 Once again, thank you so much for being here today. We are very fortunate to have a COPS community organized for public service. Our presenter is Laura Grill. She is with the Our Lady of Guadalupe Catholic Church in El Otis. We also have Tony de Osada here with, and they have been really helpful in going out in the community and doing these presentations. So let's have a round of applause for her. I want to congratulate you too on shaking yourselves out of bed on a Saturday morning. And I know it's out of love that you're here because some of you are coming with questions for yourself, but also questions for your family and for your friends. And today we're also going to celebrate some sweet fruit because I understand that we have navigators and CACs with us today who have trained and invested a lot of time and energy in order to be able to answer your questions. So now they'll have that opportunity before the day is over to visit with you. As Irma said, my name is Laura Brill. I'm a parishioner at Our Lady of Guadalupe in El Otis. And I'm also a member of an organization called COPS Metro. COPS Metro is a broad based institution with 33 dues paying member institutions. This organization, rather, it combines faith leaders, educators, school people. And we work effectively in our communications, not only amongst ourselves, but with elected officials and with business community leaders. So our presentation today is one that we want to continue to improve on. And see how we can serve our greater community area. One thing about COPS is that it fosters a relational culture. So we're not just pushing out information to you. We want to have a conversation with you. We want to hear your story and the question that you have, what your experiences are, and have that loop. So that in doing so, we can consider together how we can improve the situation. How can we advocate for positive change? The big elephant in the room is that the website, the healthcare.gov, is not where we thought that it would be at this time. And so it's going to take a lot of communication on an ongoing basis so that we can catch up to the point where that is working, as well as the navigators and the CACs and the own lines and the other ways. We'll have to continue that conversation, keep communicating to our community, what's working, what's not working, what needs to change. So in this session, this is a little bit of an introduction to the rest of the morning. We want to give you a background on the state of healthcare, just a very light overview. We want to talk about the health insurance marketplace, which at one time was known as the exchange. We want to talk about who benefits, how it works. And it wouldn't be a COPS Metro presentation if we didn't give you a little bit of an opportunity to discuss together what your reactions are and what our next step should be. So regarding the background, according to the Center for Public Policy Priorities, which is a nonpartisan group, there are 6.1 million uninsured Texans, a million of which are children. And one of our leaders included that bullet, Texas leads the nation. Everything's big in Texas, this is a big problem. Okay, we don't want to be number one in this. In our own Bear County, we have 390,000 uninsured, about a quarter of our population. So what is the health insurance marketplace and how does it help us with that gigantic problem? In 2010, the Patient Protection Affordable Care Act created the marketplace, or also known as exchange. And the idea is that it would provide a one stop shop to compare plans. So as opposed to visiting Humana, and then you visit Etna, and then you visit Blue Cross, Blue Shield, it'd be a way for you to dive into one stop on the internet or on the phone or with your navigator, with a broker, and find what your options are. Also, the Affordable Care Act provides tax subsidies to make insurance more affordable. So a subsidy is just money that the government puts in to make a product more affordable, of course, the government gets this money from us. But it's a way of making health insurance coverage affordable for the people we've heard about on that previous slide. So what are the benefits of the insurance that is provided under the health insurance marketplace? Preventive care is covered 100%. And we know that that's one of the things that drive health care costs up, is that we wait until it's an emergency or a crisis before we get attention. Be cheaper to do it with preventive care. Maternity and newborn care, that's our most vulnerable population. Prescription drugs, we don't want people choosing between food and their medicines. Mental health and substance use disorder services. That's an area I think we all know in our community that many struggle. It's not, they have healthcare issues, but it's come because they weren't having their mental health needs addressed. Also, these kinds of plans cover children on their parents plan until age 26. And I'm sure some of you in this room are probably waiting to kick out your 40-year-old. So we know they don't grow up even at 26. It caps out-of-pocket expenses. So what the individual pays versus what the plan pays. So who benefits? This graph has done a lot of information on it. Where you see FPL that stands for federal poverty level. So we've got family annual income, family size across the horizontal axis. So family size of one, an individual. Family size of two, maybe husband and wife, mom and child. The family size under the ACA is you and your dependent. So even if grandma lives in the household, if she's a dependent, she's part of your family as well. So 100% of the federal poverty level, up to 400% of the federal poverty level, is who is going to benefit. So for example, let's say we took a family size of three, maybe single mom and two kids, federal poverty level is $19,530. So that family size that has a combined income of between $19,530 and $78,120 would be eligible for some help with their insurance plan. So what is the status for right now? We're in that enrollment period, October 1 to the end of next March. Now I was just listening to a news report this morning. And the goal, the promise is that by the end of November, that we would