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California moves ahead with health reform


With the question of whether the federal Affordable Healthcare Act of 2010 (ACA) is  constitutional now firmly decided by the Supreme Court, attention has shifted to understanding exactly what the law means for Californians.

By the numbers, the meaning is fairly straightforward. According to the California Health Benefit Exchange, when fully implemented in 2019, nearly 5 million state residents will have access to affordable health insurance.

That includes 2-3 million uninsured in Los Angeles County, which also counts an estimated 80,000 people in the Antelope Valley.

Between 1.8 and 2.1 million of the uninsured will obtain subsidized coverage through a new health exchange established; between 1.2 and 1.6 million will be covered under an expansion of Medi-Cal, and an additional 2.1 million are expected to purchase guaranteed coverage through the exchange or in the individual market.

In the Medi-Cal expansion, all eligible Californians who make less than 138 percent of the federal poverty level–$15,415 for an individual and $31,810 for a family of four–will be eligible for fully paid health coverage through Medi-Cal.

Those earning between 138 and 400 percent of the federal poverty level will qualify for a sliding scale subsidy given in the form of a tax credit.

The credit can be used to help pay the premium for health insurance purchased through the California Health Benefit Exchange.

The mission of the exchange is to increase the number of insured Californians, improve healthcare quality, lower costs, and reduce health disparities through an innovative, competitive marketplace that empowers consumers to choose the health plan and providers that give them the best value.

According to James Cook, CEO of the Antelope Valley Community Clinic, the first federally qualified health center to open in the Antelope Valley, the Medi-Cal expansion portion of the ACA will have the most impact on his clinic.

Cook says since July of last year, he has also seen 1,200 people obtain insurance through a program called Healthy Way L.A. That resulted in 400 to 500 additional patient visits. His organization expects those figures to double in the next year.

Healthy Way L.A. is open to individuals who have been denied admission to the Medi-Cal program and who have no children, no disability and are U.S. citizens.

Cook says his organization services the entire Antelope Valley–2,000 square miles–with three walk-in clinics and two mobile units. By his estimates, Cook’s facilities reach nearly one-quarter of the 80,000 uninsured Antelope Valley residents.

T.H.E. clinic, another federally qualified community health clinic serving residents primarily in South and Southeast Los Angeles through seven locations and one mobile unit also treats a high number of low-income residents.

According to clinic CEO Rise R. Phillips, T.H.E. serves everyone, but says that about 63 percent of their patients are under 100 percent of the federal poverty level. This will probably be the case for the next decade, added Phillips. However, she also sees a growing number of people with insurance who are coming to T.H.E. because of the affordability of the care provided.

Like the Antelope Valley Community Clinic, Phillips projects that T.H.E. can expect its patient load to grow as well–18,000 to 20,000 people over the next three years.

Cook and Phillips say that the Supreme Court’s decision is a good one for the L.A. County health system because it means that fewer people will use hospital emergency rooms as their “doctor of last resort.”

But there is a drawback to more people having insurance–there is a shortage of primary-care physicians, which could potentially mean that patients have longer waits to see a doctor.

Cook says his organization has three search firms looking for primary-care physicians to hire. Additionally, his company can offer loan repayment assistance.

“. . . We work and manage in teams,” explained Phillips about how they are currently addressing the doctor shortage. “. . . the team takes the weight off the primary-care physician.”

Phillips says their teams can consist of physician assistants, and nurse practitioners. In the coming months, health coaches will also be incorporated into the teams.

Among the other provisions of the ACA are a requirement that every American citizen and legal resident have health insurance or pay a penalty that begins at $95 per uncovered family member beginning in 2014. The penalty will increase each year.

People exempt from the requirement to purchase insurance include those who have been uninsured for less than three months as well as those who will have to pay more than 8 percent of their household income for healthcare premiums.

Additionally, companies can no longer deny people insurance because of pre-existing conditions like high blood pressure or diabetes or, as Phillips pointed out, for just being a woman.

Another provision of the ACA also allows young people to remain on their parent’s insurance until age 26.

States will also be required to establish pools like the exchange that enables the uninsured purchase low-cost insurance.