Health-care reform is looming over state policymakers like a thick fog, and deciphering what the changes will mean for ordinary Californians through the haze remains difficult.
South Coast women will get a chance this week to hear some of those details explained from one of the state commissioners working to implement the Patient Protection and Affordable Care Act, which is slated to begin next January.
Janice Rocco, deputy commissioner of health policy for the California Department of Insurance, will speak at 11:30 a.m. Friday to the Santa Barbara Women’s Political Committee at the Montecito Country Club, 920 Summit Road in Santa Barbara. Limited seats are still available and the committee can be reached at 805-564-6876.
Rocco, who has been overseeing the regulation of health insurance and implementation of the Affordable Care Act, spoke with Noozhawk on Wednesday about the law and its logistics.
“Businesses have seen significant rate increases year after year, and individuals have seen rates go even higher,” she said. “It has not been uncommon to see 15 to 20 percent increases in individual market rates followed by similar increases the next year.”
She said one of the key problems surrounding that issue is that California’s insurance commissioner doesn’t have the authority to reject those rate hikes 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, adding that 35 other states and the District of Columbia do have that authority.
Sen. Dianne Feinstein tried to get a provision allowing for that regulation into the Affordable Care Act, but it didn’t make it into the law, Rocco said. Because of that, voters will be asked to approve a ballot measure in 2014 that would allow the commissioner to regulate hikes.
The state is implementing many of the provisions of the ACA already, but Gov. Jerry Brown and the Legislature are still working out the details on Medi-Cal expansion, as well as the details about how the products will be sold in the individual market.
Historically, it’s been difficult to compare rates and policies between insurance companies, but an exchange would put plans in a central place so people can compare and choose, and will sell both individual plans as well as plans to small group markets, such as businesses.
While the small group market provisions have already been signed into law, the details of the individual market plans are expected to go to the governor by the end of this month.
Open enrollment for the plans is expected to begin Oct. 1 of this year, and “people will have a number of months to get enrolled,” Rocco said, adding that the enrollment period runs until March 31, 2014.
According to the federal law, people will be required to purchase health insurance unless the plans available cost more than 8 percent of their income or if they aren’t required to file income tax returns, Rocco said.
One reader question that Noozhawk received asked how much people will be fined if they don’t purchase insurance through the exchanges.
Rocco said the penalty in the first year “is not a significant dollar amount,” about $95 a year or 1 percent of the person’s annual income, whichever is higher. However, that penalty would increase as the plan becomes more established, starting in 2015 or 2016.
Getting people to sign up for Medi-Cal has been a significant challenge in the past, Rocco said, with many people who qualify not enrolling because of the difficulty of the process. Signing up people for the exchanges is crucial, and “the state is engaged in efforts to make this is easy as possible to do,” she said.
Whether people are eligible for Medi-Cal or for subsidies to offset the cost of the exchange, “a lot of work is being done” to get people enrolled easily, she said.
The federal government has given funding to implement the law for the first three years starting next January, but after that, “California does need to be self sufficient,” she said.
After that “the exchange will be charging a fee to health insurers to pay for the benefits,” she said, adding that the fees charged to fund the exchange may be passed on to the policyholders. As people are expected to enroll, the increase in patients seeking health care will be dramatic.
CenCal estimates Medi-Cal enrollment alone to increase by 25,000 people in Santa Barbara County under the Affordable Care Act, even as the state has decreased the amount of Medi-Cal funding it is willing to pay per patient.
Rocco said the ACA includes funding to “substantially increase” what primary care doctors are paid to treat Medi-Cal patients, with the idea that doctors will have more incentive to accept these patients.