Q&A: What does health care law do?

Published: Friday, Jun. 29, 2012 - 12:00 am | Page 1A
Last Modified: Tuesday, Apr. 23, 2013 - 10:24 am

>Who will be affected by the Supreme Court decision upholding most of President Barack Obama's health care law?

The law affects nearly everyone in some way. The law tells almost everyone they must have health coverage and guarantees it will be available even if they are already ill or need hugely expensive care. It helps the poor and many middle-class people afford coverage. However, it excludes illegal immigrants from gaining health insurance coverage under its provisions.

>What will the Supreme Court decision upholding health care reform mean to me if I already have insurance?

If you already have individual or group coverage, the law's intent is that you will not have to change doctors and that you can remain with the health care provider of your choice. You do not have to worry about the individual mandate or its tax penalties.

>What does the law do for the very poor who cannot afford health insurance?

California is one of the states that has embraced the law's expansion of Medicaid coverage to 133 percent of the federal poverty level. This means that people with an annual income of $14,856 or a family of four making $30,657 can get affordable coverage through Medi-Cal, California's version of Medicaid. Between 1.2 million and 1.6 million more Californians are predicted to be enrolled in Medi-Cal in 2019 than otherwise would have been without the law.

>What about people with middle-class incomes who cannot afford health coverage?

The law promises to make health insurance more affordable to people with incomes of up to 400 percent of the federal poverty level through tax subsidies. This means that an individual making $44,689 annually, or a family of four with an income of up to $92,200, will be able to take advantage of tax breaks to purchase insurance. Between 1.8 million and 2.1 million Californians are expected to have subsidized coverage through the state's insurance exchange by 2019.

>How does the tax subsidy for low-income and middle- income people work?

The amount of subsidy assistance will vary and is structured so that a person or family will pay no more for insurance than a certain percentage of annual income. This ranges from 2 percent for those with incomes up to 133 percent of the federal poverty level to 9.5 percent for those whose income ranges from 300 percent to 400 percent of the federal poverty level.

>What proportion of people in California are uninsured and might be helped by the law?

Statewide, nine out of 10 people under 64 are expected to be be insured when the Affordable Care Act is fully implemented. In 2010, according to the latest census figures, about 25 percent of California's working-age adults lacked health insurance. In the Sacramento region, 18 percent of working-age adults were uninsured.

>How does that break down in terms of California's ethnic communities?

Across all age groups statewide, 29 percent of Latinos, 16 percent of blacks and 15 percent of Asians were uninsured in 2010, compared with 11 percent of whites. Almost half of California residents who are not citizens are uninsured.

>Based on education and income, who is most likely to be uninsured?

Insurance coverage often correlates with education level and income. Almost 40 percent of California adults who dropped out of high school lack health insurance, compared with 9 percent of adults with a bachelor's degree. Californians falling below or just above the poverty line are more than twice as likely to lack insurance as those with more income.

>How will the Supreme Court decision affect hospitals?

With more people insured, hospitals will be collecting more fees, instead of losing money caring for the uninsured. In Sacramento County, roughly 73,000 uninsured patients, or 18 percent of all patients, used emergency rooms during 2010. That figure nearly doubled from 2006, when only 39,000 uninsured patients used Sacramento County emergency rooms.

>What other businesses may benefit from the health care laws?

Other health care providers, pharmaceutical companies and insurance companies are expected to benefit by having more people with insurance coverage and the ability to pay for health care and medicine. In particular, insurance companies were among the biggest backers of the individual mandate, which helps even out their costs of caring for the ill by having more healthy people pay into the system.

>What will the law do for people turned down for insurance because of pre- existing conditions?

Already in California, people with pre-existing conditions can buy insurance just as the law intended. The Pre-Existing Condition Insurance Program is giving 8,600 Californians coverage. A new state law ensures that California children will have access to private coverage regardless of their health status. In the four-county Sacramento region, 523 patients are enrolled in the Pre-Existing Condition Insurance Program.

>Besides expanding Medi-Cal's income level qualifications, what is the biggest change in that program's expansion?

For the first time, childless adults will be permitted to sign up for Medi-Cal, ending the program's longtime rule that Medi-Cal be extended only to parents and children ages 6 to 19.

>What's a downside of the health care reforms in California?

One aspect of the health care matrix that may need attention is the Medi-Cal program, which some physicians refuse to participate in because they say it is underfunded. A recent survey of Medi-Cal enrollees reported that only 43 percent say it is easy to find a specialist who will accept Medi-Cal.

Sources: Information for this article was culled from original Bee research, the U.S. Census Bureau, the Associated Press, the California Healthcare Foundation, the UC Berkeley Labor Center, the UCLA Center for Health Policy Research, Health Access California, eHealth, the California Medical Association, the California Pre-Existing Condition Health Insurance Plan and the California Primary Care Association.

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