Uncertainty Over Federal Money Could Spur Covered California Rate Hikes

June 15, 2017 by · Leave a Comment 

If the federal government does not clarify by mid-August whether it will continue an important health insurance subsidy for consumers next year, California’s state-run exchange will instruct its insurers to sell plans with significantly higher premiums to cover the loss of the money.

“Bottom line, we have come to the conclusion that if there’s no federal commitment to fund [the subsidies] by mid-August, we will presume they will not be funded and use higher rates for 2018,” Amy Palmer, director of communications for Covered California, said in an email.

At issue are the so-called cost-sharing subsidies that reduce what some consumers pay out of their own pockets for medical expenses such as physician visits, prescription drugs and hospital stays. These reduced rates are only available to Covered California enrollees who choose silver-level plans, the second-least expensive among the exchange’s four tiers. The subsidies are to help people whose annual income is between 139 percent and 250 percent of the federal poverty level, or about $34,200 to $61,500 for a family of four.

As of last summer, about half of the exchange’s enrollees — currently about 1.4 million people — benefited from cost-sharing reductions, Palmer said

The subsidies are under challenge in a pending lawsuit by House Republicans, and President Donald Trump has threatened to stop making the payments, which go directly to health insurers to cover the cost of lowering consumers’ out-of-pocket expenses. The subsidies are separate from the federal health law’s tax credits, which reduce monthly premiums for qualified consumers.

A recent analysis commissioned by Covered California estimated that premiums for silver plans would jump by 16.6 percent if federal funding for cost-sharing subsidies were lost. That is over and above any annual rate increases on the table.

Earlier this month, Covered California instructed participating insurers to submit alternative premium hike proposals for 2018 in the event they lose the federal payments. The agency told them to apply the hikes only to silver-tier plans, since the cost-sharing subsidies are available only to people who buy those plans.

The insurers’ proposed rates are due to Covered California by June 30, and the agency will publicly announce the final rates in mid-July, after negotiations with the health plans.

After that, the exchange can’t wait too long before determining which rates consumers will face in 2018, Palmer said. State regulators will still have to review the rates, and Covered California as well as the health plans will need to time to prepare for open enrollment in the fall.

As a result, the exchange determined this week that it will move forward with the higher rates in August if the uncertainty remains about the federal payments.

“As we hear about health plans exiting some markets, and as we work hard to create necessary market stability, waiting for clear federal guidance on [the subsidy] funding is no longer an option,” Covered California Executive Director Peter Lee wrote in an email to colleagues and health policy leaders last week.

Lee noted that if Covered California adopts the higher premiums to cover the cost of the subsidies, many consumers would nonetheless be protected from them. That’s because as premiums rise to make up for the loss of the cost-sharing subsidies, federal tax credits would grow to offset those higher premiums.

“These increased costs will be borne by the federal government … and will be significantly more than the federal government would pay if it continued making direct payments” for the subsidies, Lee wrote in a separate letter to Seema Verma, head of the Centers for Medicare & Medicaid Services.


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.”


California Retira Petición Para Acceso de Indocumentados A Planes de Salud

January 26, 2017 by · Leave a Comment 

Los legisladores en Sacramento han frenado un esfuerzo, el primero en la nación, para que California amplíe el acceso a la cobertura de salud para los inmigrantes indocumentados.

A instancias de la Legislatura estatal, Covered California, el mercado de seguros del estado, retiró su solicitud de vender planes de salud sin subsidio a personas indocumentadas.

Bajo la Ley de Cuidado de Salud Asequible (ACA), las personas que no pueden demostrar que están en el país legalmente tienen prohibido comprar cobertura en el mercado de seguros.

Los inmigrantes en esta situación habían depositado sus esperanzas en la solicitud del estado de una exención a esa regla, presentada el otoño pasado al gobierno federal. Si se hubiera aprobado, se les habría permitido a los californianos indocumentados comprar planes bajo Covered California y unirse a los aproximadamente 1,3 millones de personas actualmente inscritas.

El senador estatal Ricardo Lara (demócrata de Bell Gardens) y otros demócratas encabezaron el esfuerzo para ampliar el acceso. La legislación fue aprobada el año pasado y el gobernador Jerry Brown firmó la medida en junio, autorizando que Covered California presentará una solicitud a los funcionarios federales para renunciar a la prohibición de tales ventas.

Pero las posibilidades de aprobación federal se atenuaron considerablemente con la elección de Donald Trump, quien se ha comprometido a deportar a los inmigrantes que estén en el país sin documentos oficiales, y a derogar la ley de salud.

