 Good morning. Welcome to the Affordable Care Fair. I'm Rogelio Sainz. I'm the Dean of the College of Public Policy. And it is my honor to be serving as a moderator this morning. And I would very much like to appreciate your time and your effort for coming out today, despite the very cold weather. It probably would have been better to be at home in the toasty house and so forth. But thank you for coming. I'll provide giving a few general overviews to set the context. And then I'll mention a few things that are going on with the fair as well. As we well know, the 2010 Affordable Care Act was signed into law in 2010. And despite becoming a law and so forth, we have seen that there has been much effort to try to do away, to scrap, to change, to modify, to delay the Affordable Care Act. So there's a lot of misinformation that has also been taking place over the course of its life. Despite the last month or so, we've had the massive problems with the web page, which has contributed a lot to the negativity associated with the Affordable Care Act. Despite the problems with the website, despite the efforts that have been put forth to try to do away with the Affordable Care Act or delay it, we know that this is much, much, much better than what the system that we have in place, that for many people here in our country, in our state, as well as in our community, translates to not having any health care at all. So that for many people, it is going to be very much of a blessing for individuals who have no access to health care or limited health access to health care. And again, despite the fact that it's not the ideal, in many ways, it helps us get to the ideal of seeing health care as a human right, something that we as humans should be able to access. And just briefly, some statistics related to the city of San Antonio. Here in San Antonio, there are about one out of every five individuals here in our community lack health insurance. Among the Latino population, it's 25%. So one out of every four individuals who are young between the ages of 19 and 25 have a high prevalence of not having health care insurance. About 37% of individuals who are 19 to 25 do not have health care insurance. Individuals that are non-citizens, about 52%, about one out of every two do not have health care insurance. Individuals with low levels of education, 30% or so, for high school graduates, 38% for individuals who are not high school graduates. The employed, even people who are working, 38% of the employed do not have health care insurance. The unemployed, about 56%. So you can see that despite overall one out of five being uninsured, in reality, there are segments of our community that have very serious needs for the health care insurance and the Affordable Care Act, in many ways, provides relief for these individuals. A couple of things going on here. We have the free enrollment counselors with the community care that are outside. We also have free flu shots by University Hospital, University Health. Then we also will have a raffle, a $50 raffle from HEB that individuals can register in the first table there right outside so you can be in the drawing. Now what I want to do is introduce our panelists. And then I will ask, after I've introduced each one, I will ask each one to give three to five minute remarks. First, on my far left, we have Greg Geisman, who is the CEO of the Community First Health Plans. Welcome, Greg. Then we also have District 5 Councilwoman Shirley Gonzalez. Then we also have Chiara Sherard from Community Care. Welcome. And then we also have Jose Ivarra from Enroll America. Thank you very much. And then so if I can ask each of you three to five minutes to give a little bit of your thoughts here. Five minutes may be a little short for me. OK. Thank you for the opportunity to participate. And again, I also appreciate everyone braving the weather to come out and join us this morning. People ask me from the perspective, what is our perspective or issues with the Affordable Care Act? And Community First is somewhat unique in that, although we are a health plan, a licensed health plan in the state, we provide coverage to 88,000 Medicaid lives, 30,000 CHIP lives, and other 18,000 commercial lives. We are provider-owned. The University of Health System owns us. And we are local in the community. Our offices are here. All of our employees live here. And when people ask me that question from that perspective as an insurance professional as well as a provider, I always go back to the goals and the intent of the Affordable Care Act. And there are really two main goals in the legislation when it was created several years ago. The first was to guarantee affordable insurance for nearly all Americans. And there was really three ways to do that. One was to set up the insurance exchanges in every state, which we're here to talk about today. And the second was to provide financial help and subsidies for those to pay the premiums associated with those products and or expand the Medicaid program to help other low-income individuals. And the third and most significant way of increasing that access was to require that insurers had to provide coverage to an individual and they couldn't limit their coverage. They couldn't kick them out. They couldn't offer any different benefits if they were sick and needed a lot of services. The second critical goal, and it's a longer-term goal, was to improve the efficiency and the quality outcomes. But we'll spend some more time talking about the first issue, the access, because that's why we're here. And as the Dean alluded to, there's been much debate and issue regarding the strategies and obviously problems with the implementation of the Affordable Care Act. You can't argue with the goals in terms of providing access to folks. From community-first perspectives, we believe those goals are real, legitimate, they are important