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"content": "\u003cfigure id=\"attachment_19598\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/187909352.jpg\">\u003cimg class=\"size-large wp-image-19598\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/187909352-640x426.jpg\" alt=\"Covered California executive director Peter Lee, seen here at a November, 2013, press conference. (Max Whittaker/Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Covered California executive director Peter Lee, seen here at a November, 2013, press conference. (Max Whittaker/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>UPDATE: June 20\u003c/strong>\u003c/p>\n\u003cp>\u003cspan class=\"Apple-style-span\" style=\"color: #000000\">KQED's April Dembosky attended the Covered California board meeting Thursday afternoon where the board expressed concern \u003cspan class=\"Apple-style-span\">that a voter initiative on the upcoming November ballot could compromise its authority. The initiative\u003c/span>\u003c/span> would give the state’s insurance commissioner the authority to reject excessive rate increases in health insurance premiums. But Covered California already negotiates rates with insurance plans. How would the initiative, if passed, affect Covered California?\u003c/p>\n\u003cp>\u003cspan class=\"Apple-style-span\" style=\"color: #000000\">Covered California board member Susan Kennedy called on agency staff to conduct an intensive analysis of the initiative’s potential impact Covered California's ability to operate -- and to get it done soon.\u003cbr>\n\u003c/span>\u003c!--more-->\u003c/p>\n\u003cp>\u003cspan class=\"Apple-style-span\" style=\"color: #000000\">\"The impact from my perspective could be, really huge, and very negative on our ability to function. We ought to raise the alarm level on this and be much more aggressive,\" Kennedy said.\u003c/span>\u003c/p>\n\u003cp>The board also questioned its ability to meet federal Obamacare deadlines and effectively market plans if rates are caught up in a review process at the Department of Insurance. A coalition of health plans, hospitals and other health care organizations have organized to defeat the measure.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan class=\"Apple-style-span\" style=\"color: #000000\">Julianne Broyles of the California Association of Health Underwriters said it could be problematic if rates aren’t finalized by the time the marketplace opens in mid November.\u003c/span>\u003c/p>\n\u003cp>\"Anything that delays open enrollment, technological or rate review, will create chaos for consumers,\" Broyles said.\u003c/p>\n\u003cp>Proponents of the measure insist fears are overblown.\u003c/p>\n\u003cp>Jamie Court of the nonprofit Consumer Watchdog, which sponsored the initiative, said the ballot measure would bring the process of regulating rates into the public eye.\u003c/p>\n\u003cp>\"The difference between rate regulation and rate negotiation is transparency. And all negotiations for Covered California over rates are done in secret,\" Court said.\u003c/p>\n\u003cp>He said if voters pass the measure, health insurance companies would have to justify their rates to the public and swear under penalty of perjury what they say is true. And he says that will be key in preventing premiums from becoming increasingly unaffordable.\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>Ahead of its \u003ca href=\"http://board.coveredca.com/meetings/2014/6-19/PDFs/Agenda%20(Open)%20-%20June%202014%20Board%20Meeting_Public.pdf\" target=\"_blank\">board meeting\u003c/a> Thursday, Covered California officials are raising questions -- literally -- about a November ballot initiative that some say could destabilize the state's health insurance marketplace.\u003c/p>\n\u003cp>If approved by voters the \u003ca href=\"http://www.sos.ca.gov/elections/ballot-measures/qualified-ballot-measures.htm\" target=\"_blank\">Insurance Rate Public Justification and Accountability Act\u003c/a> would give California's insurance commissioner the authority to reject excessive health insurance premium increases. While this idea likely sounds good to consumers, there are concerns that such authority could destabilize Covered California.\u003c/p>\n\u003cp>On Wednesday, Covered California released \u003ca href=\"http://board.coveredca.com/meetings/2014/6-19/PDFs/Insurance%20Rate%20Public%20Justification%20and%20Accountability%20Act%20-%20Operational%20Questions%20Outline.pdf\" target=\"_blank\">an outline of more than three dozen questions\u003c/a> it will analyze. Among the many unknowns: a rate challenge could mean open enrollment would start without finalized premiums.\u003c/p>\n\u003cp>In Covered California's \"\u003ca href=\"http://board.coveredca.com/meetings/2014/6-19/PDFs/Insurance%20Rate%20Public%20Justification%20and%20Accountability%20Act%20-%20Operational%20Questions%20Outline.pdf\" target=\"_blank\">Potential Operational Questions Outline\u003c/a>\" are references to the \"tightly choreographed sequence\" the agency must follow to meet the open enrollment deadline. \"Under the current timelines, there is very little flexibility in the event there are major delays\" -- delays presumably referring to challenges to rate increases.\u003c/p>\n\u003cp>Betsy Imholz is with Consumers Union in San Francisco. She noted that Consumers Union generally supports the kind of rate review proposed in the ballot initiative, but said the group has not yet taken a position on the California initiative.\u003c/p>\n\u003cp>\"The questions are fair,\" Imholz said. \"I think we all have to look at the questions and think about both the underlying policy issues and the operational issues. This is a unique situation we have here, and those questions have to be considered.\"\u003c/p>\n\u003cp>California already has a complicated regulatory health insurance environment, with two regulators governing health insurance products: the Department of Managed Health Care and the Department of Insurance.\u003c/p>\n\u003cp>In addition, the state law that governs Covered California mandates that the agency is an \"active purchaser.\" Covered California has \"statutory responsibility to negotiate with the (health) plans,\" Imholz said, \"to selectively choose the best plans and get the best rates for Californians ... and that makes analyzing (the ballot initiative) a little more complicated.\"\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"j00e1jF7KYyWzdH7BjJKFX9oTR3NYdYH\"]\u003c/p>\n\u003cp>Proponents of the initiative say concerns are overblown and that consumers would benefit if the insurance commissioner had veto power over health insurance rates. Proposition 103, passed by the voters in 1988, already gives the commissioner veto authority over auto, homeowner, property and casualty insurance. The November initiative would extend Prop. 103 to health insurance.\u003c/p>\n\u003cp>Dave Jones, California's insurance commissioner supports the initiative. When he was a state legislator, he tried more than once to pass a law giving the officeholder the authority to reject rates, and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/27/insurance-commissioner-defends-health-insurance-initiative/\" target=\"_blank\">frequently points out\u003c/a> that 35 states give their insurance commissioners the authority to reject health insurance rate hikes, but not California.\u003c/p>\n\u003cp>Jamie Court, president of Consumer Watchdog, which sponsored the initiative, said that \"other states have health insurance exchanges and other states have health insurance rate regulations.\" He insisted that \"there shouldn't be any concerns about timing,\" that rate rejection authority can work smoothly with Covered California's timeline. Rates must be approved within 60 days, he said, and that over the many years that Prop. 103 has been in effect, there have only been 10-15 hearings in \"an industry with 6,000 filings a year,\" Court said.\u003c/p>\n\u003cp>Jones has previously stated that his office gets only about \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/27/insurance-commissioner-defends-health-insurance-initiative/\" target=\"_blank\">100 health insurance rate filings \u003c/a>a year.\u003c/p>\n\u003cp>Court said he had sent a letter to Covered California offering to meet with officials and address their concerns. But \"they demurred,\" he said. \"We're looking forward to answering (the questions) because we can answer all of them.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Covered California will take public comment on the ballot initiative at its board meeting Thursday afternoon.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19598\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/187909352.jpg\">\u003cimg class=\"size-large wp-image-19598\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/187909352-640x426.jpg\" alt=\"Covered California executive director Peter Lee, seen here at a November, 2013, press conference. (Max Whittaker/Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Covered California executive director Peter Lee, seen here at a November, 2013, press conference. (Max Whittaker/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>UPDATE: June 20\u003c/strong>\u003c/p>\n\u003cp>\u003cspan class=\"Apple-style-span\" style=\"color: #000000\">KQED's April Dembosky attended the Covered California board meeting Thursday afternoon where the board expressed concern \u003cspan class=\"Apple-style-span\">that a voter initiative on the upcoming November ballot could compromise its authority. The initiative\u003c/span>\u003c/span> would give the state’s insurance commissioner the authority to reject excessive rate increases in health insurance premiums. But Covered California already negotiates rates with insurance plans. How would the initiative, if passed, affect Covered California?\u003c/p>\n\u003cp>\u003cspan class=\"Apple-style-span\" style=\"color: #000000\">Covered California board member Susan Kennedy called on agency staff to conduct an intensive analysis of the initiative’s potential impact Covered California's ability to operate -- and to get it done soon.\u003cbr>\n\u003c/span>\u003c!--more-->\u003c/p>\n\u003cp>\u003cspan class=\"Apple-style-span\" style=\"color: #000000\">\"The impact from my perspective could be, really huge, and very negative on our ability to function. We ought to raise the alarm level on this and be much more aggressive,\" Kennedy said.\u003c/span>\u003c/p>\n\u003cp>The board also questioned its ability to meet federal Obamacare deadlines and effectively market plans if rates are caught up in a review process at the Department of Insurance. A coalition of health plans, hospitals and other health care organizations have organized to defeat the measure.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan class=\"Apple-style-span\" style=\"color: #000000\">Julianne Broyles of the California Association of Health Underwriters said it could be problematic if rates aren’t finalized by the time the marketplace opens in mid November.\u003c/span>\u003c/p>\n\u003cp>\"Anything that delays open enrollment, technological or rate review, will create chaos for consumers,\" Broyles said.\u003c/p>\n\u003cp>Proponents of the measure insist fears are overblown.\u003c/p>\n\u003cp>Jamie Court of the nonprofit Consumer Watchdog, which sponsored the initiative, said the ballot measure would bring the process of regulating rates into the public eye.\u003c/p>\n\u003cp>\"The difference between rate regulation and rate negotiation is transparency. And all negotiations for Covered California over rates are done in secret,\" Court said.\u003c/p>\n\u003cp>He said if voters pass the measure, health insurance companies would have to justify their rates to the public and swear under penalty of perjury what they say is true. And he says that will be key in preventing premiums from becoming increasingly unaffordable.\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>Ahead of its \u003ca href=\"http://board.coveredca.com/meetings/2014/6-19/PDFs/Agenda%20(Open)%20-%20June%202014%20Board%20Meeting_Public.pdf\" target=\"_blank\">board meeting\u003c/a> Thursday, Covered California officials are raising questions -- literally -- about a November ballot initiative that some say could destabilize the state's health insurance marketplace.\u003c/p>\n\u003cp>If approved by voters the \u003ca href=\"http://www.sos.ca.gov/elections/ballot-measures/qualified-ballot-measures.htm\" target=\"_blank\">Insurance Rate Public Justification and Accountability Act\u003c/a> would give California's insurance commissioner the authority to reject excessive health insurance premium increases. While this idea likely sounds good to consumers, there are concerns that such authority could destabilize Covered California.\u003c/p>\n\u003cp>On Wednesday, Covered California released \u003ca href=\"http://board.coveredca.com/meetings/2014/6-19/PDFs/Insurance%20Rate%20Public%20Justification%20and%20Accountability%20Act%20-%20Operational%20Questions%20Outline.pdf\" target=\"_blank\">an outline of more than three dozen questions\u003c/a> it will analyze. Among the many unknowns: a rate challenge could mean open enrollment would start without finalized premiums.\u003c/p>\n\u003cp>In Covered California's \"\u003ca href=\"http://board.coveredca.com/meetings/2014/6-19/PDFs/Insurance%20Rate%20Public%20Justification%20and%20Accountability%20Act%20-%20Operational%20Questions%20Outline.pdf\" target=\"_blank\">Potential Operational Questions Outline\u003c/a>\" are references to the \"tightly choreographed sequence\" the agency must follow to meet the open enrollment deadline. \"Under the current timelines, there is very little flexibility in the event there are major delays\" -- delays presumably referring to challenges to rate increases.\u003c/p>\n\u003cp>Betsy Imholz is with Consumers Union in San Francisco. She noted that Consumers Union generally supports the kind of rate review proposed in the ballot initiative, but said the group has not yet taken a position on the California initiative.\u003c/p>\n\u003cp>\"The questions are fair,\" Imholz said. \"I think we all have to look at the questions and think about both the underlying policy issues and the operational issues. This is a unique situation we have here, and those questions have to be considered.\"\u003c/p>\n\u003cp>California already has a complicated regulatory health insurance environment, with two regulators governing health insurance products: the Department of Managed Health Care and the Department of Insurance.\u003c/p>\n\u003cp>In addition, the state law that governs Covered California mandates that the agency is an \"active purchaser.\" Covered California has \"statutory responsibility to negotiate with the (health) plans,\" Imholz said, \"to selectively choose the best plans and get the best rates for Californians ... and that makes analyzing (the ballot initiative) a little more complicated.\"\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"j00e1jF7KYyWzdH7BjJKFX9oTR3NYdYH\"]\u003c/p>\n\u003cp>Proponents of the initiative say concerns are overblown and that consumers would benefit if the insurance commissioner had veto power over health insurance rates. Proposition 103, passed by the voters in 1988, already gives the commissioner veto authority over auto, homeowner, property and casualty insurance. The November initiative would extend Prop. 103 to health insurance.\u003c/p>\n\u003cp>Dave Jones, California's insurance commissioner supports the initiative. When he was a state legislator, he tried more than once to pass a law giving the officeholder the authority to reject rates, and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/27/insurance-commissioner-defends-health-insurance-initiative/\" target=\"_blank\">frequently points out\u003c/a> that 35 states give their insurance commissioners the authority to reject health insurance rate hikes, but not California.\u003c/p>\n\u003cp>Jamie Court, president of Consumer Watchdog, which sponsored the initiative, said that \"other states have health insurance exchanges and other states have health insurance rate regulations.\" He insisted that \"there shouldn't be any concerns about timing,\" that rate rejection authority can work smoothly with Covered California's timeline. Rates must be approved within 60 days, he said, and that over the many years that Prop. 103 has been in effect, there have only been 10-15 hearings in \"an industry with 6,000 filings a year,\" Court said.\u003c/p>\n\u003cp>Jones has previously stated that his office gets only about \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/27/insurance-commissioner-defends-health-insurance-initiative/\" target=\"_blank\">100 health insurance rate filings \u003c/a>a year.\u003c/p>\n\u003cp>Court said he had sent a letter to Covered California offering to meet with officials and address their concerns. But \"they demurred,\" he said. \"We're looking forward to answering (the questions) because we can answer all of them.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Covered California will take public comment on the ballot initiative at its board meeting Thursday afternoon.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_19539\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/480530545-2.jpg\">\u003cimg class=\"size-large wp-image-19539\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/480530545-2-640x411.jpg\" alt=\"Customers entering a Hobby Lobby store in the San Francisco Bay Area community of Antioch. (Justin Sullivan/Getty Images).\" width=\"640\" height=\"411\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Customers entering a Hobby Lobby store in the San Francisco Bay Area community of Antioch. The owners of the company are evangelical Christians and object, on religious grounds, to providing certain types of birth control. (Justin Sullivan/Getty Images).\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Julie Rovner,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/June/13/Supreme-Court-Hobby-Lobby-contraception-birth-control.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>One of the \u003ca href=\"http://www.kaiserhealthnews.org/stories/2014/march/20/supreme-court-arguments-contraception-mandate.aspx\" target=\"_blank\">most watched issues\u003c/a> before the Supreme Court this term may turn on the question of religious freedom. But it will also likely determine how women will be able to access a key provision of the Affordable Care Act – one seeking to guarantee no-cost prescription contraception in most health insurance plans.\u003c/p>\n\u003cp>The justices' ruling on \u003ca href=\"http://www.scotusblog.com/case-files/cases/sebelius-v-hobby-lobby-stores-inc/\" target=\"_blank\">Sebelius v. Hobby Lobby Stores\u003c/a> and \u003ca href=\"http://www.scotusblog.com/case-files/cases/conestoga-wood-specialties-corp-v-sebelius/\" target=\"_blank\">Conestoga Wood Specialties Corp v. Sebelius\u003c/a>, two cases that are being considered together, is expected by the end of this month. The court will decide whether those companies, and potentially all other for-profit companies, must abide by the so-called contraceptive mandate. It's a complicated legal thicket, so here is some background.\u003c/p>\n\u003cp>\u003cstrong>1. What is the contraceptive mandate?\u003c/strong>\u003c/p>\n\u003cp>The health law requires that most insurance plans provide preventive care services without out-of-pocket expense to beneficiaries. The Obama administration included all contraceptives approved by the Food and Drug Administration as part of a package of \u003ca href=\"http://www.hrsa.gov/womensguidelines/\" target=\"_blank\">preventive services for women\u003c/a>.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Interestingly, for many plans,\u003ca href=\"http://www.npr.org/blogs/health/2012/02/10/146662285/rules-requiring-contraceptive-coverage-have-been-in-force-for-years\" target=\"_blank\"> this wasn't new\u003c/a>. The Equal Employment Opportunity Commission ruled in 2000 that failure of employer health insurance plans to cover contraceptives was a violation of the 1978 Pregnancy Discrimination Act. But the new mandate extends that coverage to all plans, including those in the individual and small group markets, and it requires that the plans offer a specific array of contraceptive options for no cost.\u003c/p>\n\u003cp>More than half the states have their own \"\u003ca href=\"http://www.nwlc.org/resource/contraceptive-equity-laws-your-state-know-your-rights-use-your-rights-consumer-guide-0\" target=\"_blank\">contraceptive equity\u003c/a>\" laws on the books, many of which include religious exemptions that are similar to ones included in the federal regulation.\u003c/p>\n\u003cp>\u003cstrong>2. Who must comply with the mandate?\u003c/strong>\u003c/p>\n\u003cp>Most plans are covered by the mandate, but the federal regulation includes several exceptions. Churches and other strictly religious employers, who primarily employ those of the same faith and whose primary purpose is religious, are exempt from the requirement.\u003c/p>\n\u003cp>Nonprofit, religiously affiliated organizations, such as hospitals and universities, have a \u003ca href=\"http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/womens-preven-02012013.html\" target=\"_blank\">separate set\u003c/a> of rules. They do not have to provide the contraceptives directly, but must make them available to employees through a third party. Catholic Church officials as well as some others have objected to this requirement. There are at least \u003ca href=\"http://www.nwlc.org/status-lawsuits-challenging-affordable-care-acts-birth-control-coverage-benefit\" target=\"_blank\">three dozen court cases\u003c/a> challenging those rules still pending, according to the National Women's Law Center.\u003c/p>\n\u003cp>For-profit companies, however, including the plaintiffs in the cases before the Supreme Court now, aren't exempt.\u003c/p>\n\u003cp>\u003cstrong>3. The owners of Hobby Lobby and Conestoga Wood are not Catholic and say they have no problem offering birth control. So what is their challenge to the mandate?\u003c/strong>\u003c/p>\n\u003cp>Most forms of artificial contraception are contrary to Catholic teaching. But the Green family, which owns the nationwide craft chain Hobby Lobby, are evangelical Christians. And the Hahn family that owns Pennsylvania cabinet-maker Conestoga Wood Specialties are Mennonites. Both families already offer most forms of birth control as part of their health plans.\u003c/p>\n\u003cp>The owners say they are opposed to some forms of birth control — particularly emergency contraceptives \u003ca href=\"http://ec.princeton.edu/pills/plan-b.html\" target=\"_blank\">Plan B\u003c/a> and \u003ca href=\"http://ec.princeton.edu/pills/ella.html\" target=\"_blank\">Ella\u003c/a>, which can be used to prevent pregnancy if taken within 24 hours to as much as five days after unprotected sex — because these contraceptives prevent a fertilized egg from implanting in a woman's uterus. That, they say, is tantamount to a very early abortion, which violates their religion, they argue. The Greens – but not the Hahns – also object to two types of intrauterine devices for the same reasons.\u003c/p>\n\u003cp>\"These abortion-causing pills go against our faith, and our family is now being forced to choose between following the laws of the land that we love or maintaining the religious beliefs that have made our business successful and supported our family and thousands of our employees and their families,\" Hobby Lobby founder David Green told reporters on a conference call when the lawsuit was originally filed.\u003c/p>\n\u003cp>\u003cstrong>4. Do those drugs and devices actually cause abortions?\u003c/strong>\u003c/p>\n\u003cp>Not according to the vast majority of medical and scientific opinion.\u003c/p>\n\u003cp>\"Federal law and State law – which do preclude funding for abortions – don't consider these particular forms of contraception to be abortion,\" said U.S. Solicitor General Donald Verilli during the oral arguments in the case on behalf of the Obama administration. \"We've got about 2 million women who rely on the IUD as a method of birth control in this country. I don't think they are engaged in abortion in doing that.