Financiación Futura de Medi-Cal En Riesgo

April 6, 2017 by · Leave a Comment 

La población con seguro de salud en California ha crecido enormemente en los últimos años con Medi-Cal, el seguro médico subsidiado por el estado, aunque el futuro de su financiación no está claro, indica un estudio presentado hoy.

El análisis, “Financiando el programa Medi-Cal”, elaborado por el Instituto de Política Pública de California (PPIC), señala que cada vez California debe disponer de más fondos para mantenerlo al nivel actual, que representa el segundo gasto después de la educación en el presupuesto general.

“Mientras el Gobierno federal ha financiado una gran parte del crecimiento del programa, los costos estatales también han aumentado”, señaló Shannon McConville, autora del informe junto con Paul Warren y Caroline Danielson.

“Este aumento de costos combinado con una política mayor de cambios todavía concebibles a nivel federal, ha creado incertidumbre adicional acerca del futuro de la financiación de medical Medi-Cal”, anotó la analista de PPIC.

Según señala el estudio, actualmente Medi-Cal representa el 15% del total general de gastos del presupuesto del estado, el segundo mayor después de la educación de kínder a preparatoria.

El análisis destacó también que en la última década el costo del programa, conocido en el resto del país como Medicare, aumentó de 40.000 millones de dólares en el período 2005-2006 a cerca de $100.000 millones en el 2016-2017.

En ese mismo período, la participación en la financiación por parte de California ha disminuido de cerca del 40% hasta aproximadamente el 20% y “adicionalmente, la financiación de otras fuentes incluyendo gobiernos locales y proveedores ha aumentado”.

Igualmente el estudio señaló que el Gobierno federal en los años 2014 a 2016 de implementación de la Ley de Salud Asequible (ACA), pagó el 100% de los costos de la cobertura de Medi-Cal para el nuevo grupo elegible, básicamente adultos de bajos ingresos sin niños dependientes.

Sin embargo, bajo los términos de la ley actual, esa aportación federal disminuirá gradualmente para llegar a 90% en 2020.

Otra ayuda federal establecida por ACA representó entre el 2010 y 2015 más de $10.000 millones en pagos a hospitales que atienden un alto número de usuarios de Medi-Cal y pacientes sin seguro médico.

No obstante, de continuar esa ayuda, se reducirá a cerca de $6.000 millones para el 2020, en algunos casos con la obligación de una participación igual por parte de los gobiernos locales o los proveedores de los servicios de salud.

El análisis calcula que actualmente los gobiernos locales pagan cerca de $5.000 millones cada año, equivalentes a un 20% de los fondos de Medi-Cal, a través principalmente de pagos de los sistemas hospitalarios, que provienen mayoritariamente de otros fondos del gobierno como las universidades públicas.

Con la “volatilidad de los ingresos previstos” en el presupuesto general de California, el tema de Medi-Cal se torna un punto de importante discusión en la próxima aprobación del Plan de Gastos.

El estudio recomienda que se busquen fuentes de financiación para Medi-Cal “que puedan ser ofrecidas consistentemente a largo plazo” y que también sean “económicamente eficientes y simples”, entre otras características.

Californianos Luchan Por Mantener Obamacare

March 30, 2017 by · Leave a Comment 

La Coalición Lucha por Nuestra Salud de California, apoyada por el poderoso Sindicato Internacional de Trabajadores de Servicios (SEIU), realizó manifestaciones por todo el Estado Dorado, el 23 de marzo, para pedir que se mantenga la ley actual de Cuidado de Salud Accesible (ACA).

Las protestas fueron convocadas al cumplirse siete años del llamado Obamacare y mientras la Cámara de Representantes se disponía a votar la nueva propuesta republicana para derogar y reemplazar la ley sanitaria, un plan que cuenta con una fuerte oposición dentro de los propios conservadores.

Una marcha que terminó con una manifestación frente al edificio Federal Edward Roybal en el centro de Los Ángeles contó con el apoyo de la supervisora del condado Hilda Solís y de cerca de 70 secciones sindicales y organizaciones comunitarias y de salud.

En Modesto otra protesta se realizó en la sede del representante republicano Jeff Denham en la que los participantes “murieron” frente a las instalaciones para dramatizar el impacto que, según sus denuncias, tendría la nueva ley especialmente entre la niñez y los ancianos.

“Sin ACA habrá un efecto dominó en nuestras comunidades. Más gente dejará de recibir cuidado preventivo y tendrá que ser tratada cuando se enferme y sea más costoso”, aseguró Rogenia Cox, miembro de SEIU y empleada del Departamento de Salud Pública del Condado de Fresno.

Los manifestantes insistieron en la cifra presentada por un informe de la Oficina de Presupuesto del Congreso de “24 millones de estadounidenses que quedarán sin seguro de salud” en la próxima década si se aprueba el nuevo proyecto.

Algunos legisladores estatales también denunciaron durante una conferencia de prensa frente al Capitolio en Sacramento las “pérdidas potenciales” que puede significar para California el nuevo proyecto.

