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.


California Estimates It Would Lose $24 Billion By Decade’s End Under GOP Health Plan

March 23, 2017 by · Leave a Comment 

California would lose $24.3 billion in federal funding by 2027 for low-income health coverage under the current Republican plan to replace the Affordable Care Act, according to a new state analysis released Wednesday.

The bill, up for a vote in the House on Thursday, represents a “massive and significant fiscal shift” from the federal to state governments by setting caps on spending, reducing the amount of money available for new enrollees and eliminating other funding for hospitals and Planned Parenthood, the analysis said. The analysis, based on internal cost, utilization and enrollment data, was sent Tuesday to the state’s secretary of Health and Human Services.

“It’s really devastating,” said Mari Cantwell, state Medicaid director with the California Department of Health Care Services, who co-wrote the analysis. “It raises some serious questions about whether we can continue to operate the program the way we do today.”

Although the analysis didn’t explain how the state would deal with the federal cuts, Cantwell said it would have to look at changes to eligibility, benefits or provider rates — or all three.

The Republican bill, called the American Health Care Act, would dramatically change funding for the Medicaid program, known as Medi-Cal in California. Since its inception, Medicaid funding has been open-ended, based on need. Under the new bill, federal money would be capped either through block grants or fixed per-capita amounts.

Medi-Cal provides coverage to 13.5 million low-income residents, about half of California’s children and a third of the adults. About 3.7 million people of those became newly eligible for the publicly funded health coverage through the Affordable Care Act, helping to reduce the state’s uninsurance rate from 17 percent in 2013 to about 7 percent in 2016, according to the UC Berkeley Labor Center for Education and Research.

The public insurance program is funded jointly by California and the federal government and provides health, dental, mental health, long-term care and other services. The Affordable Care Act allowed states to expand their Medicaid programs in 2014 to low-income childless adults, and the federal government is paying nearly all the costs for those new beneficiaries.

The bill could put hospitals, clinics and other providers in a tenuous financial position by forcing them to live within the cost limits while at the same time seeing more uninsured patients, the analysis said.

California health officials said they estimated that Medi-Cal costs would exceed per-capita caps by nearly $680 million in 2020, with the gap growing to $5.28 billion by 2027. That spending limit could have a “devastating and chilling effect” on any increases in provider payments or plan rates, according to the analysis.

The state also expects an additional $3.3 billion in costs in 2020, growing to $13 billion by 2027, because of a change that reduces federal funds for new enrollees and for people who have a break in coverage. The bill would require certain beneficiaries to renew coverage every six months rather than once a year, which state officials say will cause many to lose their coverage.

According to the analysis, the state would face additional costs from other federal cuts, including to a program that pays for in-home care for elderly and disabled residents. In addition, the proposed freeze on federal funding to organizations that provide abortions would make the state responsible for $400 million in payments to Planned Parenthood, which serves more than 600,000 people in Medi-Cal and a state family planning program.

A new study by UC Berkeley’s Labor Center released Wednesday also warned of dramatic cuts in federal Medi-Cal funding that would threaten coverage for low-income adults. The center estimated that the state would have to increase spending by $10 billion each year to maintain coverage for those who became eligible for coverage under the Affordable Care Act. Without that funding, the researchers wrote, 3.7 million people could lose coverage by 2027.


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


GOP Health Proposal Would Upend Consumers’ Cost Calculations In California

March 9, 2017 by · Leave a Comment 

For better or worse, Californians who aren’t insured through their employers could see major changes in their health insurance costs under a Republican replacement for the Affordable Care Act.

A House GOP proposal introduced Monday would provide substantially less financial help to many consumers in higher-cost areas of California, from San Francisco to Monterey. But people in lower-cost markets like Los Angeles could fare better.