\"\u003c/p>\n\u003cp>\u003ca href=\"http://sblog.s3.amazonaws.com/wp-content/uploads/2013/10/13-354-BRIEF-OF-AMICI-CURIAE-PHYSICIANS-FOR-REPRODUCTIVE-HEALTH-et-al....pdf\" target=\"_blank\">The brief\u003c/a> filed by 10 medical groups led by the American College of Obstetricians and Gynecologists noted that \"there is a scientific distinction between a contraceptive and an abortifacient and the scientific record demonstrates that none of the FDA-approved contraceptives covered by the Mandate are abortifacients.\"\u003c/p>\n\u003cp>That's because the standard medical definition of the \u003ca href=\"http://www.kaiserhealthnews.org/stories/2011/june/01/npr-abortion-legislation.aspx\" target=\"_blank\">start of pregnancy\u003c/a> is when a fertilized egg implants in a woman's uterus, not when sperm and egg first unite.\u003c/p>\n\u003cp>But while blocking implantation of a fertilized egg does not fit the medical definition of pregnancy, it does qualify as ending a life for many religious people.\u003c/p>\n\u003cp>\"As far as the science goes, the FDA has said these four drugs and devices can terminate a human embryo,\" said Lori Windham, senior counsel for the Becket Fund for Religious Liberty, which has been representing Hobby Lobby. She noted that the labels for the emergency contraceptives and IUDs say they can prevent implantation.\u003c/p>\n\u003cp>In the case of one and perhaps both of the emergency contraceptive pills, however, new research suggests they may not work that way at all – they much more likely \u003ca href=\"http://www.nytimes.com/2012/06/06/health/research/morning-after-pills-dont-block-implantation-science-suggests.html?pagewanted=all&_r=0\" target=\"_blank\">simply prevent the fertilization of the egg\u003c/a> in the first place.\u003c/p>\n\u003cp>\u003cstrong>5. Does whether these products cause abortion matter for purposes of this case?\u003c/strong>\u003c/p>\n\u003cp>Probably not. At the heart of the case is what the company owners believe, and no one doubts the sincerity of their views. At issue is whether the owners can exercise those religious objections via their corporations under a 1993 law called the \u003ca href=\"http://www.scotusblog.com/2014/02/symposium-why-is-rfra-still-valid-against-the-federal-government/\" target=\"_blank\">Religious Freedom Restoration Act\u003c/a> (RFRA). It says the government may not impose a \"substantial burden\" on the free exercise of religion unless that burden is the narrowest possible way to further a compelling governmental interest.\u003c/p>\n\u003cp>The federal government and advocates for the mandate say that corporations cannot exercise religious rights, only individuals may.\u003c/p>\n\u003cp>The \u003ca href=\"http://sblog.s3.amazonaws.com/wp-content/uploads/2014/01/01.12.14_brief_for_petitioners_doj.pdf\" target=\"_blank\">government's brief\u003c/a> in the case said Hobby Lobby and a subsidiary Christian book store, \"for-profit corporations conducting commercial enterprises, are not persons exercising religion within the meaning of RFRA.\"\u003c/p>\n\u003cp>\u003cstrong>6. What would happen if the court extended religious standing to for-profit corporations?\u003c/strong>\u003c/p>\n\u003cp>Lots of bad things, say those who are siding with the government in the case.\u003c/p>\n\u003cp>For example, said Barry Lynn, executive director of Americans United for Separation of Church and State, in health care alone, \"Scientology-believing employers could insist upon non-coverage of its nemesis, psychiatry. And Jehovah's' Witness corporations could demand exclusion of surgical coverage, under the theory that so many of such procedures require the use of whole blood products, forbidden by their faith.\"\u003c/p>\n\u003cp>The potential for using religion to escape the reach of federal law doesn't end with health, said Lynn. Corporations could also claim that they don't need to abide by equal pay laws \"because of male dominance in their scriptural social order,\" he said, or, for those who offer public accommodations, \"you can hear them say we don't believe marriage equality is biblical, so you, (gay and lesbian) travelers, cannot stay in our hotel or eat in our restaurant.\"\u003c/p>\n\u003cp>Windham of the Becket Fund finds all those scenarios far-fetched. \"We've had this law on the books for 25 years and none of those cases have happened,\" she said.\u003c/p>\n\u003cp>During the \u003ca href=\"http://www.supremecourt.gov/oral_arguments/argument_transcripts/13-354_5436.pdf\" target=\"_blank\">arguments before the Supreme Court\u003c/a>, Justice Samuel Alito said much the same thing. \"In all the years RFRA has been on the books,\" he asked, \"has any of these claims involving minimum wage, for example, been brought and have they succeeded?\"\u003c/p>\n\u003cp>\"Very few of these claims have been brought,\" responded Paul Clement, the attorney who argued Hobby Lobby's case at the high court.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Justice Elena Kagan, however, said if the court upholds Hobby Lobby's claim, that might change. \"[T]hen you would see religious objectors come out of the woodwork with respect to these laws,\" she said.\u003c/p>\n\n",
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"excerpt": "The court will issue a decision this month that will determine the implementation of the Affordable Care Act's guarantee of no-cost prescription contraception.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19539\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/480530545-2.jpg\">\u003cimg class=\"size-large wp-image-19539\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/480530545-2-640x411.jpg\" alt=\"Customers entering a Hobby Lobby store in the San Francisco Bay Area community of Antioch. (Justin Sullivan/Getty Images).\" width=\"640\" height=\"411\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Customers entering a Hobby Lobby store in the San Francisco Bay Area community of Antioch. The owners of the company are evangelical Christians and object, on religious grounds, to providing certain types of birth control. (Justin Sullivan/Getty Images).\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Julie Rovner,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/June/13/Supreme-Court-Hobby-Lobby-contraception-birth-control.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>One of the \u003ca href=\"http://www.kaiserhealthnews.org/stories/2014/march/20/supreme-court-arguments-contraception-mandate.aspx\" target=\"_blank\">most watched issues\u003c/a> before the Supreme Court this term may turn on the question of religious freedom. But it will also likely determine how women will be able to access a key provision of the Affordable Care Act – one seeking to guarantee no-cost prescription contraception in most health insurance plans.\u003c/p>\n\u003cp>The justices' ruling on \u003ca href=\"http://www.scotusblog.com/case-files/cases/sebelius-v-hobby-lobby-stores-inc/\" target=\"_blank\">Sebelius v. Hobby Lobby Stores\u003c/a> and \u003ca href=\"http://www.scotusblog.com/case-files/cases/conestoga-wood-specialties-corp-v-sebelius/\" target=\"_blank\">Conestoga Wood Specialties Corp v. Sebelius\u003c/a>, two cases that are being considered together, is expected by the end of this month. The court will decide whether those companies, and potentially all other for-profit companies, must abide by the so-called contraceptive mandate. It's a complicated legal thicket, so here is some background.\u003c/p>\n\u003cp>\u003cstrong>1. What is the contraceptive mandate?\u003c/strong>\u003c/p>\n\u003cp>The health law requires that most insurance plans provide preventive care services without out-of-pocket expense to beneficiaries. The Obama administration included all contraceptives approved by the Food and Drug Administration as part of a package of \u003ca href=\"http://www.hrsa.gov/womensguidelines/\" target=\"_blank\">preventive services for women\u003c/a>.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Interestingly, for many plans,\u003ca href=\"http://www.npr.org/blogs/health/2012/02/10/146662285/rules-requiring-contraceptive-coverage-have-been-in-force-for-years\" target=\"_blank\"> this wasn't new\u003c/a>. The Equal Employment Opportunity Commission ruled in 2000 that failure of employer health insurance plans to cover contraceptives was a violation of the 1978 Pregnancy Discrimination Act. But the new mandate extends that coverage to all plans, including those in the individual and small group markets, and it requires that the plans offer a specific array of contraceptive options for no cost.\u003c/p>\n\u003cp>More than half the states have their own \"\u003ca href=\"http://www.nwlc.org/resource/contraceptive-equity-laws-your-state-know-your-rights-use-your-rights-consumer-guide-0\" target=\"_blank\">contraceptive equity\u003c/a>\" laws on the books, many of which include religious exemptions that are similar to ones included in the federal regulation.\u003c/p>\n\u003cp>\u003cstrong>2. Who must comply with the mandate?\u003c/strong>\u003c/p>\n\u003cp>Most plans are covered by the mandate, but the federal regulation includes several exceptions. Churches and other strictly religious employers, who primarily employ those of the same faith and whose primary purpose is religious, are exempt from the requirement.\u003c/p>\n\u003cp>Nonprofit, religiously affiliated organizations, such as hospitals and universities, have a \u003ca href=\"http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/womens-preven-02012013.html\" target=\"_blank\">separate set\u003c/a> of rules. They do not have to provide the contraceptives directly, but must make them available to employees through a third party. Catholic Church officials as well as some others have objected to this requirement. There are at least \u003ca href=\"http://www.nwlc.org/status-lawsuits-challenging-affordable-care-acts-birth-control-coverage-benefit\" target=\"_blank\">three dozen court cases\u003c/a> challenging those rules still pending, according to the National Women's Law Center.\u003c/p>\n\u003cp>For-profit companies, however, including the plaintiffs in the cases before the Supreme Court now, aren't exempt.\u003c/p>\n\u003cp>\u003cstrong>3. The owners of Hobby Lobby and Conestoga Wood are not Catholic and say they have no problem offering birth control. So what is their challenge to the mandate?\u003c/strong>\u003c/p>\n\u003cp>Most forms of artificial contraception are contrary to Catholic teaching. But the Green family, which owns the nationwide craft chain Hobby Lobby, are evangelical Christians. And the Hahn family that owns Pennsylvania cabinet-maker Conestoga Wood Specialties are Mennonites. Both families already offer most forms of birth control as part of their health plans.\u003c/p>\n\u003cp>The owners say they are opposed to some forms of birth control — particularly emergency contraceptives \u003ca href=\"http://ec.princeton.edu/pills/plan-b.html\" target=\"_blank\">Plan B\u003c/a> and \u003ca href=\"http://ec.princeton.edu/pills/ella.html\" target=\"_blank\">Ella\u003c/a>, which can be used to prevent pregnancy if taken within 24 hours to as much as five days after unprotected sex — because these contraceptives prevent a fertilized egg from implanting in a woman's uterus. That, they say, is tantamount to a very early abortion, which violates their religion, they argue. The Greens – but not the Hahns – also object to two types of intrauterine devices for the same reasons.\u003c/p>\n\u003cp>\"These abortion-causing pills go against our faith, and our family is now being forced to choose between following the laws of the land that we love or maintaining the religious beliefs that have made our business successful and supported our family and thousands of our employees and their families,\" Hobby Lobby founder David Green told reporters on a conference call when the lawsuit was originally filed.\u003c/p>\n\u003cp>\u003cstrong>4. Do those drugs and devices actually cause abortions?\u003c/strong>\u003c/p>\n\u003cp>Not according to the vast majority of medical and scientific opinion.\u003c/p>\n\u003cp>\"Federal law and State law – which do preclude funding for abortions – don't consider these particular forms of contraception to be abortion,\" said U.S. Solicitor General Donald Verilli during the oral arguments in the case on behalf of the Obama administration. \"We've got about 2 million women who rely on the IUD as a method of birth control in this country. I don't think they are engaged in abortion in doing that.\"\u003c/p>\n\u003cp>\u003ca href=\"http://sblog.s3.amazonaws.com/wp-content/uploads/2013/10/13-354-BRIEF-OF-AMICI-CURIAE-PHYSICIANS-FOR-REPRODUCTIVE-HEALTH-et-al....pdf\" target=\"_blank\">The brief\u003c/a> filed by 10 medical groups led by the American College of Obstetricians and Gynecologists noted that \"there is a scientific distinction between a contraceptive and an abortifacient and the scientific record demonstrates that none of the FDA-approved contraceptives covered by the Mandate are abortifacients.\"\u003c/p>\n\u003cp>That's because the standard medical definition of the \u003ca href=\"http://www.kaiserhealthnews.org/stories/2011/june/01/npr-abortion-legislation.aspx\" target=\"_blank\">start of pregnancy\u003c/a> is when a fertilized egg implants in a woman's uterus, not when sperm and egg first unite.\u003c/p>\n\u003cp>But while blocking implantation of a fertilized egg does not fit the medical definition of pregnancy, it does qualify as ending a life for many religious people.\u003c/p>\n\u003cp>\"As far as the science goes, the FDA has said these four drugs and devices can terminate a human embryo,\" said Lori Windham, senior counsel for the Becket Fund for Religious Liberty, which has been representing Hobby Lobby. She noted that the labels for the emergency contraceptives and IUDs say they can prevent implantation.\u003c/p>\n\u003cp>In the case of one and perhaps both of the emergency contraceptive pills, however, new research suggests they may not work that way at all – they much more likely \u003ca href=\"http://www.nytimes.com/2012/06/06/health/research/morning-after-pills-dont-block-implantation-science-suggests.html?pagewanted=all&_r=0\" target=\"_blank\">simply prevent the fertilization of the egg\u003c/a> in the first place.\u003c/p>\n\u003cp>\u003cstrong>5. Does whether these products cause abortion matter for purposes of this case?\u003c/strong>\u003c/p>\n\u003cp>Probably not. At the heart of the case is what the company owners believe, and no one doubts the sincerity of their views. At issue is whether the owners can exercise those religious objections via their corporations under a 1993 law called the \u003ca href=\"http://www.scotusblog.com/2014/02/symposium-why-is-rfra-still-valid-against-the-federal-government/\" target=\"_blank\">Religious Freedom Restoration Act\u003c/a> (RFRA). It says the government may not impose a \"substantial burden\" on the free exercise of religion unless that burden is the narrowest possible way to further a compelling governmental interest.\u003c/p>\n\u003cp>The federal government and advocates for the mandate say that corporations cannot exercise religious rights, only individuals may.\u003c/p>\n\u003cp>The \u003ca href=\"http://sblog.s3.amazonaws.com/wp-content/uploads/2014/01/01.12.14_brief_for_petitioners_doj.pdf\" target=\"_blank\">government's brief\u003c/a> in the case said Hobby Lobby and a subsidiary Christian book store, \"for-profit corporations conducting commercial enterprises, are not persons exercising religion within the meaning of RFRA.\"\u003c/p>\n\u003cp>\u003cstrong>6. What would happen if the court extended religious standing to for-profit corporations?\u003c/strong>\u003c/p>\n\u003cp>Lots of bad things, say those who are siding with the government in the case.\u003c/p>\n\u003cp>For example, said Barry Lynn, executive director of Americans United for Separation of Church and State, in health care alone, \"Scientology-believing employers could insist upon non-coverage of its nemesis, psychiatry. And Jehovah's' Witness corporations could demand exclusion of surgical coverage, under the theory that so many of such procedures require the use of whole blood products, forbidden by their faith.\"\u003c/p>\n\u003cp>The potential for using religion to escape the reach of federal law doesn't end with health, said Lynn. Corporations could also claim that they don't need to abide by equal pay laws \"because of male dominance in their scriptural social order,\" he said, or, for those who offer public accommodations, \"you can hear them say we don't believe marriage equality is biblical, so you, (gay and lesbian) travelers, cannot stay in our hotel or eat in our restaurant.\"\u003c/p>\n\u003cp>Windham of the Becket Fund finds all those scenarios far-fetched. \"We've had this law on the books for 25 years and none of those cases have happened,\" she said.\u003c/p>\n\u003cp>During the \u003ca href=\"http://www.supremecourt.gov/oral_arguments/argument_transcripts/13-354_5436.pdf\" target=\"_blank\">arguments before the Supreme Court\u003c/a>, Justice Samuel Alito said much the same thing. \"In all the years RFRA has been on the books,\" he asked, \"has any of these claims involving minimum wage, for example, been brought and have they succeeded?\"\u003c/p>\n\u003cp>\"Very few of these claims have been brought,\" responded Paul Clement, the attorney who argued Hobby Lobby's case at the high court.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Justice Elena Kagan, however, said if the court upholds Hobby Lobby's claim, that might change. \"[T]hen you would see religious objectors come out of the woodwork with respect to these laws,\" she said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_19442\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/P1040047.jpg\">\u003cimg class=\"size-large wp-image-19442\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/P1040047-640x480.jpg\" alt=\"Morgan Smith, a registered nurse with the Redwood Empire Food Bank Diabetes Wellness Project, conducts free diabetes screenings once a month at the Graton Day Labor Center. The center serves as a conduit between its members -- many of whom are undocumented -- and health organizations around the region. (Lisa Morehouse/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Morgan Smith, a registered nurse with the Redwood Empire Food Bank Diabetes Wellness Project, conducts free diabetes screenings once a month at the Graton Day Labor Center. The center serves as a conduit between its members -- many of whom are undocumented -- and health organizations around the region. (Lisa Morehouse/KQED) \u003ccite>( Lisa Morehouse/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Lisa Morehouse\u003c/strong>\u003c/p>\n\u003cp>California may lead the nation in numbers of people signed up for health insurance under the Affordable Care Act, but there are still millions in the state without health insurance.\u003c/p>\n\u003caside class=\"pullquote alignleft\">'That leaves a lot of low-wage workers without any health care coverage.' \u003c/aside>\n\u003cp>Some of the people most likely to remain uninsured are undocumented Californians. While they can buy health insurance with their own money, they are specifically excluded from receiving any benefits under the ACA. Community groups and non-profits in cities and towns across California work to fill in the gaps.\u003c/p>\n\u003cp>One of them is Graton, a small town in Sonoma County, about 20 miles west of Santa Rosa.\u003c/p>\n\u003cp>When I arrive at the Graton Day Labor Center a woman named Maria is standing behind a table filled with containers of homemade food. There’s oatmeal -- with no added sugar, she tells me -- tortillas and salsa, fish for tacos, and salad.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Maria (because of her immigration status, we are not using her last name) is selling the food to laborers heading out to work for the day in agriculture, construction and hospitality. They’re all members of the Day Labor Center which connects its members with employers and also does training and advocacy work. Maria makes nutritious food to try to keep her customers healthy. She clearly cares about good health, but she does not have health insurance.\u003c/p>\n\u003cp>Speaking in Spanish, she first jokes, “I don’t have insurance because I don’t get sick!”\u003c/p>\n\u003cp>Then she explains the real reason. “It’s because they won’t accept me because I don’t have social security,” she says in reference to a Social Security number.\u003c/p>\n\u003cp>Maria is undocumented, so she can’t qualify for expanded Medi-Cal or sign up for Covered California.\u003c/p>\n\u003cp>“This new Obamacare hasn’t helped my situation at all,” she says.\u003c/p>\n\u003cp>When I ask what would happen if she got really sick, she laughs and holds up a little plastic container. “I’d pass a box around because I couldn’t afford it.”\u003c/p>\n\u003cp>She’s not alone. Up to a million undocumented immigrants in California are expected to remain uninsured after the ACA is fully implementation in 2019.\u003c/p>\n\u003cp>“That leaves a lot of low-wage workers without any health care coverage,\" says Jesus Guzman, an organizer with the Graton Day Labor Center. \"That leaves a population very much vulnerable.”\u003c/p>\n\u003cp>Earlier this year, State Senator Ricardo Lara proposed \u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_1001-1050/sb_1005_bill_20140213_introduced.pdf\" target=\"_blank\">a bill \u003c/a>which would give undocumented Californians access to expanded Medi-Cal and a dedicated insurance exchange with subsidies available, funded by the state. But the bill is currently \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2014/5/soda-warning-bill-passes-committee-plan-to-insure-undocumented-does-not\" target=\"_blank\">on hold\u003c/a> in the Senate appropriations committee. Lara’s staff says they’ll be back with another proposal next year. Given that, Guzman says preventive care makes the most sense for the uninsured undocumented immigrants. Access to services and resources can be a challenge.\u003c/p>\n\u003cp>“What we can do here is serve as a conduit between some of those (health) organizations and the folks that need them.”\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/153576790&color=ff5500&auto_play=false&hide_related=false&show_artwork=true&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>Graton Day Labor partners with community health centers and hosts a physician’s assistant once a week. They offer trainings in heart healthy practices, and provide job skill and safety education.\u003c/p>\n\u003cp>Because diabetes is a huge problem among Latinos, nutrition is another big push. Once a month, the Redwood Empire Food Bank drops off produce at the Graton Day Labor Center. Out of the back of a van, Morgan Smith unloads boxes heavy with lettuce, cabbage, cauliflower, oranges, apples, and sweet potatoes. He also brings special boxes for diabetics.\u003c/p>\n\u003cp>“This month the box has things like brown rice, dried black beans, high fiber cereal, canned tuna and canned chicken,” Smith says. “Healthy carbos, healthy fats, healthy proteins, about 25 pounds of shelf-stable food, which will hopefully help someone get through the month.”\u003c/p>\n\u003cp>Smith is also a registered nurse. He and a colleague set up tables in the center's parking lot. They give free diabetes screenings and share prevention information. Maria and her sisters get in line, and confer about their family health history. Maria holds out her finger for a blood sugar test.\u003c/p>\n\u003cp>Smith tells Maria her results are normal, and then lets her know about two clinics near where she lives if she has any health needs.\u003c/p>\n\u003cp>Inside the center, Maria’s sister, Flor, joins other members collecting produce. Like her sister, Flor is undocumented and uninsured. She says that if she got insurance tomorrow, she’d go to the doctor and get check-ups for the whole family. She knows well that preventive care only goes so far.\u003c/p>\n\u003cp>“A while back my husband was injured in an accident at work,” she explains. “And a bill came, oh my! He had only cut the tip of his finger off, and it cost $10,000.”\u003c/p>\n\u003cp>Flor says that eventually her husband’s employer paid the bill, but only because her husband had worked for him for so long. Otherwise, she says, she doesn’t know what they would have done.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Lisa Morehouse reported this story for the 2014 California Endowment Health Journalism Fellowship, a program of USC's Annenberg School for Journalism and Communication.\u003c/em>\u003c/p>\n\n",