to our community, and they match very well with the mission of community-first. Although we're an insurance company, our mission is to transition uninsured or uninsured individuals in Bayer County to more comprehensive benefit designs. That's why we're very supportive and very bullish on the Affordable Care Act. And I would agree with you, Dean, it is a step in the right direction. Okay, thank you. Thank you. Well, thank you all for coming and for being here. And I'm Shirley Gonzalez, and I represent District Five. It's where we sit right here, and it includes most of the New Year West side and includes part of the South side. And so I'm here today as a representative for our community, because we do represent a very high number of uninsured people, adults. Many of the children, most of the children in our community are covered through different programs, but it's the adults who are not, their parents and their grandparents. And so we all know that as families, that we have to support each other. And if the adults are sick or the grandparents are sick, the child is not gonna be well, regardless of how much coverage the child has. So I'm here because I really want to encourage everybody to participate in programs that are available as an employer. It was very critical for me to make sure that our employees were covered, that they had some sort of coverage so that they could, that every aspect of their lives were covered so that their employment was secure and that their health coverage could be secure. And so we were working on that. And just as a private citizen, it can be very complicated. And so we hope that through our office and through the work that we do in our district offices, we have one at Las Palmas and one at Nogalitos and one at City Hall, we can take the steps that are necessary for our community to enroll and just sort of hold their hands. There's many, many people here today that can help you enroll. We don't enroll in City Hall. We're not, we don't have that service. But we can direct people. We can get our community leaders to come to our offices so we can take the extra steps necessary. It's complicated, it can be complicated, I think, and in fact, it can be especially complicated when we have language barriers. So we're here to help with that as well. I know that all of the information is equally provided in Spanish, but just the language itself can be. And so we're here to just sort of break it down for everybody. Know that, that your council people are, and the city is here to help wherever necessary to facilitate people enrolling. And that here in District Five, we do have a very large Spanish-speaking population. And we have a very large children's population. We have a number of people under the age of 18. And so we're protecting every member of their family. And so we hope that everybody that is here today would consider enrolling, asking the questions that you need to ask. And if you can't get the answer that you need, somebody here will be here to help you. So thank you all for being here and for participating in today's forum. Hello, I'm Chiara Sherard with Community Care Health Centers and I'm the Chief Revenue Officer. So I oversee health plan contracts and billing of insurance. And now I have a new department, the Health Exchange Department. Community Care Health Centers is a federally qualified health center, which means that we receive funding from the federal government to provide healthcare to uninsured people. So in our clinics, we have dental services, primary care, pediatrics, behavioral health. We try to provide as much comprehensive primary care as possible within our clinics. But we still struggle to be able to coordinate care for patients who need specialty care. We can only do so much in our clinics. And so we see about 45,000 visits a year and about 60% of our patients are uninsured. So about 24,000 people. So we did receive a grant to help fund hiring certified application counselors. And we have hired six of them that are dedicated just to enrolling people. And then 14 additional staff members, including myself, have become certified to try to reach as many of our patients as possible who might be eligible. We've been enrolling or attempting to enroll since October 1st. The website is working much, much better now. We've assisted over 700 people with questions and with filling out the application and actually submitted over 500. We see insured patients also. We see Medicare patients, Medicaid. We work with community first. We see a lot of their patients. We've been working a lot with community partners since before October 1st to try to coordinate our efforts and not duplicate efforts. We've been working with the University Health System with the Role America. So this community has really come together, its leaders, as far as trying to coordinate, put on events like this, trying to reach as many people as possible because we do have more than 300,000 uninsured in Bear County alone. We also have clinics in Hayes County, so one of our staff members is out there. So we're really hoping to see people have access to more better, more comprehensive care than just the things that we can provide and the partners that we have who help us get the care for those patients. So we're very excited about next year. Thank you. Hello, I'm Joey Barra and I'm with an organization called Enroll America. So Enroll America is a Washington, DC-based, 501C3 non-profit, we're non-partisan, non-political, with the mission of educating the community about their options under the Affordable Care Act. And so we have operations across 13 states in the country, namely states that have chosen not to implement the marketplaces and do outreach on their own. And so Enroll America in last fall, along with the Kaiser Family Foundation, found that nearly 78% of folks polled did not know what the Affordable Care Act