County, state prepare for healthcare overhaul

By Aaron Blevins, 12/27/2012

Residents urged to prepare for the Affordable Care Act


While open enrollment for the California Health Benefit Exchange will not begin until Oct. 1, state healthcare officials are calling for residents to prepare now for the Affordable Care Act provisions that will go into effect in 2014.

The insurance exchanges, set up differently in all 50 states, will offer a transparent and competitive health insurance marketplace for people and businesses to compare and shop health benefit plans.

In Los Angeles County, approximately 2 million people are expected to enroll in health insurance programs through the Affordable Care Act, according to the Los Angeles County Department of Health.

“We do have a great deal of work to do, but we’re making a great deal of progress,” said Dr. Anish Mahajan, the director of system planning for the department.

He said the biggest provisions of the Affordable Care Act will affect Medicaid, which will be available to all residents within 138 percent of the federal poverty level, which is $11,170 for one individual and an additional $3,960 for each family member thereafter. Mahajan said the state is preparing a healthcare model to create “medical homes,” which will assign Medi-Cal patients to specific clinics and physicians who will be teamed with a set of support staff.

“We believe this is the best way to give care to patients,” he said, adding that patients would still have the option to seek healthcare at clinics that accept Medi-Cal.

Residents who are between 139 and 400 percent of the federal poverty level will be eligible for federal subsidies while participating in the California Health Benefit Exchange, which will provide “affordable” insurance to residents within that income range, Mahajan said.

He said people outside those income levels, as well as undocumented individuals, will not be eligible for federal subsidies. Mahajan said it will be up to state and federal officials to determine how to subsidize healthcare for this demographic. He cited studies that have estimated that 1.3 million L.A. County residents will remain uninsured by 2019.

Oscar Hidalgo, the communications director for the exchange, said officials anticipate 5.5 million people to enroll in the exchange next year. Approximately 2.7 million will be eligible for federal subsidies, and 2.5 million of the insured will be people who have been denied in the past, he said, adding that the exchange expects to enroll 70 percent of its target demographic.

“Our goal is realistic, and it will be a challenge to get 100 percent of Californians enrolled,” Hidalgo said.

If residents do not sign up for health insurance in some manner by 2014, they could be subject to tax penalties. Hidalgo said the penalties will likely be $95 for the first year, but could increase to $695 in a few years.

“Obviously, it’s a new law, and they want to make sure people are aware of the tax penalties and the benefits,” he said.

Mahajan said the healthcare reform bill will offer a “great” opportunity for the county and state to improve the financing of their health systems. However, the department must also undergo a “major” transformation of how it delivers care.

“It’s a big expansion,” Mahajan said, adding that the department is restructuring its clinics. “It requires a fair amount of preparation.”

Hidalgo said the exchange will essentially be an open online market, and will offer health insurance plans like a large employer — with a larger number of enrollees, it can secure better deals. He said as the years go on, he anticipates that more interest for preventative care will be generated, cutting down on costly emergency room visits. It will also keep people from coping with a treatable illness.

“I think, overall, it’s a benefit to California,” Hidalgo said.

He said that in 2010, California became the first state in the nation to pass a law to establish the Affordable Care Act. The board, comprised of several appointees, elected Diana Dooley, who is also the secretary of the state’s Health and Human Services Agency, as the president of the board.

While officials are hoping that residents begin to prepare now, the exchange will begin a public education campaign next summer to ensure that members of the entity’s target demographics are aware of what is available.

“I think by this time next year, we’ll be very well known by Californians,” Hidalgo said.

While open enrollment will begin in October, insurance plans will take effect in 2014. Officials will set up a toll-free number to assist residents with signing up for the exchange.

Several elements of the Affordable Care Act have already been implemented. Children younger than 26 are now eligible to be covered under their parents’ health insurance plans, and insurers can no longer rescind an application due to minor mistakes or omissions. Children under 19 cannot be excluded due to a pre-existing condition, and insurance companies must spend 80 percent of their premium dollars on care.

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