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"excerpt": "How undocumented immigrants manage health care since they are excluded from the ACA: not easily. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19442\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/P1040047.jpg\">\u003cimg class=\"size-large wp-image-19442\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/P1040047-640x480.jpg\" alt=\"Morgan Smith, a registered nurse with the Redwood Empire Food Bank Diabetes Wellness Project, conducts free diabetes screenings once a month at the Graton Day Labor Center. The center serves as a conduit between its members -- many of whom are undocumented -- and health organizations around the region. (Lisa Morehouse/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Morgan Smith, a registered nurse with the Redwood Empire Food Bank Diabetes Wellness Project, conducts free diabetes screenings once a month at the Graton Day Labor Center. The center serves as a conduit between its members -- many of whom are undocumented -- and health organizations around the region. (Lisa Morehouse/KQED) \u003ccite>( Lisa Morehouse/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Lisa Morehouse\u003c/strong>\u003c/p>\n\u003cp>California may lead the nation in numbers of people signed up for health insurance under the Affordable Care Act, but there are still millions in the state without health insurance.\u003c/p>\n\u003caside class=\"pullquote alignleft\">'That leaves a lot of low-wage workers without any health care coverage.' \u003c/aside>\n\u003cp>Some of the people most likely to remain uninsured are undocumented Californians. While they can buy health insurance with their own money, they are specifically excluded from receiving any benefits under the ACA. Community groups and non-profits in cities and towns across California work to fill in the gaps.\u003c/p>\n\u003cp>One of them is Graton, a small town in Sonoma County, about 20 miles west of Santa Rosa.\u003c/p>\n\u003cp>When I arrive at the Graton Day Labor Center a woman named Maria is standing behind a table filled with containers of homemade food. There’s oatmeal -- with no added sugar, she tells me -- tortillas and salsa, fish for tacos, and salad.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Maria (because of her immigration status, we are not using her last name) is selling the food to laborers heading out to work for the day in agriculture, construction and hospitality. They’re all members of the Day Labor Center which connects its members with employers and also does training and advocacy work. Maria makes nutritious food to try to keep her customers healthy. She clearly cares about good health, but she does not have health insurance.\u003c/p>\n\u003cp>Speaking in Spanish, she first jokes, “I don’t have insurance because I don’t get sick!”\u003c/p>\n\u003cp>Then she explains the real reason. “It’s because they won’t accept me because I don’t have social security,” she says in reference to a Social Security number.\u003c/p>\n\u003cp>Maria is undocumented, so she can’t qualify for expanded Medi-Cal or sign up for Covered California.\u003c/p>\n\u003cp>“This new Obamacare hasn’t helped my situation at all,” she says.\u003c/p>\n\u003cp>When I ask what would happen if she got really sick, she laughs and holds up a little plastic container. “I’d pass a box around because I couldn’t afford it.”\u003c/p>\n\u003cp>She’s not alone. Up to a million undocumented immigrants in California are expected to remain uninsured after the ACA is fully implementation in 2019.\u003c/p>\n\u003cp>“That leaves a lot of low-wage workers without any health care coverage,\" says Jesus Guzman, an organizer with the Graton Day Labor Center. \"That leaves a population very much vulnerable.”\u003c/p>\n\u003cp>Earlier this year, State Senator Ricardo Lara proposed \u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_1001-1050/sb_1005_bill_20140213_introduced.pdf\" target=\"_blank\">a bill \u003c/a>which would give undocumented Californians access to expanded Medi-Cal and a dedicated insurance exchange with subsidies available, funded by the state. But the bill is currently \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2014/5/soda-warning-bill-passes-committee-plan-to-insure-undocumented-does-not\" target=\"_blank\">on hold\u003c/a> in the Senate appropriations committee. Lara’s staff says they’ll be back with another proposal next year. Given that, Guzman says preventive care makes the most sense for the uninsured undocumented immigrants. Access to services and resources can be a challenge.\u003c/p>\n\u003cp>“What we can do here is serve as a conduit between some of those (health) organizations and the folks that need them.”\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/153576790&color=ff5500&auto_play=false&hide_related=false&show_artwork=true&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>Graton Day Labor partners with community health centers and hosts a physician’s assistant once a week. They offer trainings in heart healthy practices, and provide job skill and safety education.\u003c/p>\n\u003cp>Because diabetes is a huge problem among Latinos, nutrition is another big push. Once a month, the Redwood Empire Food Bank drops off produce at the Graton Day Labor Center. Out of the back of a van, Morgan Smith unloads boxes heavy with lettuce, cabbage, cauliflower, oranges, apples, and sweet potatoes. He also brings special boxes for diabetics.\u003c/p>\n\u003cp>“This month the box has things like brown rice, dried black beans, high fiber cereal, canned tuna and canned chicken,” Smith says. “Healthy carbos, healthy fats, healthy proteins, about 25 pounds of shelf-stable food, which will hopefully help someone get through the month.”\u003c/p>\n\u003cp>Smith is also a registered nurse. He and a colleague set up tables in the center's parking lot. They give free diabetes screenings and share prevention information. Maria and her sisters get in line, and confer about their family health history. Maria holds out her finger for a blood sugar test.\u003c/p>\n\u003cp>Smith tells Maria her results are normal, and then lets her know about two clinics near where she lives if she has any health needs.\u003c/p>\n\u003cp>Inside the center, Maria’s sister, Flor, joins other members collecting produce. Like her sister, Flor is undocumented and uninsured. She says that if she got insurance tomorrow, she’d go to the doctor and get check-ups for the whole family. She knows well that preventive care only goes so far.\u003c/p>\n\u003cp>“A while back my husband was injured in an accident at work,” she explains. “And a bill came, oh my! He had only cut the tip of his finger off, and it cost $10,000.”\u003c/p>\n\u003cp>Flor says that eventually her husband’s employer paid the bill, but only because her husband had worked for him for so long. Otherwise, she says, she doesn’t know what they would have done.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Lisa Morehouse reported this story for the 2014 California Endowment Health Journalism Fellowship, a program of USC's Annenberg School for Journalism and Communication.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Health Secretary on 'Disruptive Innovation' of the ACA",
"title": "California Health Secretary on 'Disruptive Innovation' of the ACA",
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"content": "\u003cfigure id=\"attachment_19378\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/494322659.jpg\">\u003cimg class=\"size-large wp-image-19378\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/494322659-640x433.jpg\" alt=\"Diana Dooley (right), Secretary of California's Health and Human Services Agency, talks with KQED's Lisa Aliferis about the Affordable Care Act at a New York Times conference at UCSF. (Michael Loccisano/Getty Images for New York Times)\" width=\"640\" height=\"433\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Diana Dooley (right), Secretary of California's Health and Human Services Agency, talks with KQED's Lisa Aliferis about the Affordable Care Act at a New York Times conference at UCSF. (Michael Loccisano/Getty Images for New York Times)\u003c/figcaption>\u003c/figure>\n\u003cp>Diana Dooley is head of California's Department of Health and Human Services and — in that role — also serves as chair of the Covered California board.\u003c/p>\n\u003cp>So when the New York Times came to town last week and held its \u003ca href=\"http://www.nytimes.com/marketing/conferences/health_for_tomorrow/2014/agenda.html\" target=\"_blank\">Health for Tomorrow\u003c/a> conference at UCSF, organizers invited me to interview Dooley about how the Affordable Care Act is rolling out in California.\u003c/p>\n\u003cp>Yes, sign-ups during the first open enrollment \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/04/17/final-obamacare-open-enrollment-more-than-3-3-million-californians-signed-up/\" target=\"_blank\">were strong,\u003c/a> but in no way was Dooley claiming victory. She joked that grading is happening on a curve. \"We're not absolutely good; we're relatively good,\" she said.\u003c/p>\n\u003cp>Four times during our 30-minute talk, Dooley spoke of the \"jury being out\" on whether the ACA will ultimately be a success. She referred to coverage expansion being just one leg of the ACA's three-legged stool. The other legs include payment and delivery reform, as well as prevention and wellness.\u003c!--more-->\u003c/p>\n\u003cp>\u003ciframe src=\"http://new.livestream.com/accounts/8401498/events/2985705/videos/52319389/player?autoPlay=false&height=360&mute=false&width=640\" width=\"640\" height=\"360\" frameborder=\"0\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Together the changes required in those three areas have brought about \"disruptive innovation,\" she argued.\u003c/p>\n\u003cblockquote>\u003cp>We have really disrupted the system in ways that we can't completely predict what the result is going to be. I'm reminded of a quote from Albert Einstein … [he said] after the atomic bomb, 'Everything changed, save our way of thinking.' Sometimes I think about that and where we are with the Affordable Care Act: Everything has changed, save our way of thinking.'\u003c/p>\u003c/blockquote>\n\u003cp>The system has changed for everyone, Dooley said, for providers, for health plans and for consumers. \"People are complaining that they're being forced to change,\" she said. \"They want to keep what they have, but then they complain that they don't like what they have either.\"\u003c/p>\n\u003cp>A major criticism of Covered California has come from people \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/02/11/youre-enrolled-in-an-obamacare-plan-will-your-doctor-accept-your-insurance/\" target=\"_blank\">finding it hard to find a doctor\u003c/a> who accepted their insurance. Dooley said Covered California was paying attention to the adequacy of provider networks and had worked with plans on this question:\u003c/p>\n\u003cblockquote>\u003cp>We've already seen in the last two months, with the plans expanding their networks, where we've shown that they didn't have enough physicians or there wasn't enough choice. Some of the providers themselves, the hospitals and the doctors, are coming back to the plans and now negotiating to get back in. They're seeing the success; they're seeing how many new lives (are) covered, how many new patients they can get. ... It's going to take us a couple years at least to settle into a different relationship between the doctors, the plans, the hospitals and the referral systems for care.\u003c/p>\u003c/blockquote>\n\u003cp>Dooley spoke with enthusiasm about California being one of just a handful of states participating in an ACA pilot program to coordinate the care of \"dual eligibles,\" vulnerable seniors and disabled people eligible for both Medi-Cal and Medicare. This population often has the most fragmented care.\u003c/p>\n\u003cblockquote>\u003cp>So we're working in a pilot to begin to bring that together. We've got in the provider community people who treat Medi-Cal patients and people who treat Medicare patients, and they don’t talk to each other. … We will have to push the system to create this integration and the coordination of care. … We learned a lot during the '90s with the managed care effort, but we put all this responsibility then with the insurance plans, and there was a very bad reaction to that where people just thought the management of care was the denial of care.\u003c/p>\u003c/blockquote>\n\u003cp>People view health insurance differently from other kinds of insurance, Dooley said.\u003c/p>\n\u003cblockquote>\u003cp>People don't think of health insurance like they do other indemnity products. You don't hope your house burns down to take advantage of your homeowners insurance. You don't hope you get in a wreck to take care of your auto insurance. But you expect to use your health care insurance. It's partly indemnification and it's partly prepaid plan, so we have a different relationship with our health insurance and our health delivery, and there are opportunities within (the ACA) to give us the tools to make changes to that system, and we're doing that.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>Looking back to 2010-11, California was more successful in implementing the ACA at least in part because the issue \"was not as partisanly charged\" here, Dooley said. The law was \"embraced by a Republican governor\" — referring to Gov. \u003cspan style=\"color: #000000\">Schwarzenegger — but Dooley also reminded the audience that the fiscal outlook was grim in 2011 when Gov. Jerry Brown came into office and appointed Dooley to her post. \u003c/span>\u003c/p>\n\u003cblockquote>\u003cp>For the first couple of years we were working on a conditional basis. We were preparing to implement the Affordable Care Act if we could get our fiscal house in order in California. I mention that because I think we were proceding with a great deal of humility. We knew that there were opportunities the Affordable Care Act created, but we also knew that it wasn't reasonable to expect people to believe that we could go forward at the same time we were going backward, to have the kind of expansion of coverage that the Affordable Care Act allowed at the same time we were significantly cutting programs and services. And the Health and Human Services Agency alone, in the first two years of the Brown administration, we cut $2 billion out of our programs.\u003c/p>\u003c/blockquote>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19378\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/494322659.jpg\">\u003cimg class=\"size-large wp-image-19378\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/494322659-640x433.jpg\" alt=\"Diana Dooley (right), Secretary of California's Health and Human Services Agency, talks with KQED's Lisa Aliferis about the Affordable Care Act at a New York Times conference at UCSF. (Michael Loccisano/Getty Images for New York Times)\" width=\"640\" height=\"433\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Diana Dooley (right), Secretary of California's Health and Human Services Agency, talks with KQED's Lisa Aliferis about the Affordable Care Act at a New York Times conference at UCSF. (Michael Loccisano/Getty Images for New York Times)\u003c/figcaption>\u003c/figure>\n\u003cp>Diana Dooley is head of California's Department of Health and Human Services and — in that role — also serves as chair of the Covered California board.\u003c/p>\n\u003cp>So when the New York Times came to town last week and held its \u003ca href=\"http://www.nytimes.com/marketing/conferences/health_for_tomorrow/2014/agenda.html\" target=\"_blank\">Health for Tomorrow\u003c/a> conference at UCSF, organizers invited me to interview Dooley about how the Affordable Care Act is rolling out in California.\u003c/p>\n\u003cp>Yes, sign-ups during the first open enrollment \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/04/17/final-obamacare-open-enrollment-more-than-3-3-million-californians-signed-up/\" target=\"_blank\">were strong,\u003c/a> but in no way was Dooley claiming victory. She joked that grading is happening on a curve. \"We're not absolutely good; we're relatively good,\" she said.\u003c/p>\n\u003cp>Four times during our 30-minute talk, Dooley spoke of the \"jury being out\" on whether the ACA will ultimately be a success. She referred to coverage expansion being just one leg of the ACA's three-legged stool. The other legs include payment and delivery reform, as well as prevention and wellness.\u003c!--more-->\u003c/p>\n\u003cp>\u003ciframe src=\"http://new.livestream.com/accounts/8401498/events/2985705/videos/52319389/player?autoPlay=false&height=360&mute=false&width=640\" width=\"640\" height=\"360\" frameborder=\"0\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Together the changes required in those three areas have brought about \"disruptive innovation,\" she argued.\u003c/p>\n\u003cblockquote>\u003cp>We have really disrupted the system in ways that we can't completely predict what the result is going to be. I'm reminded of a quote from Albert Einstein … [he said] after the atomic bomb, 'Everything changed, save our way of thinking.' Sometimes I think about that and where we are with the Affordable Care Act: Everything has changed, save our way of thinking.'\u003c/p>\u003c/blockquote>\n\u003cp>The system has changed for everyone, Dooley said, for providers, for health plans and for consumers. \"People are complaining that they're being forced to change,\" she said. \"They want to keep what they have, but then they complain that they don't like what they have either.\"\u003c/p>\n\u003cp>A major criticism of Covered California has come from people \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/02/11/youre-enrolled-in-an-obamacare-plan-will-your-doctor-accept-your-insurance/\" target=\"_blank\">finding it hard to find a doctor\u003c/a> who accepted their insurance. Dooley said Covered California was paying attention to the adequacy of provider networks and had worked with plans on this question:\u003c/p>\n\u003cblockquote>\u003cp>We've already seen in the last two months, with the plans expanding their networks, where we've shown that they didn't have enough physicians or there wasn't enough choice. Some of the providers themselves, the hospitals and the doctors, are coming back to the plans and now negotiating to get back in. They're seeing the success; they're seeing how many new lives (are) covered, how many new patients they can get. ... It's going to take us a couple years at least to settle into a different relationship between the doctors, the plans, the hospitals and the referral systems for care.\u003c/p>\u003c/blockquote>\n\u003cp>Dooley spoke with enthusiasm about California being one of just a handful of states participating in an ACA pilot program to coordinate the care of \"dual eligibles,\" vulnerable seniors and disabled people eligible for both Medi-Cal and Medicare. This population often has the most fragmented care.\u003c/p>\n\u003cblockquote>\u003cp>So we're working in a pilot to begin to bring that together. We've got in the provider community people who treat Medi-Cal patients and people who treat Medicare patients, and they don’t talk to each other. … We will have to push the system to create this integration and the coordination of care. … We learned a lot during the '90s with the managed care effort, but we put all this responsibility then with the insurance plans, and there was a very bad reaction to that where people just thought the management of care was the denial of care.\u003c/p>\u003c/blockquote>\n\u003cp>People view health insurance differently from other kinds of insurance, Dooley said.\u003c/p>\n\u003cblockquote>\u003cp>People don't think of health insurance like they do other indemnity products. You don't hope your house burns down to take advantage of your homeowners insurance. You don't hope you get in a wreck to take care of your auto insurance. But you expect to use your health care insurance. It's partly indemnification and it's partly prepaid plan, so we have a different relationship with our health insurance and our health delivery, and there are opportunities within (the ACA) to give us the tools to make changes to that system, and we're doing that.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>Looking back to 2010-11, California was more successful in implementing the ACA at least in part because the issue \"was not as partisanly charged\" here, Dooley said. The law was \"embraced by a Republican governor\" — referring to Gov. \u003cspan style=\"color: #000000\">Schwarzenegger — but Dooley also reminded the audience that the fiscal outlook was grim in 2011 when Gov. Jerry Brown came into office and appointed Dooley to her post. \u003c/span>\u003c/p>\n\u003cblockquote>\u003cp>For the first couple of years we were working on a conditional basis. We were preparing to implement the Affordable Care Act if we could get our fiscal house in order in California. I mention that because I think we were proceding with a great deal of humility. We knew that there were opportunities the Affordable Care Act created, but we also knew that it wasn't reasonable to expect people to believe that we could go forward at the same time we were going backward, to have the kind of expansion of coverage that the Affordable Care Act allowed at the same time we were significantly cutting programs and services. And the Health and Human Services Agency alone, in the first two years of the Brown administration, we cut $2 billion out of our programs.\u003c/p>\u003c/blockquote>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_15508\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/coveredca.jpg\">\u003cimg class=\"size-full wp-image-15508\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/coveredca.jpg\" alt=\"Screenshot from CoveredCA.com, the website of Covered California.\" width=\"640\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca-320x180.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Screenshot from CoveredCA.com, the website of Covered California.\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"color: #000000\">Contract negotiations are about to begin for health insurance companies that want to sell plans next year through the state marketplace, Covered California. One area of scrutiny by the agency is sure to be adequacy of provider networks offered by insurers. \u003c/span>\u003cbr style=\"color: #000000\">\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">\u003c/span>\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"Insurers have gotten the message that there’s some consumer dissatisfaction out there.\"\u003c/aside>\n\u003cp>Last year, in order to keep premium costs down, insurance companies sold plans with a narrowed list of doctors for customers to choose from. The goal was to offer doctors and other providers more patients in exchange for a lower cost of providing services. \u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">But many more people\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/04/17/final-obamacare-open-enrollment-more-than-3-3-million-californians-signed-up/\" target=\"_blank\"> signed up\u003c/a> for Covered California plans than had been anticipated, leaving \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/02/11/youre-enrolled-in-an-obamacare-plan-will-your-doctor-accept-your-insurance/\" target=\"_blank\">perhaps too few doctors\u003c/a> to see the patients. Many people scrambled to find a doctor. Complaints to the state show that some people were forced to leave a trusted specialist; some women in their third trimester of pregnancy found they’d have to switch to an unknown obstetrician for their birth.\u003cstrong> \u003c/strong>\u003c/span>\u003cbr>\n\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">\"It’s unfair and unrealistic,\" said Betsy Imholz, an advocate with Consumers' Union.\u003c/span>\u003cbr style=\"color: #000000\">\u003c!