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Calif. Health Exchange Plans, Rates Announced

Evening Edition

Aired 5/23/13 on KPBS Midday Edition.

GUESTS

Dana Howard, spokesperson, Covered California

Jan Spencley, Executive Director of San Diegans for Healthcare Coverage.

Vince Mudd, president and owner of San Diego Office Interiors, Immediate past Chair of the SD Regional Chamber of Commerce, and Chair-Elect at the SD Regional Economic Development Corporation.

Transcript

California Health Insurance Exchange

Health plans summary

Estimate the cost of health insurance for your family

Covered California

The state's largest health insurers, including Anthem Blue Cross, Blue Shield and Kaiser Permanente, will be among 13 plans competing to provide coverage to millions of Californians through the state's new health exchange, officials announced Thursday.

Covered California, the state agency running the health insurance marketplace, detailed plans and prices to be offered by private insurers when the exchange begins enrolling customers in October.

Coverage begins Jan. 1, the same time virtually everyone in the country will be required to have health insurance or pay a penalty.

The announcement marked the first time Californians got a clear picture of coverage offered under the new rules in President Barack Obama's Affordable Care Act.

Geography will play a key role in determining premiums. Insurers must cover even the sickest patients and are restricted in how they can vary prices between customers.

For example, a 40-year-old San Francisco resident who earns more than $46,000 a year will be able to choose among five plans. Depending on how much coverage that person wants, he or she can pay a monthly premium of between $221 and $501.

A 40-year-old resident in Fresno who earns about $15,400 a year will be able to pick from four plans and will be eligible for federal subsidies. That person can expect to pay between $53 and $102 on premiums each month on a middle-of-the road health insurance plan.

Residents can go online to view what plans are being offered in their part of the state and figure out how much they will pay for health insurance depending on their household income and level of coverage they desire.

Peter Lee, executive director of Covered California, said the agency's negotiating with health plans helped make insurance affordable in California.

"This is a home run for consumers in every region of California," he said in a statement.

Patrick Johnston, president and CEO of the California Association of Health Plans, said care providers have worked hard to ensure consumers have access to better health benefits and avoid financially crippling medical bills.

"Anthem Blue Cross looks forward to the opportunity to serve the millions of Californians who will purchase health insurance through Covered California," said Darrel Ng, spokesman for the insurance company.

The goal of the exchange is to offer individuals and small businesses a choice of private insurance plans similar to the range already offered to workers at large companies.

The intent is to provide affordable plans with access to local doctors and hospitals, an annual cap on out-of-pocket expenses, and guaranteed coverage despite current medical conditions.

While low-income people will be referred to public safety-net programs, the federal government will offer subsidies to help some middle-income households pay their insurance premiums.

The cost of health care under the federal reforms already is emerging as a concern for middle-income people who do not get their insurance through an employer. Earlier this year, an actuarial report commissioned by Covered California found that middle-income residents could see individual health premiums increase by an average of 30 percent under the new law.

Health exchange officials say the new health insurance plans will be more comprehensive, making comparisons to current plans and premiums essentially meaningless. Lee said the rates offered in many plans turned out to be lower than the actuaries had estimated.

An estimated 5.3 million Californians will be able purchase insurance through Covered California. Of that, some 2.6 million will qualify for federal assistance.

People will be able to enroll through the website, but counselors also will be available at call centers to help them find a health plan or determine their eligibility for subsidies and tax credits.

The state is offering translation to Spanish and other languages to help people compare and choose a health plan that works best for their health needs and budget.

State officials said there was high interest from insurance companies because of the number of uninsured residents in California.

On average, there will be five plans to choose from in each region of the state. Rural areas will have two or three, according to Covered California.

The 13 plans include: Alameda Alliance for Health, Anthem Blue Cross of California, Blue Shield of California, Chinese Community Health Plan, Contra Costa Health Services, Health Net, Kaiser Permanente, L.A. Care Health Plan, Molina Healthcare, Sharp Health Plan, Valley Health Plan, Ventura County Health Care Plan and Western Health Advantage.

Officials running the state's exchange divided California into 19 regions for rate-setting purposes. Aside from where a person lives, insurers are limited in their ability to charge consumers different prices for health care.

