For Covered California officials, it’s crunch time. They’ve spent $29 million on advertising, opened 500 storefronts, beefed up call centers and trained hundreds of health insurance enrollment counselors who speak 12 languages, from Arabic to Vietnamese. They’ve also rolled through 21 cities in a statewide bus tour to highlight this year’s open enrollment season, projecting the words “Enroll Now” on iconic buildings such as Sacramento’s Tower Bridge and San Francisco’s Coit Tower.
All those efforts come down to Sunday’s deadline. For most uninsured people, that’s the final day for enrollment in 2016 Covered California health care policies. And this year, the stakes are higher. For those who forget or ignore the deadline, they’ll face a stiffer federal tax penalty that can run into thousands of dollars.
One of those uninsured is Mark Burch, a former manager for a Sacramento food manufacturing company, who lost his job last summer due to a corporate buyout. With his severance benefits running out, the 60-year-old wants to be sure he’s covered so he can keep his same doctors while looking for a new job.
“For 36 years, I’ve always had medical coverage because of work,” he said. “I’ve never had to buy my own health care. This is all brand new.”
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On a recent weekday, he sat across from Jamel Johnson, a certified enrollment counselor with staffing firm 1Solution on Fruitridge Road, to consider his options. Until he finds new work, Burch’s reduced income means he could qualify for Medi-Cal, potentially ending up with free care or low-cost premiums.
Johnson said he’s signed up many first-timers like Burch in the last three years. “Whether you agree (with the federal health care system) or not, it’s the law. And it’s a way to ensure that you don’t go into an emergency room and come out with a $5,000 bill. It stops you from being financially in a bind.”
As of Wednesday, more than 329,000 Californians have signed up – for the first time – during this year’s open enrollment season, which started Nov. 1.
“That’s a very big number,” said Covered California Executive Director Peter Lee. “We walked in thinking we had about 750,000 subsidy-eligible people (to sign up), so we got about half of them already.”
In December, Covered California issued a series of statewide “heat maps” showing neighborhoods with the highest percentage of low-income, uninsured residents estimated to be eligible for subsidies covering their health care premiums. In the Sacramento region, neighborhoods on the map appear in Citrus Heights, Arden Arcade and a south Sacramento area off Highway 99 near Florin and Power Inn roads. According to Covered California, about 8 percent of residents in those three “hot spots” are subsidy-eligible, compared with an average of 3.2 percent in Sacramento County overall.
Not all of them, however, are necessarily the lowest of low-income residents, Lee said. Many are working but poor people who can earn up to $47,000 and still receive a subsidy for their health care premium. “They are not wealthy people and the subsidy is not as big, so it’s a challenge,” Lee said. “It’s taking money off your dining room table or from paying the rent bill. ... We really are competing for people’s pocketbooks.”
At an Arden Arcade shopping center on Fulton Avenue, reaction to the enrollment pitch was mixed. Some individuals, speaking Farsi or Spanish, but declining to give their names, said they were already covered.
Others, like 23-year-old Sitara Sofizada, a newly arrived immigrant from Afghanistan, were eager to sign up. “I want health insurance. It’s a good thing,” she said, speaking in English, her second language. In Kabul, she said, health insurance isn’t routine, but U.S. immigration officials briefed her and others about it being a mandatory requirement. Sofizada, a university student who now lives here with her uncle, said she intends to sign up as soon as her paperwork is completed.
Since the Affordable Care Act became law in 2010, all Americans who don’t receive insurance through work or government programs are required to purchase health care – or pay a gradually increasing tax penalty. They can buy from insurance agents or through state marketplaces such as Covered California. In the last two years, the uninsured rate among U.S. adults dropped nearly six percentage points – down to 11.4 percent in mid-2015, according to a Gallup survey. In California, more than 2 million residents have purchased Covered California policies since they became available in late 2013.
Public awareness of the health program has been high, according to a 2015 survey by a University of Chicago research group. Nine out of 10 Californians knew about the federal Affordable Care Act and 85 percent were aware of Covered California, the state’s exchange for purchasing ACA policies. That’s a healthy leap up from 2013, when just 12 percent of those surveyed knew about Covered California.