La administración estatal calcula que California tendría que asumir 6.000 millones de dólares en nuevos costos anuales para 2020 si se aprueba la nueva ley de salud y 24.000 millones por año para 2027.

Repealing the ACA Would Hurt Mental Health Care

March 23, 2017 by · Leave a Comment 

Once again Republicans are pushing to repeal the Affordable Care Act (ACA) and it will hurt millions of Americans, especially those who live with a mental health or substance abuse disorder. The Republican bill would limit access to life-saving Medicaid coverage, make private insurance more expensive, and penalize the poor and elderly — all while reducing taxes on the richest.

The GOP proposal specifically targets Medicaid, the biggest provider of health and behavioral health services in the country, by eliminating the ACA requirement that Medicaid plans cover an Essential Health Benefits package and cutting federal funding by setting a limit for federal reimbursement per enrollee, also known as a “per-capita cap,” no matter their need for care. Weakening coverage requirements and limiting the amount of funding provided to deliver services would hurt the ability to qualify and access Medicaid, especially for those with time-intensive and often costly substance abuse and mental health disorders. Under the GOP plan, a child treated through one of Pacific Clinics school-based mental health programs could potentially lose their Medicare (Medi-Cal) coverage due to budgetary constraints and lose access to care. Many of the children and young adults we see will consider, attempt, or complete suicide. This is the third leading cause of death in children between the ages of 10-14 and second cause of death between ages 15-34.

This bill would also negatively affect those who get their insurance through the Exchanges. In particular, the Republicans’ proposal to eliminate the ACA’s “actuarial value” protections, which require insurance companies to pay a fair share of the cost of your care, would mean higher deductibles and out-of-pocket expenses for low-income individuals. For the millions of Americans seeking care for chronic conditions requiring many doctor visits including mental health disorders, this is simply unacceptable and could make seeing a doctor unaffordable.

Older Americans would also see a big increase in out-of-pocket costs. The GOP plan would allow insurers to increase the “age rating” limits put in place by the ACA and charge older Americans five times as much as they would a younger customer. For the 1 in 5 older Americans who live with a mental health condition, this could mean having to make the difficult decision of going without treatment or going without food.

The Republican proposal comes at a steep cost and delivers little benefit for those seeking either mental or physical health care. According to the Congressional Budget Office (a non-partisan entity), under the GOP plan, 14 million people lose insurance in 2018. It would also cut $880 billion from the Medicaid program, which cares for low-income families and the disabled, while cutting $600 billion in taxes on wealthy individuals.

While some have argued that the ACA did not directly modify the federal mental health parity protections, it did extend those protections to millions of Americans who did not have them before. The ACA also helped millions of Americans obtain health care coverage they would otherwise not have. It is undeniable that the ACA has been successful in connecting more people with behavioral healthcare, especially young adults, children and their families. The law has had a tremendous effect in our home state of California, for example, where one in three Californians currently benefit from our state’s Medicaid program, known as Medi-Cal.

Many challenges still remain for behavioral health — too many individuals do not have access to treatment, there is a shortage of behavioral health clinicians, and the suicide rate, sadly including for children, is increasing. Repealing the ACA and replacing it with the Republican plan would hurt those most in need. We encourage all Republicans to work with us to strengthen the ACA in order to ensure that Americans everywhere have access to the health care they need.

 

Congresswoman Grace F. Napolitano (CA-32) is Chair of the Congressional Mental Health Caucus. Dr. Luis Garcia is Vice President of Quality Care, Cultural Diversity, and Outcomes at Pacific Clinics.

 

Deciphering The CBO Estimates On The GOP Health Bill

March 16, 2017 by · Leave a Comment 

The Congressional Budget Office is out with its estimate of the effect that the Republican health bill, “The American Health Care Act,” would have on the nation’s health care system and how much it would cost the federal government. The GOP plan is designed to partially repeal and replace the Affordable Care Act passed during the Obama administration.

 

Here are some of the CBO highlights:

—$337 billion reduction in the deficit. That’s CBO’s estimate over the next decade. That takes into account both decreased government spending in the form of less help to individuals to purchase insurance and lower payments to states for the Medicaid program. It also includes decreased revenues from the repeal of the taxes imposed by the ACA to pay for the new benefits.

—24 million more people without insurance in a decade. The federal budget experts estimate that people will lose insurance and that drop will begin quickly. In 2018, they say 14 million more people would join the ranks of the uninsured. It would reach the 24 million by 2026, when “an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.”

—15 to 20 percent increase in 2018 premiums, but relief would follow. Monthly costs for insurance would go up at first, due to the elimination of the requirement for most people to have insurance or else pay a tax penalty. After 2018, CBO estimates that average premiums would actually drop by 10 percent by 2026 compared to current law. That is because the lower prices for younger people would encourage more to sign up. By contrast, the law would “substantially [raise] premiums for older people.”

