Reality Check

Reality Check

Vets the truthfulness of claims and measures the efficacy of public policy

Reality Check: Will Covered California be Ready by Oct. 1?

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    NEWSLETTERS

    In this edition of Reality Check, Sam Brock takes a look into how state employees and volunteers are preparing for the Affordable Care Act. (Published Wednesday, Aug 14, 2013)

    Ready or not, Obamacare is coming.

    The state’s health care insurance exchange, Covered California, rolls open its welcome mat on October 1, paving the way for some 5.3 million uninsured or under insured Californians to access affordable health care.

    And in a state that presents itself as a leader in setting national policy, you can bet the eyes of the nation will be upon us.

    The question on the tip of the tongue for many, however, is a practical one: Is California prepared?

    “The very question you’re asking me is the very question that I was wondering myself,” said Nadia Hussain, a volunteer training to become a certified educator.

    Hussain and roughly 2,000 other people throughout the state have signed up to serve as intermediaries between the uninsured community and the state, helping to educate affected communities and jump start the process of enrollment.

    (The actual enrollment officials are a separate group…they haven’t started training yet but will also need to be trained by Oct. 1).

    Despite describing the 300-page training curriculum as the “thickest” manual she’s ever had, Hussain doesn’t seem to be discouraged by the task before her.

    “To think that I could be some kind of bridge to really help bring health care to the community, and make the community healthier was really what inspired me to take this on,” Hussain said.

    Other members of the training class NBC Bay Area attended also had ties to area groups or advocacy organizations, like Hussain, who’s an employee for Community Health for Asian Americans.

    Xochitl Castaneda, the director of the Health Initiative of the Americas at UC Berkeley, made it clear that conveying a message of access and inclusion to previously disadvantaged communities is the primary reason for her involvement.

    When asked how she’s metabolizing all that new information, Castaneda responded, “the training is fundamental, but once you get all the ingredients, the thing is pass the message in a simple, cultural, linguistically-appropriate manner.”

    Outreach to under served communities is one thing, but command of the information is quite another.

    Trainees are given 20 hours of formal instruction, and some follow-up calls and webinars, to master the details of California’s exchange.

    “I feel pretty well-equipped to answer the questions, but sooner or later they are going to stump you with something,” said Bill Mishler, a former journalist and educator in training.

    Mishler said he’s participating in Covered California because it’s in the public interest, and described the Affordable Care Act and its impact on California as “a lot simpler than I thought it would be.”

    Perhaps he’s right.

    The essence of the exchange can be distilled into one basic principle, that every person regardless of income bracket should be able to purchase affordable health care.

    “The definition of affordable health care is a cost of 9.5 percent of household income or less,” said Susan Padua, the training instructor. “The key is Covered California will be reviewing all of the plans under their umbrella and ensuring that they remain affordable, otherwise it defeats the purpose.”

    Ladua said that so far the state has endorsed 13 plans for its exchange, many of them provided by major insurance companies like Anthem Blue Cross of California, Blue Shield of California and Kaiser Permanente.

    Advocates of the ACA say prices for these plans will remain markedly lower than the open market because they must compete against one another in a single, regulated pool.

    “If you’re purchasing it on the individual market right now, you do not have access to group rates,” said Ladua. “What this program is going to do is allow individuals to band together to create a group so that the insurance becomes more affordable for all of us.”

    Once you’ve selected a plan, you can choose from four different tiers: Platinum, Gold, Silver and Bronze.
    They all cover the same benefits but vary in their payment structure.

    In the Platinum plan, for example, the consumer pays a higher premium, but the insurer covers a larger percentage of the medical costs. The Bronze plan, on the other hand, function in the reverse manner- customers pay lower premiums, but shell out higher medical costs.

    The remaining key piece of information for plan selection is eligibility for subsidies.

    Ladua wants to be clear: California residents do not have to be eligible for subsidies to purchase insurance on the exchange.

    The entire point of the exchange, she says, is to offer affordable health care to those who are either uninsured or pay more than 9.5 percent of their household income in health care premiums.

    To be eligible for premium assistance or cost-sharing (a fancy way of saying the government helps pay for essential health benefits), you must be earning above 138 percent of the federal poverty line but below 400 percent.

    Anyone earning 138 percent or below is eligible for Medi-Cal, while those earning more than 400 percent cannot receive assistance.

    For perspective, according to Families USA, an income level of 400 percent above the poverty line is roughly $46,000 for one person, and $94,000 for a family of four.

    These are the basic details of Covered California.

    Volunteers like Hussain say the rest can be resolved over time, once the appropriate populations are reached and Californians are aware of their options.

    “Language is not enough,” said Hussain, referring to one of the many obstacles educators face. “Again, many of [the uninsured] don’t even have basic, systemic knowledge like how to call a doctor or something that many of us might take for granted.”

    She said the best maxim to take away from her efforts is something that she heard at a local Congressional meeting. “This is a marathon,” said Hussain, “it’s not a race.”