was and what essentially the bill offered to them. And so our direct mission was to educate folks and make sure that they fully understood the resources available to them under the bill. And so what we're finding is that a recent poll done back in October found that that number has gone down to 49%. And so better, but still just an outstanding number of folks who don't know what's available to them. And so the top two questions that we're finding that folks do not know is one, what is the bill? Two, where can I go to enroll? And so we work with partners such as Community Care, University Health Systems, Central Med, ACOG, the folks who are enrolling people here in the county, and we try to educate folks and funnel these people to speak to the experts that are enrolling people. Thank you. So we've had an opportunity to hear from each of our speakers regarding some of the issues that they're working with, some of their services that they provide and so forth. The next part of the program, what we will be doing is I'll be asking each of them a series of questions and then after that we'll open it up for question and answers from the audience. So we're going to start first of all with Jose and we know that with the Affordable Care Act, despite the fact that there's a lot of people that are going to benefit from it, there are certain individuals, for example, individuals who are not U.S. citizens that will not have access to healthcare. Are there any other ways in which individuals that are not citizens can access healthcare? The answer quite simply is yes. And I will also say that when we are doing our outreach in the communities, we are encouraging all and ensured to seek out their options under the Affordable Care Act and to speak with one of the local groups enrolling folks. And this goes especially for the undocumented community. And so we do know that we have a large number of mixed status families in this community and so for a lot of these families, although the parents may not qualify for the marketplaces, their children might qualify for an insurance plan under the marketplaces, their children might qualify for programs like CHIP. And then when these parents are speaking to organizations like Community Care or university health systems, they're also able to find alternative methods of healthcare for themselves. And these individuals can be assured that they're not going to fear any kind of retaliation or any kind of identification and so forth of their status? Yeah, absolutely. So for folks who are entering their information into the marketplaces or enrolling their children for CHIP, they can definitely be confident that their information is not being shared with enforcement agencies or agencies like that. And I can let Kiana here or Chiara speak about Communicare, but as far as I know, none of our community-based organizations here are sharing information with law enforcement. He wanna make sure that these folks have access to affordable healthcare. Okay, thank you very much. The next question will be to Greg. And that is, what is the relationship between the university health systems care link and community clinic programs like Communicare and the CHIP STAR Medicaid program for children with insurance available through the ACA? The care link program is sponsored and run by University Health System. That is a financial assistance program. It is not insurance. And that program is available to low-income Bear County residents. There are various providers in that network of folks in that network for the care link folks to go to, UHS, Communicare and things like that. It does operate a little bit like an insurance company that you have to pick a PCP, you have to go to specific providers. The CHIP and the Medicaid program are government-sponsored insurance programs. And they are regulated by the State of Texas. They're regulated by the Department of Insurance and Health and Human Services Commission, in which an individual applies to the state. The state determines the eligibility. And the state then has relationships with managed care organizations to arrange a series of benefits associated with the Medicaid and CHIP program through a series of contracted providers. Okay, thank you very much. The next question will go to the Councilwoman. And it is, what can the city and local policy makers do to foster a healthy community? Well, I'll try and make it a little more personal. And for those of us that live in District 5, we know we have a large number of parks. And yet they're not getting used because we have poor quality sidewalks and the streets are not as well as maintained as they could be. So from the city's perspective, we're trying to be a little more proactive in people's health and wellness by improving our parks and improving our sidewalks. And so we've got that angle where we're working on prevention. But on a more personal level, I know that when people come to our council offices, they're often already in a situation where they're desperate, where they need help and they need it now. And so we are hoping that by having a program like this one, we can assist people first of all, before they get to a point where they're so sick, that they're going to the emergency room late at night. And hopefully we can steer families in a direction where we're covering their overall wellness. So as a city, we're providing better streets and lighting and improving the park so that they can enjoy them more and have a general feeling of wellness. And then on a much larger level, we can enroll people in affordable care programs. So they're not so sick and so desperate and coming to us when we are not as able to help them. So, and that's a very difficult situation to be in. And I'm sure that many of the panelists here can attest to that, that by the time people come, they are very sick. And so hopefully we can prevent that. And that's one