have that healthcare.gov site working. But the reality is, insurance is complicated business even for people who've had it for years. And so I think a lot of us are going to seek out the help of navigators and CICs and other people who can guide us through the process. And hopefully through institutions like this, like Central Med, that we trust that can just provide us that chance. Maybe to talk with each other and our neighbors about what's necessary. So we'll be using a lot of different means to get involved, to get enrolled. And we have between October 1 and 331 of next year. Coverage begins January 1. And so do penalties for those who are qualified and eligible to participate but who are not covered or choose not to be covered. So we've got a lot of time between now and the end of March. But it's one of those things where we just have to dig in. And those of you who are here are pioneers. I'm sure you'll be educating your families and your friends about it. That is one thing that penalty is looming. So people are going to have to wait. What is the cost to my family? Can I budget for this health insurance? Or am I going to pay a penalty? And what are the pros and cons of that? It's reported that 110,000 residents in our county may qualify. And you'll notice that's a different number than what we had earlier. There's going to be some people who fall through the cracks just because we didn't in the state of Texas opt to expand Medicaid. But even at that, there's going to be 110,000 who will qualify. Health and Human Services has granted some resources to higher navigators, certified application counselors, and other personnel to help. There are three navigator agencies in Merritt County. They've received some grants right now for that gigantic population. We're looking at about 22 navigators, all right? And different organizations are also training CACs and others. It's a position of great confidence and a great responsibility. These are people that are going to be handling our personal information. And so they need to have that strict privacy understanding. Our governor, too, is looking for even tighter regulations for navigators requiring US citizenship, more training for those people who are going to take that position of such great responsibility. Here are a few details. You may have heard these terms before, bronze, silver, gold, platinum. I mean, it sounds like the Olympics. But a lot of things are keyed off of that silver plan. So the expected actual value of what, during the year, my health costs are going to be, the silver plan would cover 70%. And I, as the insured, or we, as our insured family, would cover 30%. So you can see that we've got those different levels where the plan pays more than the insured family, but it varies. So the most complete coverage is where the plan is actually kicking in 90%. And so you can imagine that those who have the most dire financial situations are going to be helped subsidize so that they just don't have the budget. So that the plan will be kicking in more money. One thing that's helpful for us with COPS Metro is we want to have conversations with you, we don't want to add to the confusion. So it's important that we learn to have that vocabulary of insurance, not that we're going to be doctors and lawyers, but just so that we can understand what we're comparing, because a lot of these words are just flying around. So what is premium? That is the amount you pay for your health insurance coverage. So you might talk about an annual premium, or in this case, maybe a monthly premium. A lot of us budget on a monthly basis, so they're talking about a monthly premium. A deductible would be an amount of money you pay every year before your insurance kicks in. So if I have a $500 deductible, I'm paying out until I reach that $500 deductible. And now the plan starts paying at that percentage rate that we talked about. What is the co-pay? Some of you have experience with that. You go to the doctor, and maybe your co-pay is $25 or $30. So the bill may be $150, but when you come, before they even open the door, they say you're co-paying, okay, $25, okay, come on in. So that's how that works. The lifetime cap would be that cap, the lid, the ceiling, on what over your whole lifetime would be paid. The term out-of-pocket refers to your pocket, okay, the pocket of the insured, the insured family. And other things just to, you know, that you'll hear other terms will be healthcare navigators, application assistors, certified application counselors. You'll hear people say CACs and champions, whoo, champions for coverage. So those are some young people who are being trained in our area. Some of them are being trained for the medical profession who have taken on this role in our community to help share their goal is to help us, not only with the education process, but depending on their certification, also to enroll us. So they can sit down with us one-on-one and we can complete the enrollment process with some of those people. So what determines what the insured, what the family will pay? Each insured pays depending on their age. Okay, you can imagine a younger person versus a much older person. Where do you live? You know, some, you know, communities, you know, life's a little tougher. Family signs, whether or not you smoke, but as we know from what we first heard about Obamacare, about the ACA, one of the great things is that pre-existing conditions will not be considered. So every person, you know, who's been rejected a hundred times, you know, now will have access to health insurance. Who can use the marketplace? Actually, small businesses can also use this to help their employees, families and individuals. Now there are some restrictions, U.S. citizens and legal residents, okay? We must live in the U.S. and we're not incarcerated. Who cannot use the marketplace? Persons who are undocumented residents, the dreamers, DACA, residents with deferred action status, and those who already have insurance under Medicaid, Medicare, that's going to continue. So how is it that the government is subsidizing our participation and our ability to buy health insurance? It's through this system of tax credits. So the tax credit is