What Effect Has Health Care Reform Had In SD?

The headlines last week were all about efforts on Capitol Hill to repeal the nation's new Affordable Health Care Act. Many new Republican members of Congress made repeal of the health care law a campaign issue in November, and the new GOP majority in the house voted for repeal last week.

But, since the Senate and White House are still Democratically-controlled - health care reform will apparently remain the law of the land for the time being.

With so much talk about the new health care reform act, we thought it a good time to check in on how the various aspects of this new law are taking effect. It is a complicated law, and it's many provisions become effective in stages.

Guest

Gregory Knoll, executive director Consumer Center for Heath Education and Advocacy, which is an independent program of the Legal Aid Society of San Diego.

Read Transcript

MAUREEN CAVANAUGH: I'm Maureen Cavanaugh, You're listening to These Days on KPBS. The headlines last week were all about efforts on capital hill to repeal the nation's new affordable healthcare act, many new members of Congress made repeal of the healthcare law a campaign issue in November, and the new GOP majority in the house voted for repeal last week. But since the senate and White House are still Democratically controlled, healthcare reform will apparently remain the law of the land for the time being, with so much talk about the new healthcare reform law, [check] aspects of this law are taking effect. It's a complicated law, and its many provisions become effective in stage of joining us with an update is my guest, Gregory knoll, he's executive director of consumer center for [check] independent program of the legal aid society of San Diego. Gregory, welcome.

KNOLL: Hello, good morning, Maureen, how are you?

MAUREEN CAVANAUGH: I'm great, thank you for joining you. We invite our listeners to join the conversation. Has the new healthcare act helped you out yet? What provisions are you waiting to see go into effect? Give us a call with your questions and comments of and Greg, what major provisions of this new healthcare reform act have gone into effect so far?

KNOLL: Well, I think the most [check] with preexisting conditions who are now being notified that they have coverage after wrapping up enormous emergency room bills caring for their previously uninsured kids of I think that's really huge. I think that the -- 450000 California seniors, about 50000 here in San Diego getting help with prescriptions is very important. You're looking at insurance companies not being able to drop coverage due to illness, not refusing to pay out of networking emergency bills, all the preventive services that are now covered, routine screenings, pap smears, colonoscopies, which is really what we've always wanted because the early diagnosis of that reduces long-term cost down the road. Preexisting conditions for everyone will go out in 2014, but the one for kids now is really making parents happy. And of course, the ones that came before which are about 20600 young folks that are on their parents' policy till age 26 now.

MAUREEN CAVANAUGH: Right, right, and do you find that people are confused, though, because this is such a complicated plan and it does roll out in stages? Like, what went into effect in January, this year, January of 2011?

KNOLL: Well, you know, it's funny that you say that. It's absolutely confusing. The biggest problem with it, everybody was saying that on September 23rd, these certain things went into effect. But what they didn't say was that they went into effect on the date of renewal of the policy. So instead of 923, it could have been October 1st, which a lot were, November 1, or January 1. So there was this delay that people were very upset about, because they thought, after all the news hit, that they were automatically going to qualify. And that wasn't the case. I think it's getting a little easier to understand, but I think people really do have to contact telephone number, called the consumer center, if they need an update and want to know whether or not they are covered under a particular provision.

MAUREEN CAVANAUGH: Right. Now, do we know how many more people have health insurance here as a result of this? So far?

KNOLL: No, absolutely not. There's a great group call insure the uninsured project, Los Angeles was trying to come up with that information, but it's too early to grab the numbers of the newly insured.

MAUREEN CAVANAUGH: I see. Now, I'm wondering we hear a lot about state budget cuts, right? So the state is cutting the budget as healthcare reform act is rolling out the implementation of more and more benefits for people to -- Medicare recipients and so forth. Do these two intersect in some way that people should know about? Are state budget cuts making it more difficult to implement these roll outs?

KNOLL: I think that last year's October effective budget cuts certainly came along at a very inopportune time. San Diego County lost about $660,000 just for immunization services for kids and teens. And 340000 for an immunization registry. And over all, San Diego County lost about 5.3 million for immunization work. What this does because the county cannot back bill state cuts, this really makes our clinics and health centers have to scramble to figure out how to serve the population. In addition are safety net providers to clinics and family health centers are seeing nearly a 20 percent increase of the number of uninsured people presenting at their clinics, and at least in the past 3 to 4 months, 2 clinics, one rural and one downtown have closed in San Diego County. So certainly budget cuts as they come along are always traumatic, but to the extent that we can do the bridge to reform and begin to say county by county that we are going to start covering people, paying the federal match and expanding the Medi-Cal numbers, I think we could eventually ride that out. The biggest problem, of course, is what our community clinics always have to do. Which is cost shift constantly. But there are a number of proposals with governor brown that make us, you know, cringe at -- regarding healthcare. You upon, the use of the mental health services money, the reduction and elimination of benefits in Medi-Cal and helping family programs, increasing co-pays and share of cost, that's scary because that's usually what prevents people from actually seeking help. In-home supportive services for those who are home bound.

MAUREEN CAVANAUGH: Right.

KNOLL: Are all being cut, and of course, the one that was in an article in the paper today about the veterans service office, which does a lot to link veterans coming benefit [check] so there's a lot of concern out there because it looks like California is broke and can't really participate as thoroughly as they need to in an affordable care act.

MAUREEN CAVANAUGH: I'm speaking with Gregory knoll, he's executive director of consumer center for health education and advocacy, it's an independent program of the legal aid society of San Diego. And I also want to remind our listener, if you have a question about the new healthcare act, give us a call at 1-888-895-5727. So what -- so if I'm understanding you correctly, what we're seeing, because of the economy, and state budget cuts, is a rising number of people who are uninsured even though the affordable healthcare act is rolling out, and it's maintaining coverage for, like, kids who are going to college can stay on their parents' insurance up until age 26, I believe.

