California is on the cusp of launching the biggest health reform effort in a half-century, with a massive public awareness campaign that's designed to compel millions of Californians to obtain health insurance.
When they see television ads or billboards for Covered California, the state's health insurance exchange, or see media stories about the huge expansion of Medi-Cal, the state's Medicaid program, Californians will have questions.
A lot of those questions will go to state legislators. Assembly and Senate staff members could be deluged with calls and queries.
That's where Shana Alex Lavarreda comes in.
Lavarreda, director of health insurance studies at the UCLA Center for Health Policy Research, helped stage a recent symposium in Los Angeles for legislative staff members. Along with other UCLA researchers, Lavarreda briefed staffers on the mountain of health care information they're about to need.
"The reason why we're here and why this is so important," Lavarreda said, "is because all of the constituents will be coming to you."
About 100 legislative staff members joined the Los Angeles conference, getting a crash course in exchange subsidy eligibility, Medi-Cal expansion guidelines and the small-business health insurance program.
"Now some of this may be repetitive, but I think it's good to hear this more than once," Lavarreda said. "Because this is a lot we're throwing at you this first time."
If some of the nomenclature or details of health care reform seem murky or confusing to staff members, then it's likely to feel that way to their constituents, Lavarreda said. It's vital to have an idea of how it's all going to work. And it's an opportunity, Lavarreda said.
"It's a really wonderful thing, that you're able to bring this information to your constituency," she said. "You will be the people who know the answers."
Answering All Those Questions
At the very least, said UCLA Center for Health Policy Research Director Gerald Kominski, staff members -- whether they have answers themselves or not -- will need to know where to direct people for answers.
"When you get a phone call from a constituent who wants to know, 'Am I eligible?' -- the answer is: Covered California," Kominski said.
"Covered California is the new marketplace for insurance. ... Covered California will be making eligibility determinations via phone, via Internet, mail or in-person through about 20,000 assisters." When in doubt, he said, direct people to the Covered California web portal.
"This is the website, this is where you need to point people," Kominski said. "This is where people will be shopping for health insurance, starting Oct. 1."
Covered California is designed to be a one-stop shop for everyone, Lavarreda said.
"You can enroll in any plan, including Medi-Cal expansion, through Covered California, and the website is the best way to access it," she said. "The website will be the bulk of enrollment. It's a great first portal to send people to."
Questions Around Eligibility
Many legislative staff members wanted to understand how to handle people at varying levels of income, whether they're eligible for Medi-Cal or the exchange.
"Up to 6.5 million Californians will be eligible for benefits under the ACA. This is an enormous population in California," Kominski said, adding that a good chunk of that population will be the 1.4 million Californians newly eligible for Medi-Cal, which has been expanded up to 138% of federal poverty level. The exchange will handle an even larger segment, with people up to 400% of FPL eligible for subsidies in the exchange.
"All of us here, I would say, we know our income, but no one in this room, I'm sure, knows where their income falls on the federal poverty scale," Kominski said.
The answer varies, depending on income and family size. An individual at 138% of poverty has an annual income of slightly more than $11,000, Kominski said. For a family of four that amount goes up to $23,500 a year.
At 400% of FPL, the threshold for subsidies through the exchange, the income level is $94,000 a year for a family of four.
"If you get a constituent calling and asking, 'Where do I fall?' you're not going to be able to give a simple answer," Kominski said. He passed out charts showing a rough approximation of income levels and how they relate to the federal poverty standards.
"These are general guidelines, and they should help. And you can always steer them to Covered California, where they can get a [more precise] answer," Kominski said.
Understanding the Affordable Care Act
The briefing of legislative aides is particularly important because government actions could have a dramatic impact on the health care system in California, according to Keith Parker, assistant vice chancellor of government and communications at UCLA.
Now it's time for government workers to help explain how reform will work, Parker said.
"When we think about the civil rights movement in the 20th century, and now as we've moved into the 21st century, it is health care that has really become one of the civil rights issues of the 21st century," Parker said.
"We have to understand how to tell people about the Affordable Care Act. Really, to be without health care, think about that for a second," Parker said. "Think about the absence of health care, and what that would mean to us."
The panel of UCLA experts also discussed issues California consumers might worry about that are not affected by the ACA.
"If you get a call from a Medicare beneficiary, someone wondering how the ACA affects them," Kominski said, "then you don't have to do anything. The ACA pretty much does not affect Medicare at all."
Kominski said one of the few related changes Medicare beneficiaries might see is that costs could go down for those receiving the Medicare Part D drug benefit. Further, some Medicare beneficiaries enrolled in Medicare Advantage might see a small rise in monthly premiums. "But my message is, you can reassure your constituents who are on Medicare that they are largely unaffected by the Affordable Care Act," he said.
Another constituent concern might be what's happening with Healthy Families, the state's Children's Health Insurance Program, Lavarreda said. "Healthy Families has nothing to do with Obamacare," she said. "It is going away by 2014, but it's a Medi-Cal transition [that has nothing to do with ACA implementation]."
Lavarreda also pointed out that Covered California premiums are about 18% lower than small-group coverage plans, that undocumented workers are not eligible under ACA regulations and that the open enrollment period is limited -- from October 2013 to March 2014.
"After March, you have to wait till the fall," Lavarreda said. "So you want to really strongly encourage people to sign up October through March."