Ed’s note: This is part 1 of a 2-part series looking at some of the misconceptions and confusions about changes that are taking place in California health care under the Patient Protection and Affordable Care Act, or as it’s commonly known, Obamacare. Part 2 will run tomorrow, looking more specifically at Medi-Cal.
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Whether it’s referred to as Obamacare, the Affordable Care Act or its official name, the Patient Protection and Affordable Care Act, President Barack Obama’s health care initiative affects all Californians, said Covered California spokesman James Scullary.
“Whether or not you are insured through your work or not, they’re are provisions in the Affordable Care Act that protect all of us,” he said.
Open enrollment ends on Monday, Dec. 23 for ACA coverage starting Jan. 1, 2014, and doctors and administrators at local private practices have already started to see the results.
Obama’s hotly debated health care bill was signed into law in 2010, and the health coverage marketplace opened for enrollment in October of this year.
The goal of the ACA is to make health insurance affordable for low-income and lower middle class citizens, according to the Covered California website.
About 25,000 individuals in Los Angeles County enrolled in Covered California health insurance plans, about 23 percent of the 109,296 who have enrolled statewide during the same period.
California is one of 17 states that have created their own health benefits exchange through CoveredCA.com.
Some believe it will be a boon to patients and providers, some are working to address patient confusion over the new law and others doubt the law’s ability to truly help Los Angeles County’s uninsured population.
Coverage for the Middle Class
Currently, between 5-10 percent of her patients are uninsured or pay with cash.
“(The ACA) is taking our middle class and giving them insurance,” she said.
Those who do not receive health insurance through their employer but make too much to qualify for Medicaid or Medi-Cal can receive a government subsidy towards buying health insurance through the government marketplace, Scullary said.
“Maybe health care coverage was not accessible before because you could not afford it,” he said.
Feldman said insurance subsidies would be available primarily to patients in the $35,000-$125,000 income bracket.
And families making less than $32,499 are now eligible for Medi-Cal under the ACA.
Some Santa Clarita residents already have better access to services, especially those who might have lost their employee benefits during the recession, said Cheryl Laymon, CEO of Samuel Dixon Family Health Centers with locations in Newhall, Canyon Country and Val Verde.
“I think there are people who have lost jobs or employers have pulled back on benefits,” Laymon said.
While insurance under the ACA is supposed to be more affordable, employers are seeing health care costs go up, according to the Covering Health Care website, because the ACA requires that insurance companies cover patients with pre-existing conditions, the cost of which must be borne by all customers on the plan.
Contrary to the ACA’s stated goal, Covering Health Care also suggested that costs could go up for individuals.
“Recently, Covered California released estimated 2014 premium costs,” the site said. “An article in Forbes determined that the average cost of individual health insurance in California will likely increase by 64 to 146 percent.”
Problems with the Affordable Care Act
Local physicians readily acknowledge that the law isn’t perfect.
Feldman worried that by the second year there wouldn’t be enough health care providers for the number of patients and expressed disappointment that Medi-Cal rate increases weren’t trickling down to private practices like hers.
“The issue with the ACA has been in the execution, not in the idea itself,” she said.
Laymon was confident that in spite of the federal government’s goal to insure all Americans, there would still be a need for nonprofit centers like Samuel Dixon.
“We know that in L.A. County, uninsured really aren’t going to go away,” she said.
More than half of Samuel Dixon’s patients are uninsured, and “The number of uninsured for us hasn’t gone down, but we’re seeing a lot more new patients,” Laymon said.
Some of those patients are newly eligible for Medi-Cal.
“We’re seeing people who hadn’t accessed health care before, people who had coverage and don’t, or people who didn’t qualify for Medi-Cal, but now do,” Laymon said. “It’s better to have some form of insurance than none.”
In the Santa Clarita Valley, specifically, as opposed to the greater Los Angeles County, Michele Jenkins of The Doctor’s Office suggest that the change might be minimal, because most residents already have insurance.
“Patients out in the Santa Clarita Valley, in general, have fairly good insurance plans,” she said.
The Doctor’s Office does not accept Medi-Cal, so Jenkins said that most of the issue she sees have to do with patients not understanding how the ACA applies to their care.
Under the ACA, everyone is entitled to one free well check per year.
The caveat is that no other health issues may be discussed during the appointment, or insurance companies can charge for an office visit.
For example, HealthCare.gov states that the free checkups women are allowed once a year “include a full checkup, separate from any other visit for sickness or injury.”
“If there’s any discussion of any health issues… it moves across the line,” Jenkins said. “It’s not considered a well exam; it’s called a sick exam.”
She said that the misunderstanding has resulted in many phone calls from patients once they get their insurance bill.
“There’s a lot of confusion,” Jenkins said.
“It’s important for people to really read the provisions and understand them.”
Scullary wanted to clarify what he believed to be another common misconception that coverage under the ACA is government-run.
“There’s a stigma out there that this is government-run insurance,” he said. “It’s not.”
Instead, HealthCare.gov describes itself as a marketplace for private insurane companies.
“It’s a private insurance company that’s handling your case and insures you. It’s not government-run insurance,” Scullary said.
But as the ACA doesn’t come into effect until the beginning of next year, many of the results won’t be clear for another six months, Feldman said.
When asked what the ACA would mean for the future of health care in the Santa Clarita Valley, Jenkins summed up the sentiment well: “It will be interesting to see. I can’t really say. I don’t think it’s really certain.”
Stay tuned for upcoming coverage on Medi-Cal changes under the Affordable Care Act.
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Source: Santa Clarita News