—$880 billion drop in federal Medicaid spending over the decade. That comes primarily by imposing, for the first time, a cap on federal contributions to the program for those with low incomes.

—14 million fewer Medicaid enrollees by 2026. That’s 17 percent fewer than projected under current law. The projection includes people who are currently eligible and would lose coverage, as well as people who might have become eligible if more states, as expected, expanded coverage under the ACA. CBO projects that is unlikely to happen now.

—95 percent of people who are getting Medicaid through the health law’s expansion would lose that enhanced federal funding. The CBO estimates that only 5 percent of enrollees in the expansion program would remain eligible for the higher federal payments by 2024 since the bill would phase out those payments to states as patients cycle in and out of eligibility.

—15 percent of Planned Parenthood clinic patients would “lose access to care.” These patients generally live in areas without other sources of medical care for low-income people. The Republican bill would cut out Medicaid funding for Planned Parenthood for a year.

This California Healthline story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

picture-of-health-frame California Healthline

What Does The House Health Care Bill Mean For California?

As the most populous state with the largest economy in the country, California stands to be dramatically affected by changes to the nation’s health law.

About 1.5 million people buy health insurance through the state’s exchange, Covered California, and most get federal subsidies. About 4 million receive Medicaid (called Medi-Cal here) through the program’s expansion under the Affordable Care Act. Altogether, Medi-Cal covers 14 million people in the state, roughly a third of its population.

The current House bill proposes to significantly change how — and how much — the federal government pays for these programs.

That likely would translate into millions of people in California losing coverage or seeing their costs rise. Medi-Cal might have to cut programs and eligibility. Source: California Healthline

State Senate’s Health Chairman Vows To Defend California Coverage Gains

November 22, 2016 by · Leave a Comment 

A key state health care figure vowed Thursday to defend the coverage gains California has seen under the Affordable Care Act in the face of widely expected efforts by President-elect Donald Trump to overturn much of the health reform law.

“I want to assure you, your staff and Californians that we stand ready to fight to keep what is working in this state,” Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee, told the board members of Covered California, the state’s health insurance exchange, in their first public meeting since Trump was elected on Nov. 8.

“What we have is too important to lose,” said Hernandez, an optometrist. He cited examples of people who had come into his optometry office for the first time because of their newly gained health coverage.

Any rollback in coverage, Hernandez said, would hurt millions of Americans.

California’s rate of uninsurance has been cut roughly in half since 2014, when federally subsidized health plans sold through the exchange first took effect and eligibility for Medicaid, the health care program for low-income individuals, was expanded. Both are key features of the Affordable Care Act, also known as Obamacare.

Health advocates who addressed the board Thursday sent the same message as Hernandez, expressing support for the ongoing efforts of the exchange to sign Californians up for coverage in the fourth annual open enrollment period, which started Nov. 1 and ends Jan. 31.

Covered California officials said that Trump’s plan to “repeal and replace” the Affordable Care Act has created confusion among enrollees but that people are still signing up.

In the first two weeks of open enrollment, 44,885 new people have enrolled in health insurance through Covered California, according to numbers provided by the board. That’s down from about 50,000 in the same period last year.

But Peter V. Lee, the exchange’s executive director, noted that Covered California did not run ads at the beginning of this enrollment period because it didn’t want to compete with the election campaign. He said the new numbers are in line with Covered California’s projection of approximately 400,000 new exchange enrollees next year.

This week, the Centers for Medicare and Medicaid Services announced that more than 1 million people had selected plans on Healthcare.gov, the federal exchange website, during the first 12 days of open enrollment. Of those, 250,000 were new to the exchange. The number of people who selected plans was up 53,000 from the same period last year, according to CMS.

Covered California is the largest state-run marketplace. It has 1.4 million members, nearly 90 percent of whom receive federal tax subsidies to help pay their premiums.

Consumer advocates who spoke at the board meeting expressed optimism that California would maintain its status as a leader in health care reform, though many are also changing the conversation to focus on what parts of the Affordable Care Act might be kept.

It is unclear how far Trump will go in dismantling the health law. He conceded last week that he would like to keep some aspects of it — in particular, allowing young adults to stay on their parents’ health plans and banning insurance companies from refusing to cover people with preexisting medical conditions.

Health experts who addressed the Covered California board made it clear that everything is up in the air: The only thing they’d be willing to bet on is that the Republican replacement for the health reform law won’t be called Obamacare

Ian Morrison, a health care consultant and futurist, told board members that the Republicans’ sweep of the White House and Congress will probably mean a less regulated insurance market, the end of mandates to buy insurance, smaller federal subsidies for the uninsured and greater state control over Medicaid — which also means less federal funding for the program.

Both Trump and House Speaker Paul Ryan (R-Wis.) have endorsed the idea of transforming Medicaid into a block grant program, in which states would get fixed allotments from the federal government and would be responsible for any health spending above those amounts.

“When you hear the term block grant, that is code for less money,” Morrison said. “No one talks about block grants and more money.”