That’s because the Republican proposal takes a simpler, across-the-board approach to tax credits than the current law. The ACA offers a wide range of subsidies that take into account household income and the local cost of coverage. The nationwide Republican tax credits are tied just to age, starting at $2,000 per year for people under 30 and increasing to $4,000 for those over 60.

That doesn’t bode well for a 60-year-old in Santa Cruz. If he makes $40,000 a year, he would receive $12,836 in ACA premium subsidies to buy insurance on the state exchange for 2017, according to an analysis by the Kaiser Family Foundation. The subsidy takes into account the person’s income and the cost of insurance in the coastal town. (California Healthline is an editorially independent service of the foundation.)

The House’s American Health Care Act would cut that person’s assistance to $4,000, based purely on his age. A 60-year-old making $20,000 a year in the same town would be even worse off, because his low income wouldn’t be part of the calculation. He would get nearly $12,000 less under the House plan than under the current law.

But the GOP’s plan could benefit younger consumers in general and particularly those in lower-priced markets of Southern California. Under current law, a 27-year-old in Los Angeles making $40,000 doesn’t get any ACA subsidy because the cost of coverage is low for someone of her income. She has to pay her entire premium.

But under the House plan, she would qualify for a flat $2,000 tax credit based entirely on her age.

The GOP plan would begin to phase out age-based tax credits when an individual’s annual income reached $75,000. The upper limit under the ACA is 400 percent of the federal poverty level or about $47,000 for an individual and more than $97,000 for a family of four.

Cynthia Cox, associate director of health reform and private insurance at the Kaiser Family Foundation, said any replacement plan for the ACA will create “winners and losers.”

She said “the people likely to gain under the ACA replacement are those who are younger, higher income and live in lower-cost areas. That might be millennials living in Los Angeles.”

But she said the added costs imposed on consumers in other markets could be enormous. “For a person living in Santa Cruz or another high-cost area, that is a big chunk of their income to come up with,” she said.

California has long had a north-south divide on medical costs. Health policy experts say the lack of competition in Northern California helps explain why health insurance premiums are, on average, about 25 percent higher compared to the southern part of the state.

For 2017, rates in the Covered California exchange rose by 13.2 percent, on average, statewide. But premiums in the Santa Cruz-Monterey area jumped by nearly 29 percent.

Peter Lee, executive director of Covered California, said ignoring income and location in issuing tax credits may force thousands of people to drop coverage.

“The wide variations in the health-care system across California could result in consumers in some areas being priced out of coverage,” Lee said. “The analysis of some early proposals also underscores the importance of providing financial help that is directly tied to a consumer’s income.”

Cox said some Republicans are purposely ignoring those geographic differences because they don’t want to reward higher-priced areas with more generous taxpayer subsidies. The hope is that lower tax credits could put pressure on insurers or medical providers to charge less.

Lanhee Chen, a conservative health-policy expert and a fellow at Stanford University’s Hoover Institution, said the House Republicans’ tax-credit proposal would simplify the process and have a “positive impact on bringing down health costs over the long run.”

But even some critics of Obamacare think Republicans will have to alter their approach and account for differences in health costs within states and across the country.

“The impact will not be uniform and many parts of the country will be big losers — and not just the high-cost big cities that are traditionally Democratic areas,” said Robert Laszewski, a Virginia-based health care consultant and frequent critic of the ACA. “Many of the highest cost places are Republican strongholds. Geographic rating is as basic to health insurance 101 as anything.”

This article was originally posted on the California Healthline website.

House GOP Health Bill Jettisons Insurance Mandate, Much Of Medicaid Expansion

March 9, 2017 by · Leave a Comment 

House Republicans unveiled their much anticipated health law replacement plan Monday, slashing the law’s Medicaid expansion and scrapping the requirement that individuals purchase coverage or pay a fine. But they opted to continue providing tax credits to encourage consumers to purchase coverage, although they would configure the program much differently than the current law.

