Here’s how jail-based health treatment failed my family: Guest commentary

As the child of a formerly incarcerated person, I’ve lived with the consequences of a failed law-enforcement system that believes jails can be places for rehabilitative treatment and care. This illusion eventually cost my dad his life.

My dad was a poor man of color raised in the smallest city in Los Angeles County. He served long sentences for drug-related crimes and parole violations. Being locked up exacerbated his existing physical and mental health issues. There were no services to greet him at the gate when he was released, and so imprisonment became law enforcement’s version of treatment. When he tried to find a job and a home, he was rejected at every turn because of his felony record.

At a meeting in Sacramento earlier this month, the Board of State and Community Corrections (BSCC), a small board dominated by law-enforcement officials, appointed the chairs of the committee who will recommend where to spend the millions of dollars of savings generated through Proposition 47, the law passed one year ago that reclassifies certain low-level crimes from felonies to misdemeanors. Sixty five percent of this money must be allocated to diversion, mental health, and substance use treatment programs, giving California an opportunity to improve health outcomes for thousands of families.

But at that same meeting, despite testimonials from dozens of community members like myself whose lives have been harmed by incarceration, the BSCC voted to allocate $500 million in jail construction funds to counties across the state. Given that many of these new jail projects are being promoted as mental health treatment centers, sheriffs may soon be lining up to make the case for needing Prop. 47 funds to run these facilities. Awarding funds to expand jails makes no sense when national conversations have turned toward reducing jail populations.

The committee appointed by the BSCC to direct spending of Prop. 47 funds has the power to ensure that those savings go to treatment and care in the community, changing the culture surrounding substance use and mental health. This is the approach that finally worked for my dad.

When my dad was released for the last time in 2007, it was support from other formerly incarcerated people also grappling with substance-use and mental health conditions that helped him stay out of jail. He found his way to Homes for Life, a community-based organization in Southern California providing affordable housing and counseling for homeless and mentally-ill people. Living in a caring community empowered him to enroll in Long Beach City College’s Substance Abuse and Addiction Counseling degree program. It is bittersweet knowing that my dad didn’t find the resources he needed until he was 50 because society prioritizes punishment over healing.

Driving home to Southern California from Oakland this past spring, I prepared myself to see my dad for the first time in 20 years. It would also be the last time. I wept reflecting on 20 years of lost opportunities for our family because a poor brown man’s health conditions made him a criminal.

The real crime is the failure of law enforcement to know the difference between health care and incarceration. There is no happy ending to our story. My dad died without realizing his capacity to be a father and contribute to his community. I only find solace knowing he left this world trying to be the best person he could be.

My dad’s story is not exceptional. Families and neighborhoods continue to be torn apart by the same system that claims keeping communities safe means building more cages for people, when what they really need is comprehensive health care not administered by law enforcement.

Instead of accepting money for new jails, counties should reject the funding and give people with mental health and substance use conditions what my dad didn’t get: a fair chance at health, and a fair chance at life.

Angela Aguilar is a masters in public health candidate and a doctoral student in ethnic studies at the University of California, Berkeley.
Via: http://www.dailynews.com/opinion/20151124/heres-how-jail-based-health-treatment-failed-my-family-guest-commentary

California Senate approves health care for undocumented immigrants

A proposal to expand health care to Californians in the country illegally cleared the Senate on Tuesday, passing on a 28-11 vote and heading to the Assembly.

Senate Bill 4 would allow undocumented immigrants to purchase health insurance on the state exchange, pending a federal waiver, and enroll eligible children under the age of 19 in Medi-Cal, the state’s insurance program for the poor. A capped number of undocumented adults would also be allowed participate, if additional funding is appropriated in the state budget.

“We are talking about our friends, we are talking about our neighbors and our families who are denied basic health care in the richest state of this union,” said Sen. Ricardo Lara, D-Bell Gardens, the measure’s author. “Ensuring that every child in California grows up healthy and with an opportunity to thrive and succeed is simply the right thing to do.”

Debate got increasingly feisty as it turned into a discussion of stalled immigration reform efforts in Congress. Sen. Isadore Hall, D-Los Angeles, baited his Republican colleagues to support SB 4, calling their “excuses” not to support the measure “tools of the weak and incompetent.”

Republican Sens. Andy Vidak of Hanford and Anthony Cannella of Ceres, who both represent swing agricultural districts, joined Democrats in voting yes on the bill.

The bill aims to expand the scope of the federal Affordable Care Act, which prohibited undocumented immigrants from participating in any of the health insurance exchanges it established. Under SB 4, California would also be required to apply for a federal waiver to allow individuals to buy plans on the exchange regardless of immigration status, though those who are not citizens would not be eligible for assistance to pay for the coverage.

