tuesday.

The report commissioned by Families USA – a supporter of President Obama’s health care reforms — says that more than 85 percent of all Californians who qualify for the federal tax credits live in families with at least one full- or part-time worker who doesn’t receive employer-sponsored health insurance.

It also finds that 52 percent of Californians expected to qualify for the sliding-scale tax credits will come from middle-class families who earn up to $95,000 a year.

The biggest block of recipients — about a million people — live in Los Angeles County. About 100,000 people in Santa Clara County are expected to receive subsidies and about 75,000 people in Fresno County. (You can look up other counties in the report, on page 7. [PDF])

The report estimates that Latinos will make up half the eligible Californians; whites will make up about 30 percent; blacks about 5 percent, with the remainder comprising mostly Asians and Pacific Islanders.

The tax credits will be “advanceable,” meaning they will be applied as an upfront discount at the time enrollment in California’s new health insurance marketplace, called ”Covered California.”

“People won’t have to … pay the full premium and then try to get a reimbursement for it,” said Rep. Henry A. Waxman (D-CA) in a Tuesday morning conference call with reporters after the report’s release. “They’ll simply enter their income information, shop for coverage and then get an automatic discount of hundreds or even thousands of dollars.”

California’s health insurance marketplace is scheduled to open for enrollment this October, with coverage beginning on Jan. 1, 2014.

Covered California has a subsidy calculator where consumers can quickly get an estimate.

(seliaymiwell/flickr)

While President Obama’s health care overhaul turns three on Saturday, many states are scrambling to get everything ready for the full rollout on January 1. California was the first state to pass legislation to set up a marketplace, and the Legislature has done a lot of work since. But there’s still a lot left to do — and fast.

To bring you up to date, three major sets of bills are before the Legislature in its Affordable Care Act special session. (Six bills total; Assembly and Senate have their own versions of three proposals).

Of those, two issues are key:

• Reforming the individual market
• Medi-Cal expansion (the state’s health insurance program for the poor.

As David Gorn of the CaliforniaHealthline reports, the California Legislature went on spring recess yesterday. These ACA bills are outstanding, much to the frustration of advocates. These special session bills take effect in 90 days, once they are passed. ACA proponents had hoped passage would have happened already.

As far as the individual market reform goes, those bills were hung up over technical language which appears to have been resolved (tie-back to the federal law’s individual mandate, for you wonks out there). Gorn reports that Sen. Ed Hernandez (D-West Covina) is confident the bill will be on Gov. Brown’s desk soon after the Legislature is back in session.

That’s the good news. More from CaliforniaHealthline:

The Medi-Cal expansion legislation, though, is a different story.

“The one we’re going to have trouble with is the Medicaid expansion bill,” Hernandez said. “We’re miles apart on that one.”

Assembly member Pan, who chairs the Assembly Committee on Health, said the hang-up on passage of the special session bills has to do, in part, with the debate over distribution of federal money. Counties are likely getting a large financial reprieve from optional Medi-Cal expansion and the state would like to get a piece of that.

“The governor is looking for sources of funding for the Medi-Cal expansion,” Pan said. “The expansion itself, though, is more of a policy issue than a budget issue. Those are big issues, so let’s not hold up the policy over other concerns.”

Hernandez the Medi-Cal expansion portion of the special session could be bumped into regular session.

“My sense is the administration wants to run this in the regular session,” he said. “That one’s going to be bottled up for a long time, and I can’t tell you how long.”

The Legislature is back in session on Monday, April 1.