of the ways that the city can get involved at the ground rates level at the very beginning of this program and enroll people and take care of their whole families. And the preventive care is very important as is the parks and so forth. Because we know here in San Antonio, we have a high level of obesity, for example. And then so parks provide that venue where people can walk and get exercise and so forth. And it is a priority of mine to improve our parks because we have a lot of them here in this district, better than in the other parts of the city where you just have one or two very large parks. We have many small parks. And I think that's really an ideal situation to be in where you don't have to travel too far. You can walk to your local park and bring your children and enjoy the playgrounds and then just walk back home. And hopefully there's a grocery store nearby and you're picking up some healthy food and NNM. And it's just an overall program. And so when we bring these affordable care act to people, it covers them completely. And so that's really what we're after with something like this and how the city can help take care of people just in general. Chirlian, you mentioned the access to quality food in terms of vegetables and fruits and so forth. Are there any efforts to try to make those goods more accessible to individuals? We've heard of the food deserts and things like that. Yes, and we definitely have that situation here in our district. We're trying to get more farmers markets and teaching people how to grow their own plants and their own vegetables rather. And this whole area used to be farming community not so many generations back. Many people that are just a little older than me remember that this was all farmland at one time. So we still have very fertile soil and people are learning to grow their own vegetables and how to take care of themselves. So we don't have to rely on such larger programs to help it, but this is important. And I think that at our council office, we really have people coming in every day asking for assistance with, often it's with CPS or with SAWS or with bills and mortgages and or making payments. And so we can offer assistance at every level and help people through the difficulty of filling out forms that nobody likes to fill out for. I personally hate filling out forms. My parents, as soon as I was old enough, they'd say, hey, fill out this form. I don't wanna fill out the forms. So, but, and that's why sometimes it just is help before sitting talking and saying, oh, well, what's your name? And give you, you're kind of going through the list. And then meanwhile, you're having a conversation and you make it a little bit more pleasant than just sitting there and having to fill it out. So having fairs like this one, you encourage us a little bit of camaraderie and their snacks and you make it a little more interesting than having to sit online and do the details. But that's also available. Okay, thank you. The next question will be for Kira. And we know that the people who are currently, the way we have the system, people who are currently uninsured and have health issues, find it extremely difficult because of cost and so forth to gain access to healthcare. What about with the Affordable Care Act for those individuals and who have preexisting conditions? What is their situation with the Affordable Care Act? Well, essentially the Affordable Care Act has done away with the ability for insurance companies to deny coverage to people based on preexisting conditions or to delay coverage for certain conditions. Typically, what has happened in the past is that people with preexisting conditions, if that's included in an insurance policy, they may have to wait a year before they can get any kind of coverage for a particular condition. And those conditions are usually very serious ones such as HIV, cancer, very serious things that not only do you not want to wait to get care because you're ill and you need the care, but you can actually die from these things if you don't get the care that you need. In addition to tax credits and subsidies to help pay for premiums for people who qualify based on their income, they can also qualify for cost sharing assistance. So to pay the monthly premium based on your income can be very inexpensive. And what we found when we're enrolling the people that are patients at our clinics is they pay very, very little for their premiums. But in addition to that, if they have a plan that is, say, a silver plan and it only covers 70% of the cost, the patient typically has to pay 30%. Well, most of the people who are qualifying for subsidies for premiums will also qualify for assistance for paying that 30%. And I actually have a true story about prior to working for Communicare, I worked for an oncology group and we had a patient, a 27 year old lady who came to be seen and she had been having breast pain for quite some time when she was breastfeeding and her husband had been laid off so she was uninsured for over a year. She had gone to the doctor once about the breast pain and basically he just said, oh, it's from breastfeeding and it will pass. And by the time she came to see our physicians and was diagnosed, her breast cancer had spread through her body and we put her on chemotherapy. The insurance denied the treatment stating that it was a preexisting condition. Fortunately, we were able to dispute that because she actually was not diagnosed until after she got the coverage. But because she waited over a year to be seen, that lady is no longer alive and she had two babies and these are the kind of people that this will help. Thank you very much. The next question will be to Jose. And we've heard a lot with, at one point in time, the president had indicated that people who had current insurance could keep their current insurance. And there we saw once you get into the