 Thank you for tuning in. You're watching In The Studio. I'm your host, Lynn Weaver. The program is brought to you by Davis Media Access and is broadcast on Davis Community Television, that's Comcast Channel 15 and AT&T U-Verse, Menu 99. We're also online at dctv.davismedia.org. Today's topic is the Affordable Care Act, also known as Obamacare. My guest will help us to understand this very important piece of health legislation, what it is and how it's currently being implemented in California. I have here with me Ann Gonzalez, the Public Information Officer from Calvert, California, and welcome. And thank you so much for joining the show tonight. It's a pleasure being here, Lynn. That's great. Thanks for having me. I know you're very busy and so we're particularly happy that you can make it and the honor show tonight. Let's start with a very, very basic question. What is Obamacare? So Obamacare is the actual name of the law is the 2010 Patient Protection and Affordable Care Act. And it is sometimes nicknamed Obamacare because it was Obama's vision and his very great desire to have this piece of legislation pass and become a law. And Cover California is the state's implementation of the Affordable Care Act. I see. Yes. And now who are the people you have a website and we're going to take a peek at this website in a moment, but who are the people enrolling coming to your website to enroll? Well, we this is going to be a long term multi-year shift in how insurance companies or how excuse me, healthcare providers and plans do business and how consumers can get healthcare coverage. So there are many things about the law that you know that we have adopted adapted to our state. We are one of 17 states in the nation who chose to set up and operate an insurance marketplace called an exchange. The exchange, the famous exchange. Correct. Correct. And then the remainder of the states are you know having the federal government oversee their exchange. And so our website is www.covered.ca, excuse me, www.coveredca.com. No, I'm calm. Sorry. Yeah, that's okay. So one thing, you know, it is a very complex type of legislation. And one thing that people wonder about Covered California, does it partner with Medi-Cal and Medicare? So it does. It actually, our partner is in our effort to set up the exchange is the Department of Healthcare Services, the State Department of Healthcare Services, which manages Medi-Cal in our state. And so we are not affiliated with Medicare, but we are affiliated with Medi-Cal, which is offers low income, excuse me, low cost and no cost insurance coverage for low income people, depending on their income. That's correct, it's based on their income. Now, what would you say are the key advantages of Obamacare, as opposed to what we had before? Sure. And so the the law went into effect in 2010. And since then, some consumer protections have already been put into place because of that. That would include being able to keep your child on your insurance plan, or yes, on your health plan through the age of 26, which was not possible before. It expanded that coverage period for children to stay on your plan. Also, there were some provisions for children with pre-existing conditions. You can get better coverage for them. And there was let's see, the guaranteed issue so that you cannot be denied coverage or dropped, have your coverage dropped because of a pre-existing condition. And pre-existing condition being if you have a chronic disease or some type of catastrophic serious illness, all of a sudden your insurance plan prior to Obamacare could very easily drop you. Is that correct? And it does not have to be anything too catastrophic. For instance, some individuals who were trying to get insurance in the individual market the way it is now, they were getting turned down or dropped for hypertension, diabetes, any type of or they were paying exorbitant prices for coverage. Or they were being surprised when they got to the point of delivery, either the emergency room or the doctor's office to find out that their plan didn't cover everything that they thought that they were getting coverage for. So those were the types of problems that people were having with their insurance plans so that that's where this outcry and mandate came for the Affordable Care Act. I see. And since we've talked a little bit about there are many other advantages of course, but we can't really cover them all here during this interview. But now that we've covered some of the key advantages, can you think of a drawbacks of this plan? You know that there is, it's a very controversial piece of legislation, as we all know, and especially the Republican Party is very much against Obamacare. And so what you're very experienced with with the insurance companies and how they operate, how would you say, what would you say are the drawbacks as as compared to what we had before? There is never a piece of legislation that goes through Congress and pleases everybody on both sides of the aisle, I would say. Very true, yes. However, this will be monumental in what it does for especially uninsured people or underinsured people in our country. Yes. We don't really get into the politics of putting this plan into place. Our mission is to implement the law as it was, you know, as it was passed. Yes. And keeping in mind that it has survived more than 40 challenges, I think, in the in Congress since its passage and has also been upheld by the Supreme Court. So we're pretty clear on what our job is now. Yes. It's been tested, it's been challenged, and it is now here and we're in the process of putting it into place. So I am not, we try not to get into the politics of that. Very wise. We just know that there are, every day there are people who call us, write us on Facebook, who contact us and our service center representatives are hearing from many people who have been waiting for this day and in many ways our country has been waiting for this legislation for a hundred years. That is true. So what type of, what is the range of population that you see coming to your website or calling you, making inquiries? Yes. Our target audience in California is 5.3 million people. This represents the number of people who are either uninsured or underinsured, for instance. 