NAM Hosts Briefing on Affordable Care Act

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SAN FRANCISCO – While some say health care reform may not have gone far enough, the “three big things” it delivers are greater protection for consumers against insurance companies through the new health Patient’s Bill of Rights, expansions in health care coverage and control of health care costs.

“(The Affordable Care Act (ACA)) is the biggest thing that has happened in health care policy in generations,” asserted Anthony Wright, executive director of Health Access, a non-profit health advocacy group as he gave an overview of the act and its impact on California’s communities, at an ethnic media briefing here.

“Implementing it,” he said, is the law of the land and has a direct impact on all our communities.”

That was the resounding assurance given by Wright and others on the front lines of health care, at the briefing New America Media organized at its headquarters here Feb. 21. Sixteen ethnic media representatives from the Bay Area attended.

As things stand now, Californians, especially people of color, are more likely to be uninsured, some because of “big holes” in Medi-Cal -- the state’s name for Medicaid, the federal-state health care program for indigent families, pregnant women, seniors and those with disabilities.

“You may be penniless, but if you had no children, you were denied enrollment in Medi-Cal,” Wright said, noting that hole in that public safety net has been closed by the ACA that was signed into law in March 2010. Approximately two-thirds of California’s 7 million uninsured are now likely to qualify for Medi-Cal, even those who are childless.

And for the first time, Americans who earn less than 133 percent of the federal poverty level (which is approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medi-Cal, Wright pointed out.

Additionally, starting January 1, 2014, no insurance company can deny legal residents health coverage because of pre-existing health conditions. An estimated 50 to 129 million non-elderly Americans have some type of pre-existing health condition, according to the U.S. Department of Health and Human Services. Many of them were locked out of the insurance market because of that.

But even before 2014, Americans with pre-existing health conditions can get health insurance through the Pre-Existing Condition Insurance Plan (PCIP), a temporary high-risk pool program created by the new law. Around 1,700 Californians have so far enrolled in the state’s PCIP since it went into effect last March, Wright noted.

Luisa Buada is executive director of the East Palo Alto-based Ravenswood Family Health Center, whose clientele is largely from the Hispanic, Pacific Islander and black communities. Many are either underinsured or uninsured, Buada noted, saying her clinic has been ahead of the curve in health care reform by taking steps to transform it into a “health home” facility, thereby saving San Mateo county hundreds of thousands of dollars.

One of the strategies under the ACA is to try to contain the costs of unnecessary hospital admissions and readmissions soon after discharge, by providing ongoing care by physician-led teams coordinating primary, acute and behavioral care in a “health home” setting. Ravenswood has begun doing that.

“They prevent people from going to emergency rooms,” Buada said, noting that health homes focus on “wellness rather than on illness.”

Panelist Mike Odeh, a policy associate with Children Now, said that families should be made aware of such provisions in the ACA as banning insurance companies from denying children with pre-existing conditions coverage, as well as placing annual dollar limits on their coverage.

Another provision that should be well publicized is that children can now remain on their parent’s employer-sponsored insurance plan until they turn 26.

He said there are currently about 700,000 children in California who are eligible for health care coverage but aren’t enrolled, mostly because their families don’t know about all the programs out there or because of such systemic barriers as lack of language skills.

It is those same barriers that are keeping many families from taking advantage of the Healthy Kids program that currently operates in some 30 California counties and is open even to children who are undocumented, Odeh said.

A small business owner in San Francisco, Virginia Donohue, talked about how the ACA has given her some financial relief in wanting to do the “moral” thing by her 25 employees

When she opened Pet Camp back in 2000, she said, insurance coverage for her employees cost her $30,000 per year, with no cost to her employees. Today, because insurance companies have been raising the cost of premiums at will, she is spending $90,000 on coverage that “is not as good,” with her employees picking up 20 percent of the cost of their premium.

Thanks to the ACA, last year she was able to get the 35 percent federal tax credit employers with 25 or fewer full-time employees can now get on their insurance cost.

Starting January 2014, small businesses that purchase coverage through
the Small Business Exchange will get a tax credit of up to 50 percent of
what they pay to cover their employees.

“It would be great to let small business owners know of this,” Donohue said.

J. Mario Preza of the Spanish language publication Yo Soy News noted after the briefing that information presented at the event was not known to many in the Latino community.

For more information about Healthy Kids, call 1-877-KIDS-NOW (543-7669).