Lara scaled back the bill last week to help it get past the Senate Appropriations Committee, where a similar proposal was held last year.

SB 4 still faces a challenging road in the Assembly, and should it make to Gov. Jerry Brown’s desk, a signature is not guaranteed. Brown has expressed skepticism over the bill because of its high cost, estimated to be as much as $135 million annually.

Via: http://www.sacbee.com/news/politics-government/capitol-alert/article22904433.html#storylink=cpy

New Data Shows Importance of Targeted Outreach in Languages Other than English

On Wednesday July 16th, Covered California released self-reported data on the written and spoken languages of its enrollees in each of the 19 rating regions across the state. The new data reinforces the importance of reaching out to the remaining uninsured in culturally and linguistically appropriate ways (particularly in languages other than English) in order to ensure robust enrollment in 2015.

It is estimated that at least 40% of Californians eligible for subsidies in Covered California speak a language other English; however only 17% of enrollees statewide reported a language other than English as their preferred written or spoken language. These numbers vary greatly between regions. For example, close to half (47%) of enrollees in Region 13 (Mono, Imperial, and Inyo Counties) reported Spanish as their preferred written and spoken language. Similarly, around a third of enrollees in Kern County and Northern Los Angeles County (Regions 14 and 15, respecitvely) and roughly 1 in 4 enrollees in the Central Valley (Regions 10 and 11) reported a language other than English as their preferred written and spoken language.

The data includes regional break-outs for Spanish as well as the other Medi-Cal Managed Care threshold languages: English, Vietnamese, Chinese, Korean, Farsi, Tagalog, Cambodian, Russian, Arabic, Armenian, and Hmong.

There is an opportunity to improve outreach and enrollment in languages other than English. Covered California is planning to award up to $16.9 million in grants, including to community-based organizations, for enrollment assistance during the next enrollment period slated to start November 15, 2014. A portion of the funds will be awarded specifically for targeted outreach and enrollment of hard-to-reach populations including young adults and Limited English Proficient Californians. Covered California’s new language data highlights the importance of continued targeted funding for culturally and linguistically appropriate outreach and enrollment of the remaining uninsured.

Visit Covered California's Open Enrollment Data Book for more detailed enrollee data.

© 2014 | California Pan-Ethnic Health Network | info@cpehn.org MAIN OFFICE: 1221 Preservation Park Way, Suite 200, Oakland, CA 94612 Phone: (510) 832-1160 | Fax: (510) 832-1175 SACRAMENTO OFFICE: 1225 8th Street, Suite 470, Sacramento, CA 95814 Phone: (916) 447-1299 | Fax: (916) 447-1292

IMMIGRATION: Legality of effort to repeal Prop. 187 is questioned

Some California legislators are poised to repeal Proposition 187, a controversial 20-year-old initiative that was ruled unconstitutional by a federal court and never enforced. But law scholars question whether the elected officials have the legal authority to act on their own.

“The California Constitution says you can’t amend or repeal an approved measure without submitting it to the voters unless there’s a waiver clause,” said Jessica A. Levinson, a Loyola Law School professor who specializes on election law.

Prop. 187, which sought to cut off public education, health care and welfare benefits to undocumented immigrants in California, had no such waiver, said John C. Eastman, a Chapman University Law School professor and founding director of the Claremont Institute’s Center for Constitutional Jurisprudence.

“These guys are acting lawlessly,” Eastman said. “They’ll do it if they think they can get away with it and no one will challenge them.”

California voters approved Prop. 187 – also known as the “Save our State” campaign – in November 1994 with almost 60 percent approval. A federal court ruled most of the provisions unconstitutional, and the measure was not enforced. But some of the language remains embedded in various codes, including education codes.

Sen. Kevin de Leon, D-Los Angeles, said he learned of its existence in California codes accidentally. He was recently talking to his staff about his personal history and recounting how he “cut my teeth politically against the 187 campaign.” Chief of Staff Dan Reeves decided to look into the proposition and found it had not been removed.

“These code sections are unenforceable. The Legislature has the right and power and authority to maintain the codes with our statutes and that’s we’re doing,” Reeves said.

“Essentially, it’s code cleaning,” he said.

De Leon’s staff consulted with the state’s legislative counsel, Diane Boyer-Vine, whose opinion was that “it’s not necessary to go back to the voters,” Reeves said.

State Sen. Richard Roth, D-Riverside, said unconstitutional laws should not remain on the books.

