Napa's Health Insurance Guys: What are your options when you lose your health insurance?

Dear Kyle, Tom and Alan:

I just lost my job and my wife works part-time. We're totally not used to this, and we have no health insurance from my work as of next month. We've gone online and looked for some kind of plan for us and our two kids, but man, is it expensive.

So, first, what is the deal with getting a break on monthly premiums through Covered California, and second, I've read that there is another bill in California about single-payer, and third, how does Medi-Cal fit in?

Larry

Kyle: OK, Larry, great questions. First, with your loss of employment coverage, you and your family are guaranteed to be accepted for Covered California because loss of employment is a "qualifying event."

Also, whether or not you get a break on premium (subsidy) is entirely based on household income.

According to the 2024 Program Eligibility by Federal Poverty Level, you can have an annual income of up to $120,000 and still be eligible for a subsidy. If your income drops below $82,992, what may happen is you and your wife will choose a plan, while your children will be on Medi-Cal.

Tom: Not everyone is crazy about the kids on Medi-Cal, but that's the way it is.

Al: Second, according to the Fact Sheet dated Feb. 7, 2024, Assembly Bill 2200 is revisiting a similar bill from 2022 that failed to move forward. Part of the summary reads: "AB 2200 sets in motion a single-payer health care coverage system in California, called CalCare, for all residents, regardless of citizenship status."

Kyle: A legislative analysis of the 2022 bill estimated the cost of single-payer as between $314 to $391 billion in state and federal funds. The entire California state budget for the 2024-25 fiscal year is $291.5 billion.

According to John Goodman and Linda Gorman from the Goodman Institute:

"Assembly Bill 2200 would make CalCare the state's single-payer health coverage provider. Under the act it would be illegal for any resident to pay a doctor privately for any medical treatment covered by CalCare."

"To accomplish this goal, the legislators hope to convince the federal government to turn over all California Medicare funding so they can force every senior into the new system. Ditto for Medicaid. Employer-provided health insurance would also vanish."

Al: I think they're against it. In a later part of the column, they said that in 2017 only 48% of private California physicians accepted new Medicaid patients.

An article in the LA Times noted that the California Nurses Association strongly favors a single-payer where the public (everyone) receives health insurance through the government.

Kyle: Third, and finally, Medi-Cal is our version of Medicaid. Through both federal and state funds, healthcare is provided to low-income residents. If a family of four has a household income of less than $43,056, they all qualify for Medi-Cal.

It looks like what Larry will have to do is give his best estimate of income and look into Covered California.