5 million? Yes, 5.3 million. That's a huge amount, yes. Correct. Correct. And the, I think the total number of uninsured people is actually 7 million, but some of those are going to be moving into, the Affordable Care Act also acted to expand medical coverage. That's correct. So some of those will be moving into our new Medi-Cal. Which is extended and California is taking subsidies from the federal government? Correct. That will be managed through the Department of Healthcare Services. I understand. And when a person enrolls in our, in Covered California, it is a single application, very streamlined. So when they fill out the application and it, we find that they are, can qualify for Medi-Cal, then we explain to them that they can, they can go into the Medi-Cal program for low cost or no cost coverage. And then Medi-Cal would take it from there and help them sign up for those expanded benefits under that. Do you, perhaps you don't have off the top of your head, but what, what would be the requirement for being eligible to Medi-Cal? Like, sure, the, the salary I suppose, the income. Yeah. Sure. It's on a sliding scale and it is, and I'm sorry, I, I can't, I don't want to quote the wrong income. No, no, no, no. But it is. And it's okay if you don't have it. It is actually from 138% of the federal poverty level and below. And then there are different, it also depends on how many people you have in your household. Of course, if you're a family of four. Or yes. But between 139% of the federal poverty level and 400% of the federal poverty level, there are bans, you know, there are different, different incomes, sliding scale incomes. Right. And in that area, you, you can, you qualify for help, either cost sharing subsidies that help you with your out of pocket costs, and also premium assistance, which can, which you can use towards your premiums to buy health care. And it will make it more affordable for your household. I see. Well, that's, that's very interesting. Now, let's display your website, the homepage, so that we get a feel of where, so here it is. Yes. And let's suppose that I'm looking to shop for an insurance policy. Sure. So how would I go about it there? Well, I would suggest that your first stop be, we have some tabs across the top. Yes. That explain some of the, actually, some of the points that we've been making tonight, which is the, some of the coverage basics. It will, it has some of the resources. It has a health plan booklet and health plan summary. And we'll explain all of the income levels. Oh, I see. And it will explain all of this, the essential health benefits that each plan is required to have. And if you go to the, to the middle, to the lower middle part of the page, you'll find a shop and compare tool. I see. Yes. And that would be a good starting point because that is, you do not have to enter any personal information. You enter a little bit of information. You would enter your age, the number of people in your household, and your zip code, and your income. I see. And it will call up for you a list of different plans that are offered in your region. There are 19 different rating regions. And then it would tell you what you might qualify for, either a MediCal, cost sharing subsidies, or premium assistance. Well, that's very interesting. And I am happy to say that yesterday I went onto your website and I tried to enroll and compared health plans. And I'm very happy to say that unlike the federal health, Obamacare website, your website, California cover website works beautifully. I had no trouble, no glitches, and no looping. So that's very encouraging. We've been working very, very hard, very diligently to use consumer feedback and service center feedback. Yes, testing. You did a lot of testing with consumers. And then we have been taking our enrollment function down at certain periods, very low traffic times of the day, like 10 at night until 3 in the morning. And then we have been taking it down on Sundays because our service center is not open then. And we have been increasing bandwidth. We've been increasing page loading speeds and generally trying to make it more intuitive and working on the navigation paths and making it. That's terrific. So there should be no stumbling blocks now for people going from one end to the other on enrollment. Yes. Yes. And it's a great resource. Even if you're not interested in enrolling right away or you have your own health insurance already, it's a very informative website. And I do just want to make sure that you understand that the shop and compare tool that I showed you is just that. It will give you an estimate. And then there is a tab on the front page that says start here. And that will actually take you to the enrollment portal. I see. That's very, it's a good distinction. Yes. One thing that I'm not clear about is that suppose I want some insurance and I go to your website, can I enroll in a plan without being contacted by an agent? Oh, absolutely. Are one of the, you know, one of the centers of this, the centerpieces of the ACA is that we're using online tools. Yes. So that somebody can do it themselves. That we have full functionality for somebody to complete self-service online enrollment. Very good. However, if you need help, we have hundreds of service center representatives at three different service centers throughout California. And growing every day, we're training and adding to those as our peak enrollment will probably be in November, December areas. Yes. We also have certified enrollment counselors, hundreds of those being trained and certified to give one-on-one in-person assistance. So you could go to a, we do have licensed agents that are certified to sell Cover California products. Yes. But there are many different options for you to go through the process. That's very interesting. And the population is going to be enormous. So the projection is that more than 3 million people will be looking for insurance with the Affordable Care Act. I don't know if you've listened, if you've