The mid-term congressional election is less than two months away and some observers wonder whether the event will be all about nothing.
Feb. 23--SANTA CRUZ -- If you don't have health insurance, or you know someone without it, you can get estimates at www.coveredca.com on how much a policy might cost under the federal health care overhaul kicking in Jan. 1.
Enrollment will begin in October, according to Alan McKay of the Central California Alliance for Health, who spoke Friday to the Democratic Women's Club at the Garfield Park community room about the big changes coming from the federal Patient Protection and Affordable Care Act.
The law requires everyone older than age 18 to have health insurance or pay a penalty.
If you have health insurance, you can keep it. But if you're not covered and you're a legal California resident, you will be able to buy health insurance through "Covered California," an "exchange" or online marketplace.
For a family of four earning from $29,000 to $88,000, the exchange will offer options, McKay said, referring questions about other household sizes to the website.
The cost will vary, depending on income and number of dependents. There will be a standard set of benefits with variation in the co-pay and deductible, depending on which of the four levels of plans you select.
McKay expects 11,000 to 15,000 county residents will buy health insurance with a subsidy via the exchange. The first enrollment period will last six months.
The idea of enrolling everyone is for "healthy folks to support the
rest," said McKay, who underwent 17 hours of brain surgery at 26 to save his life.
In Santa Cruz County, 9,000 to 11,000 are expected to be eligible for Medi-Cal. which serves a family of four with income of $15,000 to $30,000.
He sees Santa Cruz County as well-positioned to serve more people because of the community clinic system created by Salud Para la Gente, Santa Cruz Women'sHealth Center and the county.
The alliance, which has 210,000 low-income members in Santa Cruz, Monterey and Merced counties, ranks doctors on their ability to deliver preventive care and provides a bonus to those "at the top of their game," McKay said, noting doctors are very interested in how they compare to their peers.
The alliance put $16 million into incentives to pay doctors for best practices.
"We've taken the waste out," McKay said. "Our goal is to take a pot of money and deliver care efficiently."
Asked about big hospital bills incurred by the uninsured, he said, "This is why the alliance doesn't pay the hospital based on the chargemaster rate."
He said hospitals must ensure discharged patients don't have to be readmitted and individuals need to take personal responsibility for behaviors that contribute to chronic conditions.
He encouraged those looking for a Medigap policy to consult HICAP at 831-462-5510 but admitted when helping his mother, he found the options "rather bewildering."
One woman attended because she has a young-adult daughter without health coverage who will have to buy some.
"I'm glad I came," said Beverly Boyd. "It was very informative. Probably 95 percent of the population is confused."
Added Carol Fuller, "It's going to be a learning curve to get everyone into this program."
Follow Sentinel reporter Jondi Gumz on Twitter at Twitter.com/jondigumz
AT A GLANCE
To learn more about health insurance options, go to www.coveredca.com.
Alan McKay'sFeb. 22 talk was videotaped to air on cable television Channel 25. Air dates will be posted at www.dwcscc.org.
Rep. Sam Farr (D-Carmel) and state Sen. Bill Monning (D-Carmel) will talk about the implementation of the Affordable Care Act 7 p.m.March 28 at the Santa Cruz Police Department community room, 155 Center St., Santa Cruz. The free presentation is sponsored by the Santa Cruz County Democratic Party and the Democratic Women's Club.
(c)2013 the Santa Cruz Sentinel (Scotts Valley, Calif.)
Visit the Santa Cruz Sentinel (Scotts Valley, Calif.) at www.santacruzsentinel.com
Distributed by MCT Information Services