Steve Albion was diagnosed at age 13 with Type 1 diabetes, a chronic disease that is potentially fatal and treating it requires blood tests three to six times a day, plus insulin injections before every meal.
Albion, now 50, is supposed to closely monitor his blood-sugar levels, but he says it’s been hard to follow protocol. Like a lot of folks navigating a volatile and changing economy, he’s been in and out of jobs with no health insurance for long stretches.
During one 10-year period, Albion says he stopped testing his blood altogether because he couldn’t afford the test strips and lancets; after paying $110 in cash for his monthly insulin supply, he’d have no money left.
“The doctors thought I should have died nine times over,” he says.
Albion, who makes $11.40 per hour working part-time at a boat supplies store in Santa Barbara, hopes Affordable Care Act-instituted reforms to Medicaid mean his days of health-care insecurity are now over. He could get insurance through his job, he says, but it’s too expensive.
So, this month, under the Affordable Care Act, he applied for Medicaid, the national health-care program for low-income residents, called Medi-Cal in California.
The Affordable Care Act, popularly known as Obamacare, loosens the restrictions and raises the income caps for Medicaid and Medi-Cal, potentially expanding the program to as many as 15 million Americans, Albion among them.
For individuals, the annual income cap for eligibility is now $15,856. For a family of four, it’s $32,499. California is one of 26 states implementing the expanded program for the poor.
“It seems to me it’s going to be much better with Medi-Cal, having coverage based on an income that’s more realistic,” Albion says. “It’s not going to be an astronomical bill if I have to go to the hospital or the doctor. It will be as if I have insurance. Amazing.”
There is no single group that stands to benefit more from Obamacare than the uninsured poor. Medi-Cal offers free or low-cost health-care coverage to those who qualify.
But according to the Santa Barbara County Department of Social Services, only 1,487 applications for Medi-Cal were submitted under the Affordable Care Act in October and November.
This could mean that 1,487 individuals applied countywide, the department says, or, based on past averages, that as many as 3,568 people have attempted to enroll so far when applications for families are accounted for.
Including applicants who were eligible under the old rules, Medi-Cal enrollments for October were a third higher compared to October of last year, county officials say. But overall, enrollments in October and November represent only a fraction of the uninsured population, they say.
The Department of Social Services estimates that 25,000 county residents may be eligible for Medi-Cal under the Affordable Care Act and another 10,000 may be eligible under the old rules, but have not applied. Statewide, it’s a similar story.
A report this month from the U.S. Department of Health and Human Services shows that 181,800 Californians enrolled in Medi-Cal in October and November. That’s less than 5 percent of 3.9 million uninsured residents who are eligible for the program, according to studies by the University of California.
"This is absolutely our No. 1 priority, at the expense of lots of other things,” says Elizabeth Snyder, deputy director of the Santa Barbara County Public Health Department. “Our message is, ‘Enroll, enroll, enroll! Please! Don’t be afraid of the nonsense around the computer problems.’ If we have to, we’re resorting to paper. I wish we could get people to understand.”
The negative publicity swirling around Obamacare may have scared people away, Snyder says, or those eligible for Medi-Cal coverage may be swamped with day-to-day worries about meals, housing and jobs.
In any case, Snyder has abandoned her original goal of 6,000 new Medi-Cal enrollees through the Public Health Department by March 31, 2014.
“It’s just going to take longer than we hoped,” says Snyder. “People are totally, completely confused. They don’t trust the system. They don’t know they’re qualified. Health insurance is the last thing on their minds, especially if they’ve never had it in their life. I think it will be next July before we get some serious good numbers.”
U.S. Census data show that 17 percent of the population of Santa Barbara County is uninsured, or about 73,000 people. And according to the Snapshot of Poverty, a recent report commissioned by the county Department of Social Services that was funded in part by the Santa Barbara Foundation, about 60,000 residents, or one in seven, are living in poverty—defined as having an annual income of $11,490 for individuals or $23,550 for a family of four.
(The poverty rate is likely underestimated: as the report notes, undocumented immigrants are not counted in official statistics.)
“What happens to poor people is, they always have to delay seeing a doctor,” Snyder says. “They don’t have the money or the time. They end up pushing it all out until they’re really sick, and then they go to the hospital. But if they enroll in Medi-Cal, they can go early to the doctor and avoid really chronic, serious problems. They’re making an investment in themselves.”
Even under the expanded program, thousands of low-income Santa Barbarans do not qualify for Medi-Cal.
Undocumented immigrants are excluded from the benefits of the Affordable Care Act. According to a 2012 report by the UCLA Center for Health Policy Research, 15 percent of the uninsured population under the age of 64 on the Central Coast of California, including Santa Barbara County, is undocumented.
What’s more, as the Snapshot of Poverty report notes, the definition of poverty is based on federal thresholds that are widely viewed as inadequate. A different measure that has been adopted by many policymakers, called the Self-Sufficiency Standard, takes into account the cost of housing, food, health care, childcare, transportation and taxes, the report says.
It shows that as of 2011, a single adult in Santa Barbara County would require a yearly income of $27,912, or $13.22 per hour, to cover his or her basic needs without public subsidies. That’s more than twice the federal income threshold of $11,490 for individuals living in poverty.
Under the Self-Sufficiency Standard, Kathy Rooney of Santa Barbara, a single, 53-year-old caregiver with two half-time jobs in the health-care business, would qualify as economically insecure. Her yearly income is about $24,000, and she has no health benefits.
In a previous job as a preschool teacher at a local church in Santa Barbara, Rooney says she had health insurance for 15 years, but she lost that job three years ago in the recession. She is not eligible for the Medi-Cal expansion, but under the Affordable Care Act, she can apply for subsidized insurance.
Rooney says she signed up for a plan in which she’ll pay only $10 per month toward her premium. Even with a high deductible, she says, “I think I’ll feel more secure. I have something I can count on.”
To help spread the word about the Medi-Cal expansion, more than a dozen governmental and non-profit agencies in Santa Barbara County are signing people up, including the Santa Barbara Neighborhood Clinics, Cottage Hospital and Planned Parenthood.
The Public Health Department alone has trained 83 employees to work face-to-face with applicants. County health centers are staying open late on weekdays and Saturdays, and employees are calling hundreds of patients to schedule appointments.
On Saturday, the county Public Health Department hosted a health fair at its clinic in Santa Maria, with Rep. Lois Capps (D-Santa Barbara) and county Supervisor Salud Carbajal on hand. They urged the approximately 40 people in attendance to sign up for Medi-Cal with nine “navigators” there to assist with online applications.
“I’m proud of you for coming,” Capps said. “We have what is called a complicated healthcare system in America. We’re trying to make it better.”
— Melinda Burns is a reporter for Mission & State.