watched or listened to the news today, but the media was raging about the, this famous quote, and they kept quoting President Obama and what he's been saying for the last four years, namely, if you have a health fair plan, if you are insured and you like your plan, I don't sound like him, but anyway, I'm paraphrasing, you can keep it, period. And now it turns out that that's not, that's not always the case, that very often the plan that you had and you liked does no longer exist or is no longer offered by the insurance company under the Obamacare. Correct. Is that correct? And why is that? Well, what happened is that there was, you know, quite a bit of misinformation floating around at the time that the President was starting his education, his education process. Yes. And for them, I mean, in general, he is correct. If you have, for instance, in California, 90% of people that are insured get their insurance through their employers. Correct. And so that statement was made in a general broad sense that most people, if they have insurance, they are really not going to have to wonder about this or change. They're not going to have to change if they have employer sponsored coverage. Yes. So in California, but under the Affordable Care Act, because of these new consumer protections in the individual market, now, keeping in mind that this market has historically been the most expensive, it has been the most volatile, it's been the least secure for people is offered the leanest benefits. So these are what we call Swiss cheese plans. They have so many holes in them. Yes. And people are being dropped with no, with for preexisting or conditions or because they get sick, they are being shuffled around to other plans. They are at the mercy of the market in terms of their premiums can be increased. And of course, we have all seen across the board have seen healthcare costs rise over the last couple of decades. Yes. That 10 to 12%. Yes. So those people who are on plans that are these bare bones plans Swiss cheese, Swiss cheese plans. Yes. They what happened is they will need to, if they're not being grandfathered in, they need to bring their standards up or or move these people to other plans. So it's not really that and some in some cases, these people in fact in California, where we estimate that maybe 900,000 people will have to transition to other plans, 310,000 of those or about a third of those will be able to go to the exchange and qualify for subsidies that will either keep their premiums around the same as what they're paying or could lower their premiums. So it is a mixed bag of what's happening in terms of costs, but the important thing is all of these people will get the same benefits, the same safety net and the same security of these 10 essential health benefits that were not there before. Well, that's very reassuring. I also read that some of the insurance plans prior to the protection, the consumer protection act or affordable care act were unfair in some respect. For example, I read that women would pay more. That mammograms, for example, were not covered. Now the plans under Obamacare mammograms have to be covered and some other preventive medicine testing. Of course. Yes. There is a list of 10 essential health benefits that are outlined in the Affordable Care Act and they are on our website, but they do include maternity care, they include preventive care. Some of these plans did not even have preventive care, so you would still pay for your annual exam. We also require prescription coverage. That's right, the prescription coverage which apparently drugs are exorbitantly expensive in many cases. Now, what I wanted to ask, a lot of people are called, it's not really related to Obamacare, well it is related, but it's sort of going a little further. There are people who say that because so many more people will be insured and will be eligible for a lot more care, that California is going to have a huge shortage of doctors, especially primary care physicians. Are you aware of this and how is the state? I know it's not really your field, but how do you think the state is coping with this? Actually it's a very important issue to cover California because expanding healthcare coverage is one thing, but we also have to make sure that people can get access to the care that they have found out before. That's right, especially in rural areas for example in California. Quite a bit of time was spent. We solicited bids because we are an active purchaser and that means that we negotiate directly with the health plans. Part of that negotiation process included, look we're interested in having good premiums, we want to make this affordable, but we also need to have a balance of access to care. When these plans were submitting their bids, they had to prove that they had adequate networks, that they were able to serve the amount of people that would be coming, and they also had to submit emergency plans that would automatically kick in if we find that there are bottlenecks anywhere in the network. But you have to understand that for some people who have never had coverage, this is a brand new world, they're going to have coverage. I can't imagine not having the the reassurance of having health care. Well this is so interesting and I'm afraid that we are running out of time and so we need to leave it there, but I just want to remind our viewers that please go to the website coveredca.com and if you have any questions I'm sure that Ann Gonzalez can be reached at some point somewhere and Ann I just wanted to thank you so very much for being on our show and for giving us so much information about the Affordable Care Act and Obamacare as everybody knows it. I appreciate the opportunity to share some some information about it. Well thank you so much and of course thank you all of you for watching From Home. You've been watching In the Studio. I'm your host Lynn Weaver. Now if you want to see this program again you can go to our website at dctv.davismedia.org and perhaps while you're there you can maybe check some of our other interesting programs and enjoy them as well. Again thank you and see you next time.