--more-->\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">She says Alameda County was a hotspot for problems. Some plans forbid people who live in Oakland from seeing doctors across the bridge in San Francisco. And plans did a poor job of pointing this out to consumers before they signed on. \u003c/span>\"It’s too rigid, and it’s so far from consumers’ expectations and experience,\" she said.\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">[contextly_sidebar id=\"33f5b05a9d8b970c0679efaa3c0f74d0\"]\u003c/span>\u003c/p>\n\u003cp>Covered California will be negotiating next year’s contracts with insurers over the next several weeks, and health advocates are urging officials to bargain hard on behalf of consumers to expand networks.\u003cbr style=\"color: #000000\">\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">At Covered California's monthly board of directors meeting on Thursday, executive director Peter Lee said the agency was already helping to resolve complaints -- including many of the women told they had to change obstetricians. The agency has also asked insurers to expand their networks of doctors.\u003c/span>\u003cbr style=\"color: #000000\">\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">\"We’re doing very active monitoring and in particular in coordination with the Department of Managed Health Care to investigate and assure that plans' networks are adequate,\" he said.\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">Lee said the three top insurers in the state responded to Covered California's call to add doctors to their rolls: Anthem, Blue Shield, and Health Net \"have done significant work in the last quarter to expand networks,\" Lee said.\u003c/span>\u003cbr style=\"color: #000000\">\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">Anthem said it has added 3,800 doctors to its network since January. Health Net said it has increased its network by 64 percent. \u003c/span>\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/150938624&color=ff5500&auto_play=false&hide_related=false&show_artwork=true\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">Still, an insurance industry group cautioned the agency not to go too far.\u003c/span>\u003cbr style=\"color: #000000\">\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">“Tailored networks \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/11/28/why-narrow-networks-may-not-be-such-a-bad-idea/\" target=\"_blank\">maintain affordability\u003c/a>,” said Athena Chapman, director of regulatory affairs for the California Association of Health Plans.\u003c/span>\u003cbr style=\"color: #000000\">\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">Lee said that 200 complaints were filed to the Department of Managed Health Care over access to care since January, but acknowledged that the number likely didn't capture the full extent of problems.\u003c/span>\u003cbr style=\"color: #000000\">\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">\"Most people don’t have the sophistication or the wherewithal to know how to complain to a state agency,\" Imholz said. \"There may be more people out there who have problems who didn’t file a complaint.\"\u003c/span>\u003cbr style=\"color: #000000\">\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">Brett Johnson, associate director of the California Medical Association's Center for Medical and Regulatory Policy pointed to Covered California's own statistics presented at last month's board meeting indicating the agency was dealing with 40 to 50 access issues every day. His group did a survey of physicians and found 55 percent of them said they had difficulty finding in-network specialists to refer their patients to, particularly in fields like cardiology, oncology, nephrology, and other specialties that treat people with chronic conditions.\u003c/span>\u003cbr style=\"color: #000000\">\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">\"A lot of physicians still don’t know if they’re in or out of these networks,\" Johnson added. \"Part of that confusion is because, for certain products in California all insurance companies have to do is mail a notice to the doctor, and if they don’t hear back from you, it becomes part of your contract.\"\u003c/span>\u003cbr>\n\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">Imholz cautioned that the expanded provider networks may not solve the problem of patients who can't find doctors.\u003c/span>\u003cbr style=\"color: #000000\">\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">\"We need to dig deeper and find out, are they adding generically, are they adding them in places where we’ve been seeing the problems, are they adding them in all products?\" she said. \"But insurers have gotten the message that there’s some consumer dissatisfaction out there.\"\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_15508\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/coveredca.jpg\">\u003cimg class=\"size-full wp-image-15508\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/coveredca.jpg\" alt=\"Screenshot from CoveredCA.com, the website of Covered California.\" width=\"640\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca-320x180.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Screenshot from CoveredCA.com, the website of Covered California.\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"color: #000000\">Contract negotiations are about to begin for health insurance companies that want to sell plans next year through the state marketplace, Covered California. One area of scrutiny by the agency is sure to be adequacy of provider networks offered by insurers. \u003c/span>\u003cbr style=\"color: #000000\">\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">\u003c/span>\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"Insurers have gotten the message that there’s some consumer dissatisfaction out there.\"\u003c/aside>\n\u003cp>Last year, in order to keep premium costs down, insurance companies sold plans with a narrowed list of doctors for customers to choose from. The goal was to offer doctors and other providers more patients in exchange for a lower cost of providing services. \u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">But many more people\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/04/17/final-obamacare-open-enrollment-more-than-3-3-million-californians-signed-up/\" target=\"_blank\"> signed up\u003c/a> for Covered California plans than had been anticipated, leaving \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/02/11/youre-enrolled-in-an-obamacare-plan-will-your-doctor-accept-your-insurance/\" target=\"_blank\">perhaps too few doctors\u003c/a> to see the patients. Many people scrambled to find a doctor. Complaints to the state show that some people were forced to leave a trusted specialist; some women in their third trimester of pregnancy found they’d have to switch to an unknown obstetrician for their birth.\u003cstrong> \u003c/strong>\u003c/span>\u003cbr>\n\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">\"It’s unfair and unrealistic,\" said Betsy Imholz, an advocate with Consumers' Union.\u003c/span>\u003cbr style=\"color: #000000\">\u003c!--more-->\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">She says Alameda County was a hotspot for problems. Some plans forbid people who live in Oakland from seeing doctors across the bridge in San Francisco. And plans did a poor job of pointing this out to consumers before they signed on. \u003c/span>\"It’s too rigid, and it’s so far from consumers’ expectations and experience,\" she said.\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/span>\u003c/p>\n\u003cp>Covered California will be negotiating next year’s contracts with insurers over the next several weeks, and health advocates are urging officials to bargain hard on behalf of consumers to expand networks.\u003cbr style=\"color: #000000\">\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">At Covered California's monthly board of directors meeting on Thursday, executive director Peter Lee said the agency was already helping to resolve complaints -- including many of the women told they had to change obstetricians. The agency has also asked insurers to expand their networks of doctors.\u003c/span>\u003cbr style=\"color: #000000\">\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">\"We’re doing very active monitoring and in particular in coordination with the Department of Managed Health Care to investigate and assure that plans' networks are adequate,\" he said.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">Lee said the three top insurers in the state responded to Covered California's call to add doctors to their rolls: Anthem, Blue Shield, and Health Net \"have done significant work in the last quarter to expand networks,\" Lee said.\u003c/span>\u003cbr style=\"color: #000000\">\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">Anthem said it has added 3,800 doctors to its network since January. Health Net said it has increased its network by 64 percent. \u003c/span>\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/150938624&color=ff5500&auto_play=false&hide_related=false&show_artwork=true\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">Still, an insurance industry group cautioned the agency not to go too far.\u003c/span>\u003cbr style=\"color: #000000\">\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">“Tailored networks \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/11/28/why-narrow-networks-may-not-be-such-a-bad-idea/\" target=\"_blank\">maintain affordability\u003c/a>,” said Athena Chapman, director of regulatory affairs for the California Association of Health Plans.\u003c/span>\u003cbr style=\"color: #000000\">\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">Lee said that 200 complaints were filed to the Department of Managed Health Care over access to care since January, but acknowledged that the number likely didn't capture the full extent of problems.\u003c/span>\u003cbr style=\"color: #000000\">\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">\"Most people don’t have the sophistication or the wherewithal to know how to complain to a state agency,\" Imholz said. \"There may be more people out there who have problems who didn’t file a complaint.\"\u003c/span>\u003cbr style=\"color: #000000\">\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">Brett Johnson, associate director of the California Medical Association's Center for Medical and Regulatory Policy pointed to Covered California's own statistics presented at last month's board meeting indicating the agency was dealing with 40 to 50 access issues every day. His group did a survey of physicians and found 55 percent of them said they had difficulty finding in-network specialists to refer their patients to, particularly in fields like cardiology, oncology, nephrology, and other specialties that treat people with chronic conditions.\u003c/span>\u003cbr style=\"color: #000000\">\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">\"A lot of physicians still don’t know if they’re in or out of these networks,\" Johnson added. \"Part of that confusion is because, for certain products in California all insurance companies have to do is mail a notice to the doctor, and if they don’t hear back from you, it becomes part of your contract.\"\u003c/span>\u003cbr>\n\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">Imholz cautioned that the expanded provider networks may not solve the problem of patients who can't find doctors.\u003c/span>\u003cbr style=\"color: #000000\">\u003cbr style=\"color: #000000\">\u003cspan style=\"color: #000000\">\"We need to dig deeper and find out, are they adding generically, are they adding them in places where we’ve been seeing the problems, are they adding them in all products?\" she said. \"But insurers have gotten the message that there’s some consumer dissatisfaction out there.\"\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "In Alameda County, Leaving Jail Doesn't Have to Mean Losing Health Care",
"title": "In Alameda County, Leaving Jail Doesn't Have to Mean Losing Health Care",
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"content": "\u003cfigure id=\"attachment_19175\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/Screen-Shot-2014-05-19-at-10.24.13-AM.png\">\u003cimg class=\"size-large wp-image-19175\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/Screen-Shot-2014-05-19-at-10.24.13-AM-640x352.png\" alt=\"Rodrigo Salido, recently released from Santa Rita jail in Dublin, Calif., enrolls in Medi-Cal at Healthy Oakland clinic. (Courtesy: PBS NewsHour)\" width=\"640\" height=\"352\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Rodrigo Salido, recently released from Santa Rita jail in Dublin, Calif., enrolls in Medi-Cal at Healthy Oakland clinic. (Courtesy: PBS NewsHour)\u003c/figcaption>\u003c/figure>\n\u003cp style=\"color: #000000\">\u003cstrong>By Sarah Varney,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/May/16/inmates-leave-jail-retain-mental-health-care.aspx\" target=\"_blank\">Kaiser Health News and PBS NewsHour\u003c/a>\u003c/p>\n\u003cp style=\"color: #000000\">It's been two months since Rodrigo Salido left the maximum security wing at Santa Rita jail, about 40 miles east of San Francisco in Alameda County. It's also been two months since Salido had medication for his bipolar disorder.\u003c/p>\n\u003cp style=\"color: #000000\">\n\u003caside class=\"pullquote alignleft\">In Alameda County officials estimate 18,000 offenders in its two jails will now qualify for Medi-Cal.\u003c/aside>\n\u003c/p>\u003cp>A drug, Risperdal, prescribed by a jailhouse psychiatrist, had quelled Salido’s angry moods. “It helped me be more relaxed,” he said. “Not as much on the edge and feeling like everybody is out to get me.”\u003c/p>\n\u003cp style=\"color: #000000\">Now Salido, who served two years for burglary, assault and gang involvement, has no health insurance and until recently had few options for refilling his medication.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp style=\"color: #000000\">Many inmates leave county jails and state prisons with mental health problems and chronic physical ailments -- and no health coverage. Because they typically are not custodial parents, ex-offenders have long been ineligible for a public health insurance program aimed at kids, mothers and the disabled.\u003c!--more-->\u003c/p>\n\u003cp style=\"color: #000000\">But earlier this year, California and 25 other states, under a provision of the Affordable Care Act, opened up Medicaid to single and so-called “childless” adults. The change in eligibility criteria will extend Medicaid coverage to vast numbers of ex-offenders with very low incomes.\u003c/p>\n\u003cp style=\"color: #000000\">“Historically, 10 or 11 percent of folks in detention have been eligible for Medicaid,” said Alex Briscoe, health director for Alameda County. “That number is well over 90 percent as of January,” since the ACA took full effect.\u003c/p>\n\u003cp style=\"color: #000000\">[contextly_sidebar id=\"c4bac880693cbdd4b01c435155bec487\"]\u003c/p>\n\u003cp>Indeed, of those newly eligible under the Medicaid expansion, experts predict \u003ca style=\"color: #2262cc\" href=\"http://www.ncbi.nlm.nih.gov/pubmed/22566431\">one out of three\u003c/a> nationally will be former inmates or detainees. Health officials in Alameda County estimate 18,000 offenders in its two jails will now qualify. Recently, Rodrigo Salido began the process of enrolling in Medi-Cal, California's version of Medicaid, at a clinic, Healthy Oakland. He got a preliminary check up there, but once he gets his card will be able to visit a primary care doctor and see specialists.\u003c/p>\n\u003cp style=\"color: #000000\">Men and women involved in the criminal justice system are more likely to be sicker than the general population\u003cstrong>,\u003c/strong> with higher rates of diabetes, hypertension, depression, mood disorders and alcohol and drug addiction. Many have spent years -- perhaps their entire adult livens -- without health insurance and have medical conditions that must be stabilized when they’re incarcerated.\u003c/p>\n\u003cp style=\"color: #000000\">“They come to us in bad shape, and we get them as good as possible,” said Richard Lucia, the undersheriff for Alameda County.\u003c/p>\n\u003cp style=\"color: #000000\">At Santa Rita jail in Dublin, one of the largest detention facilities in the United States, the pharmacy dispenses some 350,000 prescription drugs each month and spends $28 million each year on medical and mental health services. But because recidivism rates are so high in Alameda County -- two out of three inmates re-offend -- the jails’ medical clinics often end up re-stabilizing the same inmates.\u003c/p>\n\u003cp style=\"color: #000000\">“They leave and they get in bad shape again,” said Lucia. “And they come back to us, and we fix them up again.”\u003c/p>\n\u003cdiv>\u003ca class=\"embedly-card\" href=\"https://www.youtube.com/watch?list=UU6ZFN9Tx6xh-skXCuRHCDpQ&v=rpOwkAsXXHM\">Former inmates stand to gain Medicaid under expansion\u003c/a>\u003c/div>\n\u003cp style=\"color: #000000\">The churning of sick offenders costs the county when inmates are in custody -- but it also strains public hospital budgets when they’re released. “When they do need care they come to our emergency department. They cost us between $600 and $800 a visit,” said Briscoe, the county health director. “The cost drivers on our system are intense.”\u003c/p>\n\u003cp style=\"color: #000000\">The Medicaid expansion, county officials contend, offers a rare opportunity to connect men and women with criminal records to ongoing medical and mental health services, and to directly reimburse the county’s general fund for medical care outside of correctional facilities.\u003c/p>\n\u003cp style=\"color: #000000\">While it remains against federal law to use Medicaid to pay for day-to-day medical care for inmates, the program, funded by federal and state dollars, will cover hospital stays longer than 24 hours. Those longer hospital visits often involve costly and complicated surgeries, and the county estimates it could save $3 to $5 million a year in off-site hospital care.\u003c/p>\n\u003cp style=\"color: #000000\">“That would shift the cost, essentially, from the county to the state or to the federal government,” said Undersheriff Lucia.\u003c/p>\n\u003cp style=\"color: #000000\">Over the last few months, a constellation of Alameda County agencies, including the sheriff’s office, public health and social services, have been feverishly working to create new protocols that will automatically enroll all eligible inmates into Medi-Cal. Other enrollment efforts are underway in Contra Costa, San Francisco, Solano and Lassen counties, and in Cook County, Illinois, the state of Washington and elsewhere.\u003c/p>\n\u003cp style=\"color: #000000\">The bureaucratic and technical challenges are immense: archaic information technology platforms must be re-tooled to share data with other county systems; arrested individuals often give false information about their marriage status, number of children, home address and income, foiling Medi-Cal eligibility background checks; and labor union rules permit only certain county workers to approve Medicaid applications.\u003c/p>\n\u003cp style=\"color: #000000\">Overcoming those obstacles is a priority, Alameda county officials said, not only because of the potential cost savings, but also because the Medi-Cal expansion offers a solid chance at reducing the county’s dismal recidivism rate. Several studies have shown that ex-inmates who have access to health care when they leave jail, especially mental health and substance abuse counseling, are less likely to re-offend.\u003c/p>\n\u003cp style=\"color: #000000\">Still, a Medi-Cal card is no panacea for troubled lives. “You can’t treat away the problems that face poor communities,” said Briscoe, the county health director. “It’s about a good job. It’s about a sense of belonging. It’s about a place to sleep, but healthcare can be a tool for social justice if it’s delivered effectively and creatively, and that’s why the Medicaid expansion is such a great opportunity for us.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Kaiser Health News (KHN) is a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "Under the Obamacare Medi-Cal expansion, many more former inmates can get insured after leaving jail.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19175\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/Screen-Shot-2014-05-19-at-10.24.13-AM.png\">\u003cimg class=\"size-large wp-image-19175\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/Screen-Shot-2014-05-19-at-10.24.13-AM-640x352.png\" alt=\"Rodrigo Salido, recently released from Santa Rita jail in Dublin, Calif., enrolls in Medi-Cal at Healthy Oakland clinic. (Courtesy: PBS NewsHour)\" width=\"640\" height=\"352\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Rodrigo Salido, recently released from Santa Rita jail in Dublin, Calif., enrolls in Medi-Cal at Healthy Oakland clinic. (Courtesy: PBS NewsHour)\u003c/figcaption>\u003c/figure>\n\u003cp style=\"color: #000000\">\u003cstrong>By Sarah Varney,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/May/16/inmates-leave-jail-retain-mental-health-care.aspx\" target=\"_blank\">Kaiser Health News and PBS NewsHour\u003c/a>\u003c/p>\n\u003cp style=\"color: #000000\">It's been two months since Rodrigo Salido left the maximum security wing at Santa Rita jail, about 40 miles east of San Francisco in Alameda County. It's also been two months since Salido had medication for his bipolar disorder.\u003c/p>\n\u003cp style=\"color: #000000\">\n\u003caside class=\"pullquote alignleft\">In Alameda County officials estimate 18,000 offenders in its two jails will now qualify for Medi-Cal.\u003c/aside>\n\u003c/p>\u003cp>A drug, Risperdal, prescribed by a jailhouse psychiatrist, had quelled Salido’s angry moods. “It helped me be more relaxed,” he said. “Not as much on the edge and feeling like everybody is out to get me.”\u003c/p>\n\u003cp style=\"color: #000000\">Now Salido, who served two years for burglary, assault and gang involvement, has no health insurance and until recently had few options for refilling his medication.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp style=\"color: #000000\">Many inmates leave county jails and state prisons with mental health problems and chronic physical ailments -- and no health coverage. Because they typically are not custodial parents, ex-offenders have long been ineligible for a public health insurance program aimed at kids, mothers and the disabled.\u003c!--more-->\u003c/p>\n\u003cp style=\"color: #000000\">But earlier this year, California and 25 other states, under a provision of the Affordable Care Act, opened up Medicaid to single and so-called “childless” adults. The change in eligibility criteria will extend Medicaid coverage to vast numbers of ex-offenders with very low incomes.\u003c/p>\n\u003cp style=\"color: #000000\">“Historically, 10 or 11 percent of folks in detention have been eligible for Medicaid,” said Alex Briscoe, health director for Alameda County. “That number is well over 90 percent as of January,” since the ACA took full effect.\u003c/p>\n\u003cp style=\"color: #000000\">\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Indeed, of those newly eligible under the Medicaid expansion, experts predict \u003ca style=\"color: #2262cc\" href=\"http://www.ncbi.nlm.nih.gov/pubmed/22566431\">one out of three\u003c/a> nationally will be former inmates or detainees. Health officials in Alameda County estimate 18,000 offenders in its two jails will now qualify. Recently, Rodrigo Salido began the process of enrolling in Medi-Cal, California's version of Medicaid, at a clinic, Healthy Oakland. He got a preliminary check up there, but once he gets his card will be able to visit a primary care doctor and see specialists.\u003c/p>\n\u003cp style=\"color: #000000\">Men and women involved in the criminal justice system are more likely to be sicker than the general population\u003cstrong>,\u003c/strong> with higher rates of diabetes, hypertension, depression, mood disorders and alcohol and drug addiction. Many have spent years -- perhaps their entire adult livens -- without health insurance and have medical conditions that must be stabilized when they’re incarcerated.