California’s Affordable Health Care Act Explained

The year 2013 marks the 25th anniversary of the Santa Barbara Women’s Political Committee (SBWPC). This feminist organization has had a strong impact on the social and political environment of Santa Barbara County since it’s founding in 1988. Many of its earliest board members campaigned successfully for office, while others have served on boards and commissions and staff to elected officials. These women have had long-term effects on governance and public policy, locally and nationally.

Perhaps, the most long lasting impact the SBWPC has had is through the women leaders it has nurtured. On March 8, the SBWPC President’s Circle will hold its annual luncheon with guest Janice Rocco, Deputy Commissioner of Health Policy with the California Department of Insurance. Rocco is an example of the many women who have emerged from the SBWPC to carry forth its feminist values.

A graduate of UCSB, Rocco worked for Planned Parenthood, served on state and national boards of the National Organization for Women, as chief of staff for State Assemblymember Hannah-Beth Jackson, as senior consultant to the California Legislative Women’s Caucus, and as chief of staff for Asemblymember Dave Jones. In college she served as SBWPC’s vice president of the board, earning their “rising star” award.

In her current position with the State Insurance Commission, Rocco oversees the implementation of the federal Affordable Health Care Act for California. In a recent interview, Rocco answered the following questions and shared her insight as to what Californians can expect from the Affordable Health Care Act by 2014.

Describe your role and specific duties in implementing the Affordable Health Care Act. The Department of Insurance (CDI) regulates health insurers in California. As Deputy Insurance Commissioner, I have oversight responsibilities for the Preferred Provider Networks (PPOs), while the Health Maintenance Organizations (HMOs) are regulated by the Department of Managed Health Care. CDI is responsible for implementing the Affordable Care Act (ACA), enforcing the new law and providing assistance to consumers who are having trouble with their insurance carriers with coverage or claims issues or have questions about their rights. Anyone who needs help from CDI can contact us at 1-800-927-HELP or www.insurance.ca.gov.

What are the criticisms or objections to the Act that you have heard? The complaint I hear the most is that many people don’t yet know what is in the Affordable Care Act and how it will impact the health insurance coverage that is available to them.

If people don’t know about the Act, what is the state doing to educate them and market the program? The federal government has just made significant changes to its website (www.healthcare.gov) where information is available about the ACA. CDI has an area of its website (www.insurance.ca.gov) devoted to health insurance reform and our staff speak at community meetings and distribute brochures that describe the major provisions of the ACA.

Later this year, the Health Benefit Exchange will undergo a major marketing effort including outreach through community organizations and paid media. We can also expect the health insurers to do a lot of marketing about the ACA and the new benefits in their products that are required in 2014.

When must the Act be implemented by? California has been implementing various provisions of the Act since its passage in 2010. A few of the protections already in place include prohibiting the denial of coverage to children with pre-existing medical conditions, covering preventative care services without co-pays or deductibles, allowing children to stay on their parents’ insurance until age 26, and requiring that at least 80 cents of every premium dollar go to pay for health care, rather than insurer administration and profits.

The most significant provisions go into effect on January 1, 2014 and include prohibiting the denial of coverage to adults with pre-existing conditions, a requirement to cover a comprehensive set of benefits termed “essential health benefits,” a mandate that large employers provide health insurance coverage to those who work at least 30 hours per week, the expansion of eligibility for the Medi-Cal program and tax credits for both small business that provide coverage and for individuals and families with incomes up to $94,200 (for a family of four) who buy their insurance through the Health Benefit Exchange.

Please describe the Health Exchanges and what they will do. The Health Benefit Exchange, which has named itself Covered California, will be a marketplace where individuals and small businesses can shop for health insurance and where many will be eligible for tax credits to pay for some of their monthly premium costs.

If you or your family are uninsured, or just looking for better coverage, you will be able to compare your options, all in one place, and sign up for any of them with one application. It will be easy to compare one product to another and to get clear information about what benefits are covered by each product and what your out-of-pocket costs will be when you use your coverage. People can start the enrollment process as early as October 1 for coverage that begins January 1, 2014.

Is there a mandate for employers to offer coverage? Large employers (those with more than 50 employees) must either provide coverage to their full time employees or provide coverage through self-insurance arrangements. The fine for a large employer that does not offer coverage will be $2,000 per full-time employee beyond the company’s first 30 workers. Small employers are not required to provide coverage.

What are the challenges facing small businesses? Currently, many small employers have a tough time finding and affording coverage that meets the needs of their employees. Starting in 2014, some small businesses will be eligible for tax credits of up to 50 percent if they purchase health insurance for their employees in the Exchange.

Small businesses are going to want to look at their options and they may want the assistance of a health agent/broker, but the Exchange will make it easier than ever before. Small employers will be able to choose the level of coverage they want to offer. That said, some employers will evaluate whether they want to purchase coverage for their employees, or whether their employers might prefer to buy coverage on their own in the Exchange where individuals and families can get significant tax credits to pay for their premiums and reduce their out-of-pocket costs.

Are individuals eligible to enroll for coverage? Even those who have been denied coverage in the past due to pre-existing medical conditions will be eligible for all the new health insurance products that will be for sale in 2014. One of the most important provisions in the ACA that will help millions of Americans afford coverage are the premium subsidies that will be available to many families that buy in the Exchange. (For more information on subsidies go to: www.coveredca.com.)

Do you think insurance premiums will increase in cost? Historically, some policies sold in the individual market have had narrow benefit packages and high deductibles. Starting in 2014 all products sold to individuals, families and small employers will need to cover “essential health benefits” and deductibles for small employer plans will be capped at $2,000. This will increase the cost of some policies, but subsidies will be available in the Exchange for many families and small employers that will bring down the cost.

How will women specifically benefit under the ACA? In California we moved forward with some of the reforms that provide better coverage for women before 2014. In 2010, we passed a law that prevents health insurers from gender discrimination in pricing. Last year we passed a law that requires health insurance policies to cover maternity. We had also passed a law that required contraceptive coverage more than a decade ago, but thanks to the ACA, women can now get their contraception without any co-pays or deductibles. Contraception is just one of the women’s preventative health care services available without co-pays or deductibles. Others include annual exams, mammograms, cervical cancer screening, screening for gestational diabetes and HPV testing. This makes these services available to many women who were not able to afford the out-of-pocket costs in the past.

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On Friday, March 8, the SBWPC will host Janice Rocco at the Montecito Country Club. The event will begin at 11:30 a.m. For more information or to reserve a seat, call (805) 564-6876 or visit www.sbwpc.org.