Ask Emily is a biweekly column by Emily Bazar of the CHCF Center for Health Reporting, answering questions about the Affordable Care Act. Read her columns at sacbee.com/ask-emily.
About 5 million Californians have new health coverage as a result of the Affordable Care Act, both through the Covered California health insurance exchange and the expansion of Medi-Cal, California’s Medicaid program for low-income residents.
But millions of others remain uninsured – by circumstance or by choice.
Up to half of California’s uninsured population is made up of immigrants who are not in the country legally, and therefore are excluded from health insurance exchanges, tax credits and most Medi-Cal coverage. Others can’t afford coverage (even if it’s subsidized), choose not to buy insurance, or are unaware that they qualify for free or subsidized insurance.
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No matter who they are or what their circumstances, they get sick, too.
Q: I’m uninsured but need medical care. What are my options?
A: It’s hard to pin down exactly how many Californians remain uninsured, but Anthony Wright, executive director of Health Access California, believes there are roughly 3 million of you.
The good news is that more than a third of you are actually eligible for coverage, either Medi-Cal or subsidized insurance through Covered California, says Laurel Lucia, an ACA expert at UC Berkeley’s Center for Labor Research and Education.
So my first piece of advice is perhaps the most important: Find out if you’re eligible for some kind of coverage.
Covered California’s open enrollment season has ended for this year, but Medi-Cal enrollment stays open year-round, and Medi-Cal is free for most people who qualify.
If you have a specific disease, you may be able to get coverage from state programs such as California Children’s Services and the AIDS Drug Assistance Program, says Daniel Zingale, senior vice president of the California Endowment.
Also, San Francisco, Los Angeles and some other counties offer county-based health benefits for uninsured residents such as Healthy San Francisco and My Health LA, Wright says. Check to see what your county offers.
If you don’t qualify for anything, your health care options will depend largely on three things: your location, your income and your immigration status.
“It really is a patchwork,” Wright says. “Depending on your county, you may have very different levels of access to care.”
County health systems
California’s counties run a mishmash of health programs. Some operate public hospitals, others contract with private providers and still others run clinics.
Your eligibility also varies widely by county, whether we’re talking income or immigration status.
“If you’re undocumented in L.A. County, the county clinics are where you’d go,” Zingale says. That is not the case in 48 of the state’s 58 counties, he says.
Check with your county to explore your options.
Separate from county clinics, California’s roughly 1,100 community health clinics serve about 5.6 million people each year, says Carmela Castellano-Garcia, president and CEO of the California Primary Care Association.
Of those, about 2 million are uninsured, she says.
There are different types of clinics, but in general clinics provide primary and preventive care regardless of immigration status, and their prices are set on a sliding-fee scale based on income, Castellano-Garcia says.
Free clinics charge nothing at all.
“How much you pay depends on the kind of clinic you go to,” she says.
Federal law requires emergency rooms to stabilize patients without asking about their immigration status or ability to pay.
But if you’re uninsured, you’ll be responsible for the bills, which can easily climb into the tens of thousands of dollars and wreck your credit.
Want proof? A December report from the Consumer Financial Protection Bureau found that medical collections make up more than half of collection accounts on credit reports.
But there are some options. Though unauthorized immigrants are not eligible for full Medi-Cal benefits, they may be eligible for emergency care and pregnancy-related services, based on income.
Also, most hospitals offer financial assistance and “charity care” to patients, also based on income, Wright says.
The ACA offers new protections to consumers who use nonprofit hospitals, such as limiting how much consumers at certain incomes can be billed.
But California has stronger protections, Wright says. A pre-existing state law requires all hospitals to inform consumers about their rights and financial options, give them 150 days before their bills get sent to collections and limit the amount that uninsured consumers at certain incomes must pay, he says.
Health Access and other groups host a website – www.HospitalBillHelp.org – that will help you find discounted or charity care in your area. You can also visit a state-run website to search for similar information: https://syfphr.oshpd.ca.gov.
Consumer groups also support legislation that would address health coverage for the uninsured. For instance, a proposed law (SB 4) would make unauthorized immigrants eligible for Medi-Cal, assuming they meet the program’s criteria, and allow them to buy unsubsidized plans from Covered California with their own money. A similar measure stalled last year.
Questions for Emily: AskEmily@usc.edu
The CHCF Center for Health Reporting partners with news organizations to cover California health policy. Located at the USC Annenberg School for Communication and Journalism, it is funded by the nonpartisan California HealthCare Foundation.