Peter Lee, director ejecutivo de Covered California, se negó a comentar sobre el retiro de la solicitud del estado. Él se refirió a una carta del mercado de seguros enviada el miércoles 18 de enero a la administración de Barack Obama, que decía que la propuesta fue archivada a petición de Lara.

Lara dijo en una declaración escrita que estaba retirando el plan porque temía que el gobierno de Trump pudiera usar la información con el propósito de deportar a inmigrantes indocumentados.

El plan para venderle cobertura a inmigrantes indocumentados sería “la primera víctima de California de la presidencia de Trump”, escribió Lara. “Tomo en serio las palabras de Trump de que cualquier persona está sujeta a deportación en cualquier momento, y California no será parte de una campaña inhumana contra los inmigrantes que están trabajando duro y siguiendo las reglas”.

La decisión de dejar al lado el plan llega justo cuando el futuro de la salud de millones de californianos pende de un hilo, ya que los líderes republicanos en Washington, D.C. intentan derogar las principales disposiciones de la ley de salud.

Anthony Wright, director ejecutivo del grupo de defensa del consumidor Health Access California, dijo que el movimiento del estado refleja una reorganización de prioridades. Lo que es urgente ahora, dijo, es preservar las ganancias actuales en la cobertura de salud de los californianos. Y para traer inmigrantes indocumentados a Covered California, los funcionarios deben asegurarse primero de que el intercambio sobreviva, explicó Wright.

“No queríamos que esta solicitud de exención, que seguramente será rechazada, impidiera la defensa de estos programas básicos que brindan cobertura a tantos”, dijo.

Era inesperado que la venta de planes de salud de Covered California a inmigrantes sin estatus legal aumentara significativamente la inscripción en el mercado. Esa población, a diferencia del aproximadamente 90 por ciento de los afiliados actuales, no habría calificado para subsidios federales para reducir sus pagos.

Esto le habría dificultado a muchos el pagar las pólizas. Por otra parte, los inmigrantes que están en el estado ilegalmente ya pueden comprar un seguro de salud en el mercado privado, y las opciones de cobertura y las costos son similares a la de los planes vendidos en el mercado de intercambio.

El pasado agosto, Covered California estimó que sólo 17.000 californianos habrían ganado cobertura de salud como resultado de la expansión del mercado a la población indocumentada.

Muchos expertos y defensores de los consumidores acordaron que el esfuerzo fue en gran parte un gesto simbólico, pero importante, para muchas personas.

Los partidarios dijeron que el permitirle a los inmigrantes indocumentados comprar cobertura en el mercado habría abordado un problema para muchas familias, aquellas que tienen miembros con y sin documentos. La propuesta habría permitido a esas familias de “estatus mixto” comprar sus seguros juntos a través de Covered California, simplificando el proceso. Muchos argumentaron que era discriminatorio prohibirle a los inmigrantes sin papeles comprar un seguro a través del mercado estatal.

Lara y otros patrocinadores del esfuerzo lo vieron como un paso importante hacia la expansión de la cobertura de salud a todos los californianos, independientemente de su estatus migratorio.

Magdalena Velázquez, de San José, quien trabaja como voluntaria en el grupo de apoyo de Servicios, Derechos de Inmigrantes y Red de Educación (SIREN), ha estado siguiendo el tema de cerca. Aunque no tiene un estatus legal en los Estados Unidos, tiene cobertura de salud a través del empleador de su esposo. Pero muchos de sus familiares y amigos no tienen seguro médico.

“Tristemente, una vez más estamos viendo que la lucha por nuestros derechos de salud tiene que ser pausada”, dijo Velázquez.

Cuando California presentó su solicitud al gobierno federal el año pasado, los partidarios esperaban que la administración Obama la revisara rápidamente, aumentando sus posibilidades de aprobación, dijo Wright. Pero hasta el martes, el proceso de solicitud sólo había pasado por una revisión preliminar.

Algunos expertos en atención de salud creen que la aprobación no se habría garantizado incluso si la administración Obama hubiera completado su revisión antes de que Trump asumiera el cargo. En primer lugar, excluir a los inmigrantes sin papeles fue un compromiso que ayudó a que ACA avanzara en el Congreso, señalaron, y los funcionarios de Obama hubieran sido reacios a renunciar a ella.

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.