The overarching question, Morrison said, is this: Will health coverage for 20 million people be significantly eroded?

He also said he found it hard to understand how guaranteed coverage for people with preexisting conditions could be kept if buying insurance was no longer a requirement for all. The authors of the health reform law believed that a lot of young, healthy people needed to be in the insurance pool in order to ensure that the sick ones didn’t drive up the cost of premiums.

John Bertko, Covered California’s chief actuary, said people should be looking to 2018, since any changes in 2017 are highly unlikely.

“I suspect with the big rate increases, 2017 is going to be a good year for plans that are in exchanges,” Bertko said. He said that was “a bit ironic” given the cloud now hanging over Obamacare.

California Faces Major Reversal If Trump, Congress Scrap Health Law

November 10, 2016 by · Leave a Comment 

California has a lot to lose if President-elect Donald Trump and the Republican-led Congress fulfill their campaign pledge to repeal Obamacare.

The Golden State fully embraced the Affordable Care Act by expanding Medicaid coverage for the poor and creating its own health insurance exchange for about 1.4 million enrollees. Supporters held California up as proof the health law could work as intended.

But now President Barack Obama’s signature law is in serious jeopardy and California officials are left wondering what Republicans in Washington may put in its place.

“There is no doubt that Obamacare is dead,” said Robert Laszewski, a health care consultant and expert on the California insurance market. “The only question is just exactly how Republicans will get rid of it.”

Health policy experts don’t expect Republicans to immediately kick millions of people off their insurance policies. Instead, they predict lawmakers may repeal parts of the law and allow for some transition period for consumers while a replacement plan is put together.

Still, the personal and financial impact for the state could be jarring. The number of uninsured Californians would more than double to 7.5 million people if the Affordable Care Act was repealed, according to a recent study by the Urban Institute.

Researchers also said California stands to lose an estimated $15 billion annually in federal funding for Medicaid expansion and insurance subsidies — more than any other state. That loss of federal money would make it difficult for California to pursue health reform on its own.

State Sen. Ed Hernandez, (D-West Covina), chairman of the Senate Health Committee, said it’s difficult to predict what the next iteration of the Affordable Care Act may look like.

“Will there be federal subsidies? Will the state legislature pay for subsidies to ensure Californians have coverage? Those are open questions,” Hernandez said. “I will do everything I can to make sure California continues to take the lead on this issue.”

Congress already has voted to eliminate funding for Medicaid expansion and premium tax credits to dismantle two key pillars of the health law. Obama vetoed that legislation earlier this year, but Trump made the repeal of Obamacare a centerpiece of his campaign.

If repeal goes through, state leaders and consumer advocates may look to the ballot box, asking voters to fund expanded health coverage through higher taxes or fees. In Tuesday’s election, Californians backed the extension of a hospital fee to help pay for Medi-Cal, the state’s Medicaid program.

State officials could aim even higher and try for a government-funded single-payer health system at the state level. But that’s expensive, disruptive to the current system and a tough sell to the public. Colorado voters soundly rejected a state single-payer initiative during Tuesday’s election.

Some Republican lawmakers in California would applaud a reversal on Medi-Cal expansion. They have argued that state and federal spending increases on the program are unsustainable.

The state’s Medi-Cal program now covers about a third of all Californians. The health law’s Medicaid expansion has added about 3.5 million Californians to the program since January 2014 and total enrollment stands at more than 13 million.

Molina Healthcare, a Long Beach-based insurer, is a major player in Medicaid managed care nationwide and also covers about 600,000 people through exchanges in California and eight other states. The company’s chief executive, Dr. J. Mario Molina, said he thinks Covered California and other exchanges will become a smaller part of health reform under a Republican plan and coverage expansion will shift more to Medicaid.

Molina said Republicans in Congress could grant governors more flexibility on Medicaid benefits to keep costs down while maintaining guaranteed access to coverage regardless of preexisting conditions, a popular provision of the health law.

“Republicans have the benefit of looking back at the experiment of Obamacare and seeing what worked and what didn’t work,” Molina said in an interview. “I think the Republicans will negotiate a deal where Medicaid gets expanded with more state control and exchanges will play a different role. The most cost effective way to do coverage expansion is through Medicaid.”

Consumer advocates acknowledged the financial challenges posed by repeal but also encouraged Californians to keep signing up for coverage in the meantime.

“Californians should continue to enroll in Covered California this open enrollment season, in Medi-Cal, and all the benefits they are still entitled to–and then fight like hell to keep them,” said Anthony Wright, executive director of Health Access California, a consumer advocacy group.

But some Covered California policyholders expressed concern about what a Trump administration might mean for their coverage.

“I worry it will be gone, and I don’t know what I will do for insurance,” said Jane Henning Childress, 61, who lives in Calaveras County.

Taking into account her federal subsidy, she said she pays about $135 a month for her exchange plan. Earlier this year, she used it to help cover surgery for an ovarian cyst. “It sure helped me out,” she said.