“The Constitution is the highest law of our nation, and I support any effort to remove any statute or language found unconstitutional,” he said.

Sen. Mike Morrell, a Rancho Cucamonga Republican who represents parts of Riverside and San Bernardino counties, said in a statement that he has not yet decided whether to vote for de Leon’s bill.

“I have not yet had a chance to review the specific language of the bill or the legal questions surrounding it,” he said.

Robin Hvidston, executive director of the anti-illegal-immigration We the People Rising and an Upland resident, urged legislators to keep the law in California codes.

“To me, it’s important because this was the direct voice of the people,” she said. “The people’s voice, the people’s will was overruled by the courts.”

She worried that stripping Prop. 187 language from state codes would set a dangerous precedent and lead to other voter initiatives being gutted.

But Maria Rodriguez, an activist with the Inland Empire Immigrant Youth Coalition, said passage of de Leon’s bill would be another signal by the Legislature that California is “an immigrant-friendly state.”

California senator unveils bill to give health care to undocumented immigrants

A plan to provide undocumented immigrants in California access to subsidized health care has been spelled out in Senate Bill 1005 by Sen.Ricardo Lara, a Democrat from Bell Gardens.

Undocumented immigrants are excluded from the federal Affordable Care Act that is now offering legal residents the ability to purchase health insurance through government-run marketplaces.

Lara's bill would create two avenues for Californians who are in the country illegally to seek health care. The state would expand Medi-Cal to include undocumented immigrants whose incomes are under 138 percent of the poverty level -- about $32,000 a year for a family of four. And for undocumented immigrants who make more than that, the state would create a marketplace to sell insurance products.

The marketplace would be similar to Covered California -- the state's exchange that was created to sell insurance under the federal Affordable Care Act, also known as Obamacare.

The bill does not spell out a cost for California to extend health insurance to undocumented immigrants.

"We are doing the number crunching now," said Anthony Wright, executive director of the Health Access advocacy group that is supporting Lara's bill.

He said the goal is to provide health insurance for roughly 3 million Californians who don't have health insurance and cannot get it under the federal health program because of their immigration status.

"The idea under this bill is to extend the same level of help that the Affordable Care Act provides but to all Californians," Wright said. "It's about fairness and inclusion for all Californians."

Currently some California counties provide health care to undocumented immigrants but the offerings vary greatly among counties.

PHOTO: Senate President Pro Temp Darrell Steinberg, D-Sacramento, speaks with Senator Ricardo Lara, D-Bell Gardens, in the Senate chambers in March 2013. The Sacramento Bee/Hector Amezcua

Read more here: http://blogs.sacbee.com/capitolalertlatest/2014/02/california-senator-unveils-bill-to-give-health-care-to-undocumented-immigrants.html#storylink=cpy

via: http://blogs.sacbee.com/capitolalertlatest/2014/02/california-senator-unveils-bill-to-give-health-care-to-undocumented-immigrants.html

Don't get too worked up over today's big ObamaCare deadline

Monday is the last day to sign up under ObamaCare for coverage that kicks in January 1... sort of.

Yes, most people must sign up by 11:59 p.m. Monday night to have coverage in place at the start of next year. And as such, the cutoff is being trumpeted as a major hard deadline for the president's health care law.

Yet due to a number of administration-mandated tweaks and delays, the deadline is actually kind of squishy, and thus more symbolic than anything.

Last Thursday, the administration announced that some of the hundreds of thousands of people who had lost their existing health care plans because of ObamaCare could be exempt from the individual mandate's penalty. The "hardship exemption" written into the mandate stipulates that someone may be considered exempt if there are "financial or domestic circumstances…that prevented him or her from obtaining coverage under a qualified health plan."

That means people who have unexpectedly been dropped from their existing plans do not necessarily need to find new ones just yet. And as the Wall Street Journal noted, there are 14 specific ways people can qualify for the "hardship exemption," some of which require little to no documentation to prove. In other words, there are more than a dozen ways around the December 23 deadline, including one specifically made available to a group of people who have become a political flashpoint for the health care law.

In addition to the new hardship exemption, the administration had already this month extended the deadline from December 23 to the end of the year for people to make their first premium payments for new coverage. And more recently, it urged insurers to retroactively extend coverage to people who sing up by the 23rd but do not make their first payment until January 10.

There will also reportedly be a "good faith" exemption for others who try but are unable to enroll by the Monday deadline, something that will further soften Monday's supposedly hard deadline, according to Reuters. As you may recall, the federal exchange marketplace functioned so poorly in the early going that it effectively prevented people from getting coverage even if they wanted to.