\u003c/p>\n\u003cp style=\"color: #000000\">“They come to us in bad shape, and we get them as good as possible,” said Richard Lucia, the undersheriff for Alameda County.\u003c/p>\n\u003cp style=\"color: #000000\">At Santa Rita jail in Dublin, one of the largest detention facilities in the United States, the pharmacy dispenses some 350,000 prescription drugs each month and spends $28 million each year on medical and mental health services. But because recidivism rates are so high in Alameda County -- two out of three inmates re-offend -- the jails’ medical clinics often end up re-stabilizing the same inmates.\u003c/p>\n\u003cp style=\"color: #000000\">“They leave and they get in bad shape again,” said Lucia. “And they come back to us, and we fix them up again.”\u003c/p>\n\u003cdiv>\u003ca class=\"embedly-card\" href=\"https://www.youtube.com/watch?list=UU6ZFN9Tx6xh-skXCuRHCDpQ&v=rpOwkAsXXHM\">Former inmates stand to gain Medicaid under expansion\u003c/a>\u003c/div>\n\u003cp style=\"color: #000000\">The churning of sick offenders costs the county when inmates are in custody -- but it also strains public hospital budgets when they’re released. “When they do need care they come to our emergency department. They cost us between $600 and $800 a visit,” said Briscoe, the county health director. “The cost drivers on our system are intense.”\u003c/p>\n\u003cp style=\"color: #000000\">The Medicaid expansion, county officials contend, offers a rare opportunity to connect men and women with criminal records to ongoing medical and mental health services, and to directly reimburse the county’s general fund for medical care outside of correctional facilities.\u003c/p>\n\u003cp style=\"color: #000000\">While it remains against federal law to use Medicaid to pay for day-to-day medical care for inmates, the program, funded by federal and state dollars, will cover hospital stays longer than 24 hours. Those longer hospital visits often involve costly and complicated surgeries, and the county estimates it could save $3 to $5 million a year in off-site hospital care.\u003c/p>\n\u003cp style=\"color: #000000\">“That would shift the cost, essentially, from the county to the state or to the federal government,” said Undersheriff Lucia.\u003c/p>\n\u003cp style=\"color: #000000\">Over the last few months, a constellation of Alameda County agencies, including the sheriff’s office, public health and social services, have been feverishly working to create new protocols that will automatically enroll all eligible inmates into Medi-Cal. Other enrollment efforts are underway in Contra Costa, San Francisco, Solano and Lassen counties, and in Cook County, Illinois, the state of Washington and elsewhere.\u003c/p>\n\u003cp style=\"color: #000000\">The bureaucratic and technical challenges are immense: archaic information technology platforms must be re-tooled to share data with other county systems; arrested individuals often give false information about their marriage status, number of children, home address and income, foiling Medi-Cal eligibility background checks; and labor union rules permit only certain county workers to approve Medicaid applications.\u003c/p>\n\u003cp style=\"color: #000000\">Overcoming those obstacles is a priority, Alameda county officials said, not only because of the potential cost savings, but also because the Medi-Cal expansion offers a solid chance at reducing the county’s dismal recidivism rate. Several studies have shown that ex-inmates who have access to health care when they leave jail, especially mental health and substance abuse counseling, are less likely to re-offend.\u003c/p>\n\u003cp style=\"color: #000000\">Still, a Medi-Cal card is no panacea for troubled lives. “You can’t treat away the problems that face poor communities,” said Briscoe, the county health director. “It’s about a good job. It’s about a sense of belonging. It’s about a place to sleep, but healthcare can be a tool for social justice if it’s delivered effectively and creatively, and that’s why the Medicaid expansion is such a great opportunity for us.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Kaiser Health News (KHN) is a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Obamacare Plans Illuminate High Cost of Going 'Out of Network'",
"title": "Obamacare Plans Illuminate High Cost of Going 'Out of Network'",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_19066\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/179324294-e1399567436110.jpg\">\u003cimg class=\"size-large wp-image-19066\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/179324294-640x426.jpg\" alt=\"Consumers learn that in some cases there is no maximum on out-of-pocket costs if they see out-of-network providers. (Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Consumers learn that in some cases there is no maximum on out-of-pocket costs if they see out-of-network providers. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-style: italic;color: #000000\">Editor's note: This post is part of the ongoing \u003c/span>\u003ca style=\"font-style: italic;color: #000000\" href=\"http://centerforhealthreporting.org/project/answers-consumer-questions-about-obamacare\" target=\"_blank\">Ask Emily\u003c/a>\u003cspan style=\"font-style: italic;color: #000000\"> column, a project of the nonprofit CHCF Center for Health Reporting. Reporter Emily Bazar answers consumer questions about Obamacare. In this issue, Bazar takes a look at the potential costs of visiting an out-of-network doctor or other provider. This is an issue anyone \u003c/span>\u003ci>with\u003c/i>\u003cspan style=\"color: #000000\">\u003ci> health insurance should pay attention to.\u003c/i>\u003c/span>\u003c/p>\n\u003cp style=\"color: #000000\">\u003cstrong>Q: I learned today that the health “insurance” I purchased for my family through Covered California does not have ANY maximum out-of-pocket cost on out-of-network providers. … How is that even possible? Our family is now faced with potentially infinite costs that could wipe us out.\u003c/strong>\u003c/p>\n\u003cp style=\"color: #000000\">A: Let’s start with a quick refresher.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Consumer learns there is no maximum on what she must pay for out-of-network doctors she saw.\u003c/aside>\n\u003cp style=\"color: #000000\">An \u003ca class=\"ext\" style=\"color: #5d93b3\" href=\"https://www.coveredca.com/glossary/\" target=\"_blank\">out-of-pocket maximum\u003c/a> is the most you would pay during the term of your health policy (usually one year) before your insurance begins paying 100 percent of covered medical services.\u003c/p>\n\u003cp style=\"color: #000000\">Deductibles, co-pays and other costs generally count toward your out-of-pocket maximum. Your monthly premiums don’t.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp style=\"color: #000000\">This year, Obamacare \u003ca class=\"ext\" style=\"color: #5d93b3\" href=\"http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/2013/061113-Michelle-Andrews-out-of-pocket-costs.aspx\" target=\"_blank\">capped\u003c/a> out-of-pocket maximums at $6,350 for an individual policy and $12,700 for a family policy.\u003c/p>\n\u003cp style=\"color: #000000\">Maureen Burke of Berkeley, who submitted the question above, settled on a Blue Shield EPO (\u003ca class=\"ext\" style=\"color: #5d93b3\" href=\"https://www.healthcare.gov/glossary/exclusive-provider-organization-EPO-plan/\" target=\"_blank\">Exclusive Provider Organization\u003c/a>) family plan from \u003ca class=\"ext\" style=\"color: #5d93b3\" href=\"https://www.coveredca.com/\" target=\"_blank\">Covered California\u003c/a> with a $12,700 out-of-pocket maximum.\u003c/p>\n\u003cp style=\"color: #000000\">It wasn’t until recently that Burke realized that those much-publicized out-of-pocket maximums –-including hers –- only apply to services obtained from medical providers IN the plan’s network.\u003c/p>\n\u003cp style=\"color: #000000\">So what about providers who are not in network? Were limits set on those costs?\u003c/p>\n\u003cp style=\"color: #000000\">In her case, to her shock, no.\u003c/p>\n\u003cp style=\"color: #000000\">As it turns out, insurers get to decide the dollar limits –- if any –- for themselves.\u003c/p>\n\u003cp style=\"color: #000000\">“The out-of-network, out-of-pocket costs for each plan would be at the plans’ discretion,” says Covered California spokesman Roy Kennedy. “You would need to inquire with the individual plans on what their policy is for out-of-network costs.”\u003c/p>\n\u003cp style=\"color: #000000\">What’s the big deal, you may be wondering. Burke and others should just stay in their networks, right?\u003c/p>\n\u003cp style=\"color: #000000\">\u003cstrong>Challenge in Determining If A Doctor is \"In Network\"\u003c/strong>\u003c/p>\n\u003cp style=\"color: #000000\">In this new health insurance environment, that’s easier said that done.\u003c/p>\n\u003cp style=\"color: #000000\">As many of you know, insurers have created “narrow networks” for many of their new plans. In plain terms, that means they have whittled down the number of participating doctors and hospitals. The providers agree to charge insurers lower fees in return for higher volumes of patients.\u003c/p>\n\u003cp style=\"color: #000000\">But for consumers, staying in network has become more difficult because there are fewer providers serving more patients.\u003c/p>\n\u003cp style=\"color: #000000\">(Good luck confirming whether your doctor and hospital are in network.\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/02/11/youre-enrolled-in-an-obamacare-plan-will-your-doctor-accept-your-insurance/\" target=\"_blank\"> Misinformation and inaccuracies\u003c/a> have plagued the network lists since the beginning.)\u003c/p>\n\u003cp style=\"color: #000000\">Burke poses a hypothetical: What if she needs surgery? She’ll make sure her doctor and hospital are in network. But, she notes, they won’t be the only ones providing services.\u003c/p>\n\u003cp style=\"color: #000000\">“One can’t know during surgery whether the assistant surgeon, the radiologist, the anesthesiologist, etc., are in network or not,” she says.\u003c/p>\n\u003cp style=\"color: #000000\">This doesn’t apply just to Covered California plans. Priscilla Myrick, also of Berkeley, bought an Anthem Blue Cross PPO (\u003ca class=\"ext\" style=\"color: #5d93b3\" href=\"http://www.ehealthinsurance.com/health-plans/ppo/\" target=\"_blank\">Preferred Provider Organization\u003c/a>) family plan on the private market.\u003c/p>\n\u003cp style=\"color: #000000\">Earlier this year, she visited the cardiologist she used to see through her previous Anthem plan and had a mammogram and bone density test at an imaging center that used to be in network.\u003c/p>\n\u003cp style=\"color: #000000\">Then she opened her mailbox and found bills totaling more than $1,500.\u003c/p>\n\u003cp style=\"color: #000000\">Myrick started digging. She learned that her cardiologist and imaging center are no longer in her network, which sent her bills skyrocketing.\u003c/p>\n\u003cp style=\"color: #000000\">Then she discovered that Anthem would assume all costs for covered services outside its network only after she had paid $30,000 out of her own pocket.\u003c/p>\n\u003cp style=\"color: #000000\">Myrick is a retired certified public accountant. “I know how to look at numbers,” she says.\u003c/p>\n\u003cp style=\"color: #000000\">But that one had not been apparent when she shopped around for plans. “How was anyone supposed to know this?” she asks.\u003c/p>\n\u003cp style=\"color: #000000\">Myrick has since cancelled a follow-up procedure ordered by the cardiologist because “I couldn’t find out how much it was going to cost,” she says.\u003c/p>\n\u003cp style=\"color: #000000\">(Find Myrick’s complaint letter to the Covered California board \u003ca class=\"ext\" style=\"color: #5d93b3\" href=\"http://board.coveredca.com/meetings/2014/04%20Apr%20Meeting%20Materials/PDFs/MASTER%20Comments%20to%20the%20Board%20-%20Table%20of%20Contents_April%2017,%202014.pdf\" target=\"_blank\">here\u003c/a>.)\u003c/p>\n\u003cp style=\"color: #000000\">Darrel Ng, an Anthem spokesman, says out-of-pocket maximums for out-of-network providers range from $10,000 to $18,000 for the company’s individual plans and $20,000 to $36,000 for family plans on the private market. On Covered California, they range from $10,000 to $15,000 for individuals, he says, and from $20,000 to $30,000 for families.\u003c/p>\n\u003cp style=\"color: #000000\">He urges consumers to do their homework before getting care, if possible, to ensure their providers are in network.\u003c/p>\n\u003cp style=\"color: #000000\">“We would encourage them to contact the hospital and find out whether all the different parts of the medical system they’ll be touching are in their network and ask, if possible, that in-network providers be used,” Ng says.\u003c/p>\n\u003cp style=\"color: #000000\">Once again, easier said than done. How will the hospital know which radiologist or pathologist or fill-in-the-blank-ologist will be working at the time of your surgery one month from now?\u003c/p>\n\u003cp style=\"color: #000000\">“Who would answer those questions? The receptionist at the hospital?” Burke asks. “It’s impossible.”\u003c/p>\n\u003cp style=\"color: #000000\">I tend to agree.\u003c/p>\n\u003cp style=\"color: #000000\">Here’s my advice: Find out what your limit is for out-of-network providers.\u003c/p>\n\u003cp style=\"color: #000000\">And hope like heck that you don’t need them.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"rC8rKUPYtGTs42rqdnohzRA7MlZkxYd3\"]\u003c/p>\n\n",
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"excerpt": "Under Obamacare, in-network maximum is capped at $6,350 for an individual. But out-of-network maximums may be much higher, even unlimited.",
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"description": "Under Obamacare, in-network maximum is capped at $6,350 for an individual. But out-of-network maximums may be much higher, even unlimited.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19066\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/179324294-e1399567436110.jpg\">\u003cimg class=\"size-large wp-image-19066\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/179324294-640x426.jpg\" alt=\"Consumers learn that in some cases there is no maximum on out-of-pocket costs if they see out-of-network providers. (Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Consumers learn that in some cases there is no maximum on out-of-pocket costs if they see out-of-network providers. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-style: italic;color: #000000\">Editor's note: This post is part of the ongoing \u003c/span>\u003ca style=\"font-style: italic;color: #000000\" href=\"http://centerforhealthreporting.org/project/answers-consumer-questions-about-obamacare\" target=\"_blank\">Ask Emily\u003c/a>\u003cspan style=\"font-style: italic;color: #000000\"> column, a project of the nonprofit CHCF Center for Health Reporting. Reporter Emily Bazar answers consumer questions about Obamacare. In this issue, Bazar takes a look at the potential costs of visiting an out-of-network doctor or other provider. This is an issue anyone \u003c/span>\u003ci>with\u003c/i>\u003cspan style=\"color: #000000\">\u003ci> health insurance should pay attention to.\u003c/i>\u003c/span>\u003c/p>\n\u003cp style=\"color: #000000\">\u003cstrong>Q: I learned today that the health “insurance” I purchased for my family through Covered California does not have ANY maximum out-of-pocket cost on out-of-network providers. … How is that even possible? Our family is now faced with potentially infinite costs that could wipe us out.\u003c/strong>\u003c/p>\n\u003cp style=\"color: #000000\">A: Let’s start with a quick refresher.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Consumer learns there is no maximum on what she must pay for out-of-network doctors she saw.\u003c/aside>\n\u003cp style=\"color: #000000\">An \u003ca class=\"ext\" style=\"color: #5d93b3\" href=\"https://www.coveredca.com/glossary/\" target=\"_blank\">out-of-pocket maximum\u003c/a> is the most you would pay during the term of your health policy (usually one year) before your insurance begins paying 100 percent of covered medical services.\u003c/p>\n\u003cp style=\"color: #000000\">Deductibles, co-pays and other costs generally count toward your out-of-pocket maximum. Your monthly premiums don’t.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp style=\"color: #000000\">This year, Obamacare \u003ca class=\"ext\" style=\"color: #5d93b3\" href=\"http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/2013/061113-Michelle-Andrews-out-of-pocket-costs.aspx\" target=\"_blank\">capped\u003c/a> out-of-pocket maximums at $6,350 for an individual policy and $12,700 for a family policy.\u003c/p>\n\u003cp style=\"color: #000000\">Maureen Burke of Berkeley, who submitted the question above, settled on a Blue Shield EPO (\u003ca class=\"ext\" style=\"color: #5d93b3\" href=\"https://www.healthcare.gov/glossary/exclusive-provider-organization-EPO-plan/\" target=\"_blank\">Exclusive Provider Organization\u003c/a>) family plan from \u003ca class=\"ext\" style=\"color: #5d93b3\" href=\"https://www.coveredca.com/\" target=\"_blank\">Covered California\u003c/a> with a $12,700 out-of-pocket maximum.\u003c/p>\n\u003cp style=\"color: #000000\">It wasn’t until recently that Burke realized that those much-publicized out-of-pocket maximums –-including hers –- only apply to services obtained from medical providers IN the plan’s network.\u003c/p>\n\u003cp style=\"color: #000000\">So what about providers who are not in network? Were limits set on those costs?\u003c/p>\n\u003cp style=\"color: #000000\">In her case, to her shock, no.\u003c/p>\n\u003cp style=\"color: #000000\">As it turns out, insurers get to decide the dollar limits –- if any –- for themselves.\u003c/p>\n\u003cp style=\"color: #000000\">“The out-of-network, out-of-pocket costs for each plan would be at the plans’ discretion,” says Covered California spokesman Roy Kennedy. “You would need to inquire with the individual plans on what their policy is for out-of-network costs.”\u003c/p>\n\u003cp style=\"color: #000000\">What’s the big deal, you may be wondering. Burke and others should just stay in their networks, right?\u003c/p>\n\u003cp style=\"color: #000000\">\u003cstrong>Challenge in Determining If A Doctor is \"In Network\"\u003c/strong>\u003c/p>\n\u003cp style=\"color: #000000\">In this new health insurance environment, that’s easier said that done.\u003c/p>\n\u003cp style=\"color: #000000\">As many of you know, insurers have created “narrow networks” for many of their new plans. In plain terms, that means they have whittled down the number of participating doctors and hospitals. The providers agree to charge insurers lower fees in return for higher volumes of patients.\u003c/p>\n\u003cp style=\"color: #000000\">But for consumers, staying in network has become more difficult because there are fewer providers serving more patients.\u003c/p>\n\u003cp style=\"color: #000000\">(Good luck confirming whether your doctor and hospital are in network.\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/02/11/youre-enrolled-in-an-obamacare-plan-will-your-doctor-accept-your-insurance/\" target=\"_blank\"> Misinformation and inaccuracies\u003c/a> have plagued the network lists since the beginning.)\u003c/p>\n\u003cp style=\"color: #000000\">Burke poses a hypothetical: What if she needs surgery? She’ll make sure her doctor and hospital are in network. But, she notes, they won’t be the only ones providing services.\u003c/p>\n\u003cp style=\"color: #000000\">“One can’t know during surgery whether the assistant surgeon, the radiologist, the anesthesiologist, etc., are in network or not,” she says.\u003c/p>\n\u003cp style=\"color: #000000\">This doesn’t apply just to Covered California plans. Priscilla Myrick, also of Berkeley, bought an Anthem Blue Cross PPO (\u003ca class=\"ext\" style=\"color: #5d93b3\" href=\"http://www.ehealthinsurance.com/health-plans/ppo/\" target=\"_blank\">Preferred Provider Organization\u003c/a>) family plan on the private market.\u003c/p>\n\u003cp style=\"color: #000000\">Earlier this year, she visited the cardiologist she used to see through her previous Anthem plan and had a mammogram and bone density test at an imaging center that used to be in network.\u003c/p>\n\u003cp style=\"color: #000000\">Then she opened her mailbox and found bills totaling more than $1,500.\u003c/p>\n\u003cp style=\"color: #000000\">Myrick started digging. She learned that her cardiologist and imaging center are no longer in her network, which sent her bills skyrocketing.\u003c/p>\n\u003cp style=\"color: #000000\">Then she discovered that Anthem would assume all costs for covered services outside its network only after she had paid $30,000 out of her own pocket.\u003c/p>\n\u003cp style=\"color: #000000\">Myrick is a retired certified public accountant. “I know how to look at numbers,” she says.\u003c/p>\n\u003cp style=\"color: #000000\">But that one had not been apparent when she shopped around for plans. “How was anyone supposed to know this?” she asks.\u003c/p>\n\u003cp style=\"color: #000000\">Myrick has since cancelled a follow-up procedure ordered by the cardiologist because “I couldn’t find out how much it was going to cost,” she says.\u003c/p>\n\u003cp style=\"color: #000000\">(Find Myrick’s complaint letter to the Covered California board \u003ca class=\"ext\" style=\"color: #5d93b3\" href=\"http://board.coveredca.com/meetings/2014/04%20Apr%20Meeting%20Materials/PDFs/MASTER%20Comments%20to%20the%20Board%20-%20Table%20of%20Contents_April%2017,%202014.pdf\" target=\"_blank\">here\u003c/a>.)\u003c/p>\n\u003cp style=\"color: #000000\">Darrel Ng, an Anthem spokesman, says out-of-pocket maximums for out-of-network providers range from $10,000 to $18,000 for the company’s individual plans and $20,000 to $36,000 for family plans on the private market. On Covered California, they range from $10,000 to $15,000 for individuals, he says, and from $20,000 to $30,000 for families.\u003c/p>\n\u003cp style=\"color: #000000\">He urges consumers to do their homework before getting care, if possible, to ensure their providers are in network.\u003c/p>\n\u003cp style=\"color: #000000\">“We would encourage them to contact the hospital and find out whether all the different parts of the medical system they’ll be touching are in their network and ask, if possible, that in-network providers be used,” Ng says.\u003c/p>\n\u003cp style=\"color: #000000\">Once again, easier said than done. How will the hospital know which radiologist or pathologist or fill-in-the-blank-ologist will be working at the time of your surgery one month from now?\u003c/p>\n\u003cp style=\"color: #000000\">“Who would answer those questions? The receptionist at the hospital?” Burke asks. “It’s impossible.”\u003c/p>\n\u003cp style=\"color: #000000\">I tend to agree.\u003c/p>\n\u003cp style=\"color: #000000\">Here’s my advice: Find out what your limit is for out-of-network providers.\u003c/p>\n\u003cp style=\"color: #000000\">And hope like heck that you don’t need them.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"rC8rKUPYtGTs42rqdnohzRA7MlZkxYd3\"]\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Even With Obamacare, Many Latinos Still Seek Medical Care in Mexico",
