(The full newsletter is available HERE.)
A NOTE FROM TONI
On March 23, 2010, President Obama signed the Affordable Care Act (ACA) into law. The ACA will protect consumers, make health coverage more affordable, and expand access so that Americans can receive the healthcare they need. Starting January, 2014, most people will be required to have health insurance or pay a penalty. In 2009, 23.2% of all adults in San Diego County, and 8.2% of children, were not covered by any health insurance. That was a total of 615,116 of our neighbors who could not receive care when they needed it and were just one serious accident or illness away from bankruptcy or even homelessness. Implementation of the ACA began in 2010, with the extension to age 26 of children's eligibility to be on their parents' health plan and with the prohibition against denying coverage to people with pre-existing health conditions. Now, 21,160 Californians have health insurance who otherwise would have been shut out due to a pre-existing condition.
California was the first state in the nation to enact legislation to begin the implementation of the ACA. It created Covered California, a state-run marketplace where Californians can compare health insurance plans and rates and buy private health coverage that cannot be denied or canceled if they are sick. When it is fully implemented, the ACA will also eliminate annual and lifetime limits on the amount of benefits a person can receive and will lower out-of-pocket costs for individuals and families.
Covered California has already begun the process of setting up the system for our state with last month's selection of private health plans to provide insurance and community organizations to help inform Californians about how the ACA works. They also have a website that can answer almost every question you may have. Visit them at http://www.coveredca.com/ or for information call 888-975-1142.
How Does The ACA Work?
Legal residents of California without access to affordable health insurance through their employer or another government program will be eligible to purchase health coverage through Covered California. Small employers with 50 or fewer full-time equivalent employees also will be able to purchase insurance through Covered California.
If you already have health benefits through your job, you do not need to make a change. The ACA may even improve your workplace insurance by requiring that 80% of all premiums be spent on health services and improving care, rather than on overhead costs. Any future rate increases will have to be justified to an independent review panel. This will keep your costs, and your employer's costs, down.
I recently joined the staff of Covered California and San Diego healthcare leaders and stakeholders for a town hall forum about implementation of the Affordable Care Act.
Insurance through Covered California will begin January 1, 2014. Enrollment opens on October 1, 2013 and continues through March, 2014. If you miss the open enrollment period, you will have to wait until the next open enrollment period in the Fall of 2014 unless you have a life-changing event such as the loss of a job or birth of a child.
Private health coverage through Covered California will be available at a variety of levels. The cost will depend upon how much coverage you choose to purchase and whether you are eligible for financial assistance. See the article below for more detail.
The biggest benefit of participating in this new health insurance system will be good health and peace of mind. But, there are also penalties for those who choose not to participate. These penalties will be based upon your income and will be paid with your taxes. They will be phased in over three years.
Beginning in 2014, the maximum penalty for an individual will be $95. By 2016, the penalty could be as high as $695. Businesses with more than 50 employees are also subject to a penalty if they do not offer health insurance to their employees and their dependents.
Some people will be exempt from these penalties, including:
- Those who would have to pay more than 8% of their income for health insurance;
- People whose income is so low they do not have to file income tax returns;
- People who qualify for religious exemptions;
- Undocumented immigrants, who are not eligible for insurance from Covered California;
- People who are incarcerated; and
- Members of Native American tribes.
Affordable, guaranteed, high quality health insurance is on its way for every Californian. In the coming months, I will continue to provide updates and information about this important undertaking through this newsletter and on my Assembly website at http://asmdc.org/members/a78/.
The initial open enrollment period for new insurance under the ACA will run from October 1, 2013 through March 30, 2014. If you are currently covered by insurance provided through your employer, no action is needed. If you miss the enrollment window, you will then have to wait until October 2014 to enroll, unless you have experienced a life-changing event like the loss of a job or birth of a child.
Who Will Cover Me? Covered California has selected six local private health plans from which San Diegans will be able to purchase their health insurance. These are Anthem, Blue Shield, Health Net, Kaiser Permanente, Molina Healthcare and SHARP Health Plan. Selected plans must meet state standards for having an adequate network of doctors, hospitals and other providers. Contracts with these health plans include provisions to promote improvements in care coordination, reduce health care disparities and foster prevention. They are also required to offer essential levels of coverage and consumer protections.
Essential coverage will include:
- Ambulatory patient services;
- Emergency services;
- Maternity and newborn care;
- Mental health and substance use disorder services, including behavioral health treatment;
- Prescription drugs;
- Rehabilitative services and devices;
- Laboratory services;
- Preventive and wellness services and chronic disease management; and
- Pediatric services, including dental and vision care.
A special marketplace in which small businesses with fewer than 50 employees can purchase health coverage for their employees will be established in the near future.