The legislation would keep the health law’s provisions allowing adult children to stay on their parents’ health insurance plan until age 26 and prohibiting insurers from charging people with preexisting medical conditions more for coverage as long as they don’t let their insurance lapse.  If they do, insurers can charge a flat 30 percent late-enrollment surcharge on top of the base premium, under the Republican bill.

In a statement, House Speaker Paul Ryan (R-Wis.) said the proposal would “drive down costs, encourage competition, and give every American access to quality, affordable health insurance. It protects young adults, patients with preexisting conditions, and provides a stable transition so that no one has the rug pulled out from under them.”

The GOP plan, as predicted, kills most of the law’s taxes and fees and would not enforce the so-called employer mandate, which requires certain employers to provide a set level of health coverage to workers or pay a penalty.

Democrats quickly condemned the bill. “Tonight, Republicans revealed a Make America Sick Again bill that hands billionaires a massive new tax break while shifting huge costs and burdens onto working families across American,” House Minority Leader Nancy Pelosi tweeted. “Republican will force tens of millions of families to pay more for worse coverage — and push millions of Americans off of health coverage entirely.”

The legislation has been the focus of intense negotiations among different factions of the Republican Party and the Trump administration since January. The Affordable Care Act passed in 2010 without a single Republican vote, and the party has strongly denounced it ever since, with the House voting more than 60 times to repeal Obamacare. But more than 20 million people have gained coverage under the law, and President Donald Trump and some congressional Republicans have said they don’t want anyone to lose their insurance.

When Republicans took control of both Congress and the White House this year, they did not have an agreement on the path for replacement, with some lawmakers from states that have expanded Medicaid concerned about the effect of repeal and the party’s conservative wing pushing hard to jettison the entire law.

Sen. Rand Paul (R-Ky.), one of those favoring a full repeal, tweeted: “Still have not seen an official version of the House Obamacare replacement bill, but from media reports this sure looks like Obamacare Lite!”

Complicating the effort is the fact that Republicans have only 52 seats in the Senate so they cannot muster the 60 necessary to overcome a Democratic filibuster. That means they must use a complicated legislative strategy called budget reconciliation that allows them to repeal only part of the ACA that affect federal spending.

Beginning in 2020, the GOP plan would provide tax credits to help people pay for health insurance based on household income and age, with a limit of $14,000 per family. Each member of the family would accumulate credits, ranging from $2,000 for an individual under 30 to $4,000 for people ages 60 and higher. The credits would begin to diminish after individuals reached an income of $75,000 — or $150,000 for joint filers.

Consumers also would be allowed to put more money into tax-free health savings accounts and would lift the $2,500 cap on flexible savings accounts beginning in 2018.

The legislation would allow insurers to charge older consumers as much as five times more for coverage than younger people. The health law currently permits a three-to-one ratio.

Community health centers would receive $422 million in additional funding in 2017 under the legislation, which also places a one-year freeze on funding for Planned Parenthood and prohibits the use of tax credits to purchase health insurance that covers abortion.

Both the Energy and Commerce and Ways and Means Committees are scheduled to mark up the legislation Wednesday. The committees do not yet have any Congressional Budget Office analysis of how much the legislation would cost or how many people it would cover.

Party leaders have said they want to have the bill to President Trump next month.

In a statement, senior Democrats on both panels said the measure would charge consumers “more money for less care. It would dramatically drive up health care costs for seniors. And repeal would ration care for more than 70 million Americans, including seniors in nursing homes, pregnant women and children living with disabilities by arbitrarily cutting and capping Medicaid,” said Rep. Frank Pallone of New Jersey and Rep. Richard Neal of Massachusetts.

The House GOP plan makes dramatic changes to Medicaid, the state-federal health insurance program that covers 70 million low-income Americans. The program began in 1965 as an entitlement — which means federal and state funding is ensured regardless of cost and enrollment. But the Republican bill would cap federal funding for Medicaid for the first time.