That is in part because California rejected an option under the federal law that allows companies to charge smokers up to 50 percent more for their premiums. Additionally, insurance companies are required to accept all applicants regardless of their medical histories and cannot charge older customers more than three times what younger customers pay.

California was one of the few states that required participating insurers to follow a uniform benefits structure so consumers would have an easier time choosing between plans.

Earlier this year, Covered California announced standard benefits that people can expect to receive under the Affordable Care Act. The state said the maximum out-of-pocket cost per year will be $6,350, which will help reduce the chance of personal bankruptcy.

Comments

Avatar for user 'muckapoo1'

muckapoo1 | May 23, 2013 at 2:07 p.m. ― 11 months ago

There goes the health care system. Our doctor has already informed us that 2014 will be a great year to retire. I question how a country can force citizens to pay for health insurance and give it to illegals for free. You know that's going to happen.

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Avatar for user 'JeanMarc'

JeanMarc | May 23, 2013 at 2:41 p.m. ― 11 months ago

Muckapoo, I also am baffled by this. It is completely insane and unsustainable. All of the values this country was founded on are eroding, our position of global dominance is already in question, and if we continue the way we have we will certainly fall behind the likes of China and India.

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Avatar for user 'bailarin'

bailarin | May 23, 2013 at 4:31 p.m. ― 11 months ago

muchapoo1,
You wrote "I question how a country can force citizens to pay for health insurance and give it to illegals for free. You know that's going to happen."

It has been happening for years. People, illegals included, with no insurance go to the emergency room for treatment and cannot be denied and we all pay for that care. They cannot afford insurance let alone preventive care. When they get really sick the cost of the cure is a lot more than the cost of preventive care.

I was at a VA Regional office waiting room with another veteran who was complaining about the benefits undocumented aliens are receiving. I asked him if he knows what President Reagan did while in office to the undocumented alien problem. His reply was "he sent them back?". I had to refrain from laughing when I told him that Reagan legalized the undocumented aliens. That action attracted more of them to come. Now Obama would like to do the same which will attract more illegals knowing full well that they will eventually be given amnesty. Funny how politicians always use the word reform.
The Immigration Reform and Control Act enacted November6, 1986, the act in brief: [1]
- required employers to attest to their employees' immigration status.
-made it illegal to knowingly hire or recruit unauthorized immigrants.
-legalized certain seasonal agricultural illegal immigrants.
-legalized illegal immigrants who entered the United States before January 1, 1982 and had resided there continuously with the penalty of a fine, back taxes due, and admission of guilt. About three million illegal immigrants were granted legal status.

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Avatar for user 'RegularChristian'

RegularChristian | May 23, 2013 at 5:19 p.m. ― 11 months ago

Great news!

I hope the new exchange brings down my premiums. They rise about 30% every year! But even if they don't, I'll be happy when fewer and fewer people show up in emergency rooms uninsured and unable to pay their bills. Finally! I won't have to pay their bills, either through higher premiums or by allocating taxes to health care instead of other equally valuable programs.

By the way, we all already enjoy several huge improvements on a mega scale. Parents can keep their kids on their current policies until the kids reach age 26. And better yet, insurance companies are now unable to rescind a policy or limit benefits when you suddenly become seriously ill. The days when insurance companies could take their customer's money for years and years and then play bureaucratic cat-and-mouse games questioning claims and refusing payments are over.

This is another good step forward. Congratulations and thanks to all those who worked so hard to make this happen.

( | suggest removal )

Avatar for user 'muckapoo1'

muckapoo1 | May 24, 2013 at 8:25 a.m. ― 11 months ago

In some respects, maybe this was intended to make the generational welfare group feel as good about healthcare as they do about food stamps. Now they will have a medical card to go with the food debit card ant the obama-phone they don't work for. They will now flood the doctor's offices like they did the emergency rooms to get free samples of cold medicine and other over-the-counter goodies they don't want to buy. Hey, you need to save up for all of the neat tattoos they have, don't you??
(In an unfortunate situation, I had to sit for hours in an emergency waiting room. It was full of moms with their children with runny noses. Many knew each other. I could not help to overhear their conversations. They clogged the system while people with real pain waited.)