details and so forth, this was a concern. And there's been a lot of debate over this about whether individuals who have their current healthcare insurance, if they can keep it even though it doesn't meet the minimum requirements. Could you address this issue, please? I'm sure. So the, again, this is the simple answer to can folks who currently have health insurance keep their health insurance even if it doesn't meet minimum standards, the answer is yes, they can. So the re-recommend to folks is to treat your health coverage like any other major purchase, any other major purchase, like you would purchasing a vehicle or a house or another big purchase like this. Essentially, when you go into the marketplace, you'll find that plans that do meet minimum standards and there are 10 minimum criteria that basically qualify an insurance plan for meeting minimum standards. You'll find that the prices are either comparable or in most cases even lower. And to share a story, we had a gentleman this past Thursday come into one of our events currently had health insurance but wanted to check his options. And so he went and checked his options for his family, a family of four. And what he found was that his current plan was better than the ones in the marketplace, but he was satisfied. He said he didn't want to leave anything unturned. He was happy that he took the time to check out the prices and essentially shop around. So I would encourage everyone, especially folks who insures plans that do not meet minimum standards to at the very least shop around. As Kiarra mentioned, the website is fully functional now. We've had folks basically breeze through and get through to the part where they're able to shop for plans in about 30 minutes. And so I again encourage you to go on, find out for yourself, turn off the TV, turn off the radio and look it up. Thank you. The next question will be for Greg. And as we've gotten information regarding the Affordable Care Act, we keep hearing about these rebates that exist and so forth. How do people go about accessing those and who are the individuals that would be eligible for them? Well, really there's two types of rebates or subsidies available to individuals. As you purchase insurance, there's a couple of things you need to worry about. One is to pay the premium to the insurance company. And then the other issue is to pay whatever co-pay or co-insurance that is necessary whenever you receive services. As Kiarra alluded to, there's really two types. The first on the premium to help you pay the amount that you need to pay to the insurance company, if your income is between 100% and 400% of the federal poverty level, there are subsidies available for that. If you pick a silver plan and your income is between 100 and 250%, there's what's called a cost reduction subsidy in which basically that helps you pay those co-payments and those deductibles at the time whenever you need services. Okay, thank you. The next question will be to Kiarra. How does a person determine what she or he or the family and children need in order to be insured? That's based mainly on your health status. Someone who is a young person in their 20s who has no chronic illnesses might want to pick a plan that has a lower premium and a higher out of pocket when they go to see the doctor because they don't need to go that often. So they'll pay less on a monthly basis. They may only go once or twice a year for an annual checkup because they're healthy. Someone who has something like diabetes who needs to be seeing the doctor a lot more often or kids with asthma might want to pick a plan that has a higher premium on a monthly basis, but then they pay less every time they go to see the doctor. That's something that people can discuss when they're enrolling with our CACs, especially if you're enrolling with one of our clinics or if you go to the center med or people who are knowledgeable about health coverage and medical needs. You can customize to a certain extent what plan you choose once you find out that you qualify based on how often you need to see the doctor what kind of medicines you take. Different plans have different formularies of drugs that they cover. So that's where I think the assistance with the enrollment really comes into play beyond just do I qualify or not, but what's the best coverage for me? What do I need? How often do I need to see the doctor? What kind of specialists and hospitals are in the network with this plan? There's a lot of assistance that you can get. All right, thank you. Let's see, the next question goes to Jose. And we often hear with young people saying that they're invincible in many ways, and particularly with health individuals saying I barely get sick. And in some ways the economy has really hurt individuals who are young adults and so forth. So the economic resources that they have is limited. We've even seen particular groups out there that have tried to encourage college students and young adults to forego this insurance because it's not beneficial for them and so forth. Could you address that issue please? Sure, so I do see some young folks here and the rest of us, we were young and invisible at one time. And so I would say it is important for young folks to explore their options and to check on the marketplace. There are plans that are specifically geared for young folks up to age 30 called catastrophic plans. And so essentially these plans are to cover young individuals for catastrophic events in a car accident on the way home if you find out that something is wrong, like a tumor or cancer if you're attending class and you accidentally fall down the stairs. So in any kind of those big unexpected accidents. So and those plans are largely affordable. And so those plans run $30 on average. So there is no assistance for those plans because they're essentially affordable already. I will share my own story