Even before the election, some major health insurers were pulling out of the exchange market nationally and premiums shot up 22 percent, on average, for state and federal exchanges for 2017.

In the Covered California exchange, the average rate increase was 13.2 percent for next year. That’s higher than the 4 percent average rate increases that California negotiated its first two years. Open enrollment started Nov. 1.

Health insurers in California and nationwide face plenty of uncertainty as well from the election outcome. Some analysts said more insurers may exit state marketplaces rather than wait for them to unravel and risk getting stuck with too many expensive patients.

Four big insurers, led by Anthem Inc. and Blue Shield of California, account for about 90 percent of Covered California’s enrollment.

“The unthinkable has happened,” said Ana Gupte, a senior health care research analyst at Leerink Research. “With a Republican sweep of the White House, Senate and the House, we are looking ahead to a 2017 filled with much change and uncertainty in the health care markets.”

Story was originally posted on the CaliforniaHealthline website.

SB10 is it worth it? What is an exemption?

June 16, 2016 by · Leave a Comment 

Nidia Torres says paying a penalty for not having health insurance is unfair if you can’t qualify for an affordable plan. It’s not easy to find health care coverage when you don’t even know where to start looking, she says.

Torres, 34, has Deferred Action for Childhood Arrivals (DACA) status, making her eligible for a reprieve from deportation and a work permit, but not for health insurance through the Affordable Care Act (ACA) —also known as Obamacare—due to her quasi-legal status.

Lea este artículo en Español: Soñadores en Busca de Cuidado de Salud Asequible

Senate Bill 10 – the #Health4All Waiver – signed by Gov. Jerry Brown Friday, however, could open the door to coverage for her and other DACA recipients and people who are undocumented now excluded from ACA coverage because they are not considered lawfully present in the country.

While many cheer the legislation as a positive step toward inclusion for immigrants, its impact may be more symbolic than practical since it does not give them access to the subsidies that are often what makes coverage affordable.

 

#Health4All Waiver

SB 10, authored by Sen. Ricardo Lara (D-Bell Gardens), allows California to seek a federal waiver to allow undocumented immigrants and DACA recipients to use their own money to buy health insurance through Covered California, the state’s online marketplace. Under ACA, states can apply for a waiver to modify provisions of the law based on guidelines set by the U.S. Department of Health and Human Services.

“This bill presents an historic opportunity for California to become the first state in the nation to request a federal waiver,” said Sen. Lara Friday in a statement.

If approved, California’s waiver will have no financial impact on the federal government because SB10 does not allow DACA recipients or the undocumented to receive the government subsidies that lower the cost of monthly premiums.

Nevertheless, proponents see it as an important step forward, and Covered California estimates as many as 50,000 more people — who make too much money to qualify for Medi-Cal — may buy coverage through the marketplace if the waiver is approved.

Nidia Torres, mother of one, is a DACA recipient with no health coverage. (Courtesy of Nidia Torres)

Nidia Torres, mother of one, is a DACA recipient with no health coverage. (Courtesy of Nidia Torres)

Torres, a single mother of one, makes about $23,000 a year, which she told EGP is too high to qualify for Medi-Cal but not high enough to purchase insurance on her own.

“I have been wanting to go to the doctor for a physical exam but I was told it is about $100” since I don’t have insurance, she told EGP, explaining she opted to pay for a one-time visit at a community clinic rather than struggle to pay monthly for insurance. “It’s not that I don’t want to buy the coverage, but I can’t afford it,” she told EGP. SB10 will not give her access to a plan she can afford.

Lara’s spokesperson Jesse Melgar told EGP that even though subsidies are not provided under SB 10, it does fight for health care for all.

There are about 390,000 undocumented immigrants who earn too much to qualify for Medi-Cal, said Melgar. “Of those, an estimated 10% earn over 400% of FPL meaning they would not be eligible for any subsidies regardless of immigration status.”

We recognize that SB10 would make a modest change but “we think the change is still important, beyond the symbolism of inclusion and of an explicitly exclusionary policy in the ACA,” Anthony Wright, executive director of Health Access California told EGP.

With over 70% of undocumented Californians in mixed-status families, it means many will get subsidies, said Wright, citing examples of two situations where people will benefit from access to Covered California. The first involves a family of three, with the child receiving free Medi-Cal, one spouse getting subsidized coverage for about a $50 a month, and the other spouse paying about $250 a month for unsubsidized coverage.

“As a family, on their income, $300 might be a stretch, but it might be doable depending on how they prioritize it,” he explained.

Access to California’s health exchange would also benefit people who have the means to pay for coverage, like contract workers in the Silicon Valley who do not have employer sponsored health coverage, Wright said.

#Health4All campaign informs the immigrant community about their options for health care services. (EGP photo by Jacqueline Garcia)

#Health4All campaign informs the immigrant community about their options for health care services. (EGP photo by Jacqueline Garcia)

Covered California spokesperson Dana Howard told EGP undocumented immigrants can currently buy private health insurance, but approval of the SB 10 waiver would benefit families in mixed status making it “easier for them to purchase their service in one place.”