going to be the way that the government helps you pay. Now one thing that's important to know, not a hundred percent sure, it'll come on a slide later, but I want you to understand that, you know, we talked about annual premiums and monthly premiums. Well, I pay, I file my taxes every year and I pay my taxes every year, and that's when I would get a refund or have to pay, you know, the rest of my taxes. That would also be when I could apply my tax credit. But that doesn't work for everybody. For some of us, it makes more sense to budget on a monthly basis. So there's also a way that we can apply these tax credits, not just when we file our taxes, but every month, okay? So there's a calculation involved. What is, you know, based on my income, my family size, all those other things we've talked about, what is my premium going to be, what is my subsidy, and then the government will give you this tax credit that you can either apply on a monthly basis or when you file your taxes at the end of the year. Now that payment doesn't go to you in a check. It goes to the insurance company to pay for your insurance coverage. Part of the calculus is that people should not be paying more than nine and a half percent of their income in healthcare premiums. So if, you know, we're looking, you know, there's a reasonable amount, a percentage of your income to spend on housing, to spend on food, to spend on insurance. So if, you know, you're looking for your options and you see, well, you know, I would love to have this insurance that I'm eligible for, but it's going to be x amount of my salary. That's what those tax credits, that's what the subsidy has in mind. To make it affordable where it's kind of in that range, no more than nine and a half percent of your income. And as I mentioned, the government sends that money, that portion of your premium, directly to the insurance company so that you just have that remainder. The two main ways that we're going to constantly be talking about getting access to the information and to enroll are the website and the 1-800 number. As I mentioned, you know, all over the United States, you know, this is just in our community that the website is not working. The hope is that by the end of November, that piece is going to be working. So that healthcare.gov, the 1-800 number works now. Now, I understand some people have called and they're getting referred to the website. So if those two things aren't working, here's another option. Besides online and phone, we have in person. Oh, sorry, I was thinking the next slide might have had a list of those people. The terms that we're using for people that help us enroll are navigators, certified application counselors, application assistants, and those champions for coverage. We in COPS Metro, we're just part of the education process, and we're part of that conversation so that we can, you know, keep advocating for making this work for our community. You may be wondering, well, what is it that I'm going to, what kind of information do I need to apply, you're going to need a Social Security member. Employer and income information for those members of your household, your dependents. If some of your family members already have insurance, you're going to need, well, what's the name of that insurance and what's the policy number? And an employer coverage tool is something that your employer will be able to give to you. And it explains what coverage you have and what, you know, the cost and so forth. So what happens if you don't get coverage? Because you can imagine a lot of people are going to throw their hands up in the air, right? So what if I don't? Well, if you don't have coverage as of January 1, you will have to pay a tax penalty. And so in the year 2014, it will be 1% of your income or $95 per person, whichever is higher. And some people are going to opt for that, okay? Now, some people, though, are going to find out what it means to have health insurance coverage and they may convert those penalty payers. But I can understand, you know, budgeting is always hard. The fee for uninsured children is $47.50 a year, but the most a family would pay in penalties would be $285 a year. Then there's an amount for 2015. It goes up, you know, marginally, I think it's like $285. And then 2016, it's $6.95. All right, of information. And again, it's not to make us experts. It's just to help us have this conversation together about, you know, what is this Affordable Care Act? What does it mean for us? What is it going to do for us? And how are we going to educate others in our community? So, Tony, do you have a suggestion for a conversation? Depending on time, what time we have. It's their time to work. I want to make sure we don't take up all the time in the morning if we could. What I think would be best to do first is for each of you to talk to someone next to you about the things you heard, a question, a question that, you know, well, you heard this, but I heard that, so what about that? You know what I mean? Talk to each other for just a minute about a question, about something you heard that you thought, oh, I didn't know that. Did I hear that right? And then after you've talked amongst yourselves, then we can have a conversation, okay? That sound okay? And this will prime the pop a little bit for you to have conversations with the navigators and the CACs. So something that stuck out for you, maybe a question that you have, something that surprised you. So it'd be great if you talked to somebody you've never even met. And we'll just take, like, three minutes to that. Yeah. You're not going to be here all that all morning, three minutes to talk to each other real quick. What did you hear? Okay, we're going to bring it back. And I'm so proud of you, except for the exhausted child in the back, everybody is having a great conversation. That's awesome. I'm just glad my voice is so soothing. We're very calming in fact, they're in a coma in the back now. But we have a lot of good questions, just so that we can all hear each other, so we're going to ask us to bring our individual conversations to a close. And let's see, we had a question from probably, you're probably the youngest person in the