“Despite this positive trend,” the study stated, “sizable numbers continue to lack knowledge on some issues, including how the subsidy and the enrollment periods work, and that Covered California is the only place they can receive premium assistance.”
(In order to receive a federal subsidy, individuals must purchase their health insurance through Covered California; anyone else can buy individual or family coverage through independent insurance brokers or enrollment agents.)
In the 2015 consumer survey, 15 percent of Californians who did not purchase health insurance said they intended to this year and 44 percent said they “might” do so. But a sizable number – 41 percent ‑ said they would not purchase health insurance in 2016.
That would include Sacramento resident John Kotarsky, 38, who said he’s never purchased a Covered California plan, and this year won’t be any different. A self-described “house flipper” who buys and rehabs distressed properties, Kotarsky said he pays out of pocket for any health care needs, rarely sees a doctor and doesn’t earn enough to pay a tax penalty. “I don’t like ultimatums, and (Obamacare) is an ultimatum. I’m waiting for a Republican president to repeal it,” he joked, as he headed into a 24-Hour Fitness gym on Fulton Avenue.
His gym buddy, Evan Ekpa, 29, said he’s happy to receive health insurance through his employer, a loan company, but added: “Truthfully, if I didn’t have it through my job, I’d probably roll the dice and not buy it. I don’t get sick. I don’t see doctors.”
Health officials call that a risky gamble, considering the high cost of emergency room visits or unexpected surgeries. And, they note, a number of preventive services such as mammograms and wellness visits are free (except for co-pays) under the Affordable Care Act and are not subject to a deductible. Federal tax penalties are another incentive to enroll; they jump to $695 per individual (or 2.5 percent of income, whichever is greater) and up to $10,000 for a family of four, for those who go without health care coverage in 2016.
But even the threat of a bigger tax bite may not be enough.
“The ACA alone won’t reach 100 percent coverage because the lowest-income individuals, and some other groups, are exempt from penalties,” said Gerald Kominski, director of the UCLA Center for Health Policy Research, in an email. “Even among those who have to pay penalties, some families decide that they have more important priorities, (such as) paying for private school tuition, than paying for health insurance. So they will pay the tax penalty rather than enroll, as long as everyone in the family stays healthy.”
There are a few exceptions to Covered California’s Jan. 31 deadline. Those who are eligible for Medi-Cal, the state’s program for low-income adults, families, pregnant women and disabled individuals, can sign up anytime during the year. Also, those who have a “life-changing” event ‑ getting married, moving, having/adopting a baby ‑ can enroll anytime after the Jan. 31 deadline.
For those with questions, enrollment counselors this weekend are extending hours, bulking up staff and hosting even more outreach events statewide, such as at Arden Fair mall in Sacramento and the Rose Bowl in Southern California.
Betty Williams, whose 1Solution company organizes open-enrollment events, said that unlike the first two years when there were “long lines out the door,” this year has been calmer. On weekends, when people aren’t at work or tied up with school schedules, it gets busier. Last Saturday at a Covered California enrollment event at Grant High School, for instance, Williams said individuals showed up early, well before the 10 a.m. start time. Demand was so high, she said, “We had to call in extra counselors.”
“It’s human to procrastinate,” said Williams, who expects a last-minute surge of enrollees this weekend. Together with the California Black Chamber of Commerce, she’ll have 33 enrollment counselors at different locations, including the Sam & Bonnie Pannell Community Center on Saturday and Antioch Progressive Baptist Church on Sunday.
Unlike last year, when Covered California extended its enrollment deadline because tax penalties were kicking in for the first time, Lee said this year’s Jan. 31 deadline is firm. “You need to get in the door.”
Covered California: Last call for 2016
Final weekend: For most people, Sunday is the last day to sign up for Covered California policies or face 2016 tax penalties. To find certified enrollment counselors at walk-in locations or to talk with counselors by phone, go to Covered California’s website, coveredca.com, or call 800-300-1506. Also, walk-in centers like Kaiser Permanente’s Shop KP sites in Natomas and South Sacramento are extending their weekend hours until 7 p.m., and new sign-up sites are popping up at Arden Fair mall and other locations.
What you’ll need: To determine premiums and potential subsidies, bring an ID or driver’s license, proof of current income, Social Security number, citizenship and ZIP code for all family members applying for coverage.