Then there's the fact that the original "hard" deadline was December 15. But when Healthcare.gov crashed in the early going, the White House extended the deadline to the 23rd.

The White House had hoped to enroll 3.3 million people in new health plans through the federally run marketplace by the end of the year. They've so far enrolled about one-third that number. And though the pace of enrollments is trending upward, polls continue to find the law deeply unpopular; a CNN survey released Monday found a record low 35 percent of Americans supported the law.

Still, there's plenty of time for people to find coverage in the new year before they'll be penalized for going uninsured. Due to another extension, the uninsured have until April 1 to enroll in coverage before they'll be hit by the individual mandate's penalty.

So in that sense, the hard deadline for the law itself is April 1 — or, given the numerous delays to date, it's the law's hard deadline for now.

via http://theweek.com/article/index/254543/dont-get-too-worked-up-over-todays-big-obamacare-deadline

Steinberg: Making high school relevant is 'top focus'

California high schools could see an infusion of new programs that link academics with career exposure to provide students a richer learning experience. That's the goal of a competitive $250 million grant process Senate leader Darrell Steinberg is promoting to schools and businesses.

The Sacramento Democrat joined several local education and business leaders at Health Professions High School today to highlight a piece of the 2013-14 state budget that he hopes will give high school a boost of relevancy by connecting students to the world of work. 

Steinberg encouraged schools and community colleges to collaborate with employers in their region and apply together for grants to create more opportunities for applied learning.

"We want business, we want lead industries to step up and see this not just as a philanthropic add-on or something that would be nice to do for kids, but to see this opportunity as the beginning of a change in our American culture," Steinberg said. "For business, helping educate and train the next century work force is an indispensable part of the bottom line."

High schools could use the grants, for example, to hire someone to serve as an internship coordinator to match students with businesses, or to train teachers to teach academic subjects in a more hands-on way that shows how they relate to careers.

Educators bill the approach as "linked learning," and hold up Sacramento's Arthur A. Benjamin Health Professions High School as an example. The school teaches a college-prep academic curriculum but blends it with preparation for careers in health care. During a tour, Steinberg visited an English class where students had read "The Hot Zone," a book about the Ebola virus, and were doing a project about its symptoms.

"Linked Learning students understand how their high school education relates to their next step and beyond," said Deborah Bettencourt, superintendent of the Folsom Cordova Unified School District.

Bettencourt was joined at today's event by Sacramento City Unified Superintendent Jonathan Raymond and Elk Grove Unified Superintendent Steven Ladd.

"Linked Learning answers the question we've all heard, and we have in fact ourselves asked, 'Why am I learning this?' Once students can answer that question for themselves they are inspired and self motivated and have higher aspirations," Bettencourt said.

School districts will be able to apply for a piece of the $250 million through the state Department of Education early next year.

Steinberg and three other state senators recently returned from a trip to Switzerland and Germany to study the way those countries teach high school. He said he was impressed with the Swiss model in which businesses take an active role in preparing students for the workplace, and government spending focuses less on remediation and more on providing a relevant education.

"As I head into my final year in the Legislature, this is is my top focus," Steinberg said. "I don't have the luxury of multi-year projects, two-year bills or do-overs any more. This is it. When it comes to making lasting change, in my view there is no more important challenge to tackle."

PHOTO: Senate President Pro Tem Darrell Steinberg talks with students at Health Professions High School in Sacramento. The Sacramento Bee/Laurel Rosenhall

via http://blogs.sacbee.com/capitolalertlatest/2013/10/steinberg-says-improving-high-school-top-priority-for-final-year-in.html

Read more here: http://blogs.sacbee.com/capitolalertlatest/2013/10/steinberg-says-improving-high-school-top-priority-for-final-year-in.html#storylink=cpy

Shutdown, or not - California launching health law Tuesday

California will forge ahead with the launch of its health insurance marketplace Tuesday, regardless of whether Congress fails to reach a last-minute deal to avert a federal government shutdown.

A possible shutdown would not stop the state because it has already received federal funding to implement the law. Much of the health care law, including federal subsidies for lower-income customers, was established through mandatory spending and not tied to annual appropriations.

On Friday, President Barack Obama promised that the insurance exchanges would open for business even if there's a government shutdown.

"That's a done deal," he said.

Indeed, Covered California - the state's version of the federal health care law - is preparing to begin enrolling customers in its health insurance exchange on Tuesday. Parts of the government would close on the same day if lawmakers in Washington don't act on legislation to extend discretionary spending.

Congressional Republicans have been working to stop the health law in its tracks.

