Lisa Agcaoili paces nervously as she waits to speak with a Covered California counselor in a West Los Angeles College cafeteria. Thousands of people have come to a Health and Enrollment Fair for solid information about their options under the Affordable Care Act.
Agcaoili hasn’t had insurance in the more than 20 years she has worked for the Lawndale Elementary School District. The part-time instructional assistant works fewer than 30 hours a week and isn’t eligible for district health plans. She is over 50 and suffers migraines daily.
“If I had medical coverage,” she said, “I would have gone to the doctor by now to see why I have headaches every day.”
In 2012, she made just under $21,500, including after-school activities and other earnings, and is raising two grandchildren that she claims as dependents on her tax return.
The ACA stresses “shared responsibility” for extending coverage as broadly as possible. Federal and state agencies, employers, insurers and the uninsured all have a role to play. Agcaoili’s responsibility is to enroll in a health plan or pay a non-coverage penalty that increases from $95 in 2014 to $325 in 2015 and $695 in 2016.
The penalty is the ACA stick and the carrot is federal subsidies to ease the cost of care for low-income individuals and households. Subsidies will vary according to family size, household income and zip code.
“I’m on pins and needles to see what’s going to happen,” Agcaoili said, “but no matter what subsidy I get, it would be an expense that I’m not paying now. Like many Americans, I’m already struggling to pay my existing bills.”
At the enrollment fair, Agcaoili got unexpected news: She is eligible for Medicaid – known as Medi-Cal in California – which would mean coverage with no premiums, deductibles or co-payments. Agcaoili can begin receiving medical care on January 1, plus dental and vision benefits in May.
While news media focused on problems with the federal ACA website, hundreds of thousands of uninsured Americans were registering for Medicaid. New rules expanded eligibility to adults without children and those with incomes up to 138 percent of the federal poverty level ($15,857 for an individual or $32,500 for a family of four).
The federal government will finance the expansion for the first three years, then taper off to 90 percent. California and 24 other states accepted the offer. During the first six weeks of open enrollment, more than four times as many people signed up for Medicaid coverage than for private plans. The Congressional Budget Office estimates that Medicaid will cover 9 million new people next year, compared to 7 million people with new private plans.
The news is especially good for Agcaoili and 208 other part-timers among the 335 school staff represented by the Lawndale Federation of Classified Employees. “The school district has so many of our members working at 28 and even 29.5 hours a week to avoid offering them medical benefits,” said Lawndale Federation President Carl Williams. “We used to think of Medi-Cal as welfare, but it’s insurance that we didn’t have access to before.”
“The school district has so many of our members working at 28 and even 29.5 hours a week to avoid offering them medical benefits. We used to think of Medi-Cal as welfare, but it’s insurance that we didn’t have access to before.”
—Carl Williams, President, Lawndale Federation of Classified Employees