KNOLL: That's right.

MAUREEN CAVANAUGH: And more children are being able to be insured because they don't have the preexisting condition clause anymore.

KNOLL: That's right.

MAUREEN CAVANAUGH: For them. So there are these two opposing effects going on at the same time.

KNOLL: Well, yeah. I -- what's really important, Maureen, on that kids up to 26 is that it's not just the kids that are in college.

MAUREEN CAVANAUGH: College, right, right.

KNOLL: It's kids that are even working. And maybe their employer doesn't offer insurance.

MAUREEN CAVANAUGH: Right.

KNOLL: It could be that they're out of work, and they're trying to raise a couple of kids, you know, themselves. Yes, they can still stay on their parents' request policies. One of the real problems around the growth of the uninsured, that we've been noticing are the higher income 50 to 65 folks who have been outsourced, down sized, lost health benefits, and are trying to get back into the insurance market without employer coverage, and every one of them, has something preexisting. And that is a huge problem that's growing.

MAUREEN CAVANAUGH: What about the breaks for small businesses offering health insurance to their employees? Do we know -- I know it's really early days yet. Do we know how many of those small businesses might have taken advantage of that?

KNOLL: Well, I talked to businesses issue it's a nonprofit small business, all the time, encouraging them to look into how much of that potential AP percent tax credit they may be able to get. But my estimates lately, and the ones that I received from the house committee of energy and commerce, are in San Diego alone, you're talking about 76400 small businesses that, you know, will be able to take advantage of the tax credit over the coming year. That's very exciting, I think, and it's something that will encourage the number of businesses offering insurance to employees to go even higher. It's about six percent now in San Diego County of small businesses that -- will 3 to 9 folks that offer healthcare.

MAUREEN CAVANAUGH: Let's take a call. Corina is calling from San Diego. Good morning, Corina, welcome to These Days.

NEW SPEAKER: Good morning, thank you for taking my call. . It was just my understanding that the preventive care was gonna be given to the policies that were bought or change after March 23rd when the [check] and the policies -- but before that were grandfathered and they're not gonna get that benefit. ; is that correct or --

KNOLL: No. The grandfathering has to do with what plans would be -- would be grandfathered. But once you have had your annual re-enrollment, your open policy time, you should see that when you applied to have unemployment for a Pap smear, for screening. -- increasing co-pays, or very little co-pay. Much less than you had paid before.

MAUREEN CAVANAUGH: So in other words, even if you stay with the same insurance carrier, as your yearly enrollment date rolls around, all those provisions kick? ?

KNOLL: That's correct.

MAUREEN CAVANAUGH: Now, what provisions are coming up next, Gregory?

KNOLL: Well, I think what we're really looking to right now, Maureen is the ability for San Diego County and the State of California to try to implement their waiver with the federal government, which is called the bridge to reform, to try to expand Medi-Cal eligibility. They're talking about spending about $50 million in it San Diego County money possibly to draw down 50 million from the feds to expand coverage to some 22000 folks in San Diego alone, there are -- I mean, those are the thick things that are happening right now, but as you continue through the -- through the bill, we are looking forward to the pre-existing conditions not being [check] being for everybody.

MAUREEN CAVANAUGH: Right.

KNOLL: You're looking at -- let's see.

MAUREEN CAVANAUGH: Well, we are looking at 2014, the actual -- the start of the managed competition pools, right?

KNOLL: Right.

MAUREEN CAVANAUGH: The pools.

KNOLL: And what you're gonna have is the health insurance exchange.

MAUREEN CAVANAUGH: Right.

KNOLL: Which you know, California was the first state to pass the legislation to enable it. That's very exciting because that's where people are going to get their insurance, where they have not been able to before, haven't been able to get employer coverage before. They're gonna enter into the competitive exchange where hopefully we can get lower prices, lower premiums for quality healthcare providers.

MAUREEN CAVANAUGH: Didn't I hear that California was trying to make that -- make that -- speed that up a little bit?

KNOLL: Yes. They have already taken the $1 million, I believe, in money in order to move that along. They are trying to tomorrow who is going to be -- what plans might be able to start providing coverage earlier, and of course, they started the preexisting condition and health plan, come is a little extensive, but still is better than nothing for some people with preexisting conditions that have no healthcare coverage.

MAUREEN CAVANAUGH: So if people actually want -- here in California want to know where they stand on being able to get cover annual and so forth, is there a clearing house for information about this when it comes to what California is doing and what the federal government is doing and how that's meshing here in California?

KNOLL: Yes, people could always go to healthcare.gov, which is a very important federal website, they can click on their state, and they can try to find out what is going on in their state relating to the affordable care act. But if people have a specific fact based situation about them, their insurance company, and their coverage, they should call me or the consumer center for health education advocacy. We are a partner with both 211 and San Diegans for healthcare coverage who are trying to get out as much information as possible to the individual folks in San Diego about how all these provisions affect them individually.

MAUREEN CAVANAUGH: Gregory, thank you, I know it's a complicated issue. Thanks so much for talking about it today.

KNOLL: Well, thanks so much for having me, Maureen.

MAUREEN CAVANAUGH: Gregory knoll is executive director of [check] it is possible that the president of the United States will mention his affordable healthcare act during his state of the union address tonight. We will talk about the president's state of the union address tomorrow here on These Days. If you would like to comment, please go on-line, KPBS.org/These Days. Stay with us for hour two, coming up in just a few minutes here on KPBS.