"title": "Even With Obamacare, Many Latinos Still Seek Medical Care in Mexico",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_19033\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/simnsa-2_rev-e1399327135736.jpg\">\u003cimg class=\"size-large wp-image-19033\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/simnsa-2_rev-640x508.jpg\" alt=\"Dr. Cecilia Espinoza meets with her patient Irma Montalvo. Montalvo, a U.S. citizen, prefers to travel to Mexico for health care, even though she signed up for a health plan through Covered California (Heidi de Marco/KHN).\" width=\"640\" height=\"508\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Cecilia Espinoza meets with her patient Irma Montalvo. Montalvo, a U.S. citizen, prefers to travel to Mexico for health care, even though she signed up for a health plan through Covered California (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp style=\"color: #000000\">\u003cstrong>By Anna Gorman,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/May/05/south-of-the-border-health-care.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp style=\"color: #000000\">TIJUANA, Mexico – Irma Montalvo signed up for a health plan through Covered California, the state's insurance marketplace, last month, getting coverage for the first time in eight years.\u003c/p>\n\u003cp style=\"color: #000000\">\n\u003caside class=\"pullquote alignleft\">\"To be honest, I like to come here better even if I have insurance.\"\u003c/aside>\n\u003c/p>\u003cp>But when she needed treatment for a painful skin rash, Montalvo didn't go to a doctor near her home in Chula Vista. Instead she drove to Mexico, about 16 miles south. Her doctor, Cecilia Espinoza, diagnosed her with shingles and prescribed medication to relieve pain and head off complications.\u003c/p>\n\u003cp style=\"color: #000000\">Montalvo, 64, said she comes to Tijuana in part because it costs just $15 to see the doctor. She can't use her insurance for care outside California but it's still cheaper because she doesn’t have to worry about a deductible. More important, she said, is that she feels comfortable with Espinoza.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp style=\"color: #000000\">\"She listens to me,\" said Montalvo, a U.S. citizen who was born in Mexico, said in Spanish. \"I come here feeling really bad, and three days later I am better.\"\u003c!--more-->\u003c/p>\n\u003cp style=\"color: #000000\">Mexican immigrants living in California, Arizona, Texas and New Mexico have long sought health care in border cities like Tijuana, Mexicali and Nogales. The Affordable Care Act won't change that, experts said, even though it has expanded coverage to millions of people, including many Latinos.\u003c/p>\n\u003cp style=\"color: #000000\">Naturalized citizens and legal residents are expected to continue traveling for check-ups, minor surgeries and dental care, drawn to treatment that is less expensive and a medical culture that is less hurried. Doctors speak their language and patients often can get appointments without long waits.\u003c/p>\n\u003cp style=\"color: #000000\">In fact, it's possible even more U.S. residents may seek care with Mexican doctors, said David Hayes-Bautista, director of the Center for the Study of Latino Health and Culture at the UCLA School of Medicine. Many Latinos in the United States live in areas with a huge undersupply of providers, and as new coverage increases the demand for care, waits for appointments could grow longer and more frustrating, he said.\u003c/p>\n\u003cp style=\"color: #000000\">\"If you don't have access to care, going to Tijuana may seem like a reasonable alternative,\" he said.\u003c/p>\n\u003cp style=\"color: #000000\">Some of these patients now going to Mexico remain uninsured, or work for employers in the U.S. offering insurance plans that pay for medical care in Mexico. Others have signed up for Obamacare to cover emergencies or avoid a fine – but face high deductibles and out-of-pocket expenses.\u003c/p>\n\u003cp style=\"color: #000000\">\"Even with insurance, it can sometimes be cheaper in Mexico,\" said Steven Wallace, who is associate director the UCLA center and has studied why Mexican immigrants seek care in Mexico.\u003c/p>\n\u003cp style=\"color: #000000\">\u003cstrong>Long Drive \"But Worth It\"\u003c/strong>\u003c/p>\n\u003cp style=\"color: #000000\">The majority of these patients are Mexican immigrants with green cards or U.S. citizenship who can travel freely across the border. One 2009 study by Wallace found that nearly half a million Mexican immigrants living in California receive medical, dental or prescription services every year south of the border.\u003c/p>\n\u003cp style=\"color: #000000\">Lorena Villanueva, who cleans houses in Riverside County, Calif., came to Tijuana on a recent day because of a flare up of allergies that gave her a sore throat and a rash on both arms. Villanueva bought a plan through Covered California for about $150 a month. Joining a plan that her husband has through his work as a car salesman was too expensive.\u003c/p>\n\u003cp style=\"color: #000000\">\"To be honest, I like to come here better even if I have insurance,\" she said. \"Over there it's wasting money and wasting time.\"\u003c/p>\n\u003cp style=\"color: #000000\">The Obamacare plan, she said, is just for emergencies. For most everything else, Villanueva said she will continue driving the 70 miles to Tijuana. \"It's a long drive … but for me, it's worth it,\" she said.\u003c/p>\n\u003cp style=\"color: #000000\">The\u003cstrong> \u003c/strong>medical office where she sees her doctor is in an eight-story, modern building just steps from the border and across the street from a bus station. Two flags – one American and one Mexican – fly above the building owned by SIMNSA, a cross-border health plan.\u003c/p>\n\u003cp style=\"color: #000000\">Just outside, security guards monitor who enters and a line of taxis waits to give patients rides. Inside, the clinic is bustling with people seeking to get their eyes checked, lab results read, cavities filled, hearts examined, allergies treated and children immunized.\u003c/p>\n\u003cp style=\"color: #000000\">Licensed in California and overseen by the state's Department of Managed Health Care, SIMNSA offers health insurance to employees of American companies in San Diego and Imperial counties. The employer plan offers the essential benefits required under the ACA, administrators said.\u003c/p>\n\u003cp style=\"color: #000000\">Patients not on the SIMNSA employer plan can walk in to the clinic and pay out-of-pocket. Or, like Montalvo, they can pay a small membership fee allowing them to see an internist for $15 and a specialist for $25.\u003c/p>\n\u003cp style=\"color: #000000\">SIMNSA provides primary and specialty care, physical therapy, spa services and a pharmacy.\u003cstrong> \"\u003c/strong>It's a one-stop shop,\" said Christina Suggett, chief operating officer.\u003c/p>\n\u003cp style=\"color: #000000\">\u003cstrong>\"Quality and Warmth\"\u003c/strong>\u003c/p>\n\u003cp style=\"color: #000000\">Suggett said appointments typically last 30 minutes or more and the doctors don't rely heavily on nurses or medical assistants – a contrast to often more rushed encounters in the United States. Physicians develop long-term relationships with their patients, who return again and again, often bringing family members along.\u003c/p>\n\u003cp style=\"color: #000000\">Ophthalmologist Josue Delgado has been seeing Alberto Luna, 49, for several years. Luna lives just over the border in National City and has a SIMNSA policy through his job at a hotel in San Diego. Luna said he never has to wait to see Delgado and that the doctor treats him like a friend.\u003c/p>\n\u003cp style=\"color: #000000\">\"We know each other by first name,\" Delgado said of Luna.\u003c/p>\n\u003cp style=\"color: #000000\">On this day, Luna was seeking follow-up treatment for a complication of his diabetes -- bleeding in his eye. Delgado explained it was causing blurry vision and wasn't healing. The doctor gave Luna a note for his boss so he could spend a few more weeks at home before returning to work. \"Make sure you rest,\" Delgado told his patient, shaking his hand\u003cstrong>.\u003c/strong>\u003c/p>\n\u003cp style=\"color: #000000\">Xochitl Castaneda, director of the health initiative of the Americas at U.C. Berkeley's School of Public Health, said Mexican clinics offer something not always found in the U.S. \"In Spanish, we say \u003cem>calidad\u003c/em> and \u003cem>calidez\u003c/em>, quality and warmth,\" she said. \"When you are sick, you need medical support. You also need emotional support. That is something that Mexican physicians give.\"\u003c/p>\n\u003cp style=\"color: #000000\">The question of quality is not settled. Experts say that some hospitals, doctors and clinics are comparable to the U.S. but that quality varies widely. Some studies find that patient satisfaction with Mexican providers is generally good while others find the care needs improvement.\u003c/p>\n\u003cp style=\"color: #000000\">It is that warmth that brings Montalvo back to Tijuana, despite her new Covered California plan. After checking Montalvo's rash, Espinoza told her to continue the medication and come back in a few weeks. She also told her to call – night or day – if she had any questions.\u003c/p>\n\u003cp style=\"color: #000000\">\"You are responding perfectly\" to the medication, Espinoza told Montalvo. \"I'm happy.\"\u003c/p>\n\u003cp style=\"color: #000000\">Montalvo smiled at her doctor before heading down to the pharmacy. \"\u003cem>Que dios le bendiga,\" \u003c/em>Montalvo told her. \"May God bless you.\"\u003c/p>\n\u003cp>\u003cem>Kaiser Health News (KHN) is a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"Uf8uyBE4OtjyA0nIu5NrIodNwMz5d52c\"]\u003c/p>\n\n",
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"description": "By Anna Gorman, Kaiser Health News TIJUANA, Mexico – Irma Montalvo signed up for a health plan through Covered California, the state's insurance marketplace, last month, getting coverage for the first time in eight years. "To be honest, I like to come here better even if I have insurance." But when she needed treatment for",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19033\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/simnsa-2_rev-e1399327135736.jpg\">\u003cimg class=\"size-large wp-image-19033\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/simnsa-2_rev-640x508.jpg\" alt=\"Dr. Cecilia Espinoza meets with her patient Irma Montalvo. Montalvo, a U.S. citizen, prefers to travel to Mexico for health care, even though she signed up for a health plan through Covered California (Heidi de Marco/KHN).\" width=\"640\" height=\"508\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Cecilia Espinoza meets with her patient Irma Montalvo. Montalvo, a U.S. citizen, prefers to travel to Mexico for health care, even though she signed up for a health plan through Covered California (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp style=\"color: #000000\">\u003cstrong>By Anna Gorman,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/May/05/south-of-the-border-health-care.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp style=\"color: #000000\">TIJUANA, Mexico – Irma Montalvo signed up for a health plan through Covered California, the state's insurance marketplace, last month, getting coverage for the first time in eight years.\u003c/p>\n\u003cp style=\"color: #000000\">\n\u003caside class=\"pullquote alignleft\">\"To be honest, I like to come here better even if I have insurance.\"\u003c/aside>\n\u003c/p>\u003cp>But when she needed treatment for a painful skin rash, Montalvo didn't go to a doctor near her home in Chula Vista. Instead she drove to Mexico, about 16 miles south. Her doctor, Cecilia Espinoza, diagnosed her with shingles and prescribed medication to relieve pain and head off complications.\u003c/p>\n\u003cp style=\"color: #000000\">Montalvo, 64, said she comes to Tijuana in part because it costs just $15 to see the doctor. She can't use her insurance for care outside California but it's still cheaper because she doesn’t have to worry about a deductible. More important, she said, is that she feels comfortable with Espinoza.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp style=\"color: #000000\">\"She listens to me,\" said Montalvo, a U.S. citizen who was born in Mexico, said in Spanish. \"I come here feeling really bad, and three days later I am better.\"\u003c!--more-->\u003c/p>\n\u003cp style=\"color: #000000\">Mexican immigrants living in California, Arizona, Texas and New Mexico have long sought health care in border cities like Tijuana, Mexicali and Nogales. The Affordable Care Act won't change that, experts said, even though it has expanded coverage to millions of people, including many Latinos.\u003c/p>\n\u003cp style=\"color: #000000\">Naturalized citizens and legal residents are expected to continue traveling for check-ups, minor surgeries and dental care, drawn to treatment that is less expensive and a medical culture that is less hurried. Doctors speak their language and patients often can get appointments without long waits.\u003c/p>\n\u003cp style=\"color: #000000\">In fact, it's possible even more U.S. residents may seek care with Mexican doctors, said David Hayes-Bautista, director of the Center for the Study of Latino Health and Culture at the UCLA School of Medicine. Many Latinos in the United States live in areas with a huge undersupply of providers, and as new coverage increases the demand for care, waits for appointments could grow longer and more frustrating, he said.\u003c/p>\n\u003cp style=\"color: #000000\">\"If you don't have access to care, going to Tijuana may seem like a reasonable alternative,\" he said.\u003c/p>\n\u003cp style=\"color: #000000\">Some of these patients now going to Mexico remain uninsured, or work for employers in the U.S. offering insurance plans that pay for medical care in Mexico. Others have signed up for Obamacare to cover emergencies or avoid a fine – but face high deductibles and out-of-pocket expenses.\u003c/p>\n\u003cp style=\"color: #000000\">\"Even with insurance, it can sometimes be cheaper in Mexico,\" said Steven Wallace, who is associate director the UCLA center and has studied why Mexican immigrants seek care in Mexico.\u003c/p>\n\u003cp style=\"color: #000000\">\u003cstrong>Long Drive \"But Worth It\"\u003c/strong>\u003c/p>\n\u003cp style=\"color: #000000\">The majority of these patients are Mexican immigrants with green cards or U.S. citizenship who can travel freely across the border. One 2009 study by Wallace found that nearly half a million Mexican immigrants living in California receive medical, dental or prescription services every year south of the border.\u003c/p>\n\u003cp style=\"color: #000000\">Lorena Villanueva, who cleans houses in Riverside County, Calif., came to Tijuana on a recent day because of a flare up of allergies that gave her a sore throat and a rash on both arms. Villanueva bought a plan through Covered California for about $150 a month. Joining a plan that her husband has through his work as a car salesman was too expensive.\u003c/p>\n\u003cp style=\"color: #000000\">\"To be honest, I like to come here better even if I have insurance,\" she said. \"Over there it's wasting money and wasting time.\"\u003c/p>\n\u003cp style=\"color: #000000\">The Obamacare plan, she said, is just for emergencies. For most everything else, Villanueva said she will continue driving the 70 miles to Tijuana. \"It's a long drive … but for me, it's worth it,\" she said.\u003c/p>\n\u003cp style=\"color: #000000\">The\u003cstrong> \u003c/strong>medical office where she sees her doctor is in an eight-story, modern building just steps from the border and across the street from a bus station. Two flags – one American and one Mexican – fly above the building owned by SIMNSA, a cross-border health plan.\u003c/p>\n\u003cp style=\"color: #000000\">Just outside, security guards monitor who enters and a line of taxis waits to give patients rides. Inside, the clinic is bustling with people seeking to get their eyes checked, lab results read, cavities filled, hearts examined, allergies treated and children immunized.\u003c/p>\n\u003cp style=\"color: #000000\">Licensed in California and overseen by the state's Department of Managed Health Care, SIMNSA offers health insurance to employees of American companies in San Diego and Imperial counties. The employer plan offers the essential benefits required under the ACA, administrators said.\u003c/p>\n\u003cp style=\"color: #000000\">Patients not on the SIMNSA employer plan can walk in to the clinic and pay out-of-pocket. Or, like Montalvo, they can pay a small membership fee allowing them to see an internist for $15 and a specialist for $25.\u003c/p>\n\u003cp style=\"color: #000000\">SIMNSA provides primary and specialty care, physical therapy, spa services and a pharmacy.\u003cstrong> \"\u003c/strong>It's a one-stop shop,\" said Christina Suggett, chief operating officer.\u003c/p>\n\u003cp style=\"color: #000000\">\u003cstrong>\"Quality and Warmth\"\u003c/strong>\u003c/p>\n\u003cp style=\"color: #000000\">Suggett said appointments typically last 30 minutes or more and the doctors don't rely heavily on nurses or medical assistants – a contrast to often more rushed encounters in the United States. Physicians develop long-term relationships with their patients, who return again and again, often bringing family members along.\u003c/p>\n\u003cp style=\"color: #000000\">Ophthalmologist Josue Delgado has been seeing Alberto Luna, 49, for several years. Luna lives just over the border in National City and has a SIMNSA policy through his job at a hotel in San Diego. Luna said he never has to wait to see Delgado and that the doctor treats him like a friend.\u003c/p>\n\u003cp style=\"color: #000000\">\"We know each other by first name,\" Delgado said of Luna.\u003c/p>\n\u003cp style=\"color: #000000\">On this day, Luna was seeking follow-up treatment for a complication of his diabetes -- bleeding in his eye. Delgado explained it was causing blurry vision and wasn't healing. The doctor gave Luna a note for his boss so he could spend a few more weeks at home before returning to work. \"Make sure you rest,\" Delgado told his patient, shaking his hand\u003cstrong>.\u003c/strong>\u003c/p>\n\u003cp style=\"color: #000000\">Xochitl Castaneda, director of the health initiative of the Americas at U.C. Berkeley's School of Public Health, said Mexican clinics offer something not always found in the U.S. \"In Spanish, we say \u003cem>calidad\u003c/em> and \u003cem>calidez\u003c/em>, quality and warmth,\" she said. \"When you are sick, you need medical support. You also need emotional support. That is something that Mexican physicians give.\"\u003c/p>\n\u003cp style=\"color: #000000\">The question of quality is not settled. Experts say that some hospitals, doctors and clinics are comparable to the U.S. but that quality varies widely. Some studies find that patient satisfaction with Mexican providers is generally good while others find the care needs improvement.\u003c/p>\n\u003cp style=\"color: #000000\">It is that warmth that brings Montalvo back to Tijuana, despite her new Covered California plan. After checking Montalvo's rash, Espinoza told her to continue the medication and come back in a few weeks. She also told her to call – night or day – if she had any questions.\u003c/p>\n\u003cp style=\"color: #000000\">\"You are responding perfectly\" to the medication, Espinoza told Montalvo. \"I'm happy.\"\u003c/p>\n\u003cp style=\"color: #000000\">Montalvo smiled at her doctor before heading down to the pharmacy. \"\u003cem>Que dios le bendiga,\" \u003c/em>Montalvo told her. \"May God bless you.\"\u003c/p>\n\u003cp>\u003cem>Kaiser Health News (KHN) is a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Obamacare in Jail: How San Francisco Policy Helps Inmates",
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"content": "\u003cfigure id=\"attachment_18958\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://www.flickr.com/photos/thomashawk/3396042806/in/photolist-hKr7ZG-NyYN7-Q4Sue-8BJVgU-NyYVm-efaaEg-effU5b-efa9kz-efaafp-effSPE-effS5L-NzrB4-NyZ2o-6b6Bdb-ba34VP-ba35eF-o4dSz-YteKt-9PtxFt-516wLR-51aJB5-kEtxz-6mvNzB-6Gh5QT-51aLt1-5GCTEz-fNW3uU-6GkWYj-6GkUN7-6Gm7rd-itxXGM-8rRNtd-6Gh31B-8rNHLR-er2Fr7-8rNHgH-8rRNyN-8rRPuY-8rNJdD-8rRNom-8rNHBn-8rRNJq-8rNHuB-8rRNgY-eZbpkD-6Gm3BC-6GgYiz-arK7kf-ba3aYt-97TLvP\">\u003cimg class=\"size-large wp-image-18958\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/3396042806_104f70f704_b-640x376.jpg\" alt=\"A new law permits San Francisco Sheriff Department staff to enroll people into health plans. (Thomas Hawk/Flickr)\" width=\"640\" height=\"376\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A new law permits San Francisco Sheriff Department staff to enroll people into health plans. (Thomas Hawk/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>The San Francisco Sheriff's Department is implementing a new city law allowing its staff to enroll inmates into health insurance under the Affordable Care Act. Sheriff Ross Mirkarimi believes that making sure people have health coverage when they're released will help prevent them from committing another crime and coming back.\u003c/p>\n\u003cp>“I believe that will go a long way to helping us improve public safety by using a public health strategy,” he said.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Health insurance sign-ups available to all inmates at the San Francisco county jail.\u003c/aside>\n\u003cp>He estimates this will help save taxpayers millions of dollars.\u003c/p>\n\u003cp>One inmate – Sophia – recently requested help signing up for health insurance. Sophia, who asked that her last name not be used, was caught driving a stolen car in January and sentenced to three months in the county jail. She says that was because she stopped getting treatment for her substance abuse and mental health problems when her health insurance expired.\u003c!--more-->\u003c/p>\n\u003cp>“It stopped in December. And I didn’t get it reinstated. So I didn’t address any of my issues and I guess that’s why I found myself in a car, driving around,” she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>She thought she might not do that again if she could get back on a health plan. She asked the jail if they could help her find one. Tanya Mara, the director of the health division of jail reentry services, came to walk her through the process of applying for health insurance.\u003c/p>\n\u003cp>“Prior to your arrest, did you have an income?\" Mara asked Sophia. \"Does your income change from month to month? What do you expect your income to be for 2014?”\u003c/p>\n\u003cp>Mara quickly identified a program for Sophia.\u003c/p>\n\u003cp>“You would likely qualify for Medi-Cal,” she says. “With the Affordable Care Act, you can now qualify for Medi-Cal based on income.” Medi-Cal is California's version of Medicaid, health insurance for people who are low income.\u003c/p>\n\u003cp>Obamacare has changed two key things for the formerly incarcerated. First, it expanded Medicaid to include childless adults. That means most prisoners will now qualify for the free government health coverage when they get out. Second, all plans must now cover treatment for mental health and substance use disorders –- problems that affect more than half the people in prison or jail, according to a report by the U.S. Department of Justice.\u003c/p>\n\u003cp>\u003cstrong>\"Captive Audience\" for Enrollment\u003c/strong>\u003c/p>\n\u003cp>Pretty soon, health insurance sign-ups like Sophia’s will happen for all inmates at the San Francisco county jail -- whether they request it or not. And they’ll happen right when most new arrivals get booked into custody.\u003c/p>\n\u003cp>“You have a captive audience,” Sheriff Mirkarimi said. He wants to make sure the 30,000 prisoners who come through the jail system every year are covered on the day they’re released.\u003c/p>\n\u003cp>The sheriff was behind the new city law. It authorizes his staff to enroll people into health care plans under the Affordable Care Act, 24 hours a day, 7 days a week. Other counties and states are exploring similar efforts for people exiting jail or prison.\u003c/p>\n\u003cp>But Mirkarimi acknowledges that getting coverage is just one small step. Just because someone has a newly minted Medi-Cal card doesn't mean they'll know how to use it.\u003c/p>\n\u003cp>“No, they’re going to have to demonstrate the wherewithal and resourcefulness to use that Medi-Cal card,” he said. “We, and our staff, help them get ready. But ultimately, it’s on them.”\u003c/p>\n\u003cp>That’s not how Wanda Fain sees it. She was just released from state prison after 21 years behind bars. Everything is new to her. Getting on and off escalators is weird. Mobile phones are a new concept. She says she needs a friend just to help her ride the bus.\u003c/p>\n\u003cp>“They tell me what bus we on, they tell me what stops to get off,” she said, “what specific things to look for so I won’t miss a stop.”\u003c/p>\n\u003cp>Don’t even get her started on housing.