In For A Shock: Exchange Customers Get Glimpse Of Painful Rate Hikes

October 20, 2016 by · Leave a Comment 

Healthline/Kaiser Health News – Covered California’s big 2017 rate hikes are starting to hit home for consumers.

The state health insurance exchange began mailing notices to its 1.3 million customers on earlier this month alerting them that they can determine exactly how much the premiums for their current plans will rise in 2017, and begin shopping around for cheaper options.

The letter urges them to sign into their Covered California accounts at www.coveredca.com and use the agency’s updated “Shop and Compare” tool to see how much premiums will be for their current plans compared with others in their region.

Many are in for a shock. After two years of moderate increases, Covered California officials announced in July that premiums will balloon by a statewide average of 13.2 percent in 2017.

Until now, however, consumers didn’t know exactly what that would mean for them, because health plan prices vary across the state, within regions, by insurer — and also by family size, age, income and other factors.

When Paula Schwartz of Los Angeles called Covered California Wednesday to inquire about her rate hike, she was told the out-of-pocket cost for her monthly premium — after tax credits are applied — would rise from $162 this year to $254 next year, an increase of about 57 percent.


“I’m very angry and disappointed,” said Schwartz, 56, who has a silver-level PPO from Blue Shield of California. “I feel like they don’t care about us.”

If you, like Schwartz, are facing a big rate hike, exchange officials urge you to consider other plans. About 80 percent of exchange consumers will be able to cap their premium increases at 5 percent if they shop around and choose the lowest priced plan at their current level of benefits, said Amy Palmer, the agency’s director of communications.

For some people, that may be the plan they already have, she said.

“Shopping is important this year,” Palmer added.

But Schwartz doesn’t want to switch plans because she doesn’t want to lose doctors she has come to know and trust, and who are familiar with her medical history, she said.

Mostly, she fears that rates will continue to climb in the coming years.

“That’s the biggest, scariest thing. How high is it going to go?” she asked.

The open-enrollment period for Covered California, as well as the open market, starts Nov. 1 and ends Jan. 31, 2017.

But existing Covered California enrollees can start renewing or switching their plans now, with a Jan. 1 effective date, Palmer said. Those who do nothing will automatically be reenrolled in their current plans.

The vast majority of Covered California enrollees’ incomes qualify them for tax credits that reduce their monthly premiums. Those credits will increase as their premiums rise and, all things being equal, absorb at least some of the rate hike.

The online “Shop and Compare” tool will tell you how much your tax credits will be next year if you sign into your account, Palmer said.

Palmer and others advise consumers who are shopping for a plan to look beyond the premiums to out-of-pocket costs. In some plans, co-pays will be lower for certain services, such as urgent care and primary care, she said. And in some cases, emergency room visits will no longer be subject to a deductible.

At the same time, deductibles and out-of-pocket maximums are going up for many plans. For example, the individual out-of-pocket maximum for the bronze plan will rise from $6,500 this year to $6,800 in 2017. The family out-of-pocket maximums are double those amounts.

Kevin Knauss, an insurance agent based in Granite Bay, near Sacramento, said consumers may be able to save money by switching to another type of plan.

“Someone may find themselves with a PPO plan they just can’t afford anymore” and some HMOs will be less expensive than PPOs, Knauss said.

Finally, if you’re considering switching plans, remember this mantra: “doctors, doctors, doctors,” he said.

If you want to keep you doctor, find out which other Covered California plans, if any, he or she participates in. The same goes for hospitals, he said.

“Just because a carrier offers a PPO plan next to their HMO plan, it does not mean the same providers are in each of those plan networks,” Knauss noted. “Some HMOs may have some hospitals the PPOs don’t, and vice versa. Don’t make assumptions.”

Cindie Flannigan, 57, of Venice, has a PPO through Anthem Blue Cross and “has managed to avoid HMOs all my life,” she said.

But now that she’s facing a 70 percent increase in her premium, she said she might consider switching to one.

“Maybe there’s no choice,” she said.

Her premium will rise from $210 this year to $357 next year after tax credits are applied, she said.

“I’m still beyond shocked. I’m speechless,” Flannigan said. “It’s got to be devastating for so many more people. It makes me feel sick to my stomach.”


Reach the author at ebazar@kff.org | @emilybazar


Incremento de Precio de Seguros de Salud en California Preocupa a Latinos

July 28, 2016 by · Leave a Comment 

Organizaciones comunitarias y usuarios hispanos del sistema de salud están preocupados por el aumento anunciado en los costos mensuales de los seguros de salud ofrecidos por Covered California para 2017.