In an interview with California Healthline, however, insurance agent Alex Hernandez said people are not rushing to buy health care plans because of the high-cost. Hernandez calculated that a woman in her mid-20s, making about $45,000 a year, would pay $304 per month for a standard Anthem-Blue Cross plan through the exchange. If she buys that same plan directly from Anthem, it would cost $303.30, he told California Healthline.

Giving all Californians access to Covered California makes the health care system more inclusive and efficient, contends Maricela Rodriguez, a program manager with The California Endowment.
“Not all undocumented individuals will be able to afford health care through Covered California and will remain ineligible for Medi-Cal,” she told EGP in an email, acknowledging that the measure is not a total solution.

“Without the assistance of subsidies, affordability will continue to be a barrier for many. Which is why this is only a first step and why we, along with advocates and policy leaders, will continue to fight for health justice for everyone,” she said.

The federal government has 225 days to grant or deny permission.

 

Excluded from Obamacare? No Penalty for Not Having Insurance

In the meantime, DACA recipients and undocumented immigrants, like Torres, who were excluded from Obamacare but penalized for not having health insurance can seek a refund and exemption from future penalties.

When Torres filed her 2015 taxes through H&R Block she was penalized about $200 for not having health insurance in 2014. “I didn’t know I was exempted,” she said.

The Covered California website states that DACA recipients and undocumented immigrants are eligible for an exemption to the tax penalty for being uninsured.

Not every tax preparer is aware of the exemption, however, and many will just have their clients pay the penalty. It’s important for DACA recipients to explain their status to their tax preparer before they file, says Elba Schildcrout, Community Wealth Dept. director and tax preparer at East LA Community Corporation (ELACC).

ELACC partners with Volunteer Income Tax Assistance (VITA)—an Internal Revenue Service program to help low- and moderate-income taxpayers file returns at no cost.

Once DACA recipients have disclosed their status, tax preparers must file Form 8965 Health Coverage Exemptions along with their 1040 tax return.

DACA recipients who previously paid the penalty can file an amendment to get their money back, said Schildcrout.

The process is doable, she said, but added that tax preparers usually charge to file the amendment.

It’s sad to see clients pay for an amendment to a tax return that was done wrong, she told EGP.

According to Schildcrout, the VITA program can help DACA recipients who were charged a penalty for not having health insurance to file the amendment at no cost.

The three-part series was produced as a project for the California Health Journalism Fellowship, a program of the Center for Health Journalism at the USC Annenberg School for Communication and Journalism.

To read Part 1: DACA and Obamacare: Who Qualifies?

To read Part 2: The Health Challenge In Mixed-Status Homes

—-

Twitter @jackiereporter

jgarcia@egpnews.com

 

 

Soñadores en Busca de Cuidado de Salud Asequible

June 2, 2016 by · Leave a Comment 

El 15 de junio de 2012 fue un día histórico para miles de jóvenes inmigrantes quienes presenciaron el anuncio del presidente Obama de una orden ejecutiva que los haría elegibles para un alivio temporal contra la deportación.

“Son jóvenes que estudian en nuestras escuelas…prometen lealtad a nuestra bandera. Son estadounidenses en su corazón, en su mente, en todos los sentidos, menos uno: en papel”, dijo Obama cuando introdujo la Acción Diferida para los Llegados en la Infancia (DACA), un programa que beneficia a cerca de 1,5 millones de jóvenes traídos al país ilegalmente cuando eran niños con un amparo contra la deportación y un permiso de trabajo, ambos renovables cada dos años.

Read this article in English: Dreamers In Search of Affordable Health Care

Más de 853.000 inmigrantes entre las edades de 16 a 31 años, usualmente conocidos como “soñadores”, se han beneficiado de DACA desde el anuncio del presidente. Para muchos, vino  la posibilidad de trabajar legalmente y la esperanza de mayores salarios y beneficios.

Sin embargo, el obtener seguro de salud no ha sido fácil para algunos. Para otros, no es una prioridad.

La Ley de Atención Médica Asequible (ACA por sus siglas en inglés), promulgada en 2014—comúnmente conocida como Obamacare—excluyó a beneficiarios de DACA de la cobertura, puesto que no son residentes permanentes legales ni ciudadanos de EE.UU.

En esta serie de tres partes, EGP analiza algunos de los desafíos que este grupo de soñadores se enfrentan en la búsqueda de atención médica asequible y las opciones que tienen para acceder a servicios médicos.

DACA y Obamacare: ¿Quién Califica?

La residente de Los Ángeles Nidia Torres llegó a EE.UU. cuando tenía seis años de edad. Como indocumentada vivió bajo las sombras durante más de dos décadas esperando no ser descubierta o deportada a México, un país al que no considera su hogar.

