Affordable Care Act makes impact on Imperial Valley residents, hospitals and clinics
A brain tumor, a pre-existing medical condition to insurance companies, had prevented El Centro resident Eric Villanueva from qualifying for health coverage.
Thirty-three-year-old Villanueva had been without health insurance for about eight years until the Affordable Care Act took effect for him Jan. 1.
“I’m so happy now that I have insurance,” he said. “I can finally look at my family and tell them everything will be all right. I don’t have to worry about how I’m going to pay. That cloud is gone and there’s no more ‘what ifs.’ I’m covered.”
The Affordable Care Act, a plan for universal health care in the United States, is being implemented through Covered California for Imperial Valley residents and all Californians.
The health plan, also known as Obamacare, has expanded coverage to people like Villanueva who were not previously eligible. This includes someone with a pre-existing medical condition, low-income individuals and families whose incomes are between 100 percent and 400 percent of the federal poverty level, plus an expansion of Medi-Cal- and Medicaid-eligible persons.
2012 uninsured rates
See the percentage of people in each Census tract who were reportedly uninsured in 2012.The darker the red color, the higher the percentage of uninsured people. Click the colored shapes to see the percentages.
As of Dec. 1, some 10,157 Imperial Valley residents enrolled for Covered California.
Although the initial deadline to receive coverage starting Jan. 1 has already passed, applications are being accepted through March 15. A secondary deadline for enrollment is coming up Wednesday and will allow anyone without health insurance currently to receive coverage starting Feb. 1.
Anyone not enrolled in some type of health plan by March 15 will incur a penalty of $95 per adult or 1 percent of a person’s taxable income, whichever is higher.
“It’s either you enroll or you pay. Either way they’re going to get you,” Villanueva said. “A lot of people are scared to get insurance, but it’s your health. Whether you’re healthy or not now, anything can happen.”
Villanueva’s familiarity with the emergency room and hospitals is greater than most because of his brain tumor. Medical bills have piled high and greatly affected his credit report.
“It shouldn’t be where you lose everything because you had to see a doctor because you’re sick,” he said. Through his experience, Villanueva encourages everyone to at least go to the Covered California website and see what they are eligible for.
“It’s well-worth it. What price can you put on someone’s health?”
Diana Peacher and Helen Palomino have been helping people enroll in Covered California as Affordable Care Act-certified enrollment counselors. Operating out of the Cancer Resource Center of the Desert, this is just one more way for them to help patients and their families.
Certified enrollment counselors can be found at various locations throughout the Imperial Valley including Neighborhood House of Calexico, Catholic Charities of California and Clinicas de Salud del Pueblo. Peacher and Palomino went through training to get certified, and although they primarily help cancer patients and families, they see anyone who has questions on enrollment.
“One of the questions that come up every time is just around health insurance itself,” Peacher said. “These are people who have never had health insurance.”
As such, Peacher and Palomino spend time explaining the different plans as well as all the terminology associated with gaining insurance such as a deductible and a co-payment.
“We go over every single thing in terms of the general plan,” Peacher said.
“Our goal is to make them feel informed in their choice,” Palomino added.
Medi-Cal expansion under the Affordable Care Act
Palomino said she and Peacher also explain how Covered California is a doorway to other things, like Medi-Cal, a program originally meant to insure low-income individuals. Medi-Cal has expanded to about 20,000 people in the Imperial Valley because of a provision in the Affordable Care Act.
It now provides insurance to low-income adults under the age of 65, including anyone with children living at home. Adults without children who have an income of up to 138 percent of the federal poverty level are also newly eligible for the Affordable Care Act.
If an individual does qualify for Medi-Cal, that person will still need to choose a plan.
In the Imperial Valley, that choice is between California Health and Wellness or Molina Healthcare of California. These two plans are part of Medi-Cal Managed Care, which organizes and delivers health care better.
Greg Buchert, chief executive officer of California Health and Wellness, said Covered California will try to sign people up for a health plan, but will also determine whether they are eligible for Medi-Cal. If they are eligible, Covered California sends that application electronically to Healthcare Options, a company that actually enrolls people for Medi-Cal.
“It’s all taken care of in a one-stop shop, which greatly simplifies things,” Peacher said.
Although it’s a lot easier to apply for Covered California now, it’s still a bit daunting for people enrolling on their own. Aside from seeing a certified counselor, Imperial County residents can attend enrollment workshops hosted near the end of January.
The first will be Jan. 21 from 2:30 to 3:45 p.m. at the Area Agency on Aging and the other will be hosted at the Citrus Festival in Calipatria on Jan. 25.
Since it is January, there is a constant surge of people accessing the website and trying to apply, creating issues with the website itself. However, many of the website’s issues have been sorted out and it seems to be working relatively well, said Edith Lara-Trad, public information officer of Covered California in Southern California.
“I tested the website from my end and it seems to be running well,” she said. “We do have a lot of individuals who have successfully enrolled.”
The number of enrollment applications is recorded week to week. The latest numbers show that 1,157,798 people in California have enrolled for health care through Jan. 4.
Impact on hospitals and clinics
With the increased number of people with insurance, El Centro Regional Medical Center and health clinics have been preparing for additional patients.
“(The Affordable Care Act) is steamrolling its way into every aspect of hospital operations,” said Ronald Olds, chief nursing officer at ECRMC.
Patients have to pay higher deductibles and co-pays and there is a slight increase of patients to the emergency room, he said. Olds said he expects the ER visits to increase by 5,000 in fiscal 2014.
Financial consultant Dale Howard said he sees no incentive for low-income individuals to sign up for the Affordable Care Act.
“They can get free care anyway because they’ll just go to the emergency room,” he said. “The hospital is not allowed to turn anyone away.”
Howard said he hopes to see an increase of people at least on Medi-Cal because then some of the medical bills would get paid.
“If we could figure out a way to get them to sign up when they go into the emergency room for the first time, that would be great,” Howard said.
With a lack of doctors, the question becomes whether people will get the care they need or if they will end up getting primary care in the ER.
“Prior to the Affordable Care Act, uninsured people would use the ER as their primary care provider. The only change to this is that same people are using the ER, but now have Medi-Cal,” Olds said. “I should note that many people use the ER as their primary care provider because there are not enough primary care providers in the Imperial Valley. The current wait time to see community physicians is between three to five weeks.”
Wait times in the ER are generally affected by the time of the season, he said, and as this is currently flu season, wait times are already up.
“I don’t believe the Affordable Care Act has had an effect on our ER wait times. However, we are tracking this daily,” Olds said.
Niland resident Michael Buzick enrolled as soon as he could, back in October, and is having issues making an appointment with a general physician.
“The problem now is there are so many people who have Medi-Cal, it’s hard to get an appointment with a doctor,” the 52-year-old Buzick said. He’s been trying for days now to make an appointment, but has not been successful yet.
Buzick said it feels wonderful to have insurance again. The last time he had insurance was in 2000, he said.
After qualifying for certain subsidies, his premium is rather low, he said. These subsidies are given to people with incomes between 139 percent and 400 percent of the federal poverty level and are given as a refundable tax credit.
“Where you live makes a big difference. Imperial County gets one of the biggest subsidies in the nation because of the high unemployment rates,” he said.