Lisa Agcaoili nervously waited to speak with a Covered California counselor in a West Los Angeles College cafeteria, where thousands of people had 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 with special education students for the Lawndale School District. The instructional assistant isn’t eligible for district health plans because she works less than 30 hours weekly. In 2012, she made just under $21,500, and is raising two grandchildren whom she claims as dependents.
Agcaoili is over 50, suffers migraines and is increasingly concerned about her future care. “If I had medical coverage, I would have gone to the doctor to see why I have headaches every single day.”
The ACA stresses “shared responsibility” among federal and state agencies, employers and insurers. The responsibility of the uninsured is to enroll in a plan or pay a penalty that increases from $95 in 2014 to $325 in 2015 and $695 in 2016.
The penalty is the ACA stick. 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.
“No matter what subsidy I get,” Agcaoili said, “it would be an expense that I’m not paying now. I’m already struggling to pay my bills.”
But the Covered California counselor delivered good news: Agcaoili was eligible for Medicaid with no premiums, deductibles or co-payments. Medi-Cal — as the system is known in California — will also begin providing dental and vision benefits in May.
“We used to think of Medi-Cal as welfare, but it’s insurance that we didn’t have access to before.” — Carl Williams, Lawndale Federation of Classified Employees
While news media focused on problems with the ACA website, hundreds of thousands of uninsured Americans have been registering for Medicaid. New rules expanded eligibility to adults without children and those with incomes up to 138 percent of the federal poverty level. (See table at right)
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 who will get new private plans.
“We used to think of Medi-Cal as welfare,” says Carl Williams, president of Agcaoili’s union, the Lawndale Federation of Classified Employees. “But it’s insurance that we didn’t have access to before.”
Paul Humann has been teaching English Composition part time for three years. In 2012, he earned about $35,000 for teaching two classes at Santa Cruz County’s Cabrillo College and two classes at San Jose’s Evergreen Valley College. Cabrillo lists him as 45 percent and Evergreen as 40 percent.
Humann is 31 and was covered by his parents’ medical plan until he was 24, though he doesn’t consider himself one of the “young invincibles” who doubt they will need medical insurance. “I had asthma as a kid, so I appreciate the value of a healthcare plan.”
Part-time faculty can often access union-negotiated district health benefits. Humann plans to find the best plan for his needs and resources and enroll in it by December 15, but it has been hard to navigate the labyrinth of deductibles, premiums and co-payments and come up with a strategy.
Both his campuses offer health coverage to adjunct faculty working at least 40 percent, but Humann said few part-timers enroll because of the cost. A district reimbursal cuts a $591 monthly premium in half, but he still worries how he will foot the additional bill.
Humann qualifies for subsidies with an ACA health plan, but he would have to give up the district reimbursement, which only applies toward the employer’s plan. “I might change my mind if I find a niche plan that includes something like free allergy shots, but right now it looks like the district plan works best for me.”
Linton Bowie teaches biology at College of San Mateo. Bowie retired from Pacific Gas and Electric and began to consult and teach in 2002. She now teaches two classes in the fall, three in the spring, and two in the summer.
Bowie is covered by Kaiser through the San Mateo Community College District, which reimburses eligible employees up to $1,000 per year for any medical insurance.
Bowie’s rates are rising from $668 monthly in 2013 to $743 next year, but the 61-year-old is finding that Covered California may not fit her needs.
Last year, she made about $39,000 from teaching, which would have qualified her for ACA subsidies, but she also received about $7,000 from a PG&E pension, putting her income above the cut-off.
Bowie’s biggest fear before the ACA was a catastrophic illness burning through her life savings. “The nightmare scenarios that I hear from people with private plans are of much higher out-of-pocket expenses, and being dropped when they hit the lifetime cap on benefits.”
She created a grid with data from the district’s Kaiser plan, the cheapest plan available, and bronze and silver Kaiser plans through Covered California, then crunched the numbers for two scenarios: a typical year with a minor mishap and one with a major medical incident. The premiums for her current coverage totaled more per year, but the bottom line flipped when she factored in co-pays, deductibles and other out-of-pocket expenses.
“With the district plan, I might pay a little more per year, but
the same options cost me $120 on the minor year and $1,500 on the
major year. I’m likely to have more medical expenses as I get
older, so I think the district plan is less risky.”
— By Steve Weingarten, CFT Reporter
QUICK FACTS: Affordable Care Act
Insurance companies cannot deny coverage for pre-existing medical conditions, cancel an employee’s policy if he or she gets sick, or deny care to a sick child.
- Health plans must offer free check-ups and preventive care and eliminate lifetime caps on coverage.
- The policyholder only needs to pay his or her portion of the bill, which will vary according to choice of premiums, deductibles and co-pays.
- The government will send a check for its share of coverage directly to the insurer.
- Insurers must refund the money a policyholder pays if they don’t spend 80 percent of it on healthcare.
- Young adults can stay on their parents’ plans until they are 26.
- Large employers (with 50 or more workers) who fail to offer affordable coverage to employees who work 30 or more hours per week on average will be penalized; however, those penalties have been delayed until January 2015. Meanwhile, some businesses are cutting weekly work schedules to avoid crossing the dividing line between full- and part-time employees.
- Enroll by December 23, 2013, to obtain coverage by January 1, 2014.