Janice Rocco often gets phone calls from people struggling with their health insurance, sometimes in the midst of life or death situations.
A deputy commissioner of health policy for the California Department of Insurance, Rocco recalled one such call from a father whose daughter was being hospitalized for an eating disorder that had taken a life-threatening turn, but had been told she would have to be discharged because the insurance would only pay for a week in the hospital.
“I knew right away that violates the law,” Rocco told the audience gathered Friday at Montecito Country Club.
Because of mental health parity laws, insurers must cover mental health treatment like any other health condition, and Rocco called the insurer to make sure the law was being followed.
“Insurers still never cease to amaze us with the things they are willing to do to make a profit,” she said.
The parity law was on the books in California before the Patient Protection and Affordable Care Act was enacted in 2010, but having it in the federal law “really makes a difference,” Rocco said.
During her presentation to those gathered at the Santa Barbara Women’s Political Committee luncheon, Rocco talked about many of the differences Californians will see come to fruition when health-care reform also known as Obamacare is implemented next year.
The event was packed with Santa Barbara County movers and shakers from almost every level of government, from Congress to city advisory boards.
Rocco’s talk comes as big changes are being made on the state level, one of which occurred Thursday. The Legislature approved two bills to expand Medi-Cal coverage to more than 1 million low-income Californians under the umbrella of health-care reform, and more changes are being made to prepare residents for the new insurance exchange system that is to be put in place in 2014.
Next year will be “a year of huge changes across this nation,” she said, although she added that many changes already are in place.
Among them are requirements that at least 80 percent of premiums people pay for insurance must go toward actual health care instead of toward profit for insurers, she said.
Children with pre-existing conditions must be covered now as well. Before, she said, insurers has stopped selling policies to children altogether so they wouldn’t have to cover those with pre-existing conditions.
As a result, Rocco’s office issued a regulation that required insurers to cover children or they wouldn’t be allowed to sell policies to adults, and “companies immediately started selling (to kids) again,” she said.
Preventative coverage without co-pays or deductibles is also a change, and will save money while keeping people healthier in the first place, she said.
That law also applies to contraceptives, and Rocco said federal officials in Washington have called her to see how religious employers in California are handling that issue.
“It was helpful for the folks in D.C. to understand that it can work,” she said.
Among the talk of changes, there is also fear among many about how the coverage will work. Many people don’t know what the benefits will be, just that they’ll be required to purchase something, Rocco said.
But the federal government will be subsidizing the cost of premiums beginning next year, and policies will cover more services than they have in the past, she said.
According to Rocco, insurance rates have climbed, mostly unchecked, because Jones’ office doesn’t have the authority to reject such increases if he deems them excessive.
“We can reject rate hikes in auto insurance, homeowners and even medical malpractice insurance, but not for health care,” Rocco said earlier this week, adding that 35 other states and the District of Columbia do have that authority.
“It’s a very difficult situation when we get to 2014,” she said Friday.
Rocco said Jones has tried to get laws passed giving his office that power for six years in a row, but each time has been met with intense lobbying from HMO and PPO companies. A ballot initiative is expected to go before voters in 2014, asking them to grant that power to the insurance commissioner.
Rep. Lois Capps, D-Santa Barbara, also spoke about the health-care law, a law she said “we worked for a year to pass.”
“Almost 19 million women stand to gain affordable coverage ... This is a significant benefit,” she said, adding that insurers will no longer be able to charge women more for coverage because of their gender.
“We have really experienced deficits with our health-care coverage, but no longer,” she said.