El mercado que regula los seguros de salud en California ha previsto incrementos que podrían alcanzar el 13,9% y 16,4% en las dos regiones del Condado de Los Ángeles, el 14,4% en el Condado de Orange y el 13,2% en promedio en California.

El mayor aumento de tarifas se proyecta en los condados de Monterrey, San Benito y Santa Cruz, con un incremento del 28,6%, y el menor en el área conformada por los condados de San Joaquín, Stanislaus, Merced, Mariposa y Tulare, con el 8,4%.

“Las mensualidades de los seguros de salud son un reflejo de los costos subyacentes de la prestación de la atención de la salud”, aseguró Peter Lee, director ejecutivo de Covered California.

El ejecutivo recomendó buscar alternativas más baratas con las mismas condiciones de servicio, entre las diferentes aseguradoras afiliadas a Covered California.

“Cerca del 80% de nuestros consumidores podrán pagar menos este año de lo que pagan ahora o ver que sus tarifas no aumenten más del 5% si buscan y compran el plan de más bajo costo con el mismo nivel de beneficio”, anunció Lee en un comunicado.

No obstante, para algunas organizaciones comunitarias y consumidores de los servicios la recomendación no satisface.

“Nos preocupa éste aumento anunciado de cerca del triple de los dos años anteriores y el efecto que tendrá en el costo directo para los usuarios”, declaró Anthony Wright, director ejecutivo de Acceso a la salud, un grupo de defensa de los consumidores.

Para Jhonny Gómez, usuario individual de los seguros de salud, la recomendación de Lee no parece válida.

“Antes de comprar mi seguro de salud yo comparé entre todas las ofertas posibles y conseguí la más económica para mi plan de salud”, aseguró Gómez.

El usuario notó que si el promedio de aumento será de más del 13%, debido a los costos de los servicios, “es muy posible que la compañía que ofrece mi plan sea una de las que tengan que aumentar más (sus tarifas) para compensar”.

Covered California informó de que el aumento de dos dígitos en las tarifas es causado principalmente por el incremento previsto por dos proveedores de servicios.

Blue Shield de California anunció que sus tarifas aumentarán el 19,9% mientras Anthem Inc. elevará sus costos el 17,2% de promedio.

Entre las dos compañías se cuentan más del 54% del total de los cerca de 1,4 millones de usuarios activos en marzo, según datos de Covered California.

¿Vale la Pena la SB10? ¿Qué es una Exención?

June 16, 2016 by · Leave a Comment 

Nidia Torres dice que pagar una multa por no tener seguro de salud es injusto al no ser elegible para un plan asequible y no es fácil encontrar cobertura de salud cuando no se sabe  por donde comenzar.

Torres, 34, tiene el estatus de Acción Diferida para los Llegados en la Infancia (DACA), haciéndola elegible para un aplazamiento de la deportación y un permiso de trabajo, pero no para el seguro de salud a través de la Ley de Asistencia Médica Asequible (ACA)—también conocida como Obamacare—debido a su estatus cuasi-legal.

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

Sin embargo, la medida estatal SB10—conocida como la Exención #Health4All—firmada por el gobernador Jerry Brown el viernes le podría abrir las puertas a la cobertura médica a ella y a otros beneficiarios de DACA y personas indocumentadas que actualmente están excluidos del Obamacare, puesto que no son considerados con presencia legal en el país.

Mientras que muchos celebran la legislación como un paso positivo hacia la inclusión de los inmigrantes, su impacto puede ser más simbólico que práctico, ya que no les da acceso a los subsidios que a menudo permiten que una cobertura sea asequible.


Exención #Health4All 

La SB10, escrita por el senador Ricardo Lara (D-Bell Gardens), permite a California pedir una exención federal para permitir que los inmigrantes indocumentados y los beneficiarios de DACA utilicen su propio dinero para comprar un seguro de salud a través de Covered California, el mercado de seguros en línea del estado. Bajo ACA, los estados pueden solicitar una exención para modificar provisiones de la ley basada en las directrices establecidas por el Departamento de Salud y Servicios Humanos de EE.UU.

“Este proyecto de ley presenta una oportunidad histórica para que California se convierta en el primer estado en la nación para solicitar una exención federal”, dijo el senador Lara el viernes en un comunicado.

De ser aprobada, la exención de California no tendrá ningún impacto financiero en el gobierno federal porque la SB10 no permite que indocumentados ni beneficiarios de DACA reciban subsidios del gobierno que reducen el costo de las primas mensuales.

