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Some local health care professionals embrace the Affordable Care Act; others do not.
“I’m very excited,” said Kathy Price, who is on the board of directors for Plumas District Hospital. “I’m so happy that in my lifetime I can see this.”
“I’m terrified,” said Doug Lafferty, the hospital’s chief executive officer.
Price and Lafferty talked about the Affordable Care Act during a forum organized by the Plumas County League of Women Voters on Nov. 25.
Mimi Hall, the county’s public health director, and Lori Lomas, an insurance provider certified to enroll people in Covered California, also addressed the topic.
Hall, Lafferty and Lomas shared what the Affordable Care Act means from their perspectives and then answered questions from the audience of about 30 who gathered in the library meeting room.
Hall said that she plans to hold similar forums in Portola, Indian Valley and Chester.
Hall’s message: The Affordable Care Act is about more than health insurance; it’s about improving the health of the nation’s population.
She provided statistics that indicated what U.S. citizens pay for health care, which is double or triple that of many European nations, as well as the country’s mortality rate, which ranks 28th, behind Japan, Sweden, Spain, the United Kingdom and a host of other countries.
“You would think that a nation that spends so much on health care, we’d have great health,” Hall said.
As the county’s public health director, she said it’s her primary job to improve the health of the county’s citizens. She said the Affordable Care Act, which guarantees access to health care, includes critical preventive care.
Hall personalized her presentation by sharing some of her family’s experiences of paying exorbitant premiums, of being dropped by an insurance company and of being unable to find other providers because of pre-existing conditions.
The Affordable Care Act seeks to address those issues by providing premium assistance for most citizens, and by expanding those who are covered through Medi-Cal, which Hall described as health insurance for low-income people.
People with incomes up to four times the poverty level can qualify for subsidies to pay their premiums.
An individual can earn up to $45,960 and be eligible for premium assistance. (See chart for more information.)
While it’s not in her job description to help people sign up for health insurance, Hall does it.
“I’ve met people in coffee shops and have been to their homes,” she said.
How to sign up
A person whose job it is to help people enroll in Covered California is Lori Lomas, a local insurance agent.
Lomas, who has been an agent for 21 years, said that the vast majority of people in the county would receive premium assistance.
“A family of four, who makes $40,000 per year, would pay $85 per month,” she said of the coverage.
Assistance is based on a family’s adjusted gross income. She said when one visits the website, CoveredCA.com, one can fill in basic income information and a ZIP code and will immediately learn how much assistance they will receive.
The website will also detail the four plans: bronze, silver, gold and platinum. They all offer the same benefits but differ on the cost of monthly premiums and copayments.
Lomas said that the new health insurance plans are guaranteed renewable, do not deny coverage for pre-existing conditions, provide a host of preventive care benefits and now also cover mental health, substance abuse and maternity.
“Plans can offer better, but they can’t offer worse,” she said of other options on the marketplace.
Covered California is an option for those who are not already covered by an employer. The only exception is if the cost of those premiums exceeds 9.5 percent of an individual’s annual pay.
Individuals have until Dec. 23 to sign up for coverage that will go into effect Jan. 1. This first year there is a grace period until March 31.
While obtaining information is relatively easy on the site, actually signing up has proven more difficult, even for the professionals.
“I’m a huge fan of Covered California, but I hate the website,” Lomas said.
Public Health Director Hall agreed and said that she recommends that people call the 800 number (800-300-1506). “It takes about 30 minutes to sign up,” she said.
A different perspective
As a chief executive officer of Plumas District Hospital, Doug Lafferty is concerned about the bottom line, and worries about how the Affordable Care Act will impact his hospital.
“I don’t know how we’re going to manage it,” he said referring to the many unknowns.
But he said for the first year, the changes will only affect about 5 percent of the hospital’s business. He said that Medicare, which accounts for 35 percent of the hospital’s business, doesn’t change, and Medi-Cal, which accounts for 30 percent, “essentially doesn’t change.”
Commercial or employer-based insured patients account for another 30 percent, and he said those accounts shouldn’t change for 2014.
Both Hall and Lomas reiterated that the Affordable Care Act doesn’t affect Medicare in any way.
“The exchange is for people under 65,” Hall said. “Medicare doesn’t change.”
Despite his trepidation about what it will ultimately mean financially for the hospital, Lafferty said that the Affordable Care Act contains some positives.
“One of the good things is the screenings,” he said and enumerated a host of procedures from colonoscopies to Pap smears that are now covered.
“These are essentially free to you,” he told the audience.
Audience members posed questions on cards. The first question was directed to Lafferty: Are you afraid of Obamacare for personal reasons or for professional reasons?
“As a provider, I don’t know what the cash flow will be,” Lafferty said, adding that he worried that providers “could pick up the pieces of self pays.”
Public Health Director Hall looked at it from a different perspective, noting that there would be more people covered by health insurance so there should be less to fear.
Another audience member asked if assets were considered in determining eligibility.
“Assets are no longer an issue,” Hall said. Previously people had to exhaust all of their assets before they could qualify for assistance.
Another asked insurance agent Lomas if the insurance crossed state lines for people who used Reno-based providers.
“It’s supposed to work the way that it’s always worked,” Lomas said and advised individuals to call their providers for verification.
With regard to a question about income changes, Lomas said that insurance costs are based on the modified adjusted gross income from the past year, but major changes such as a job loss or winning the lottery should be reported. If income were to be under-reported, an individual would be responsible for paying back the premium assistance.
Where to find answers
A lot of information is contained on the Covered California website or by calling the 800 number.
Despite his reservations about Covered California, Lafferty said that California’s website is one of the two best in the nation, the other being New York’s.
Local help can be found by calling the social services department, a certified insurance agent or Mimi Hall. Hall said that she wants to know about problems or glitches in the system because she works with the state officials responsible for the program.
Following are the contact numbers:
Covered California: go to CoveredCa.com or call 800-300-1506.
Plumas County Social Services: 283-6351.
Mimi Hall: 283-6342 or firstname.lastname@example.org.
Lori Lomas: 283-2341.
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