En 2013, todo cambió. Torres recibió su estatus de DACA y esperanzada comenzó a planear para el futuro. Ella le dijo a EGP que en ese momento supo que las oportunidades que un permiso de trabajo, una licencia de conducir y número de seguro social traerían a su vida serían interminables, incluyendo el poder proveer un mejor futuro para su hija que nació en EE.UU.

“No más vergüenza por no tener papeles”, Torres dice que pensó en cuanto recibió su permiso de trabajo por correo.

Nidia Torres, 34, junto a su hija de cuatro años dijo que DACA le ha proveído grandes oportunidades, a excepción del seguro médico, en el país que considera su hogar. (Foto cortesía de Nidia Torres)

Nidia Torres, 34, junto a su hija de cuatro años dijo que DACA le ha proveído grandes oportunidades, a excepción del seguro médico, en el país que considera su hogar. (Foto cortesía de Nidia Torres)

Inmediatamente Torres consiguió un trabajo de mesera en un restaurante de una cadena nacional donde le pagaban el salario mínimo más propinas, pero no le ofrecieron seguro de salud.

“Ya puedo trabajar legalmente, mi hija tiene Medi-Cal. Creo que estoy bien”, ella le dijo a EGP, explicando que después de años de trabajos mal pagados con largas horas que le dejaban poco tiempo para ver a su hija, el nuevo trabajo fue un gran avance.

“Yo quería un trabajo”, le dijo a EGP. “Además casi no me enfermo” por lo que el seguro de salud no fue un gran problema, añadió aseverando que tampoco tenía idea de dónde obtener cobertura por su cuenta.

Torres, quien habla inglés y español, y tiene algo de educación universitaria pronto fue ascendida a supervisora y está ganando más dinero, pero todavía no tiene cobertura de salud.

El objetivo de Obamacare era aumentar “la calidad, la disponibilidad y la asequibilidad” del seguro médico privado y público a los entonces más de 44 millones de estadounidenses sin seguro, siempre y cuando sean residentes legales permanentes de Estados Unidos o ciudadanos. Para mantener los costos bajos, un gran número de jóvenes, sanos—el mismo grupo elegible para DACA—tendría que estar inscrito, sin embargo, los inmigrantes indocumentados y beneficiarios de DACA no son elegibles para comprar cobertura de salud a través de los planes patrocinados por el gobierno ni a recibir créditos tributarios de primas u otros ahorros en el mercado, pese a que ellos pagan al sistema fiscal.

Gabrielle Lessard, abogada de políticas de la salud con el Centro Nacional de Leyes de Inmigración, dice que la política es injusta. Los beneficiarios de DACA están trabajando y pagando impuestos por un servicio que no pueden solicitar, le dijo a EGP.

“La exclusión de los beneficiarios de DACA probablemente aumenta el precio del seguro para todas las demás personas”, dijo Lessard.

Sin embargo, en California, algunos inmigrantes indocumentados de bajos ingresos y beneficiarios de DACA podrían calificar para Medi-Cal, un programa de seguro de salud financiado por el estado para familias de bajos ingresos, personas con discapacidades, mujeres embarazadas, niños en hogares de crianza y adultos de bajos ingresos.

Torres no es uno de ellos. De acuerdo con el Departamento de Servicios para el Cuidado de la Salud de California y de los requisitos de elegibilidad federales, el ingreso anual de $23.000 de Torres la pone por un corto margen por encima del nivel federal máximo de pobreza (FLP) de $ 22.108 para una familia de dos, haciéndola inelegible para Medi-Cal.

(DHHS)

Esta gráfica le ayuda a ver si reúne los requisitos para Medi-Cal—sin importar su estatus migratorio—basado en sus ingresos anuales. (DHHS)

Al igual que muchos otros receptores de DACA con ingresos “demasiado altos” para los subsidios del seguro de salud, las opciones de Torres para una cobertura de salud son limitadas, y el proceso para encontrar cobertura asequible pueden ser complejas, de acuerdo con el estudio de la UC Berkley, “Realizando el sueño para los californianos elegibles para la Acción Diferida para los Llegados en la Infancia: Necesidades de salud y acceso a servicios de salud”.

El estudio encontró que muchos receptores de DACA ni siquiera saben que tienen opciones,. La falta de información refleja “la complejidad” de la red de programas disponibles y el proceso para su acceso, señalaron los investigadores.

El obtener atención médica no tiene por qué ser un problema, dice Irene Holguin, directora de relaciones comunitarias con Arroyo Vista Family Center, una red de cinco clínicas que sirven al lado este y noreste de Los Ángeles.

Durante una feria de la salud gratuita para la familia que se llevó a cabo el viernes en la clínica de Arroyo Vista en Lincoln Heights, Holguín le dijo a EGP que hay opciones para todos, independientemente de su estatus migratorio o ingresos económicos.

Cuando las personas llegan a una de nuestras clínicas por primera vez pasan por una evaluación financiera para determinar a qué tipos de programas son elegibles, dijo. “Nosotros no rechazamos a nadie”, añadió.

Holguín explicó que la clínica ofrece programas de descuentos y opciones de pago para los que no califican para el programa estatal o federal financiado.