when I was just out of college right before I started my first job, I was left uninsured. I was in between that period where I was covered through the basic coverage to the university and before I received employer coverage and I wound up getting the whole right side of my face paralyzed. And I was very in shape at that point. I was in the Marines at the same time or I had just gotten out, was running five times a day. I thought I was invincible. And for me, if it wasn't through sheer luck or grace of God, however you want to mention it, that I met a doctor in the emergency room who decided to take me under his wing and care for him. I would have been laced with huge amounts of debts to cover me. So that's my story. It could happen to, things can happen to young people, anybody at any time. So young folks, it would definitely understand the feeling of being invincible. I would say don't put that to chance. Of course, and individuals of young adults, if their parents have insurance, is there any way that they can also get this? If your parents have insurance, young folks up to age 26 can be covered under their parents' insurance. Okay, thank you. Let's see, the next question will go to Akira. And we know that there are a number of states around the country that have not expanded Medicaid and our own state is one of these. Are there any organizations or what are organizations doing, if anything, to address these kinds of shortcomings that come about with not expanding Medicaid? This is a topic that's come up in just about every meeting or any committee that I've attended because we do have a gap in coverage for people who are not citizens or who may fall into that hole where they don't qualify for Medicaid or CHIP or the health exchange. As I mentioned, Communicare is a federally qualified health center that receives federal funding to provide care to uninsured people. Central Med is another organization in Bear County that is similar to us. We expect that at some point that that funding will be decreased, but not gone. We still will be able to provide care to people who qualify based on income. They receive care at our clinics or at a place like Central Med at a very low cost. They can come in and have a visit, have lab work done, have a basic X-ray. We will continue to do that beyond 2014. Also, we partner with University Health System, has a program called CareLink. We see those patients, some of those patients will qualify for the health exchange and some will not. So that program is also not going away. We partner with foundations like the Coleman Foundation for women to have breast cancer screenings. So all of the programs that we participate with and the funding that we get to see uninsured patients is not going to go away because of the affordable care. Perfect. Okay, thank you very much for answering these questions. And before we open it up for the audience, if I'll go around with the panelists here, is there any additional remarks that they would like to make? I think we also need to recognize it as we talk about the Affordable Care Act. It really isn't a one size fits all. There really are 50 affordable care acts depending upon which state you're in. Because the states had significant latitude in determining how the Affordable Care Act was going to be rolled out in that state. They determined whether they were going to run the insurance exchange. They determined what the benefit design was going to be for those benefits in addition to the essential benefits. And they decided whether to expand Medicaid or not. And as you know in Texas, Texas decided as did 36 other states to allow the federal government to set up the exchange and it decided not to expand Medicaid. And also the Affordable Care Act, a lot of parts of it have already been implemented. There are things that have been done to dates in terms of expanding coverage to include dependent children until they're 26 requiring insurers to spend a certain percentage of their premium on medical care. If not, they need to refund that back to the subscribers in terms of some limits and benefit designs associated with children. So the Affordable Care Act is a great big thing. And a lot of the components have already been implemented. And Texas has the ability to make certain decisions on itself and those decisions have led to some of the issues that care and the folks have talked about here today. So first I just wanna thank everybody that came out and to all the volunteers that have came today, my staff that comes on Saturdays to work and represent our community and to be also an advocate for something like the Affordable Care Program and for everybody that's here trying to inform themselves to improve their lives and their families, it really is important every step of the way. I mean, every person that enrolls in our community is showing that they're protecting their families. And as a council person, what I'm really most concerned about is that we have a healthy community that's thriving, that's growing and also taking advantage of the services that are available. And so there is often a distrust amongst our community members when we have big programs like this one or even in city government. And so this is an opportunity, I think, to really ask the questions to get informed and to also let us help you. So I always get nervous and say we're the government, we're here to help. But we really do want to encourage everybody to enroll and to ask the questions. And as much as we can through our offices, and by the way, this is our office, our city hall, district five office, I'm not speaking on behalf of the entire council, just for us. And because we do believe that we have, and I'm here because we have such a large number of uninsured people in our community. And we also have a very elderly community and a very, in general, sicker than other places. So we want to help