The Affordable Care Act is meant to bring insurance to nearly everyone, but it excludes one major group: undocumented immigrants. Yet the cost of care for these immigrants will not be going away. It will simply continue to be hidden in the cost of everyone’s insurance and in our tax bills. And that cost might actually be higher because undocumented immigrants will remain without a source of dependable care.
California Focus: Daniel Weintraub
Jerry Schumacher’s Fullerton-based engineering firm seems like the perfect example of what President Obama would like to see from American business when it comes to health care. The company offers coverage to all of its full-time employees, and pays 100 percent of the monthly premium. But Schumacher still lives in fear of the Affordable Care Act, the federal health insurance reform known widely as “Obamacare.” He thinks it can only make things tougher on him. With fewer than 50 employees, Schumacher isn’t affected by the law. And even if the company payroll grows and surpasses that threshold, the most the federal law would require of Schumacher is to do what he does now voluntarily: provide affordable coverage for his workers. Still, he’s worried. “Obamacare is just another way of taxing people,” he says. “It’s another thing that squashes the small guy, and even the medium-size employer.” Schumacher is not alone. Small business owners across California and around the country are struggling to understand what federal health reform means for them, its benefits and its burdens.
Community clinics – the backbone of California’s health care safety net – face a whipsaw from the Affordable Care Act. On the one hand, the law opens the state’s free health program for the poor, Medi-Cal, to more than a million Californians who don’t have insurance today. This should mean a big increase in business for the clinics, a rush they might struggle to accommodate. But the ACA also makes private insurance available to the working poor, many of whom have depended on the clinics for their care until now. These people will now have other options.
The Affordable Care Act promises to bring insurance to millions of Californians who don’t have it now. But will it bring them health care?
The biggest winners from the federal health reform known as the Affordable Care Act will probably be older adults who are too young to be eligible for Medicare.
The people who designed the Affordable Care Act employed an “If we build it” strategy reminiscent of the Field of Dreams, the classic 1989 film about an iconic baseball diamond built in an Iowa cornfield. If they built a more accessible health insurance system, the reasoning in Congress went, consumers would come and use it.
But will they?
In less than 30 days, California’s new online health insurance market is scheduled to open for business when Covered California throws the switch on a web site designed to allow consumers to shop for coverage and obtain subsidies in the form of tax credits from the federal government. Oct. 1 2013 has been circled on the calendar of health insurance reformers since shortly after Congress passed President Obama’s Affordable Care Act more than three years ago. The state has spent hundreds of millions of dollars building the web site and the back-office connections to allow the system to communicate with a federal database to check the details in a consumer’s application. More than a million Californians who don’t get insurance through their job are expected to use the new marketplace in the first year. But as of now, state officials will say only that they expect the system to allow consumers to begin their applications online on Oct. 1. What happens then?
For millions of Californians who buy health insurance on their own – and even for many who get it through work – the Affordable Care Act will change almost everything about the experience. The federal health reform law completely upends the business model of private insurance companies, changing their incentives and, very likely, the way they deal with customers. Under current law, which goes away on Jan. 1, insurance companies make money by minimizing their risk, and they do that by screening out potential customers who might actually need the product the insurance companies are selling. Using questionnaires and detailed interviews about a person’s medical history, insurers decide who is most likely to get sick. If you are one of those people, you will probably not be offered coverage. If you do get a chance to buy a policy, it will be priced at a level you will almost certainly not find affordable. But in a few months that will no longer be the case.
The federal health reform known as the Affordable Care Act has so many moving parts that it is almost impossible to predict with confidence how it all will work once the law inches closer to full implementation on Jan. 1. But one very big piece of the Act is almost certain to roll out as intended: the expansion of the Medi-Cal program to accommodate more than a million low-income Californians who until recently had almost no access to the doctors, hospitals and labs that many people take for granted.
The eyes of the entire nation will soon be on President Obama’s Affordable Care Act, which takes full effect Jan. 1 with the requirement that nearly all Americans obtain health insurance or else pay a penalty on their taxes. But many people probably don’t know that much of the new law has actually been in place for nearly three years now, and millions of Californians are already benefiting from its provisions.