On Monday, Senate Democrats tabled two House-approved amendments to a spending bill that would delay for one year implementation of the health law as well as repeal a medical-device tax designed to help pay for its implementation. Obama and Senate Democrats are urging the House to pass the Senate-approved spending bill with no provisions on the health care law.

California, one of 14 states rolling out its own marketplace, will mark opening day with a series of events in Sacramento, Fresno, San Francisco, Los Angeles and San Diego. The federal government will oversee the launch in the remaining states.

Photo: Samuel Butler inquires at a Covered California booth last weekend at the George Sim Center in Sacramento. Lezlie Sterling/The Sacramento Bee

Read more here: http://blogs.sacbee.com/capitolalertlatest/2013/09/shutdown-or-not---california-launching-obamacare-tuesday.html#storylink=cpy

Covered California Open Enrollment

News Bulletin Covered California Open Enrollment Begins October 1, 2013 Covered California will begin open enrollment on October 1, 2013, with coverage beginning January 1, 2014. This is an exciting time, as communities of color represent two-thirds of the 2.7 million individuals who will be eligible for tax credits to purchase affordable coverage in Covered California. Additionally, more than one million eligible adults will speak English less than very well, making language access a priority. We need to spread the word about available resources to maximize enrollment among those eligible in our communities: ·         Covered California's website is currently available in both English and Spanish ·         Fact sheets about Covered California are available in 13 different languages ·         Covered California's telephone help line: 1-800-300-1506 will provide interpreters in any language. ·         The new application for coverage will be available in 12 different languages and will have dedicated, toll-free numbers for telephone assistance in each language. If your organization is interested in helping to get people enrolled in either Covered California or Medi-Cal, visit Covered California's Enrollment Assistance Program, where you can complete an online application to become a Certified Enrollment Entity. Upcoming Convening Provides Information on Outreach and Enrollment For more information on outreach and enrollment efforts, be sure to attend our upcoming convening, A New Era of Coverage: Maximizing Participation in the ACA. At this event, you can get updates on the state's outreach and enrollment efforts and hear about how local organizations are enrolling communities of color in available coverage opportunities. Register today and join us in Fresno (10/3), Oakland (10/8), Los Angeles (10/15), or San Diego (10/16). If you have further questions, email Cary Sanders at csanders@cpehn.org. If you would like to change your contact information, please email info@cpehn.org. If you would like to unsubscribe from CPEHN's Action Alerts, please email unsubscribe-actionalerts@cpehn.org. If you would like to unsubscribe from ALL CPEHN email communications, please email unsubscribe-all@cpehn.org. GET INVOLVED ·         Share With a Friend ·         Subscribe to our Newsletter, Action Alerts, or Event Invites ·         Join Our Network ·         Follow Us on Twitter @CPEHN ·         Like Us on Facebook ·         Donate

© 2013 / California Pan-Ethnic Health Network / info@cpehn.org MAIN OFFICE: 1221 Preservation Park Way, Suite 200, Oakland, CA 94612 Phone: (510) 832-1160 / Fax: (510) 832-1175 SACRAMENTO OFFICE: 1225 8th Street, Suite 470, Sacramento, CA 95814 Phone: (916) 447-1299 / Fax: (916) 447-1292

Personal Finance: New federal health care mandates kick in starting Oct. 1

By Claudia Buck

Love it or hate it, the launch date for the country’s sweeping new health care mandates is just around the corner. In 10 days, the essential piece of the federal government’s Affordable Care Act kicks in, allowing everyone across the country to sign up for health care coverage.

Starting Oct. 1, you’ll need to make some choices, whether you’re currently covered at work, have been buying health insurance on your own, or never had it in the first place.

“We’re getting slammed” with inquiries, said Anne Gonzales, spokeswoman for Covered California, the state’s new health care exchange offering policies under the new law. “People are very focused on Oct. 1, but we’ve already been taking phone calls from consumers and people trying to get educated.”

Although health care policies can’t be purchased online until Oct. 1, “We encourage people to call in ahead of time,” said Gonzales, “so they can shop and compare. There’s no reason to wait.”

While there’s been much heated debate over the merits of affordable health care in the last four years, there are some definite positives. Among them: Everyone will be entitled to 10 “essential services” (see box) and you can’t be denied health care for pre-existing conditions, whether it’s diabetes, cancer, AIDS or anything else.

Whether it’ll be cheaper depends on your family circumstances and your health care needs.

“People who’ve been declined (for pre-existing conditions) all these years will be happy. But if you’re a family of four making $90,000 a year, you’re going to see a big increase,” said Carrie McLean, director of customer care at eHealthInsurance.com, an online health coverage comparison site.