Por ejemplo, si un paciente sólo puede pagar $10, Arroyo Vista le ayudará a establecer un plan de pago asequible para pagar el balance, dijo Holguín.

Las clínicas Arroyo Vista proporcionan atención de salud en las comunidades donde aproximadamente el 98% de las familias son latinos y muchos de ellos de bajos ingresos, explicó Holguín.

“Hay mucho [más] que hay que hacer en lo que respecta a informar a la comunidad y animar a la gente a ser proactivos y buscar los servicios de salud preventivos”, aseveró “porque hay muchas personas que tienen enfermedades que ni siquiera saben que padecen”.

En cuanto a Torres, ella le dijo a EGP que estaría dispuesta a visitar una clínica como Arroyo Vista para saber cuales son sus opciones. “Más vale prevenir que lamentar”, dijo.

 

La serie de tres partes fue producida como un proyecto para la California Health Journalism Fellowship, un programa del Centro de Periodismo de la Salud de la Escuela de Comunicaciones y Periodismo de USC Annenberg.

 

Para leer Parte 2: El desafío de la salud en hogares con estatus mixtos.

Para leer Parte 3: ¿Vale la pena la SB10? ¿Qué es una exención?

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Twitter @jackiereporter

jgarcia@egpnews.com

Supreme Court Rules Nationwide Subsidies Should Stay

July 1, 2015 by · Leave a Comment 

New America Media – Debbie Richardson, 62, said she had been having the “heebie-jeebies” for the last few months, wondering if she might be forced to disenroll from Florida’s health care exchange should the U.S. Supreme Court strike down the nationwide tax subsidies under the Affordable Care Act (ACA).

Now, she can breathe easy.

In a 6-3 ruling handed down by the high court Thursday, the justices said that the 8.7 million people like Richardson who are currently receiving subsides to make heath insurance affordable on the exchange will continue receiving it no matter where they live. The ruling was a resounding affirmation of Congress’ intention of subsidizing insurance coverage under ACA.

“I was a wreck wondering what I’d do if Florida lost its subsidies,” said the Clearwater, Fla., resident, who didn’t want her real name used for this story, in a telephone interview.

Florida is among 37 states where the federal government set up a health care exchange – HealthCare.gov — under ACA because those states decided they would not set up their own.

At 1.4 million, Florida leads the nation in the number of people who get subsidies, said Nick Duran, director of the Florida chapter of Enroll America, the nation’s leading health care enrollment coalition.

He said 93.5 percent of Florida residents enrolled on the exchange are getting financial assistance. Nationwide, about 85 percent who purchased insurance on exchanges qualify for assistance to help pay for coverage, based on their income.

The plaintiffs in the King v Burwell case, which generated the ruling, maintained that people who bought insurance on the federal exchanges were not entitled to subsidies. They noted that the law says financial help is available for those who enroll through exchanges “established by the state.” The Obama administration argued that Congress clearly intended to help everyone who qualified for it.

Had the court ruled against the administration, many of those on the federally run exchanges would have been unable to afford insurance, forcing them to drop their coverage. The court’s majority agreed that this would have left insurers with a large pool of sicker customers, who would need to stay insured to get required care. That would have resulted in premiums going up across the board, putting the ACA in jeopardy and caused what the justices called a “death spiral” for the law.

California, a leader in making health care accessible to most of its residents, and one of the first states to set up its own exchange, had nothing immediate to fear about which way the Supreme Court ruled on the King v Burwell case. Even so, had the ruling gone against the Obama administration, it could have resulted in changes to the ACA down the road, observed Peter Lee, executive director of Covered California, the state’s exchange.

Dana Howard, deputy director of Covered California, strenuously dismissed reports in the media that enrollment on the state’s exchange has dropped by almost 30 percent this year. He said that the state registered 85 percent of renewals in January 2015, bringing the number of enrollees to 1.35 million.

“The exchange is working extremely well,” Howard asserted. “We have exceeded our projections (of 1.3 million.)”

Of the 9 million people enrolled in exchanges nationwide, the federal government pays an average subsidy of $272 a month. Richardson pays $356 for the $800-a-month plan she’s on.

She said she couldn’t afford to be without health care because she has a genetic disorder that makes her a prime candidate for a stroke unless she manages her cholesterol. Within months after her employer-sponsored health insurance ended two years ago when her company folded, the federal government stepped in to set up Florida’s health care exchange.

Richardson purchased a Silver Plan, but when it came up for renewal last October, she switched to a lower-level Bronze Plan, which has a $6,000 deductible needed to be paid out-of-pocket before coverage kicks in.

“Thanks to the ACA, no insurer could deny me coverage because of my pre-existing condition,” she said.

Richardson was more recently diagnosed with cancer. Between the two serious health challenges she faces, she said, she wouldn’t be able to afford to pay for her medications but for her insurance.

“I am not alone in this situation,” Richardson said. “There are millions out there who are like me.”

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