The federal government picks up between half and 70 percent of Medicaid costs. The percentage varies based on the relative wealth of the state.

Under the GOP plan, federal funding would be based on what the government spent in the fiscal year that ended Sept. 30. Those amounts would be adjusted annually based on a state’s enrollment and medical inflation.

Currently, federal payments to states also take into account how generous the state’s benefits are and what rate it uses to pay providers. That means states like New York and Vermont get higher funding than states like Nevada and New Hampshire and those differences would be locked in for future years.

Republicans have pushed to cap federal funding to states in return for giving them more control in running the program.

The legislation also affects the health law’s expansion of Medicaid, in which the federal government provided enhanced funding to states to widen eligibility. The bill would also end that extra funding for anyone enrolling under the expansion guidelines starting in 2020. But the legislation would let states keep the extra funding Obamacare provided for individuals already in the expansion program who stay enrolled.

About 11 million Americans have gained Medicaid coverage since 2014.

Changing the expansion program is a delicate balance for the Republicans. Four GOP senators from states that took that option said Monday they would oppose any legislation that repealed the expansion.

“We are concerned that any poorly implemented or poorly timed change in the current funding structure in Medicaid could result in a reduction in access to life-saving health care services,” Sens. Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Lisa Murkowski of Alaska wrote in a letter to Majority Leader Mitch McConnell.

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

If Obamacare Is Being Repealed, Do The Uninsured Still Face Penalties?

February 9, 2017 by · Leave a Comment 

California Healthline – In some recent emails, readers asked about what to expect as Republicans move to overhaul the health law. Should people bother paying the penalty for not having health insurance when they file their taxes this year? Will they be able to sign up on the exchange for 2018 after their COBRA benefits end? Here are some answers.

  1. I didn’t have health insurance for part of last year and thought I’d get stuck paying a penalty. Now the new administration is talking about not enforcing the insurance requirement. Could I really be off the hook at tax time?

As long as the “individual mandate” — which requires most people to have health coverage or face a tax penalty — is the law of the land, you should pay the fine for not having coverage in 2016 unless you qualify for an exemption, said Tara Straw, a senior policy analyst at the Center on Budget and Policy Priorities. Straw also manages a Volunteer Income Tax Assistance site, part of an Internal Revenue Service program that provides free tax filing services for low and middle income taxpayers.

Straw said she has heard that some tax preparers are advising taxpayers either not to pay the penalty or to delay filing because they anticipate changes in the law.

Bad idea. “It’s not a thing a reputable tax preparer would do,” Straw said. “The requirement that people have health insurance or an exemption [from the mandate] is still in effect.”

The confusion stems from uncertainty over Republican officials’ comments that they may do away with the individual mandate when they overhaul the health law. In addition, President Donald Trump signed an executive order in January that required federal agencies to waive or exempt health law-related provisions that would impose costs or penalties on individuals, to the extent permitted by law.

One strategy that has been discussed has been to broaden the hardship exemption so more people would qualify for it, which the secretary of Health and Human Services has the authority to do.

However, Straw says that approach might run into trouble. “A hardship has to mean something, you can’t say that everyone has a hardship,” she said. “Complying with the law is not considered a hardship.”

Some experts say changing the rules now could create even more confusion, since some people have already filed their returns. Those taxpayers might have to file amended returns, an extra expense if they use a tax preparer.

“Since the 2016 tax season is already underway, I would think it unlikely that the Treasury Department would say, ‘Don’t bother paying the penalty,’” said Mark Luscombe, a principal federal tax analyst at Wolters Kluwer Tax & Accounting, an information services company.

KHN contributing columnist Michelle Andrews writes the series Insuring Your Health, which explores health care coverage and costs.

Foul-Up Means Thousands On State Exchange Surprised By Higher Premiums

January 26, 2017 by · Leave a Comment 

California Healthline – Thousands of Covered California enrollees face higher-than-expected bills from their insurers because the exchange sent incorrect tax credit information to the health plans.