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Avatar for user 'DeLaRick'

DeLaRick | May 24, 2013 at 9:20 a.m. ― 11 months ago

Muckapoo1,

I had a feeling the popularity of tattoos was due to the Affordable Care Act. For a while, I thought the desire for outward expression and improved techniques were behind the craze. I shoulda' known it was Obama all along.

( | suggest removal )

Avatar for user 'Missionaccomplished'

Missionaccomplished | May 24, 2013 at 10:32 a.m. ― 11 months ago

The following is for _uckapoo! with the hope (cough, cough,) he/she will become better informed:

]
ImmIgratIon Myths And The Facts - US Chamber of Commerce

www.uschamber.com/.../immigration/.../14484immigrationmythfacts.pdf‎

U.S. CHAMBER OF COMMERCE. IMMIGRATION MYTHS AND THE FACTS BEHIND THE FALLACIES. Dear Reader,. There is a great deal of misinformation

RAND Study Shows Relatively Little Public Money Spent Providing ...

<p>www.rand.org › News and Events › News Releases › 2006‎

Nov 14, 2006 – RAND Study Shows Relatively Little Public Money Spent Providing Health Care to Undocumented Immigrants. Print; Share

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Avatar for user 'Missionaccomplished'

Missionaccomplished | May 24, 2013 at 10:42 a.m. ― 11 months ago

Well, If Kaiser Permanente is going to "compete" for our business with others, hopefully that means they will lower their premiums to more relatively reasonable rates. I discontinued KP because they were taking a good $500 plus chunk per month on my paycheck and that is for a single person. No copays on visits, but it's not as if I'm in there every week or every month.

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Avatar for user 'Missionaccomplished'

Missionaccomplished | May 24, 2013 at 10:50 a.m. ― 11 months ago

BAILARINA, you don't learn, do you? Check the above websites. Do your homework--and PLEASE try to stay on-topic.

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Avatar for user 'Peking_Duck_SD'

Peking_Duck_SD | May 24, 2013 at 12:11 p.m. ― 11 months ago

While not perfect, this will be an improvement.

Personally I feel a single-payer system would make much more sense, but healthcare opponents who want to keep the status quo are kicking and screaming about just going this far.

I see the usual posters alarmed that the sky is falling as they usually are whenever anything in our country changes.

Being the only developed country on the planet who doesn't have universal healthcare, it's safe to assume that America would not be able to sustain our hegemony by having tens of millions of a segment we call "the working poor" without access to basic medical care.

Is see posters like muckapoo complaining about the status quo (emergency room's being used as primary doctors) and then complaining about reform to relieve this issue.

Complain, complain about the way it is now and the way it will be when Obamacare is 100% implemented.

Of course, nowhere in the flurry of complaining is there any semblance of a suggestion of what we SHOULD do.

Have you thought of running for Congress, muckapoo? Congressman Poo? Sounds like you would fit right in with your fellow obstructionists in Washington. Say no to any and all attempts to improve healthcare in our country, but come up with no solutions yourself.

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Avatar for user 'Peking_Duck_SD'

Peking_Duck_SD | May 24, 2013 at 12:16 p.m. ― 11 months ago

JeanMarc: 'All of the values this country was founded on are eroding."

So trying to build a safety net for the less fortunate is against America's values?

Telling insurance companies they can't refuse to cover someone who has cancer is against our values?

Ensuring higher productivity by making sure those who do the physically laborious lower-paying jobs in our country take fewer sick days and are healthier and more productive because they actually have access to preventive care is against our values?????

These things may be against your personal values, but they are certainly NOT against the values of America.

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Avatar for user 'Peking_Duck_SD'

Peking_Duck_SD | May 24, 2013 at 12:20 p.m. ― 11 months ago

Even if you are one of those people who thinks poor people should not be allowed to go to the doctor or the hospital if they can't pay out of pocket and can't afford insurance and should die in the street if they become sick and have the cost of removing their body billed to their family (muckapoo? Jean? this your vision of healthcare for the poor??) I would think you would at least be smart enough to realize that having a healthy, productive working poor actually benefits the rich.