That’s due to a combination of lower caps on what everyone has to pay out of pocket for medical expenses, as well as the mandated coverages required of all health care policies. To cover those costs, health care companies are raising rates on certain policies and premiums.

That’s why it pays, more than ever, to spend some time on your health care choices this fall. Here’s a look at some of the basics:

Covered at work

If your employer provides health care insurance, you’re already in the loop. No doubt you’ve been invited to company presentations, directed to websites or received information packets about changes in your company’s health care plan for 2014.

Open those packets; attend the meetings; go online to look at your options. During this year’s open enrollment, it’s more critical than ever.

Some companies are changing carriers, offering incentives or switching some benefits. Some are urging employees to consider health savings accounts, for instance. (More on that topic in a future column.) And unlike years past, where employees may have been automatically enrolled in a company’s health care plan, this year’s changes often mean you need to proactively take steps to ensure you’re enrolled. If you forget to sign up, you may be out of luck until 2015.

A recent MetLife study found that a majority of employees “are on autopilot” during open enrollment and don’t really scrutinize their health care choices, which could be especially risky this year. “Employee benefits are not ‘one size fits all,’” said Michael Fradkin, MetLife’s senior vice president for worksite benefits, in an email. To avoid “missing new coverage options and money being left on the table, we encourage all employees to take the time to closely evaluate all of their benefits options.”

If you’re confused or unclear about your choices, contact your company’s HR department for guidance.

Buying it yourself

If you’ve never had health care insurance, either because you were too young, had a pre-existing condition or your employer didn’t provide it, now’s your chance to get coverage and shop for the best rate.

Insurance on the exchanges comes in four levels: bronze, silver, gold and platinum. At the lowest level, bronze, your monthly premiums will be the cheapest, but you’ll pay more for doctor visits and co-pays. The plan will cover about 60 percent of your medical costs. At the higher gold and platinum levels, your premiums are higher but you’ll pay less when you see a doctor or buy a prescription. Those plans will cover 80 percent to 90 percent of your costs.

That’s where doing your online comparisons comes in. “Start playing around with the online computer to look at your coverage options,” said Gonzales. Using the “Shop and Compare” tool on the Covered California website, you type in your age, ZIP code, income and family size. You’ll instantly get a list of the companies offering plans in your county.

For instance, a single, 26-year-old male in the 95814 ZIP code making $25,000 a year could get a bronze-level plan for $75 to $84 a month. That’s with a federal subsidy of $126 a month. A family of four in the same ZIP code earning $80,000 a year could choose from four bronze plans priced at $386 to $417 a month, with a $332 subsidy.

You can purchase health insurance from any local or online broker, but you must go through Covered California if you want to apply for a federal subsidy.

When comparison shopping, have an idea what’s important in your health plan. Do you still want to see your same doctors? Will it cover the prescription drugs you take? How often do you see a physician; do you just need basic coverage? How much can you comfortably afford, both in monthly premiums and out-of-pocket expenses?

“It’s like car insurance. You can lower lower your premium, but if you get in a car accident, you want to be sure you’re covered,” said McLean. “We all hope we won’t get cancer and won’t need the insurance. But if you get seriously ill midyear and originally purchased a bronze level plan, you’ll hit your out of pocket quickly. And you won’t be able to change that until next open enrollment.”

To get personal help, you can call Covered California’s toll-free number or use its online LiveWebchat to speak with a health care insurance counselor in 13 languages. Covered California has hired hundreds of call-center staffers and is training 16,000 enrollment counselors who will be available through community organizations, county offices and nonprofits to help with health care sign-ups.

If you’ve been buying your own insurance on an individual plan, your premium rates will likely go up significantly as companies adjust their costs for mandatory coverages, said eHealthInsurance’s McLean.

But the good news is that for all Americans, out-of-pocket medical expenses will be capped. For a single person, the most you’ll have to pay from your own wallet for prescription drugs and medical care is $6,350. For a married couple with kids, the highest is $12,700. (In some cases, those caps have been delayed until 2015 to give insurers time to comply.)

Options for young adults

Adult children up to age 26 who are covered on a parent’s health care plan can remain so; the new enrollment season does not affect their status. But depending on what your employer charges for dependent premiums, it may be cheaper to have your son or daughter buy a single health insurance plan. It also can make sense if your child lives out of state and has to use costlier, out-of-network doctors and hospitals.

Young adults who don’t have coverage from Mom or Dad or from an employer can purchase individual plans. They’re also eligible for a special, limited category of health insurance called “catastrophic coverage.” Available to those 30 or younger, it doesn’t cover regular medical expenses, such as doctor’s visits, prescription drugs or even an ER visit. Instead, it’s designed to handle “excessive medical bills” that could come with a hospitalization or serious illness.