those that are eligible to get all of the assistance that they need. So please ask the questions and let us help you. And if we don't have the answers, we can always ask all of our partners to get the answers for you. So thank you all. I think I just wanted to point out that the preventative care and wellness is one of the most important aspects of the Affordable Care Act. People who have chronic illnesses and can only afford to go to the doctor once or twice a year just to get sicker. As the councilwoman said, we have a generally sicker population. People who take care of themselves and get screened for conditions and are healthier don't miss work and they don't miss school as much and they get a better education. They live longer. This affects every part of people's lives. And for me, I think that the preventative care and the screenings and the wellness will just lead to an overall healthier population for those who take advantage of it. I would just like to encourage everyone to explore their options. So it really is minimal in the time investment that you have to spend to simply see what's available to you and your family. And I think that goes especially for folks who are uninsured or underinsured. I think it's important that as I mentioned before, we turn off the TVs and the radios and not listen to the talking heads but find out for ourselves. And so this is the tool that we have been given at this current time to help solve this problem that we have in this country and our community of folks who are uninsured and underinsured. And as Dr. Sainz mentioned when we first started in Bear County, we have over 300,000 uninsured. And so one in five for the general population and one in four for the Latinos here in the room. So I guarantee you, we have friends and family members who are uninsured. So after you explore your own options and educate yourself, I encourage you to talk to your friends and family members about it and make sure we're taking care of our community as a whole. Thank you. We can give a round of applause to our panelists. And now what we'd like to do is open it up to the audience if they have any questions or issues that they wanna address and if you can step up and identify yourself and then ask your question or provide your comment. It'll be shy, alright. Juan Mejia and currently I'm in a college, I'm a college student and I was wondering, is there a penalty for not having insurance? There is a penalty for people who do qualify for the insurance but choose not to take it but there are also, there are exceptions to every role. If you do not make, if the cost of the insurance is more than 8% of your income, you're exempt from a penalty. There are hardship rules. Many times college students who don't have much income at all will maybe exempt. So there is a penalty, I think it's $95 a year for the first year for an individual. But like I said, the healthcare has to be affordable for your situation and if it's not, you're exempt. There's a whole list of reasons for people to be exempt. I just had, Dr. Sainz mentioned earlier, especially for young folks, there are groups out there encouraging young folks to take the penalty. That it's gonna wind up being a lower cost in the long run throughout the year than having insurance even if it's the catastrophic insurance. And so to that we've been telling our young folks that essentially when you take the penalty, you're paying and you're not getting anything in return. And so I think it's a much better decision to go ahead and make the investment in your own health and cover yourself, have that peace of mind in case something does happen. You'll be able to take care of yourself. Thank you. Thank you. Anyone else with a question, comment? Thank you, my name is Roberto Escobedo. I have a question on the penalty also. When and how is a penalty applied? Because I know this is a big scare factor that is being used by the people that were opposed to this plan. So could you answer that question for me? It's that the penalties are assessed when you file your taxes. And the same with the subsidies, if you qualify for assistance, you have the option of accepting assistance at the time you enroll in the insurance so that it's applied against your premium or you can wait till the end of the year when you file your taxes to get a credit back because if there's change in your income either more or less, it may change what you qualify for. But the penalties will be assessed when you file your taxes. Federal tax, thank you. Okay, anyone else? Okay, the U.S. Department of Health and Human Services in D.C. My role down here is to help and assist in any way the department can in having this plan implemented. And I've been in the valley and I've been here in San Antonio in El Paso. And we have some great, great organizers, great presentations, navigators, et cetera. My, what I see missing is the audience. That is, how are we getting the word out for that? So when you have these type of assistance programs, informational programs, that you get more of a participation from the community. Univision is a great, was made, did very well in Houston. They filled up the convention center in Houston, but for one day. But getting, putting that aside for the moment, my question is to Dean Sines. Is UTSA an exception in the higher educational efforts with regard to ACA? This is the first one I've seen that hosts something like this. And it, to me, it would be also important if the various community colleges and the various universities took it more. I mean, became more involved with this effort to enroll and to participate in this rollout of ACA. And that question is for you, because I think you would know whether UTSA is an exception, is University of Texas in Austin doing it, is University of Texas at El Paso doing it. Because I think that would make a big, big difference. Students would trust, that