Sin embargo, los defensores lo ven como un paso importante hacia adelante, y Covered California estima que unas 50.000 personas adicionales—que ganan demasiado dinero para calificar para Medi-Cal—podrán comprar cobertura a través del mercado si la exención es aprobada.

Nidia Torres junto a su hija Jimena es beneficiaria de DACA. (Cortesía de Nidia Torres)

Nidia Torres junto a su hija Jimena es beneficiaria de DACA. (Cortesía de Nidia Torres)

Torres, quien es madre soltera de una niña y gana $23.000 al año, le dijo a EGP que su ingreso es considerado demasiado alto para calificar para Medi-Cal, pero no lo suficientemente alto como para adquirir un seguro médico por su cuenta.

“He estado queriendo ir al médico para un examen físico y me dijeron que cuesta alrededor de $100” porque no tengo seguro, le dijo a EGP, explicando que optó ir a una clínica comunitaria y hacer un solo pago en vez de tratar de pagar mensualmente por un seguro que tal vez no ocupe constantemente.

“No es que no quiera comprar la cobertura, pero es que no me alcanza”, le dijo a EGP.

La SB10 no le dará acceso a un plan asequible para su bolsillo.

El portavoz de Lara, Jesse Melgar le dijo a EGP que a pesar de que no habrá subsidios bajo la SB10, esta propuesta si lucha por atención de salud médica para todos.

Hay alrededor de 390.000 inmigrantes indocumentados que ganan demasiado para calificar para Medi-Cal, dijo Melgar. “De ellos, se estima que el 10% ganan más del 400% del FPL (límite de pobreza federal) que significa que no serían elegibles para ningún subsidio independientemente de su estatus migratorio”.

Reconocemos que la SB10 haría un cambio modesto pero “creemos que aun así el cambio es importante, más allá del simbolismo de la inclusión y de una política explícita de exclusión en el ACA”, Anthony Wright, director ejecutivo de Acceso a la Salud de California le dijo a EGP.

Con más del 70% de los californianos indocumentados en familias de estatus mixto, esto significa que muchos obtendrán subsidios, dijo Wright, citando dos ejemplos donde personas se beneficiarían al obtener acceso a Covered California.

El primero es una familia de tres; el niño recibe cobertura gratis de Medi-Cal, uno de los padres tiene cobertura con subsidio por alrededor de $50 al mes, y el otro paga alrededor de $250 al mes para una cobertura sin subsidio.

“Como familia, en sus ingresos, $300 podrían ser un esfuerzo, pero podría realizarse dependiendo como priorizan”, explicó.

El acceso a Covered California también beneficiaría a las personas que tienen los medios para pagar por la cobertura, como a los trabajadores contratados en el Silicon Valley que no tienen cobertura de salud patrocinado por el empleador, dijo Wright.

Residentes de Los Ángeles sin seguro médico tienen la opción de visitar clínicas comunitarias para recibir sus servicios de salud. (EGP foto por Jacqueline García)

Residentes de Los Ángeles sin seguro médico tienen la opción de visitar clínicas comunitarias para recibir sus servicios de salud. (EGP foto por Jacqueline García)

El portavoz de Covered California, Dana Howard le dijo a EGP que en la actualidad los inmigrantes indocumentados pueden comprar seguro médico privado, pero la aprobación de la SB10 beneficiaría a las familias de estatus mixtos haciendo “más fácil el comprar sus servicios [médicos] en un solo lugar”.

Sin embargo, en una entrevista con California Healthline, el agente de seguros Alex Hernández dijo que la gente no se apresura a comprar planes de salud, debido al alto costo.

Hernández calcula que una mujer en sus 20 años, que gana alrededor de $45.000 al año, tendría que pagar $304 por mes para un plan estándar de Anthem Blue Cross a través del intercambio del mercado de salud. Si compra ese mismo plan directamente de Anthem, le costaría $303.30, le dijo a California Healthline.

Dar acceso a todos los californianos a Covered California hace que el sistema de salud sea más inclusivo y eficiente, sostiene Maricela Rodríguez, gerente de programa con The California Endowment.

“No todos los individuos indocumentados podrán pagar el cuidado de salud a través de Covered California y seguirán siendo excluidos de Medi-Cal”, le dijo a EGP en un correo electrónico, reconociendo que la medida no es una solución total.

“Sin la ayuda de subsidios, la asequibilidad seguirá siendo una barrera para muchos. Es por eso que este es sólo un primer paso y junto a defensores y líderes políticos, vamos a seguir luchando por la justicia de salud para todos”, enfatizó.

