Take Two for July 18, 2013

What you need to know about the California health care exchange

El Monte Pharmacy

Stephanie O'Neill

Pharmacist Gloria Goh provides a free blood sugar test to El Monte Pharmacy customer Maria Medina of Rowland Heights.

Covering California series icon 2013

President Obama made a speech on Thursday from the White House, promoting the Affordable Care Act, better known as Obamacare. A key element of the plan, a requirement that most individuals have health insurance, goes into effect at the first of next year.

The plan calls for states to set up health care exchanges to help individuals obtain insurance policies.  Here in the Golden State, the exchange is called California Covered.

Who can buy insurance through the exchange? How much will policies cost, and what if you can't afford one? When can you begin shopping for a plan?

KPCC's health reporter Stephanie O'Neill has answers to all these questions, and more.

With Covered California, how can insurance companies suddenly begin covering more for a lesser cost?

"The answer is not so simple. At first, there was a bidding process preceded by weeks of negotiations with Covered California officials and the insurers. Thirteen health plans were chosen, and those plans agreed to bring down their profit margins to two to three percent. They did that in large part by negotiating lower reimbursements for hospitals and for doctors, and in exchange they're going to have a ready-made marketplace of over 5,000 Californians."

What are some fears and concerns about the plan?

"There are different contracts offered outside of the exchange. So while basic coverage benefits will be provided, there is concern that there will be far fewer doctors and hospitals available to consumers that purchase the Covered California plan. Blue Shield, for instance, has said that its exchange customers will be restricted to 36 percent of its regular physician networks statewide, and there's other hospitals like Cedar Sinai Medical Center, that are excluded all together from all of the plans."

Any hint on who can buy these policies?

"There's an estimated 5.3 million Californians who will qualify to buy insurance in the state marketplace. These are people who don't have employer-provided insurance, and don't qualify for other government programs like Medicare and Medicaid."

What if you can't afford the policies?

"For those who still can't afford the plan, Governor Brown has agreed to an expansion of Medical, which is California's version of Medicaid, to cover low-income folks who make 138 percent of the poverty level or less. That means about $16,000 a year."

Covered California customer service representatives are available from 8 a.m. to 5 p.m. Monday through Friday at 1-(888) 975-1142.


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