is if they trust the administration, your own administration. We had that problem when I was in college. So, but during the anti-war movement, where did all that effort come from, but from the universities? So, anyway, that's my question. Okay, yeah, and I think that as you find information about what's going on and so forth, a lot has to do with websites and so forth, a lot of listserv programs. And in many ways, I haven't heard that there are many universities that have been engaged in this kind of activity. Here in the College of Public Policy and the Center for Policy Studies that Roger Enriquez is the director, who's taking pictures over here. One of our primary objectives is community engagement and getting people out involved and talking about issues affecting the community so that we've done, for example, at town hall forums where the San Antonio Express News and Immigration Reform Congressman Lloyd Dogget also did a town hall meeting that was also pretty successful on a relative scale that we probably had about 125 people that showed up and so forth. So, these are our efforts, I think, that the College of Public Policy and the Center for Policy Studies have tried to engage that kind of community relations. And I think with partners like each of the panelists here that this has been something that slowly and surely we're gaining a little bit more success. But I totally agree with you in terms of in order to have a major kind of impact, you really need broader kind of participation and getting the word out. The mass media, obviously, as Univision and so forth represents a very useful vehicle for bringing about those kind of activities. But I appreciate the question. I'll just elaborate really quickly on colleges and universities at least from the standpoint of Enroll America. And so, we have been able to partner with local universities, community colleges. I know, Louise, that you've traveled up and down the border region. Texas A&M International and Laredo has been a very good partner for us. The Laredo Community College System, UT, Pan Am, and Ennenberg has been great. UT Austin has done several events. UTEP let our folks speak to students and other adults at their football games. We were essentially tailgating with them and disseminating information. So, in February, we have plans to essentially hold a week-long enrollment sessions at St. Philip's. So, I do wanna share that we have found some good partners and universities. I definitely agree that we can ramp up efforts and definitely use universities as a way to get out information to the broader community. And I know for us, we are a volunteer-based organization and we have found that a lot of our college students here in San Antonio and throughout South Texas have made amazing volunteers for us. In fact, one of our paid staffers is a current UTSA student. And I was also reminded that we're being broadcast here and filmed by Nowcast, so that this will be available beyond this room as well. Any other comments? I just wanted to, I guess, challenge the panel to encourage private insurance agents to get certified, because that is an army of folks that, not only locally but nationally, could really help enroll America. And I was talking to an HHS official this week that had come in from D.C. And I believe just nationally, there's only 500 insurance, private insurance agents participating. There is a certification process and I encourage you all to encourage other insurance agents to get certified and possibly to invite them to the table during enrollment times, because I think that would be awesome. I think everybody pretty much has an insurance agent somewhere. They're not all certified, but I do encourage the partners here to do that. Thank you. Okay, thank you. Come on in. My name is Miguel, I work here at UTSA and I was thinking there is a saying that says that the best medication is the doctor himself or herself. When I get insured through ACA, who chooses my physician or my providers? Do I choose them or does the insurance choose them for me? And how many of, what percentage of the medical profession is behind the ACA? So that when I choose ACA, I know that my doctor with whom I have an established relationship already will be there. The insurance company does not choose your doctor for you, but based on the kind of plan you choose, if you choose an HMO plan, then you're gonna be limited to, you might be more limited to which providers are in the network or within HMO the primary care doctor that you choose has to manage your care within the network that is available. There are PPO plans which give you more options as far as who you can see and what the steps are to see, for example, a specialist. But the plans that we have in Bear County include Community First, there's a plan by Superior, which is another large company, Blue Cross, Aetna and Humana. So those are very large companies that most providers participate with. I can tell you that with community care we participate, we already participated with all of those plans before ACA came along, so we're gonna continue to participate. If you're already seeing a physician, you can find out from their office. I know with Blue Cross that we had to opt in with Humana and Aetna, they just automatically added us as providers and that happened with the other plans as well. So the plans that are available have very large networks of providers. So you should not be limited and you always have the ability to choose your doctor. Thank you. Thank you. Any other questions or comments? Okay, if not, then we'll give another round of applause to our panelists and again, thank you very much for coming out and I remind you that we have the counselors out there for individuals who want to enroll. We also have the flu shots and a variety of other services and don't forget we also have the raffle that is going on for the first week.