How Much Will It Cost? There will be four basic levels of coverage available to consumers: Platinum, Gold, Silver and Bronze, with Platinum being the broadest, but also the most expensive. This ranking system will make it easier to compare different health plans. The choice will between a plan that costs more now, but provides services at lower cost later, or a plan that is less expensive now, but under which services would cost more. In addition, a "catastrophic" plan will be available to those who are under 30 years old or can provide a certification that they are without affordable coverage or are experiencing hardship. On the whole, premiums will be similar or less expensive than those for current comparable plans, with expanded benefits in many cases. Specifics will depend on your individual situation. For an estimate of your costs, you can use the following online calculator. Rates for small businesses will be announced in late June.
Subsidies Available: Many Californians will be eligible for subsidies to greatly reduce the cost of their new insurance. These include tax credits for individuals and families who meet certain income requirements and do not have access to affordable or comprehensive health insurance coverage through their employer. An individual making up to $44,680 and a family of four earning up to $92,200 may be eligible for a tax credit. For example, a family of four with an income of $88,800 would see their monthly premium reduced from just over $1,000 per month to $700 per month due to tax credits. The same family with an income of $33,900 would pay only $100 per month. Tax credits are available only through Covered California and are paid directly to your health plan. You pay only the reduced cost. Tax credits will also be available to small businesses with fewer than 50 employees.
Other subsidies to help make health coverage affordable include cost-sharing subsidies, which reduce co-payments and other out-of-pocket costs, and expanded Medi-Cal benefits. Starting in 2014, the State of California will expand the federal Medicaid program, called Medi-Cal in California, to cover people under age 65, including people with disabilities, with an income of less than $15,000 for a single individual and $31,180 for a family of four. The coverage is free for those who qualify.
How Do I Do It? You can shop online, over the phone or in person. Beginning later this year, trained "assistors" will be available to help you compare plans and find the plan that is best for you. They can also help you determine if you are eligible for any of the subsidies. Covered California will offer assistance in numerous languages to help you enroll and to provide information about assistance programs and a health plan that best meets your needs.
May 31st was the deadline for all bills to be passed by the house of the legislature in which they were introduced, which in the case of my bills means they had to be passed by the Assembly. I am grateful to my colleagues in the Assembly for forwarding a number of my bills to the State Senate. The Senate will now consider these proposals, first in committees and then in the full Senate, before the September 13th deadline for sending them to the Governor. The Governor will then have until October 13th to sign or veto the measures.
My bills address a wide range of issues. Highlights include:
AB 976 - Enforcement of Violations of the California Coastal Act: Provides the Coastal Commission with the authority to impose fines upon violators of the California Coastal Act. These violations threaten beach access, wildlife, and fragile coastal ecosystems.
AB 425 - Copper-Based Boat Hull Paint: My other environmental protection bill this year directs the California Department of Pesticide Regulation (DPR) to evaluate and make recommendations regarding whether to make copper-based anti-fouling boat hull paint subject to increased state oversight and how best to mitigate its potentially harmful effects. This paint protects hulls, but can be dangerous to aquatic life.
AB 154 - Improving Early Abortion Access: Expands the categories of health practitioners permitted to perform early abortions to include nurse practitioners, nurse midwives, and physicians' assistants. Over half of California's counties have no abortion provider and this bill will help women avoid excessive delays or traveling long distances in order to access this healthcare service.
AB 1121 - Legal Name Changes and the Transgender Community: Current law requires transgender people seeking to change their name or gender on official documents to go to court and publish a notice in the newspaper. This is expensive and lengthy. My bill provides a simple, alternative process.
AB 1229 - Inclusionary Zoning and AB 952 - Special Needs Housing: These two bills improve our system of providing affordable housing. AB 1229 re-affirms that local governments that have existing inclusionary zoning ordinances may still require developers to include affordable housing without fear of litigation. AB 952 makes more housing tax credits available to developers who build projects that include special needs populations. On the Senate side of the legislature, SB 391 by Senator DeSaulnier, of which I am a principle co-author, will provide for a permanent source of funding for affordable housing through real estate transactions. SB 391 was passed by the Senate and now heads to the Assembly.
ACR 36 - Veterans Treatment Courts and AB 163 - Sales Tax Exemption Veteran Services: These two bills support our veterans. ACR 36 encourages every county in California to implement the Veterans Court program, like the one we have here in San Diego. Vets Court helps those who served make a successful transition to civilian life despite legal and other challenges. This measure has already been passed by both the Assembly and the Senate and is enacted. AB 163 extends the sales tax exemption for thrift shops on military bases. Proceeds from these shops help veterans and active duty military families with emergency cash and services.
AB 662 - Infrastructure Financing Districts: A follow-up to the dissolution of redevelopment agencies last year, this bill streamlines and clarifies the dissolution process to maximize a local government's ability to pursue valuable projects and to predict finances.
Click here to obtain more information about my bills.