California Insurance Commissioner Dave Jones said there will be “some speed bumps, pot holes and road washouts” on the road to healthcare reform, but he feels the Affordable Care Act will be “successful in implementation.”
California Insurance Commissioner Dave Jones said there will be "some speed bumps, pot holes and road washouts" on the road to healthcare reform, but he feels the Affordable Care Act will be "successful in implementation."
Jones held a public forum Sunday to discuss the ACA with California residents at the College of the Siskiyous Rural Health Institute campus.
Key talking points were benefits the ACA has already put in place, changes to health insurance coming on Jan. 1, 2014, and the challenges presented by those changes. Members of the community also had an opportunity to ask questions of the commissioner, learning what they needed to do to prepare for next year and clearing up many misconceptions surrounding the reform.
Jones said implementation of the ACA "is not an easy thing to do. We're talking about significant changes in a very big marketplace, but we're hitting all the deadlines."
Jones opened his discussion by pointing to changes that aren't really changes at all, since they have already been enacted across the state, he said.
These benefits include the medical loss ratio requirement – a ratio requiring insurers to put between 80 and 85 percent of their collected premiums toward paying medical providers, representing an increase of about 20 percent more than the previous average, Jones said.
The ACA has also already made may preventative tests free, rendered the practices of medical recensions illegal, eliminated lifetime caps, reduced the "doughnut hole" gap for senior citizen prescription drug costs and entitled young people to stay on their parents' insurance until the age of 26, thereby ensuring that 300,000 young persons have health coverage.
"It's no longer a pre-existing condition to be a woman," Jones said, pointing out that a traditional insurance practice was to charge women more than men for the same coverage. He also noted insurance companies will no longer be able to discriminate against children for pre-existing conditions.
About the changes coming on Jan. 1, Jones said one of the aims is to protect those shopping the insurance marketplace from "junk insurance," which are misleadingly worded plans that come with high deductibles and slim payouts.
Each insurance provider in the state healthcare exchange (in California, it's Covered California) is required to organize their packages within tiers labelled bronze, silver, gold and platinum. This way, Jones said, consumers can have an "apples to apples comparison" of all their health insurance and HMO options.
"(The change) empowers you as the consumer," said Jones. "It empowers small businesses to make better choices as to what's in their best interests.
"I think it's important to underscore this; this is a private marketplace approach," Jones continued. "These are private products being offered through an exchange and out of it as well. It is not government insurance by any stretch of the imagination."
Changes to Medi-Cal will include the addition of more citizens to the pool of eligible applicants. Jones encouraged anyone able to receive Medi-Cal to do so.
He noted many individuals who do not have health insurance don't seek treatment until their injury or illness is acute, resulting in a much higher cost of treatment. These costs are then shifted onto taxpayers and insurance carriers.
Being on Medi-Cal helps prevent this as insured people generally seek out preventative tests and earlier treatments, reducing both the total bill and the impact of cost shifting.
Speaking about small business, Jones said those with less than 50 employees will not be mandated to do so, but will be able to purchase health insurance through the state exchange (Covered California). If they do, a tax credit system is in place to assist them.
Jones also took time to discuss the challenges of the new law.
He said two to three million uninsured people will be coming into the system. One danger of this is the creation of a "lop-sided pool," where there aren't enough healthy and insured individuals to balance those with ailments. To try to prevent this, penalties will be assessed to those who elect to not purchase any type of health insurance on their tax returns beginning in 2014.
"Success requires signing up people to purchase health insurance," Jones said. "This thing only works if people elect to have the product."
Another challenge is the inability of an agency to combat excessive insurance rates. Calling this a "missing piece" of the ACA, Jones said the Insurance Rate Public Justification and Accountability Act is looking to provide that piece on the November 2014 ballot.
Jones answered several questions about the ACA and covered topics such as retro-coverage, whether ACA will allow participants to seek treatment outside the US, whether the ACA will grant states the ability to set up their own non-private insurance, and the chances of the ACA being repealed.
Jones's answer to the last one: "give or take a zero percent possibility."
"I don't think you should do it just because I tell you it's a good thing," Jones said about signing up for insurance through the exchange or elsewhere. "I don't thing you should do it because somebody else tells you it's a good thing. You should look yourself, take a look at the rates."
For more information about the ACA and its implementation in California, go to coveredca.com or call 1(800)300-1506. Jones also provided forum attendees the hotline for the Department of Insurance: 1(800) 927-4357.
Insurance can be purchased on the exchange as early as Oct. 1 and coverage will kick in on Jan. 1.