The exchange confirmed it gave insurers wrong subsidy information for about 25,000 policy holders, resulting in inaccurate bills. Insurers are now sending out new bills correcting the errors, and in most cases that means higher premiums than consumers had initially anticipated.

“It feels like this is a bait-and-switch,” said Beth Freeman, 53, of San Bruno. “Now what am I going to do? I don’t know if I can afford it.”

Freeman said she owes about $330 per month more on her premium than she had expected.

Covered California said it doesn’t know what caused the problem. “We are focused on reaching [enrollees] and making sure they know what to expect,” said spokeswoman Lizelda Lopez. “We will do an analysis afterwards to understand all the details.”

Lopez said Covered California originally sent consumers their correct tax credit amounts in notices during the renewal period, but it gave the incorrect amounts to their insurers.

However, Kevin Knauss, an insurance agent in Sacramento, said a Covered California representative told him in a phone conversation that consumers had found incorrect tax credit amounts when they signed onto their online Covered California accounts.

Tax credits are the income-based subsidies that about 90 percent of Covered California enrollees receive to lower their monthly premiums.

In another mistake related to tax credits, Covered California discovered in December that about 24,000 policy holders hadn’t provided consent for the agency to verify their income, even though the agency thought they had. Without that consent, thousands of consumers lost their 2017 tax credits, at least temporarily.

“I don’t know what’s going on,” Knauss said. “2015 and 2016 went fairly smoothly. Now we’re starting to see these weird glitches.”

Lopez said most consumers affected by the latest mistake will owe more out of pocket than they originally thought, and that health plans are entitled to bill them for the difference.

“Some may,” she said. “Some may not.”

The recent tax credit error has left consumers like Freeman feeling shocked and frustrated.

She had struggled through administrative headaches with her Covered California plan last year, so when it came time to renew it — or choose a new one — for 2017, “I was very cautious and nervous. I shopped around and got information from the folks at Covered California and Blue Shield,” she said.

She said Covered California gave her inconsistent information about the amount of tax credits she would receive. So she called the exchange twice to confirm the number, and was told both times it would be $800 a month. That was more than she expected, and it allowed her to afford a more expensive plan with better coverage, she said.

After receiving an updated bill last week that showed her actual tax credits were hundreds of dollars less than expected, Freeman called Covered California again and was told the problem had been caused by a “computer data error,” she said. The agent told her there was nothing Covered California could do and that she should try to negotiate directly with Blue Shield, she said.

“I subscribed to Blue Shield based on the information given to me and confirmed by Covered California,” she said. “It’s unethical that Covered California is unwilling to accommodate me so I can stay in my contracted plan.”

Enrollees in this situation can call Covered California’s special hotline at 844-623-2070 for more information.

If their updated premiums are unaffordable, there’s still time for enrollees to switch health plans before open enrollment ends on Jan. 31, Knauss said.

But Freeman already has seen new doctors with her new plan. “Why must the consumer carry the burden of these errors?” she asked.

“Covered California continues to mismanage and, worse, misinform the public when they make errors. And there’s no accountability, no follow up.”


Budget Scorekeepers Say GOP Plan Would Raise The Number Of Uninsured By 32M

January 19, 2017 by · Leave a Comment 

The bill considered the most likely prototype for partial repeal of the Affordable Care Act would result in as many as 32 million more people without health insurance and would double premiums in the individual insurance market, budget scorekeepers said Tuesday.

The estimate by the Congressional Budget Office and the Joint Committee on Taxation was on the impact of the bill passed by the Republican Congress in 2015 and vetoed by President Barack Obama last January. The analysis was conducted at the request of Senate Democrats.

“The number of people who are uninsured would increase by 18 million in the first new plan year following enactment of the bill,” said the report. That increase could reach 32 million in 2026.