room. Okay, so the, oh, that's right, but he doesn't count, he's in a coma. We need the health care to get started right away. But ask your question again. I was asking for some clarification on the dates for the March 30th birthday compared to the January first day. You know, a lot of this centers, a lot of the enforcement centers around the IRS. Okay, and so you can imagine that if our charge is we have to make a decision about this and enroll by 331 2014. If we have not, then for this calendar year of 2014, we are going to owe that penalty. Okay, so they're probably not going to catch up with us until we do our taxes. But the idea is that every year, every calendar year, you have to make some kind of decision about your insurance. Hopefully you'll make an informed one by coming to things like this, but that's, you know, the penalty kicks in. They're not going to come to your house on January 1. It's that when you fill out your taxes and so forth, you're going to be responsible for that tax penalty. Okay. Yes, sir? First of all, let me convene on your presentation. I've been in several of these presentations. You have made a pair of claims. I don't know how complicated that is. That's a very important push-off done. To my major concern is what I hear in the community. I work with a legal resource alliance. Because the communities that we're working, a lot of people don't have computers. And they can't go online either. Specifically in the east-west and southern sectors of the city. What is the strategy of COPS Metro and Central Med in making sure that we get those people enrolled in the system? Do you all have a strategy for that? I think what you're doing here is beautiful, but I think we have a lot of people who can't even have a computer. And we could get those numbers up now. So what is the strategy for you? Sorry, if I may. What we're going to be doing with COPS Metro, first of all, as you know or may have heard, we sponsored a stakeholder's gathering a little over a month ago of different organizations who are going to be in the forefront of this particular ACA. From there, there are some decisions made on how to help streamline the process for folks, especially those folks who don't have access to the internet. Central Med has their own plan because they were there too. They're part of that conversation and they're here. They can give us more information about what they're doing. One of the issues in San Antonio is that there's different organizations that were funded to promote this program. Central Med and Communicare being the federally qualified health centers were giving the funding to provide application assistance, in particular to their own patients first and to their local community. So whatever service area we are at, that's where we're marketing. However, we joined forces with the City of San Antonio and Bear County because there's different organizations that are doing outreach and education. COPS being one of them, the City of San Antonio Metropolitan Health District, the mayor's office, the county judge's office, and also a university health system, UT Health Science Center. There's a lot of organizations that we're part of a committee that we visit with and go over what areas are not being addressed. And if those areas are not being addressed, ACOG was one of the organizations that was funded through CMS. They're the ones that have navigators. There's a difference between certified application counselors and navigators. And the difference is that the navigators were funded through CMS grant directly. The certified application counselors came from a grant through the Bureau of Primary Health Care for community health centers. And the main difference between a navigator and a certified application counselor is that the navigators are also responsible for educating the small business community about the SHOP program. They can sign up for a better rate for their employees. Bless you. And so they're marketing to small businesses. We're marketing to community. So all these organizations are meeting together and planning where are the pockets of areas that nobody is marketing to. There's another organization, the IPAs. I forgot what they stand for. But they were contracted, I think they're called in-person assistors through CMS grant. And they will go to people's homes. They will go into different areas that are not being addressed. They're meeting together and sharing a map of what we're focusing on. And those areas that are being left untouched, they're going to be directed to ACOG and or IPA. I think the biggest health though is going to be people like yourself that have a heart for our neighbors. And we know who is confused and is not likely to even ask about it. And they're just going to face this penalty. So we need to watch our neighbors and then point them. I think there's going to be a Clearinghouse website through Fair County. Fair County. I hear you and I respect what you're saying. Some of the groups you mentioned, outreach is not in their DNA. You mentioned the city of San Antonio, red flag goes up. You mentioned Fair County hospitals, red flag goes up. They don't know anything about reaching our people. And let me clarify that. You raised a good point in that. And yes, thank you for, I want to say tops with the Texas Organizing Project. We're doing outreach and we've worked with TC and this group and we just hired canvassers and we're hiring phone bankers. They're not in the neighborhood. The other thing is that we're also working with COPS to see what we can do to outreach to the faith-based organizations because we know... I have all the comments in the world. COPS makes real life. So I've worked with it in the past. They have a track record in the people who trust them. Here's what we're up against. We're up against the Fox News stand and we have a lot of people in our community specifically in the west side, south side, east side where they're being brainwashed by the Rush Limbaugh stand about not participating in this program. And I'm just going to say this. I think we have done a lousy job in how we have framed decision and that's why we're getting beat up so bad by the right wing conservative because we're not