I know you think economics only "trickles down", but if a wealthy industrialist has a healthy, productive workforce then that puts money into his or her pocket.

Yes, it does "trickle up" sometimes.

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Avatar for user 'muckapoo1'

muckapoo1 | May 24, 2013 at 4:54 p.m. ― 11 months ago

I would expect that someone with the old name of the Chinese capital in their name would hate big business and embrace socialized medicine.

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Avatar for user 'Peking_Duck_SD'

Peking_Duck_SD | May 24, 2013 at 11:42 p.m. ― 11 months ago

Mr. Poo,

You failed to answer my question to you.

Please, do share - what is YOUR solution for the poor who can't afford health insurance or medical care?

You have said you don't like:

(1) Them being able to access the ERs
(2) Government supplementation

So what is your proposal?

If you think people who can't afford health insurance or medical care should be turned away to suffer and die on their own without access to a doctor, come right out and say it.

And don't do what the slime-ball political parasites like Congressman Cantor did when confronted with this question and replied "rely on charities and churches" because there is not enough charity to cover the tens of millions of Americans who have no access to healthcare.

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Avatar for user 'benz72'

benz72 | May 25, 2013 at 7:48 a.m. ― 11 months ago

"If you think people who can't afford health insurance or medical care should be turned away to suffer and die on their own without access to a doctor, come right out and say it. And don't do what the slime-ball political parasites like Congressman Cantor did when confronted with this question and replied "rely on charities and churches" because there is not enough charity to cover the tens of millions of Americans who have no access to healthcare."

Isn't this something of a false dichotomy? Surely some would rely on charity (as they do now) and others would die (as they also do now). The numbers may shift, but I don't think we would see anything unprecedented.
Other viable options:

License medical practitioners with less training to perform more routine & less invasive forms of health care (increase the supply). EMTs and nurses are very capable professionals.

Promote pre-approved medical loans (with pre-researched limits) for persons who choose not to purchase insurance (removing the ‘cash in hand’ issue while maintaining personal accountability).

Expect an increase in charitable donations from all the people you claim view this as an important issue.

( | suggest removal )

Avatar for user 'muckapoo1'

muckapoo1 | May 25, 2013 at 10:27 a.m. ― 10 months, 4 weeks ago

There is no solution to the problem other than socialism at this point. We have too many willing to just wait for the government to be their nanny. Generations of whiners sitting on the stoop, smoking Newports, dreaming of their next tattoo, waiting on their monthly checks, waiting on their food stamp card to be renewed. This country is done. You can only tax the ones willing to work so much before they quit too. But yet , there are those who say give them more. Well, I do what I can for my family, everyone else needs to do the same. The lib policies of the past have made it too easy for people to drop out of school and sit waiting to see what the next perk they will get. I worked really hard to get what I have. I will be happy to share with someone physically unable, but not the lazy or the stupid that chose not to learn.

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Avatar for user 'muckapoo1'

muckapoo1 | May 25, 2013 at 11 a.m. ― 10 months, 4 weeks ago

Going to take a chance of having this comment removed. Betting "the duck" has never had a real job. Sits at home until the wage-earner brings home the bacon.

( | suggest removal )

Avatar for user 'Missionaccomplished'

Missionaccomplished | May 25, 2013 at 5:59 p.m. ― 10 months, 4 weeks ago

_uckapoo, you did NOT respond to Duckster with your grandiose "solution." Anything concrete to say other than your usual Social Darwinist babble?

( | suggest removal )

Avatar for user 'Peking_Duck_SD'

Peking_Duck_SD | May 25, 2013 at 6:20 p.m. ― 10 months, 4 weeks ago

Muckapoo, I don't want your comment removed because it illustrates your ignorance and propensity to make baseless assumptions and crude stereo-types.

Anyone who is in favor of healthcare access for all must be some kind of deadbeat, right?

I have a job and health insurance through my job.

But you are a "real American" because you think people who can't afford healthcare should just rot in the street.

