With full implementation of the federal Patient Protection and Affordable Care Act drawing closer each day, Santa Barbara County officials met Thursday night to answer questions about what that will look like for local residents.
The Affordable Care Act is set to officially take effect Jan. 1, 2014.
After a brief introduction from county Supervisor Janet Wolf, CenCal Health CEO Bob Freeman and County Public Health Director Dr. Takashi Wada gave presentations before a packed board room at Goleta Union School District offices.
The 1,000-page bill, which passed in 2009, seeks to increase the number of Americans who have coverage while decreasing rising costs — which account for about $8,000 a year per person, he said.
As of 2010, 15 percent of the nation is uninsured, and “we’re not a society that denies people medical care due to an inability to pay,” Freeman said.
Uninsured people often tend to wait to be treated for medical conditions, so they’ll go to the emergency room, where care is the most expensive, he said.
People who are not eligible for Medi-Cal now may be able to qualify as of Jan. 1, including low-income people with children.
Insurance for employees of smaller companies is “vastly more expensive” than for larger companies. Individuals and groups will be able to purchase insurance from the state’s exchange, Covered California, where people will be able to compare insurance plans and rates.
“Think Expedia for your insurance,” Freeman said.
Some of the more publicized changes the Affordable Care Act will bring include prohibiting denial of coverage because of pre-existing conditions and allowing parents to keep adult children on their plans until age 26. Individuals who do not opt in will face a penalty, which is common for other types of insurance, such as auto, he said. The penalty for individuals is $95 a year, up to 1 percent of income, whichever is more for the first year, and will go up every year after that, Freeman said.
Subsidies will also be available for lower-income people to obtain insurance in the exchanges.
“The idea is to make it as affordable for everyone as possible,” he said.
Under the plan, people with existing insurance will not need to change their insurance or current coverage, and should see no real change.
However, some of the provisions of the law require that all health care plans provide coverage for things like pre-existing conditions, and will affect everyone with health insurance.
The audience peppered the speaker with questions, including the feasibility of the plan.
“Do you think this is going to work?” one man asked.
“To me, it makes sense,” Freeman answered, adding that care for uninsured people through emergency rooms is more expensive and less effective than insuring them in the first place.
The average per member per month was $320, and subsidies could be applied, he said.
Dr. Wada spoke next about the local impacts and said that 67,000 Santa Barbara County residents are uninsured currently, according to modeling done by the department.
“We don’t actually know the exact numbers,” he said. “But in general, this is what we think will happen.”
Wada said 40,000 people are expected to gain insurance, but 27,000 still will be uninsured for a number of reasons. The person could be undocumented or could be someone who can’t or won’t enroll even if they’re eligible for coverage.
He said 25,000 new patients will be eligible for Medi-Cal, and getting people enrolled in the program, and keeping them enrolled, will be a huge task.
The Department of Social Services is currently accepting applications for Medi-Cal for people who already qualify and will also be responsible for new enrollees as well.
“It already takes a long time to get a medical appointment,” one woman said, adding that the increase in the number of patients could make wait times even longer.
“A lot of these individuals are already in our system,” Wada said. “But you’re absolutely right, there’s going to be a period of pent-up demand.”
Wada said the county is working to fill capacity on the primary care side, specialty side and mental health and behavioral health. People can start pre-enrolling in the exchanges in October, so they’ll be eligible on Jan. 1, and can do so by phone, online and in offices across the state.
The county has already implemented electronic health records, a huge part of the Affordable Care Act.
A patient may see a primary care physician at a county clinic, but that physician is able to look at the patient’s records from a local emergency room or a nearby pharmacy, giving a full picture of the patient’s health and preventing duplication, such as having the same tests run twice or being prescribed medicines that are contraindicated.
“There are still a lot of unknowns,” he said, but added that more information is coming out daily and the county is striving to be ready.