At the same time, CBO and JCT estimate, premiums for those who purchased coverage in the individual insurance market would increase by 20 to 25 percent in the first year, “and premiums would about double by 2026.”

Republicans called last year’s bill a “dress rehearsal” for what they might try this year, because it was a “budget reconciliation” bill that needs only 51 votes to pass in the Senate and cannot be filibustered. Last week the House and Senate passed a budget resolution instructing specific committees to begin work on dismantling the health law, using the same budget reconciliation process.

Only items that directly impact the federal budget can be included in such a bill, however. That meant last year’s legislation would have repealed most of the ACA taxes that help fund the health law’s programs, the penalty for individuals who don’t have coverage and the tax subsidies for people to purchase coverage, as well as the funding to expand the Medicaid program. But it could not change the health law’s regulation of the insurance market, including the provision requiring insurers to sell to people with pre-existing health conditions.

The result, said CBO, would have been fewer healthy people purchasing coverage, which would leave the insurance pool with higher percentage of sick enrollees and drive premiums up. Insurers, according to the report, would likely stop offering coverage in the individual insurance market.

Senate Minority Leader Mitch McConnell, R-KY., heads to his office in the U. S. Capitol on September 30, 2013. The House of Representatives passed a continuing resolution with language to defund U.S. President Barack Obama’s national health care plan (Obamacare) two days ago. (Douglas Graham/CQ Roll Call)

Senate Majority Leader Mitch McConnell and other Republican leaders called last year’s bill a “dress rehearsal” for what they might try this year. (Douglas Graham/CQ Roll Call via Getty Images)

“CBO and JCT estimate that about half of the nation’s population lives in areas that would have no insurer participating in the nongroup market in the first year after the repeal of the marketplace subsidies took effect,” said the report. And that would rise to “about three-quarters of the population by 2026.”

Democrats were quick to pounce on the estimate as evidence that Republicans are on a dangerous path.

“Repeal and delayed replacement is repeal,” outgoing Health and Human Services Secretary Sylvia Burwell told reporters at a briefing. “CBO has just stated with analytics and real numbers what happens during that interim period” when part of the law is taken away and part remains.

“Today’s CBO report is a clear repudiation of the Republicans’ misguided plan to repeal the Affordable Care Act,” said Rep. Richard Neal, D-Mass., the ranking Democrat on the House Ways and Means Committee.

Republicans cautioned, however, that last year’s bill might not be a good reflection of what will happen in the coming weeks and months.

“The CBO can’t score the replacement because it hasn’t been drafted,” wrote GOP health policy analyst Avik Roy in Forbes. “But its estimates of the impact of (last year’s bill) are largely meaningless without consideration of what the GOP’s replacement will look like.”

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

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, 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 Set to Be First State to Allow Undocumented Residents to Buy Health Coverage on Online Marketplace

June 9, 2016 by · Leave a Comment 

New America Media – As early as next year, undocumented immigrants will be able to buy health insurance on Covered California, the state’s online marketplace. That is, if Uncle Sam gives the state a federal waiver to do so.

In a bipartisan vote of 27 to 8, the California state senate on June 2 approved SB 10, the Health For All Waiver authored by Sen. Ricardo Lara, D-Bell Gardens. Under the proposal, the state will ask for a waiver so that undocumented adults can buy coverage on Covered California.

However, undocumented immigrants would not be able to get any subsidies when making their purchase. An estimated 390,000 immigrants who earn an income too high to qualify for Medi-Cal could purchase health care coverage through this program – if they can afford it.

Sen. Lara introduced the waiver as a result of President Obama’s signature health care legislation, the Affordable Care Act (ACA), which bars undocumented immigrants from purchasing health insurance on the online marketplaces set up by state or federal governments. The ACA subsidizes the costs, making the premiums affordable.