\u003c/p>\n\u003cp>“Us parolees, we can’t leave San Francisco. But at the same token, we can’t afford to stay in San Francisco,” she said. “Cause it’s, what ,$4,000 for a one bedroom? Who coming out of prison got that money?”\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/147255043&color=ff5500&auto_play=false&hide_related=false&show_artwork=true\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>Navigating the health care system is even more confusing. Fain has seizures, lymphoma, and bipolar disorder. In prison, the guards regulated all of her care for her. She wasn't allowed to eat a meal until she took her meds. But on the outside, it's up to her to find the right doctor, the right pharmacy –- and to figure out which four buses she needs to take to get there.\u003c/p>\n\u003cp>“It's little things like that that people think are so easy,\" she said, shaking her head. “They are so overwhelming.”\u003c/p>\n\u003cp>If Sheriff Mirkarimi's plan is going to work, people getting out of jail are going to need help on the other side.\u003c/p>\n\u003cp>\u003cstrong>Clinic Helps Former Prisoners Navigate Health Care System\u003c/strong>\u003c/p>\n\u003cp>Most inmates leaving jail or prison are like Fain and have several chronic conditions. And most are so focused on other things that they rarely get medical help until things are so bad that they end up in the Emergency Room.\u003c/p>\n\u003cp>“These are really some of the sickest patients we see in our system,” said Shira Shavit, a family doctor in San Francisco. “They have high rates of hospitalization, very high rates of using the emergency room, and also very high rates of death.”\u003c/p>\n\u003cp>Dr. Shavit is trying to shift those trends. She’s the director of The Transitions Clinic, a specialized program designed for former prisoners, where doctors, psychiatrists, and social workers all consult together on the same patients. But its key staff are community health workers who have all spent time behind bars, too; people like Juanita Alvarado who help patients with all the tasks that would otherwise get in the way of caring for their health -- applying for housing, social security, finding a job, printing out paperwork or bus maps.\u003c/p>\n\u003cp>“Basically holding their hands in the first few weeks after they’re out,” Alvarado said.\u003c/p>\n\u003cp>She keeps the bookshelf behind her desk stocked with soup, breakfast bars, peanut butter, and tuna fish. A lot of their patients are denied food stamps because of drug convictions and have trouble finding affordable groceries.\u003c/p>\n\u003cp>“So I hook them up with a little bag,” Alvarado said.\u003c/p>\n\u003cp>The one-stop-shop approach works. Transition program patients show up for their appointments at higher rates than other patients, and, Dr. Shavit says ER use among their patients has dropped by 50 percent.\u003c/p>\n\u003cp>That caught the attention of the federal government, which foots a lot of those ER bills with taxpayer dollars. It gave the clinic a special $6.8 million \u003ca href=\"http://innovation.cms.gov/initiatives/Health-Care-Innovation-Awards/California.html\" target=\"_blank\">innovation grant\u003c/a> created under the Affordable Care Act to expand the concept beyond San Francisco. The team is using the money to help 11 clinics in six states and Puerto Rico hire and train former prisoners to staff similar programs. Federal health officials believe this will ultimately save $8 million.\u003c/p>\n\u003cp>The even broader goal – for both Mirkarimi’s plan and the Transitions Clinic – is that health care will help keep people from going back to jail or prison. Recidivism rates have dipped in recent years, but they are still high – 61 percent of people who leave a California prison return within three years. For people on parole or probation in San Francisco, the rate is even higher.\u003c/p>\n\u003cp>Wanda Fain feels like she’s just skirting those statistics. She lives a short walk away from the Transitions Clinic and comes often to get help with a range of tasks and health issues.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“If I didn't have Juanita Alvarado, or Dr. Shavit, or any of them, I’d be in – I don’t know where I’d be,” she said. “Probably on my way back.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_18958\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://www.flickr.com/photos/thomashawk/3396042806/in/photolist-hKr7ZG-NyYN7-Q4Sue-8BJVgU-NyYVm-efaaEg-effU5b-efa9kz-efaafp-effSPE-effS5L-NzrB4-NyZ2o-6b6Bdb-ba34VP-ba35eF-o4dSz-YteKt-9PtxFt-516wLR-51aJB5-kEtxz-6mvNzB-6Gh5QT-51aLt1-5GCTEz-fNW3uU-6GkWYj-6GkUN7-6Gm7rd-itxXGM-8rRNtd-6Gh31B-8rNHLR-er2Fr7-8rNHgH-8rRNyN-8rRPuY-8rNJdD-8rRNom-8rNHBn-8rRNJq-8rNHuB-8rRNgY-eZbpkD-6Gm3BC-6GgYiz-arK7kf-ba3aYt-97TLvP\">\u003cimg class=\"size-large wp-image-18958\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/3396042806_104f70f704_b-640x376.jpg\" alt=\"A new law permits San Francisco Sheriff Department staff to enroll people into health plans. (Thomas Hawk/Flickr)\" width=\"640\" height=\"376\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A new law permits San Francisco Sheriff Department staff to enroll people into health plans. (Thomas Hawk/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>The San Francisco Sheriff's Department is implementing a new city law allowing its staff to enroll inmates into health insurance under the Affordable Care Act. Sheriff Ross Mirkarimi believes that making sure people have health coverage when they're released will help prevent them from committing another crime and coming back.\u003c/p>\n\u003cp>“I believe that will go a long way to helping us improve public safety by using a public health strategy,” he said.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Health insurance sign-ups available to all inmates at the San Francisco county jail.\u003c/aside>\n\u003cp>He estimates this will help save taxpayers millions of dollars.\u003c/p>\n\u003cp>One inmate – Sophia – recently requested help signing up for health insurance. Sophia, who asked that her last name not be used, was caught driving a stolen car in January and sentenced to three months in the county jail. She says that was because she stopped getting treatment for her substance abuse and mental health problems when her health insurance expired.\u003c!--more-->\u003c/p>\n\u003cp>“It stopped in December. And I didn’t get it reinstated. So I didn’t address any of my issues and I guess that’s why I found myself in a car, driving around,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She thought she might not do that again if she could get back on a health plan. She asked the jail if they could help her find one. Tanya Mara, the director of the health division of jail reentry services, came to walk her through the process of applying for health insurance.\u003c/p>\n\u003cp>“Prior to your arrest, did you have an income?\" Mara asked Sophia. \"Does your income change from month to month? What do you expect your income to be for 2014?”\u003c/p>\n\u003cp>Mara quickly identified a program for Sophia.\u003c/p>\n\u003cp>“You would likely qualify for Medi-Cal,” she says. “With the Affordable Care Act, you can now qualify for Medi-Cal based on income.” Medi-Cal is California's version of Medicaid, health insurance for people who are low income.\u003c/p>\n\u003cp>Obamacare has changed two key things for the formerly incarcerated. First, it expanded Medicaid to include childless adults. That means most prisoners will now qualify for the free government health coverage when they get out. Second, all plans must now cover treatment for mental health and substance use disorders –- problems that affect more than half the people in prison or jail, according to a report by the U.S. Department of Justice.\u003c/p>\n\u003cp>\u003cstrong>\"Captive Audience\" for Enrollment\u003c/strong>\u003c/p>\n\u003cp>Pretty soon, health insurance sign-ups like Sophia’s will happen for all inmates at the San Francisco county jail -- whether they request it or not. And they’ll happen right when most new arrivals get booked into custody.\u003c/p>\n\u003cp>“You have a captive audience,” Sheriff Mirkarimi said. He wants to make sure the 30,000 prisoners who come through the jail system every year are covered on the day they’re released.\u003c/p>\n\u003cp>The sheriff was behind the new city law. It authorizes his staff to enroll people into health care plans under the Affordable Care Act, 24 hours a day, 7 days a week. Other counties and states are exploring similar efforts for people exiting jail or prison.\u003c/p>\n\u003cp>But Mirkarimi acknowledges that getting coverage is just one small step. Just because someone has a newly minted Medi-Cal card doesn't mean they'll know how to use it.\u003c/p>\n\u003cp>“No, they’re going to have to demonstrate the wherewithal and resourcefulness to use that Medi-Cal card,” he said. “We, and our staff, help them get ready. But ultimately, it’s on them.”\u003c/p>\n\u003cp>That’s not how Wanda Fain sees it. She was just released from state prison after 21 years behind bars. Everything is new to her. Getting on and off escalators is weird. Mobile phones are a new concept. She says she needs a friend just to help her ride the bus.\u003c/p>\n\u003cp>“They tell me what bus we on, they tell me what stops to get off,” she said, “what specific things to look for so I won’t miss a stop.”\u003c/p>\n\u003cp>Don’t even get her started on housing.\u003c/p>\n\u003cp>“Us parolees, we can’t leave San Francisco. But at the same token, we can’t afford to stay in San Francisco,” she said. “Cause it’s, what ,$4,000 for a one bedroom? Who coming out of prison got that money?”\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/147255043&color=ff5500&auto_play=false&hide_related=false&show_artwork=true\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>Navigating the health care system is even more confusing. Fain has seizures, lymphoma, and bipolar disorder. In prison, the guards regulated all of her care for her. She wasn't allowed to eat a meal until she took her meds. But on the outside, it's up to her to find the right doctor, the right pharmacy –- and to figure out which four buses she needs to take to get there.\u003c/p>\n\u003cp>“It's little things like that that people think are so easy,\" she said, shaking her head. “They are so overwhelming.”\u003c/p>\n\u003cp>If Sheriff Mirkarimi's plan is going to work, people getting out of jail are going to need help on the other side.\u003c/p>\n\u003cp>\u003cstrong>Clinic Helps Former Prisoners Navigate Health Care System\u003c/strong>\u003c/p>\n\u003cp>Most inmates leaving jail or prison are like Fain and have several chronic conditions. And most are so focused on other things that they rarely get medical help until things are so bad that they end up in the Emergency Room.\u003c/p>\n\u003cp>“These are really some of the sickest patients we see in our system,” said Shira Shavit, a family doctor in San Francisco. “They have high rates of hospitalization, very high rates of using the emergency room, and also very high rates of death.”\u003c/p>\n\u003cp>Dr. Shavit is trying to shift those trends. She’s the director of The Transitions Clinic, a specialized program designed for former prisoners, where doctors, psychiatrists, and social workers all consult together on the same patients. But its key staff are community health workers who have all spent time behind bars, too; people like Juanita Alvarado who help patients with all the tasks that would otherwise get in the way of caring for their health -- applying for housing, social security, finding a job, printing out paperwork or bus maps.\u003c/p>\n\u003cp>“Basically holding their hands in the first few weeks after they’re out,” Alvarado said.\u003c/p>\n\u003cp>She keeps the bookshelf behind her desk stocked with soup, breakfast bars, peanut butter, and tuna fish. A lot of their patients are denied food stamps because of drug convictions and have trouble finding affordable groceries.\u003c/p>\n\u003cp>“So I hook them up with a little bag,” Alvarado said.\u003c/p>\n\u003cp>The one-stop-shop approach works. Transition program patients show up for their appointments at higher rates than other patients, and, Dr. Shavit says ER use among their patients has dropped by 50 percent.\u003c/p>\n\u003cp>That caught the attention of the federal government, which foots a lot of those ER bills with taxpayer dollars. It gave the clinic a special $6.8 million \u003ca href=\"http://innovation.cms.gov/initiatives/Health-Care-Innovation-Awards/California.html\" target=\"_blank\">innovation grant\u003c/a> created under the Affordable Care Act to expand the concept beyond San Francisco. The team is using the money to help 11 clinics in six states and Puerto Rico hire and train former prisoners to staff similar programs. Federal health officials believe this will ultimately save $8 million.\u003c/p>\n\u003cp>The even broader goal – for both Mirkarimi’s plan and the Transitions Clinic – is that health care will help keep people from going back to jail or prison. Recidivism rates have dipped in recent years, but they are still high – 61 percent of people who leave a California prison return within three years. For people on parole or probation in San Francisco, the rate is even higher.\u003c/p>\n\u003cp>Wanda Fain feels like she’s just skirting those statistics. She lives a short walk away from the Transitions Clinic and comes often to get help with a range of tasks and health issues.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“If I didn't have Juanita Alvarado, or Dr. Shavit, or any of them, I’d be in – I don’t know where I’d be,” she said. “Probably on my way back.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Yes, California Leads in Obamacare -- But the Marathon is Just Beginning",
"title": "Yes, California Leads in Obamacare -- But the Marathon is Just Beginning",
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"content": "\u003cfigure id=\"attachment_15508\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/coveredca.jpg\">\u003cimg class=\"size-full wp-image-15508\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/coveredca.jpg\" alt=\"Screenshot from CoveredCA.com, the website of Covered California.\" width=\"640\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca-320x180.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Screenshot from CoveredCA.com, the website of Covered California.\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Dan Diamond,\u003c/strong> \u003ca href=\"http://www.californiahealthline.org/road-to-reform/2014/how-california-took-the-lead-on-obamacare-and-why-its-too-early-to-take-a-victory-lap\" target=\"_blank\">California Healthline\u003c/a>\u003c/p>\n\u003cp>Joel Ario says he meant it as a compliment.\u003c/p>\n\u003cp>It was January 2011, and Ario -- the White House's point man on exchanges at the time -- was having dinner with Diana Dooley, California's newly installed HHS secretary. And seeking to praise California, Ario told Dooley that her state had emerged as one of the nation's \"pace cars\" when it came to implementing the Affordable Care Act.\u003c/p>\n\u003caside class=\"pullquote alignleft\">The enrollment numbers are terrific, \"but it's too early to hang the Mission Accomplished banner.\"\u003c/aside>\n\u003cp>Dooley quickly corrected him, Ario recalled in an interview with \u003cem>California Healthline \u003c/em>this week.\u003c/p>\n\u003cp>\"[Dooley] told me, 'Pace cars don't actually win the race,'\" Ario said. \"'We want to be the \u003cem>lead \u003c/em>car.'\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Forty months later, California's clearly pulled ahead of the pack. No state signed up more residents during Obamacare's first open enrollment period, or grew its Medicaid rolls by a larger amount.\u003c/p>\n\u003cp>But not all glitters in the Golden State. While Covered California drove national enrollment -- nearly one in five of all 8 million national ACA sign-ups went through the state's insurance exchange -- its faltering website and sometimes spotty service made for an occasionally bumpy ride.\u003c!--more-->\u003c/p>\n\u003cp>\"Road to Reform\" interviewed Ario and more than 10 other ex-officials and experts -- many of whom also spoke with \u003cem>California Healthline \u003c/em>last fall on the \u003ca style=\"color: #6d1618\" href=\"http://www.californiahealthline.org/road-to-reform/2013/california-raced-to-set-the-pace-on-obamacare-implementation-did-it-pay-off\" target=\"_blank\">eve of open enrollment\u003c/a> -- to assess the state of the state's Obamacare implementation, and what roadblocks loom ahead.\u003c/p>\n\u003cp>\u003cstrong>How California Grabbed Pole Position\u003c/strong>\u003c/p>\n\u003cp>As many of those experts predicted in interviews last fall, California's early investments ended up staking the state to its later lead.\u003c/p>\n\u003cp>For example, the state and advocates focused on successfully growing California's Medicaid program, a decision that's been somewhat overlooked in recent months with all of the attention on the exchange. More than 600,000 state residents got coverage through California's early expansion of Medi-Cal, the \u003ca style=\"color: #6d1618\" href=\"http://www.californiahealthline.org/road-to-reform/2014/this-program-was-bigger-than-covered-california-why-did-we-ignore-it\" target=\"_blank\">Low-Income Health Plan\u003c/a>. And \"we spent literally tens of millions of dollars [reaching out] to the lowest-income people,\" says Daniel Zingale of the California Endowment.\u003c/p>\n\u003cp>The state and community groups also planned to pour more than \u003ca style=\"color: #6d1618\" href=\"http://www.californiahealthline.org/articles/2013/4/26/calif-health-exchange-to-spend-290m-on-public-outreach-efforts\" target=\"_blank\">$200 million dollars\u003c/a> into exchange-related awareness and outreach, and while some of the marketing materials were panned as being too dry and earnest -- Covered California made a commitment to stay away from \"funny\" advertisements -- the final numbers speak for themselves, several state officials told \u003cem>California Healthline\u003c/em>.\u003c/p>\n\u003cp>Even when the exchange's website crashed under demand in early October, California was able to weather its early difficulties and bounce back -- a pattern of flexibility that generally persisted throughout the enrollment period. Meanwhile, the other purported pace cars couldn't keep up, largely because of technical failures. Maryland's website stalled out. Oregon's never got out of the gate. Even vaunted Massachusetts had problems with its exchange's engine. California's aggressive pursuit of Obamacare implementation allowed the state to maximize year one of coverage expansion, experts say.\u003c/p>\n\u003cp>For example, when Covered California released its latest enrollment update last Thursday, the sheer totals were striking. As of April 15:\u003c/p>\n\u003cul>\n\u003cli>1.4 million people had signed up for private plans through the exchange -- about \u003ca style=\"color: #6d1618\" href=\"http://www.californiahealthline.org/road-to-reform/2014/1m-cancellations-1-2m-enrollments-how-many-californians-really-signed-up\" target=\"_blank\">twice as many as expected\u003c/a>;\u003c/li>\n\u003cli>1.9 million people had enrolled in Medi-Cal, with 1.1 million coming through the exchange and 600,000-plus coming through the Low Income Health Plan; and\u003c/li>\n\u003cli>1.3 million Latinos had \u003ca style=\"color: #6d1618\" href=\"http://www.californiahealthline.org/capitol-desk/2014/4/more-than-one-million-latinos-enrolled-in-exchange-or-medical-in-six-months\" target=\"_blank\">obtained coverage\u003c/a> through the exchange or Medi-Cal.\u003c/li>\n\u003c/ul>\n\u003cp>The Golden State's coverage gains look even more eye-popping when extrapolated nationwide.\u003c/p>\n\u003cp>As Larry Levitt of the Kaiser Family Foundation has \u003ca style=\"color: #6d1618\" href=\"https://twitter.com/larry_levitt/status/445613060045406208\" target=\"_blank\">consistently noted\u003c/a>, Covered California ended up enrolling 42% of its projected \u003ca style=\"color: #6d1618\" href=\"http://kff.org/health-reform/state-indicator/marketplace-enrollment-as-a-share-of-the-potential-marketplace-population/\" target=\"_blank\">eligible market\u003c/a>.\u003c/p>\n\u003cul>\n\u003cli>If every state had kept up with California's pace, national exchange enrollment would have topped 12 million.\u003c/li>\n\u003cli>If every state had been limited to Massachusetts' pace? National exchange enrollment would have been around 3 million.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>Lessons From The State\u003c/strong>\u003c/p>\n\u003cp>For all of California's pre-planning, the state's health care leaders had to make several important decisions during the open enrollment period.\u003c/p>\n\u003cp>One key moment: When California was forced to choose whether it would allow residents to keep plans that didn't meet ACA requirements, after the White House punted the decision to the states. After a \u003ca style=\"color: #6d1618\" href=\"http://ww2.kqed.org/stateofhealth/2013/11/21/californians-with-canceled-policies-cannot-renew-says-covered-california-board/\" target=\"_blank\">high-profile debate\u003c/a>, California ultimately said no -- and Ario thinks that decision will end up being \"a big advantage\" for the state.\u003c/p>\n\u003cp>\"That means the risk pool is going to be better,\" he said, suggesting that more young, healthy enrollees ended up picking new plans through the exchange rather than keeping their old, non-compliant policies. (Since leaving the White House, Ario now tracks health reform implementation as a managing director with Manatt Health Solutions.)\u003c/p>\n\u003cp>Covered California also pivoted when Latino enrollment lagged estimates, nearly doubling its Latino-related marketing in the first quarter of 2014 and partnering with a prominent advocate, Dolores Huerta. That had an impact, officials now say: The proportion of enrollees who self-identified as Latino went from 18% of all sign-ups in October through December to 32% in the first weeks of March.\u003c/p>\n\u003cp>California's leaders had shown flexibility before, too. After Gov. Arnold Schwarzenegger (R) made a prominent, \u003ca style=\"color: #6d1618\" href=\"http://www.californiahealthline.org/road-to-reform/2010/governors-support-for-reform-not-just-political\" target=\"_blank\">early commitment\u003c/a> to the ACA in 2010, the statehouse changed hands later that year. And a smooth hand-off was no guarantee, Zingale notes. \"We had one candidate for governor [in 2010] who said she'd support the repeal,\" he says.\u003c/p>\n\u003cp>\"We had one candidate for attorney general who said he'd join the Supreme Court case against the law.\" But Kim Belshé -- Dooley's predecessor as HHS secretary, under Schwarzenegger -- thinks the eventual, seamless transition helped get California where it wanted to go. \"Our state's success is a testimony both to the early action and foresight of Governor Schwarzenegger and the 2010 Legislature,\" Belshé tells \u003cem>California Healthline\u003c/em>, \"and to Governor Brown and his Administration [who] stepped behind the wheel and steered the course of implementation so ably and successfully.\"\u003c/p>\n\u003cp>\u003cstrong>Frustrations Persist\u003c/strong>\u003c/p>\n\u003cp>Still, nearly every expert -- and the head of Covered California himself -- acknowledges that not everything went to plan.\u003c/p>\n\u003cp>\"I will be the first to admit our launch has not been perfect,\" Peter Lee, head of Covered California, told a U.S. House of Representatives committee earlier this month. \"Many have compared it to building the car while driving 70 miles an hour.\"\u003c/p>\n\u003cp>\"We did have a colossally bad opening day,\" Zingale ruefully reflects. \"We were like the 'Ishtar' of [debuts] ... October and November were rough.\"\u003c/p>\n\u003cp>Zingale and others reiterate that they'd grade Covered California's overall performance as very good, or even great. But they note that several problems persistently plagued the state's efforts.\u003c/p>\n\u003cp>\u003cstrong>Website breakdowns: \u003c/strong>While not as bad as other states, Covered California suffered its own share of website outages, and ensuring that the online provider directory was accurate also proved consistently problematic.