El gobierno federal tiene 225 días para conceder o denegar el permiso.


¿Excluido de Obamacare? No hay multa por no tener seguro médico

Mientras tanto, los inmigrantes indocumentados y beneficiarios de DACA, al igual que Torres, que fueron excluidos de Obamacare pero multados por no tener seguro de salud pueden solicitar un reembolso y una exención ante futuras sanciones.

Cuando Torres presentó sus impuestos en el 2015 con H&R Block fue penalizada alrededor de $200 por no tener seguro de salud en el 2014. “Yo no sabía que estaba exenta”, dijo.

La página web de Covered California establece que los beneficiarios de DACA y los inmigrantes indocumentados son elegibles para una exención de impuestos por no tener seguro médico.

Sin embargo, no todos los preparadores de impuestos saben de la exención y muchos harán que sus clientes paguen la multa. Es importante que los beneficiarios de DACA expliquen su estado legal a su preparador antes de presentar sus impuestos, dice Elba Schildcrout, directora del departamento de Riqueza Comunitaria y preparadora de impuestos en East LA Community Corporation (ELACC).

ELACC esta asociado con el programa de Asistencia Voluntaria para Presentación de Impuestos (VITA)—del Servicio de Impuestos Internos—para ayudar sin costo alguno a contribuyentes de bajos y medianos ingresos a presentar sus impuestos.

Una vez que los beneficiarios de DACA han revelado su estado, los preparadores de impuestos deben presentar la Forma 8965 Health Coverage Exemptions (Exenciones de Cobertura de Salud) junto con su declaración de impuestos 1040.

Quienes han pagado la multa por error pueden presentar una enmienda para recuperar su dinero, dijo Schildcrout.

El proceso es factible, aseveró, pero agregó que los preparadores de impuestos generalmente cobran para presentar una enmienda.

Es triste ver que los clientes pagan por una enmienda a una declaración de impuestos que estuvo mal hecha, Schildcrout le dijo a EGP.

El programa VITA puede ayudar a beneficiarios de DACA a presentar una enmienda, libre de costo, si pagaron una multa en el pasado por no tener un seguro de salud, confirmó Schildcrout.


La serie de tres partes fue producida como un proyecto para 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 1:  DACA y Obamacare: ¿Quién Califica?

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


Twitter @jackiereporter


Senado Aprueba Ley que Permite a Indocumentados Acceso a Covered California

June 9, 2016 by · Leave a Comment 

El Senado de California aprobó la semana pasada una norma que abre una vía para que los inmigrantes indocumentados puedan comprar planes de salud en el mercado estatal, Covered California.

La SB10, que ya había sido aprobada por la Asamblea estatal y queda ahora a expensas de la firma o el veto del gobernador, permite que una persona indocumentada que resida en California pueda comprar seguros de salud en el mercado promovido por la reforma sanitaria emprendida por el presidente Barack Obama.

“Es inmoral discriminar contra alguien basándose en donde nació”, afirmó el jueves pasado el senador Ricardo Lara, autor de la norma.

Aunque los indocumentados pueden comprar en la actualidad seguros de salud en los mercados privados, los defensores de la medida argumentan que ahora este grupo puede acceder al mercado de salud estatal, y además facilita el acceso de las familias “de estatus mixto”, donde hay ciudadanos o residentes legales y miembros indocumentados.

“Más allá del simbolismo importante de inclusión, esta propuesta ofrecerá un beneficio práctico para muchas familias de California con un estatus de inmigración mixto, que podrán comprar cobertura conjuntamente aún si en la misma familia hay miembros que son elegibles para los subsidios y otros que no”, enfatizó Anthony Wright, director ejecutivo de Health Access California.

Cynthia Buiza, directora ejecutiva del Centro de Políticas de Inmigración de California consideró los beneficios de la medida para las familias inmigrantes.

“Con uno de cada seis niños en California creciendo con al menos un padre indocumentado, será importante para todos los miembros de la familia tener un portal para buscar opciones de cobertura en el mercado de nuestro estado”, dijo Buiza.
Varias organizaciones como NumbersUSA, que se opone a la inmigración indocumentada, se han manifestado en contra de la medida argumentando que es innecesaria y busca otorgar un beneficio legal a los indocumentados.
Además de la firma del gobernador, para que la exención se aplique hace falta que el gobierno federal autorice a los indocumentados a comprar los seguros de salud en estos mercados.

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.

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