( | suggest removal )

Avatar for user 'RegularChristian'

RegularChristian | May 26, 2013 at 7:04 a.m. ― 10 months, 4 weeks ago

I also like the provision in the law which requires that at least 80% of premiums be spent by the insurance companies for health care benefits, i.e., not for marketing, compensation, or other non medical costs.

We often forget that insurance companies and reform advocates had almost fifty years to find a way to bring costs down and failed. They had a business model that left no room for profit in this segment of the insurance market. So, it had to be legislated by reformers.

This new law is already bringing down the rate of federal spending for health care. I hope it does the same on an individual scale. It would be sad if the law ended up giving insurance companies a guaranteed subsidy and the policy holders a lemon. (Kind of like the Chargers ticket guarantee)!.

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Avatar for user 'muckapoo1'

muckapoo1 | May 26, 2013 at 10:16 a.m. ― 10 months, 4 weeks ago

Duck, you want me to appear that I want people to die on the street. Wrong. I just stated that they would clog the doctor office system like they did the emergency rooms. Time will prove me right. I lived it in another state where the welfare group was much larger and more creative than here. Read back and show me where I said people should die.

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Avatar for user 'Peking_Duck_SD'

Peking_Duck_SD | May 26, 2013 at 8:41 p.m. ― 10 months, 4 weeks ago

Muckapoo, you can't have your cake and eat it too.

Either you favor some supplementation of healthcare for the poor, or you want them to die without access to basic care.

If you have a way to ensure all people have access to basic health services without government involvement, then pease spell it out, I'm willing to listen.

Medical care and insurance is very expensive, and not all people who cannot afford it are "deadbeats".

Many work but, because their employers don't provide health insurance, they can't afford it.

Even if you have a system where the poor get treatment, but then get billed and have to declare bankruptcy when thy can't pay, that eventually impacts the tax payers.

Bottom line is it does come down to a fundamental choice - do you want those who can't afford it to get help, or o you think they should be turned away if hey can't pay ?

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Avatar for user 'muckapoo1'

muckapoo1 | May 27, 2013 at 1:16 p.m. ― 10 months, 3 weeks ago

Duck, learn to read. I just said they will clog the system. It seems to be you that has some infatuation with their deaths. I already admitted that your favorite form of healthcare (socialism) is the only way out.
Let me share a story. Campers became surrounded by hungry bears. They gave the bears the rest of their sandwiches and the bears quit growling. The bears came back, the campers gave them some of their cake. Bears were satisfied for a few minutes, then returned. The campers gave them their only remaining food-jelly beans, and the bears went away for a short time. When the bears returned the last time, found no food, they ate the campers.
This country has very few jelly beans left to offer unless we quit trying to support the entire world. When will the bears come for us?

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Avatar for user 'muckapoo1'

muckapoo1 | May 29, 2013 at 8:01 a.m. ― 10 months, 3 weeks ago

I am done commenting on this article, I have to start scheduling doctor visits for the next ten years to make sure I can get in. Bye all !!!!!!!

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Avatar for user 'DeLaRick'

DeLaRick | May 29, 2013 at 9:42 a.m. ― 10 months, 3 weeks ago

M1,

Physicians' practices (businesses) can grow just like any other enterprise. Some even go on to form their own medical groups or IPAs. They'll compromise margins (contract rates) for volume and win with increased efficiency.

Going to take a chance of having this comment removed. Betting "you" have never run your own physician practice.

( | suggest removal )

Avatar for user 'benz72'

benz72 | May 30, 2013 at 7:38 a.m. ― 10 months, 3 weeks ago

Is there anyone in this discussion who has run a physician practice and can discuss their financials in a public forum?

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Avatar for user 'DeLaRick'

DeLaRick | May 30, 2013 at 10:02 a.m. ― 10 months, 3 weeks ago

Benz,

Sure. Limit your questions to networks and access. Don't ask questions about specific financial information.

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Avatar for user 'jennifer_aicrag'

jennifer_aicrag | September 27, 2013 at 9:34 a.m. ― 6 months, 3 weeks ago

Benz72 - "License medical practitioners with less training to perform more routine & less invasive forms of health care (increase the supply). EMTs and nurses are very capable professionals."

Good idea in my opinion. Sensible.

( | suggest removal )

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