 SB 10 by Sen. Ricardo Lara (pictured) wins bipartisan support for seeking waiver to allow undocumented residents to by health insurance through Covered California. (New America Media)

SB 10 by Sen. Ricardo Lara (pictured) wins bipartisan support for seeking waiver to allow undocumented residents to by health insurance through Covered California. (New America Media)

States were, however, given a so-called 1332 waiver option so they could fashion a new coverage system customized for local preferences. Proposed state changes have varied widely, from minor fixes to substantial redirections.

In California, the state with the largest immigrant population, an estimated 3 million adults and children have been left without insurance because of the ACA barrier. Thanks to efforts spearheaded by Lara, nearly 170,000 undocumented children became eligible last month for full health coverage through Medi-Cal, the state’s name for Medicaid, the health insurance program for low-income people.

“It is immoral to discriminate against anyone based on where they were born,” Lara said in a press release after the Senate approved the SB 10 measure June 2. “This bill presents a historic opportunity for California to become the first state in the nation to request a federal waiver to allow the exchange to sell health insurance to undocumented immigrants.”

Governor Brown, the fiscally conservative leader, is expected to sign the waiver request because no state spending is involved.

“Beyond the important symbolism of inclusion, this proposal will provide a practical benefit for many California families with mixed immigration status, who will be able to buy coverage together, even if some family members are eligible for subsidies and others are not,” noted Anthony Wright, executive director of Health Access California, the statewide health care consumer advocacy coalition.

In seeking the waiver, the state must certify that the proposal will not diminish coverage or affordability on the exchange, and will not add costs for the federal government.

Then the federal Department of Health and Human Services and Department of Treasury have 225 days to make a decision. By expediting state approval of the bill, Lara hopes to have the request considered by the Obama administration before he leaves office.

The Health Challenge In Mixed-Status Homes

June 9, 2016 by · Leave a Comment 

Huntington Park resident Stephanie Martinez was just five years old when her parents brought her illegally to live in the United States. Now 23, she’s one of an estimated 853,000 people in the country who have temporary, quasi-legal status through President Obama’s Deferred Action for Childhood Arrivals (DACA) program enacted in 2012.

Today she has health insurance, but like so many in her situation the road to coverage was filled with obstacles, complicated by her family’s mixed-immigration status and a combined household income slightly too high to qualify for health subsidies but too low to pay for private insurance.

Under DACA, young people between the ages of 16 and 31 who were brought to the country illegally as children can temporarily avoid deportation and work legally in the U.S., provided they meet certain eligibility requirements, such as attending or completing high school and passing a criminal background check.

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

For many who have qualified there’s a sense of normalcy, of no longer living in society’s shadow, that is unless like Stephanie you live in a “mixed-status” home, where some members of your family are citizens, legal residents, or DACA recipients, but others are undocumented.

When enacted in 2014, the Affordable Care Act (ACA)—also known as Obamacare—explicitly excluded DACA recipients – often referred to as “dreamers” – and undocumented immigrants from buying health insurance from state or federally sponsored health insurance marketplaces and the premium tax credits, subsidies and other savings on marketplace plans.

“It’s political,” Gabrielle Lessard, a health policy attorney with the National Immigration Law Center told EGP, explaining that the Obama Administration knew it would face a backlash if the undocumented and DACA recipients were allowed to take part in the program, even though they pay into the tax pool that subsides the coverage.

In her early twenties, Stephanie wasn’t worried about not having health insurance; after all, she’s young and healthy. The same couldn’t be said for her father Alvaro Martinez who suffers from diabetes and needs ongoing medical attention, but struggles to get care because he is undocumented.

So last year, when Stephanie’s father asked her to apply for health coverage for the family through the state’s health exchange, Covered California, she gladly filled out the application at a local health fair sponsored by AltaMed.

Marketing Coordinator Laura Ochoa works on AltaMed’s “Dreamers and Medi-Cal” program, which screens DACA recipients for eligibility for the state’s Medi-Cal program for low-income families. DACA recipients can qualify for coverage under the state’s recognition of the Permanently Residing in the United States Under Color of Law (PRUCOL), a public benefits eligibility category created by the courts.