Compare the “catastrophic” price with the lowest-level bronze premiums to see if the savings are worth the limited coverage.

A little pain: penalties

If you don’t sign up for health care coverage? There are tax penalties, which phase in over three years. In 2014, the first-year penalty for not buying health insurance is 1 percent of annual income or $95 per adult, whichever is greater. The maximum penalty per family is $285.

By 2016, the penalty will be 2.5 percent of income or $695 per adult, with a maximum per family of $2,085. After that, it’s adjusted for inflation.

The penalty is based on the number of days or months you go without coverage after March 31.

Some are exempt from the new health care penalties: inmates, undocumented immigrants, American Indian tribal members and those with religious objections. Also exempted are low-income folks who don’t have a tax-filing requirement.

At least in the first year, it’s expected that many people will make the calculation that it’s worth gambling they won’t get sick. Some may decide they’d rather pay the $95 individual penalty than spend several hundred a month in health care premiums. But that calculation could change in future years as the penalties go up – and if they become seriously ill or hospitalized and are stuck with uncovered medical bills.

A little help: subsidies

To make mandatory health care coverage more affordable, the federal government is providing subsidies, either tax credits (to help cover premiums) or cost-sharing (to help cover out-of-pocket costs), or both. The only way to apply for a subsidy is through a state-sponsored exchange, like Covered California. Its website has a calculator that quickly determines, based on income, if you qualify. (It also determines if you qualify for Medi-Cal or Medicare.)

Generally, if you’re single and make up to $46,000 a year, you will qualify for assistance. For a family of four, you can make up to $90,000 and still qualify.

Note: In most cases, if you’re covered at work by your employer, you won’t qualify for a federal subsidy. The only exception is if your company’s annual health care premiums are more than 9.5 percent of your household income.

Take a breath

As bewildering as some of the choices may be, you don’t have to have everything wrapped up by Oct. 1. “Take a deep breath and know that you have some time to make a decision,” said eHealthInsurance’s McLean. “It’s new for California ... Give it some time. You don’t have to see and shop it all at once.”

You can also post questions about the new Affordable Care provisions to “ Ask Emily,” a new feature that appears weekly in The Sacramento Bee’s Business section. The advice is from Emily Bazar, writer with the California HealthCare Foundation’s Center for Health Reporting. Send your questions directly to her at: AskEmily@usc.edu.

Read more here: http://www.sacbee.com/2013/09/22/5751632/new-federal-health-care-mandates.html#storylink=cpy

Covered California delays offering 'embedded' dental plans

Board members of the California Health Benefit Exchange voted Thursday to delay soliciting bids for medical plans that include pediatric dental care until next year.

Covered California, the state's health insurance exchange, has said it will offer five stand-alone pediatric dental plans for 2014 as well as what's called a "bundled" plan in which insurers pair a stand-alone dental plan with a medical plan.

Critics have argued that Covered California should also offer so-called "embedded" pediatric dental plans that are included in medical plans.

But Leesa Tori, senior adviser for plan management, told the board at its special meeting that too many questions remain for the exchange to offer embedded pediatric dental plans before 2015.

The exchange still must decide whether to make purchasing dental insurance mandatory, and for whom it would be necessary. Until Covered California makes this decision, Tori said, staff members will not know which types of plans to include in the exchange.

"There is no silver bullet for 2014," said Tori, as board members considered final recommendations on pediatric dental plans. "What we are suggesting here is that we go back, we do the proper policy analysis, look at the various products and then put it into a portfolio for 2015."

Tori also said that six of the eight health insurance firms with the ability to provide embedded dental plans said they could not develop a bid for next year.

"If we thought we could, we would," said Susan Kennedy, one of the board members. "We don't believe it's technically feasible or in the best interests of consumers to do so right now."

The board's plan to solicit multiple options for children's dental plans in 2015 comes in response to concern from children's advocates and families about the affordability of pediatric dental care. Monthly premiums for the pediatric dental plans to be offered in 2014 start at $10 per child, depending on the plan. The plans cover children up to age 19.

A coalition of children's health advocates sent a letter on Monday to the health exchange's board members urging them to request bids for embedded pediatric dental plans in addition to the stand-alone and bundled plans the exchange has already solicited.

The coalition -- which includes Children Now, United Ways of California, California Coverage and Health Initiatives, The Children's Partnership and Children's Defense Fund California-- called for the board to give the public the opportunity to choose their dental coverage.