framing the issue. We're marketing to our people the way it should be done. The best program I've seen is what this young lady has done here this morning. I've been to a lot of programs and this program is what needs to happen but we need to get it out on the airways. We need to get it out in our media to make sure that people know what's going on. Are we going to get beat up and go back? There's a comment back here. We have Saturday events, two or three events a month for the next couple of months. One of the things we're also noticing is that when we ask people, how did you hear about us? They're citing news articles on TV and newsprint. So we're getting the word out that way and we're clunking that data and finding out what method is reaching that population that we're discussing. And the faith-based organization, we've been in touch with several churches and other religious groups around the communities and where we are at above. And so they're sending people to and from our toll point to a spike dramatically in the last week of the national visibility. So I think people is a trickle-down effect in terms of awareness. And then the United Way Health Plan is another resource where people are calling to find out where to go to have an in-person assistor with the applications while the website is not functioning properly. So it's here and there, but it is coming together. I mean, we're launching something from Ground Zero to get it up and moving. Well, I would invite Central Med to be a part of the KRLB radio station. This is a radio station out in Florida. San Antonio Community Radio. We meet a lot of those people. We've had talks on them. We've had the old America. We haven't had you guys, honestly. And, Tisi, thank you so much. And I think we did reach these people and they're here to get their one-on-one. We'll continue discussion with you. And we need to continue this discussion, but we want to get these people into the application of site. Thank you. In the meantime, let's go ahead and take... Oh, you have a question. I was going to say, how much more time do we have? I just want to know. We have another two people that already signed up, but we want to just put these families in a... with a family, I mean, application assistant program. I was going to say, let's take the value of the time that we spent asking our questions. Have those questions ready for when you have that opportunity. And so, you know, just before our presentation concludes, I really want to thank you again for coming and also to say, you know, hopefully with everything that's happened in our capital that people are ready now, people of good will, you know, conservatives, liberals, whatever, you know, however people self-identify, hopefully they're ready to be pragmatic and work together, especially to reach our most vulnerable. So God bless you for what you're doing. Thank you for coming out today. Thank you to the opposite. Quick question. Well, there's different numbers. So for Central Med, because we are making appointments according to your schedule, we are directing people to our main call center, which is 9227,000. However, if you want to promote it to anybody in the community, you're welcome to do that. But you also can call the 211 line and they can direct it to a location that's near your neighborhood. There might not be, you know, this might not be convenient to somebody in the east side. They can direct it to Communicare and Communicare. I know they're here as well. And they're one of the agencies that was funded as well. And they have a site at the Frank Bryant Center and different locations. So there's different locations that can help you. But 211 is a main line that can direct you to different places. Central Med can help you. And we can also direct you to other locations. So we're all working to do that. If you want to see any of these slides that we've talked about, you can go to the COPS Metro Alliance website. And you can go to the email section there. Hopefully with only one voice. So anybody who's ready? You have that quick question right here. I'm sorry. I was just going to say that when I called the numbers that are on the the recorder. What do they have? They have the numbers for the different central meds which refer me to the 922-700 option four. So even though I called the specific med, they still transfer me somewhere else to call. Yeah. encourage you to call the different clinic sites because we have a system where it's going to track how many calls we're getting but direct but and we need to follow up with them as to why they're listing that number because we're telling everybody to list the 9227 thousand. You're listing all of them in location. Yeah that's too bad. I can't control what media prints but we'll give that a go into it. Yeah. Thank you for coming. Thank you for coming. I have a question. Y'all dial the 9227 thousand. Make sure you get the option 4. Yeah. And it'll direct you directly where you want to go. Instead of dialing another option besides the 4. If you dial the 4 it'll take you directly where you want to go. And it'll take you directly to the certified application counselors who sometimes patients just have a question. You know do I have to apply have care link? Well no you don't. You know if you have care link it is not an insurance. I'm talking about this. Yeah. So but if they can direct you you can encourage them to listen to town 4. We're just encouraging them to listen to the 4 options that are available. If you want to make an appointment or visit with a doctor or whatever. But town 4 is for the health insurance market. But in the meantime let me take you into an exam room. Let me take you into an office visit where we can personally and help you apply for the process. And although I know the system is not working we do see a lot of families that really want to do the 101 application. And we are doing paper applications. And we've already seen the people we've applied that have applied through the paper application are already getting enrolled. So it is a fast turnaround time. However I heard that the easiest and the fastest system is calling the one 800 line. So it's up to you but we can help you either way.