According to US immigration officials, “an individual may be eligible for Medicaid (Medi-Cal), if the individual is an alien residing in the United States with the knowledge and permission of the Immigration and Naturalization Services (INS) and the INS does not contemplate enforcing the alien’s departure,” as in the case of DACA recipients.

California and New York see DACA recipients as having met the PRUCOL standard, Lessard said.

Stephanie Martinez reviews the Medi-Cal documents she received by mail. (EGP photo by Jacqueline Garcia)

Stephanie Martinez reviews the Medi-Cal documents she received by mail. (EGP photo by Jacqueline Garcia)

Requirements to qualify for California Medi-Cal for DACA recipients include having a valid work permit, a social security number, identification and proof they are low-income, Ochoa told EGP.

But Stephanie’s case was more complicated. Her family’s combined household income of $46,000 exceeded the maximum Federal Poverty Level (FPL) of 138%, or $33,534 a year for a family of four to qualify for Medi-Cal. Their mixed-immigration status, her parents are still undocumented, also made group coverage through the health exchange unlikely. Private insurance is too expensive, Stephanie said.

A study by the UCLA Labor Center’s Dream Resource Center found that one in seventeen children in the U.S. live in mixed-immigration status homes.

“Mixed-status families are a growing demographic in the United States” and their health outcome provides insight into the health of the future of the U.S. population, according to “Undocumented and Uninsured; A five part Report on Immigrant Youth and the Struggle to Access Health Care in California.”

Stephanie attends Santa Monica College and works part-time. She says she’s still dependent on her family for necessities like food and the roof over her head.

According to Ochoa, Stephanie’s best option is to apply as an individual. She said students who earn about $10,000 could qualify for Medi-Cal even if their parents claim them as deductions.

“If they are part-time students and part-time workers, most likely they are eligible,” she added.

Earlier this year, Stephanie applied as an individual and was approved for Medi-Cal coverage effective June 1 through the L.A. Care Health Plan.

While exploring her family’s options, Stephanie also discovered that Mr. Martinez qualifies for coverage under Los Angeles County’s Ability to Pay (ATP) program, which offers affordable health services to L.A. county residents who do not qualify for Medi-Cal, Medicare or Covered California plans, regardless of their immigration status.

The program is free to “individuals with incomes at or below $1,367 per month” and has a “low-cost [option] for individuals with incomes above $1,367 per month,” which works for Mr. Martinez.

ATP applicants only pay for the month they visit the hospital or its partner clinics. Services include doctor and ER visits, hospital care, tests and medicines, explains the Health Services of L.A. County website.

The “Undocumented and Uninsured” study states that the health of undocumented Californians is crucial to the wellbeing of the state.

They recommend expanding ACA to all Californians regardless of their immigration status or income level.

“There’s no such thing as individual health; all health is public and communal,” states the study.

A bill by state Sen. Ricardo Lara, SB 10, the Health For All Waiver, recently approved by state lawmakers, could allow undocumented immigrants to buy health coverage through the Covered California online marketplace, but would first require federal approval.

Martinez told EGP she is happy she now has health insurance, but still worries about her father’s ongoing health issues. “He has more need than me,” she said.

Immigrants with one of the following statuses qualify to use the Marketplace:
•Lawful Permanent Resident (LPR/Green Card holder)

•Asylee •Refugee •Battered Spouse, Child and Parent

•Victim of Trafficking and his/her Spouse, Child, Sibling or Parent

•Individual with Non-immigrant Status, includes worker visas and student visas

•Deffered Action Status (Exeption: Deferred Action For Childhood Arrivals -DACA)

[For a full list of eligible statuses visit]


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 3: SB10 is it worth it? What is an exemption?


Twitter @jackiereporter

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