"Consumer choice is important, and we recognize that for some families the option to select a stand-alone plan will be attractive," the letter read. "But stand-alone plans must not be the only choice."

PHOTO: Tribal dentist Gurminderajit Sufi works on Jonathan Jesus Lomeli, 10, of Arbuckle at the Colusa Casino's Wellness Center on April 23, 2013. The clinic offers subsidized medical care for low-income families. The Sacramento Bee/ Randy Pench.

Read more here: http://blogs.sacbee.com/capitolalertlatest/2013/08/covered-california-delays-offering-embedded-pediatric-dental-plans.html#storylink=cpy

An autism treatment lost in California's shift from Healthy Families

By Chris Megerian

July 7, 2013, 8:24 p.m.

SACRAMENTO — Evan Kim was 2 years old when he was diagnosed as autistic last year, and his parents searched for some way to curb his head-banging tantrums.

Using a state-financed healthcare program for low-income families, they found therapists who could provide a specific kind of autism treatment aimed at analyzing and improving behavior. The therapists spent 40 hours a week with Evan at the family's home in the Los Angeles area, coaxing him to stop the tantrums and improving his communication skills.

Evan's mother, Jenny Kim, was relieved — until last month, when her children's healthcare plan changed and the therapy, known as applied behavior analysis, was no longer covered.

"I'm afraid he's not going to make any progress from now on," Kim said. The same service, she said, would cost $10,000 a month out of pocket.

Evan's therapy was a casualty of the state's effort to phase out its Healthy Families insurance program and shift the nearly 900,000 children it covered into Medi-Cal, the broader healthcare program for the poor. Despite officials' assurances that the transition would not jeopardize services, activists say hundreds of children are losing coverage for applied behavior analysis.

"Those are the families that fall through the cracks," said Julie Kornack, a public policy analyst at the Los Angeles-based Center for Autism and Related Disorders. "If they don't get the treatment they need, they won't be contributing members of society. And everyone will have to pay to take care of them."

Activists fear that other coverage gaps could surface as the state prepares to move the final 150,000 children into Medi-Cal in the next two months. Elizabeth Abbott, an official at the advocacy group Health Access, said she worried that dental resources could also become strained.

"This is potentially the tip of the iceberg," Abbot said.

Rene Mollow, a deputy director at the California Department of Health Care Services, said the transition has been mostly smooth. She said some children can get similar autism therapy through a federal program or local school district, but she conceded that those services won't be available to everyone.

Lawmakers agreed to eliminate Healthy Families last year as a savings measure pushed by Gov. Jerry Brown, but the money hasn't materialized the way the administration had hoped. The state saved only one-fifth of the $13.1 million it had projected in the fiscal year that just ended.

Administration officials say that's the result of delays, increasing healthcare costs and other factors.

Senate leader Darrell Steinberg (D-Sacramento) pushed to restore coverage for applied behavior analysis for children with autism in the state budget that went into effect last Monday. However, the $50 million was not included in the budget that lawmakers sent Brown last month.

"The administration promises us a resolution, but we don't have one yet," Steinberg said.

Mollow said the Brown administration was concerned about the cost as the state emerges from a years-long budget crisis.

"We're coming out of a significant deficit," she said. "We're just looking to be prudent with the dollars that we have."

Applied behavior analysis is an intensive treatment in which therapists use positive reinforcement to improve a child's behavior and detailed instructions to make learning new tasks easier. It is used to teach a child, among other things, how to get dressed in the morning and play well with others.

Brown expressed skepticism of the therapy when he signed a 2011 bill requiring many private insurers — but not Medi-Cal — to cover applied behavior analysis.

"There are remaining questions about effectiveness, duration and the cost of the covered treatments that must be sorted out," he said in a statement.

Autism experts disagree, saying the therapy can be costly but is vital.

"They're taking away the only scientifically proven treatment for children who have a very significant medical condition," said Jonathan Tarbox, director of research and development at the Center for Autism and Related Disorders. The center provides applied behavior analysis through state-funded programs.

Patrick Sullivan of San Diego said his 6-year-old autistic daughter, Naia, has benefited dramatically from applied behavior analysis.

Sullivan said a state employee assured him earlier this year that his daughter's transition to Medi-Cal would be "seamless." Later, he learned that her therapy would no longer be covered at the end of this month.

Sullivan hopes his daughter can receive treatment at one of California's regional centers that provide services to the developmentally disabled. But Naia's autism, he said, may not be severe enough for her to qualify, or the amount of therapy she receives could be sharply reduced.

"I don't know what's going to happen," he said.

chris.megerian@latimes.com

Copyright © 2013, Los Angeles Times