\u003c/p>\n\u003cp>Addressing those issues will be an area of focus moving forward, state officials say. \u003cstrong>\"\u003c/strong>We'll be working throughout the summer to improve our online platform experience,\" Larry Hicks, a Covered California spokesperson, tells \u003cem>California Healthline\u003c/em>.\u003c/p>\n\u003cp>\u003cstrong>Consistent service issues\u003c/strong>: The exchange also grappled with off-line problems: In February and through mid-March, about one-third of callers to Covered California got a busy signal and less than 5% of calls to Covered California were answered within 30 seconds, \u003ca style=\"color: #6d1618\" href=\"http://articles.latimes.com/2014/mar/20/business/la-fi-mo-health-exchange-california-20140320\" target=\"_blank\">Chad Terhune wrote\u003c/a> for the \u003cem>Los Angeles Times\u003c/em> last month. \"Overall, 40% of exchange customers surveyed said they found the enrollment process difficult,\" Terhune added.\u003c/p>\n\u003cp>There were less visible back-office problems, too. Covered California didn't expect that so many health insurance brokers would be interested in getting certified, notes Micah Weinberg of the Bay Area Council. \"They planned for 3,000 and ended up with over 10,000,\" according to Weinberg. \"So there were delays getting brokers training and certified, and it looks like brokers overperformed their expected enrollments while other channels underperformed.\" And brokers and community assisters didn't \u003ca style=\"color: #6d1618\" href=\"http://www.californiahealthline.org/articles/2014/2/25/covered-calif-broker-payments-delayed-by-data-problems\" target=\"_blank\">get paid\u003c/a> on time.\u003c/p>\n\u003cp>\u003cstrong>Outreach to minority communities\u003c/strong>: Several experts pointed out that while Covered California hit its enrollment goals, there were some potholes in the approach.\u003c/p>\n\u003cp>\"I'm not a marketing expert,\" UCLA's Dylan Roby tells \u003cem>California Healthline\u003c/em>, \"but I've heard some pretty compelling arguments from the Latino community about the disconnect between their typical process for purchasing [insurance] and the campaign targeted at Latinos ... the Enrollment Counselor model has been pretty successful once it got going, but the late start and lack of a paper application in Spanish until Dec. 30, 2013, was harmful to the overall effort.\"\u003c/p>\n\u003cp>The end of open enrollment means that state leaders must grapple with new challenges, too.\u003c/p>\n\u003col>\n\u003cli>\u003cstrong>The safety-net could be stressed\u003c/strong>:\u003cstrong> \u003c/strong>A \"coverage expansion\" isn't equivalent to \"coverage for all,\" and safety-net providers already are reporting an uptick in visits -- even as many immigrants and lower-income residents still find themselves left out of the ACA's new plans but still need access to care, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/04/16/obamacare-means-new-challenges-for-safety-net-providers-in-salinas-and-cathedral-city/\" target=\"_blank\">Lisa Morehouse wrote\u003c/a> for \"State of Health.\"\u003c/li>\n\u003cli>\u003cstrong>Disparities in costs\u003c/strong>: The ACA's insurance market reforms shine a light on how much an identical insurance policy costs in different parts of the state, Kaiser's Levitt points out, \"and the disparities are eye-popping.\" For example, Levitt says that a policy in San Francisco can cost 50% more than the same policy in Los Angeles. \"That's due to big differences in the underlying cost of health care across the state,\" he adds. \"Will this create market or political pressure to do something about that?\"\u003c/li>\n\u003cli>\u003cstrong>Keeping the exchange on budget: \u003c/strong>Covered California officials last week said they needed to boost the exchange's fiscal year 2013-2014 budget by \u003ca style=\"color: #6d1618\" href=\"http://www.californiahealthline.org/capitol-desk/2014/4/exchange-goes-over-firstyear-budget\" target=\"_blank\">nearly $90 million\u003c/a>, mainly citing the scramble to spend more on information technology. But unlike other states -- which may need to trim their exchange budgets moving forward, because enrollment didn't measure up -- that's not the case in California, officials say. \"We are positioned to cover all our expenses through our revenue, because our enrollment was so large,\" according to Covered California's Hicks. \"It's not a concern.\"\u003c/li>\n\u003c/ol>\n\u003cp>\u003cstrong>Don't Declare 'Mission Accomplished' Yet\u003c/strong>\u003c/p>\n\u003cp>The key question that's looming:\u003c/p>\n\u003cp>Has California won the race to implement Obamacare, or is the state just leading after a lap?\u003c/p>\n\u003cp>Even Covered California's Lee concedes that the state has a ways to go.\u003c/p>\n\u003cp>\"Although we have closed our first open-enrollment period, we are not declaring success. This is not the finish line, but it is a very good beginning,\" the exchange director \u003ca style=\"color: #6d1618\" href=\"http://news.coveredca.com/2014/04/covered-californias-executive-director.html\">wrote\u003c/a> in a blog post this week.\u003c/p>\n\u003cp>Other experts agree. The early enrollment numbers are terrific, Zingale says, \"but it's too early to hang the Mission Accomplished banner,\" especially given the ongoing areas of focus.\u003c/p>\n\u003cp>\"It's been a bumpy, and unpredictable ride, so far\" he notes, and \"I doubt that it's over.\"\u003c/p>\n\u003cp>Belshé laid out some of the state's top priorities. \"With the initial open enrollment just completed, we turn to retention of enrollees, the next open enrollment period, and ongoing Medi-Cal enrollment,\" she tells \u003cem>California Healthline\u003c/em>. \"And, we turn to the critical issue of access and health improvement.\"\u003c/p>\n\u003cp>\"Enrollment is not the end point but the starting point for better care, better quality, and better health,\" Belshé adds.\u003c/p>\n\u003cp>For his part, Ario believes that the Golden State has moved ahead of the pack -- just as Dooley suggested it would, all those years ago.\u003c/p>\n\u003cp>\"I think California is \u003cem>the \u003c/em>lead car,\" Ario concluded this week. \"If Massachusetts was the state that got ACA passed originally, California is the state that's getting it legitimated for the nation.\"\u003c/p>\n\u003cp>\u003cem>Dan Diamond is a contributing editor for California Healthline.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"uQmYzmYGunyU5htZ7GoSpYmQK6yQShwu\"]\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_15508\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/coveredca.jpg\">\u003cimg class=\"size-full wp-image-15508\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/coveredca.jpg\" alt=\"Screenshot from CoveredCA.com, the website of Covered California.\" width=\"640\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca-320x180.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Screenshot from CoveredCA.com, the website of Covered California.\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Dan Diamond,\u003c/strong> \u003ca href=\"http://www.californiahealthline.org/road-to-reform/2014/how-california-took-the-lead-on-obamacare-and-why-its-too-early-to-take-a-victory-lap\" target=\"_blank\">California Healthline\u003c/a>\u003c/p>\n\u003cp>Joel Ario says he meant it as a compliment.\u003c/p>\n\u003cp>It was January 2011, and Ario -- the White House's point man on exchanges at the time -- was having dinner with Diana Dooley, California's newly installed HHS secretary. And seeking to praise California, Ario told Dooley that her state had emerged as one of the nation's \"pace cars\" when it came to implementing the Affordable Care Act.\u003c/p>\n\u003caside class=\"pullquote alignleft\">The enrollment numbers are terrific, \"but it's too early to hang the Mission Accomplished banner.\"\u003c/aside>\n\u003cp>Dooley quickly corrected him, Ario recalled in an interview with \u003cem>California Healthline \u003c/em>this week.\u003c/p>\n\u003cp>\"[Dooley] told me, 'Pace cars don't actually win the race,'\" Ario said. \"'We want to be the \u003cem>lead \u003c/em>car.'\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Forty months later, California's clearly pulled ahead of the pack. No state signed up more residents during Obamacare's first open enrollment period, or grew its Medicaid rolls by a larger amount.\u003c/p>\n\u003cp>But not all glitters in the Golden State. While Covered California drove national enrollment -- nearly one in five of all 8 million national ACA sign-ups went through the state's insurance exchange -- its faltering website and sometimes spotty service made for an occasionally bumpy ride.\u003c!--more-->\u003c/p>\n\u003cp>\"Road to Reform\" interviewed Ario and more than 10 other ex-officials and experts -- many of whom also spoke with \u003cem>California Healthline \u003c/em>last fall on the \u003ca style=\"color: #6d1618\" href=\"http://www.californiahealthline.org/road-to-reform/2013/california-raced-to-set-the-pace-on-obamacare-implementation-did-it-pay-off\" target=\"_blank\">eve of open enrollment\u003c/a> -- to assess the state of the state's Obamacare implementation, and what roadblocks loom ahead.\u003c/p>\n\u003cp>\u003cstrong>How California Grabbed Pole Position\u003c/strong>\u003c/p>\n\u003cp>As many of those experts predicted in interviews last fall, California's early investments ended up staking the state to its later lead.\u003c/p>\n\u003cp>For example, the state and advocates focused on successfully growing California's Medicaid program, a decision that's been somewhat overlooked in recent months with all of the attention on the exchange. More than 600,000 state residents got coverage through California's early expansion of Medi-Cal, the \u003ca style=\"color: #6d1618\" href=\"http://www.californiahealthline.org/road-to-reform/2014/this-program-was-bigger-than-covered-california-why-did-we-ignore-it\" target=\"_blank\">Low-Income Health Plan\u003c/a>. And \"we spent literally tens of millions of dollars [reaching out] to the lowest-income people,\" says Daniel Zingale of the California Endowment.\u003c/p>\n\u003cp>The state and community groups also planned to pour more than \u003ca style=\"color: #6d1618\" href=\"http://www.californiahealthline.org/articles/2013/4/26/calif-health-exchange-to-spend-290m-on-public-outreach-efforts\" target=\"_blank\">$200 million dollars\u003c/a> into exchange-related awareness and outreach, and while some of the marketing materials were panned as being too dry and earnest -- Covered California made a commitment to stay away from \"funny\" advertisements -- the final numbers speak for themselves, several state officials told \u003cem>California Healthline\u003c/em>.\u003c/p>\n\u003cp>Even when the exchange's website crashed under demand in early October, California was able to weather its early difficulties and bounce back -- a pattern of flexibility that generally persisted throughout the enrollment period. Meanwhile, the other purported pace cars couldn't keep up, largely because of technical failures. Maryland's website stalled out. Oregon's never got out of the gate. Even vaunted Massachusetts had problems with its exchange's engine. California's aggressive pursuit of Obamacare implementation allowed the state to maximize year one of coverage expansion, experts say.\u003c/p>\n\u003cp>For example, when Covered California released its latest enrollment update last Thursday, the sheer totals were striking. As of April 15:\u003c/p>\n\u003cul>\n\u003cli>1.4 million people had signed up for private plans through the exchange -- about \u003ca style=\"color: #6d1618\" href=\"http://www.californiahealthline.org/road-to-reform/2014/1m-cancellations-1-2m-enrollments-how-many-californians-really-signed-up\" target=\"_blank\">twice as many as expected\u003c/a>;\u003c/li>\n\u003cli>1.9 million people had enrolled in Medi-Cal, with 1.1 million coming through the exchange and 600,000-plus coming through the Low Income Health Plan; and\u003c/li>\n\u003cli>1.3 million Latinos had \u003ca style=\"color: #6d1618\" href=\"http://www.californiahealthline.org/capitol-desk/2014/4/more-than-one-million-latinos-enrolled-in-exchange-or-medical-in-six-months\" target=\"_blank\">obtained coverage\u003c/a> through the exchange or Medi-Cal.\u003c/li>\n\u003c/ul>\n\u003cp>The Golden State's coverage gains look even more eye-popping when extrapolated nationwide.\u003c/p>\n\u003cp>As Larry Levitt of the Kaiser Family Foundation has \u003ca style=\"color: #6d1618\" href=\"https://twitter.com/larry_levitt/status/445613060045406208\" target=\"_blank\">consistently noted\u003c/a>, Covered California ended up enrolling 42% of its projected \u003ca style=\"color: #6d1618\" href=\"http://kff.org/health-reform/state-indicator/marketplace-enrollment-as-a-share-of-the-potential-marketplace-population/\" target=\"_blank\">eligible market\u003c/a>.\u003c/p>\n\u003cul>\n\u003cli>If every state had kept up with California's pace, national exchange enrollment would have topped 12 million.\u003c/li>\n\u003cli>If every state had been limited to Massachusetts' pace? National exchange enrollment would have been around 3 million.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>Lessons From The State\u003c/strong>\u003c/p>\n\u003cp>For all of California's pre-planning, the state's health care leaders had to make several important decisions during the open enrollment period.\u003c/p>\n\u003cp>One key moment: When California was forced to choose whether it would allow residents to keep plans that didn't meet ACA requirements, after the White House punted the decision to the states. After a \u003ca style=\"color: #6d1618\" href=\"http://ww2.kqed.org/stateofhealth/2013/11/21/californians-with-canceled-policies-cannot-renew-says-covered-california-board/\" target=\"_blank\">high-profile debate\u003c/a>, California ultimately said no -- and Ario thinks that decision will end up being \"a big advantage\" for the state.\u003c/p>\n\u003cp>\"That means the risk pool is going to be better,\" he said, suggesting that more young, healthy enrollees ended up picking new plans through the exchange rather than keeping their old, non-compliant policies. (Since leaving the White House, Ario now tracks health reform implementation as a managing director with Manatt Health Solutions.)\u003c/p>\n\u003cp>Covered California also pivoted when Latino enrollment lagged estimates, nearly doubling its Latino-related marketing in the first quarter of 2014 and partnering with a prominent advocate, Dolores Huerta. That had an impact, officials now say: The proportion of enrollees who self-identified as Latino went from 18% of all sign-ups in October through December to 32% in the first weeks of March.\u003c/p>\n\u003cp>California's leaders had shown flexibility before, too. After Gov. Arnold Schwarzenegger (R) made a prominent, \u003ca style=\"color: #6d1618\" href=\"http://www.californiahealthline.org/road-to-reform/2010/governors-support-for-reform-not-just-political\" target=\"_blank\">early commitment\u003c/a> to the ACA in 2010, the statehouse changed hands later that year. And a smooth hand-off was no guarantee, Zingale notes. \"We had one candidate for governor [in 2010] who said she'd support the repeal,\" he says.\u003c/p>\n\u003cp>\"We had one candidate for attorney general who said he'd join the Supreme Court case against the law.\" But Kim Belshé -- Dooley's predecessor as HHS secretary, under Schwarzenegger -- thinks the eventual, seamless transition helped get California where it wanted to go. \"Our state's success is a testimony both to the early action and foresight of Governor Schwarzenegger and the 2010 Legislature,\" Belshé tells \u003cem>California Healthline\u003c/em>, \"and to Governor Brown and his Administration [who] stepped behind the wheel and steered the course of implementation so ably and successfully.\"\u003c/p>\n\u003cp>\u003cstrong>Frustrations Persist\u003c/strong>\u003c/p>\n\u003cp>Still, nearly every expert -- and the head of Covered California himself -- acknowledges that not everything went to plan.\u003c/p>\n\u003cp>\"I will be the first to admit our launch has not been perfect,\" Peter Lee, head of Covered California, told a U.S. House of Representatives committee earlier this month. \"Many have compared it to building the car while driving 70 miles an hour.\"\u003c/p>\n\u003cp>\"We did have a colossally bad opening day,\" Zingale ruefully reflects. \"We were like the 'Ishtar' of [debuts] ... October and November were rough.\"\u003c/p>\n\u003cp>Zingale and others reiterate that they'd grade Covered California's overall performance as very good, or even great. But they note that several problems persistently plagued the state's efforts.\u003c/p>\n\u003cp>\u003cstrong>Website breakdowns: \u003c/strong>While not as bad as other states, Covered California suffered its own share of website outages, and ensuring that the online provider directory was accurate also proved consistently problematic.\u003c/p>\n\u003cp>Addressing those issues will be an area of focus moving forward, state officials say. \u003cstrong>\"\u003c/strong>We'll be working throughout the summer to improve our online platform experience,\" Larry Hicks, a Covered California spokesperson, tells \u003cem>California Healthline\u003c/em>.\u003c/p>\n\u003cp>\u003cstrong>Consistent service issues\u003c/strong>: The exchange also grappled with off-line problems: In February and through mid-March, about one-third of callers to Covered California got a busy signal and less than 5% of calls to Covered California were answered within 30 seconds, \u003ca style=\"color: #6d1618\" href=\"http://articles.latimes.com/2014/mar/20/business/la-fi-mo-health-exchange-california-20140320\" target=\"_blank\">Chad Terhune wrote\u003c/a> for the \u003cem>Los Angeles Times\u003c/em> last month. \"Overall, 40% of exchange customers surveyed said they found the enrollment process difficult,\" Terhune added.\u003c/p>\n\u003cp>There were less visible back-office problems, too. Covered California didn't expect that so many health insurance brokers would be interested in getting certified, notes Micah Weinberg of the Bay Area Council. \"They planned for 3,000 and ended up with over 10,000,\" according to Weinberg. \"So there were delays getting brokers training and certified, and it looks like brokers overperformed their expected enrollments while other channels underperformed.\" And brokers and community assisters didn't \u003ca style=\"color: #6d1618\" href=\"http://www.californiahealthline.org/articles/2014/2/25/covered-calif-broker-payments-delayed-by-data-problems\" target=\"_blank\">get paid\u003c/a> on time.\u003c/p>\n\u003cp>\u003cstrong>Outreach to minority communities\u003c/strong>: Several experts pointed out that while Covered California hit its enrollment goals, there were some potholes in the approach.\u003c/p>\n\u003cp>\"I'm not a marketing expert,\" UCLA's Dylan Roby tells \u003cem>California Healthline\u003c/em>, \"but I've heard some pretty compelling arguments from the Latino community about the disconnect between their typical process for purchasing [insurance] and the campaign targeted at Latinos ... the Enrollment Counselor model has been pretty successful once it got going, but the late start and lack of a paper application in Spanish until Dec. 30, 2013, was harmful to the overall effort.\"\u003c/p>\n\u003cp>The end of open enrollment means that state leaders must grapple with new challenges, too.\u003c/p>\n\u003col>\n\u003cli>\u003cstrong>The safety-net could be stressed\u003c/strong>:\u003cstrong> \u003c/strong>A \"coverage expansion\" isn't equivalent to \"coverage for all,\" and safety-net providers already are reporting an uptick in visits -- even as many immigrants and lower-income residents still find themselves left out of the ACA's new plans but still need access to care, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/04/16/obamacare-means-new-challenges-for-safety-net-providers-in-salinas-and-cathedral-city/\" target=\"_blank\">Lisa Morehouse wrote\u003c/a> for \"State of Health.\"\u003c/li>\n\u003cli>\u003cstrong>Disparities in costs\u003c/strong>: The ACA's insurance market reforms shine a light on how much an identical insurance policy costs in different parts of the state, Kaiser's Levitt points out, \"and the disparities are eye-popping.\" For example, Levitt says that a policy in San Francisco can cost 50% more than the same policy in Los Angeles. \"That's due to big differences in the underlying cost of health care across the state,\" he adds. \"Will this create market or political pressure to do something about that?\"\u003c/li>\n\u003cli>\u003cstrong>Keeping the exchange on budget: \u003c/strong>Covered California officials last week said they needed to boost the exchange's fiscal year 2013-2014 budget by \u003ca style=\"color: #6d1618\" href=\"http://www.californiahealthline.org/capitol-desk/2014/4/exchange-goes-over-firstyear-budget\" target=\"_blank\">nearly $90 million\u003c/a>, mainly citing the scramble to spend more on information technology. But unlike other states -- which may need to trim their exchange budgets moving forward, because enrollment didn't measure up -- that's not the case in California, officials say. \"We are positioned to cover all our expenses through our revenue, because our enrollment was so large,\" according to Covered California's Hicks. \"It's not a concern.\"\u003c/li>\n\u003c/ol>\n\u003cp>\u003cstrong>Don't Declare 'Mission Accomplished' Yet\u003c/strong>\u003c/p>\n\u003cp>The key question that's looming:\u003c/p>\n\u003cp>Has California won the race to implement Obamacare, or is the state just leading after a lap?\u003c/p>\n\u003cp>Even Covered California's Lee concedes that the state has a ways to go.\u003c/p>\n\u003cp>\"Although we have closed our first open-enrollment period, we are not declaring success. This is not the finish line, but it is a very good beginning,\" the exchange director \u003ca style=\"color: #6d1618\" href=\"http://news.coveredca.com/2014/04/covered-californias-executive-director.html\">wrote\u003c/a> in a blog post this week.\u003c/p>\n\u003cp>Other experts agree. The early enrollment numbers are terrific, Zingale says, \"but it's too early to hang the Mission Accomplished banner,\" especially given the ongoing areas of focus.\u003c/p>\n\u003cp>\"It's been a bumpy, and unpredictable ride, so far\" he notes, and \"I doubt that it's over.\"\u003c/p>\n\u003cp>Belshé laid out some of the state's top priorities. \"With the initial open enrollment just completed, we turn to retention of enrollees, the next open enrollment period, and ongoing Medi-Cal enrollment,\" she tells \u003cem>California Healthline\u003c/em>. \"And, we turn to the critical issue of access and health improvement.\"\u003c/p>\n\u003cp>\"Enrollment is not the end point but the starting point for better care, better quality, and better health,\" Belshé adds.\u003c/p>\n\u003cp>For his part, Ario believes that the Golden State has moved ahead of the pack -- just as Dooley suggested it would, all those years ago.\u003c/p>\n\u003cp>\"I think California is \u003cem>the \u003c/em>lead car,\" Ario concluded this week. \"If Massachusetts was the state that got ACA passed originally, California is the state that's getting it legitimated for the nation.\"\u003c/p>\n\u003cp>\u003cem>Dan Diamond is a contributing editor for California Healthline.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Despite Obamacare, Why Some Choose to Skip Health Insurance",
"title": "Despite Obamacare, Why Some Choose to Skip Health Insurance",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_18906\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/scott-belsha_wide-a87f62e61a76732bf9dfab9cef2e11f13fc600ee-s40-c85.jpg\">\u003cimg class=\"size-large wp-image-18906\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/scott-belsha_wide-a87f62e61a76732bf9dfab9cef2e11f13fc600ee-s40-c85-640x360.jpg\" alt=\"Scott Belsha says he opted out of buying health insurance because he has never had it and has managed to stay healthy (Stephanie O'Neill/NPR).\" width=\"640\" height=\"360\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Scott Belsha says he opted out of buying health insurance because he has never had it and has managed to stay healthy (Stephanie O'Neill/NPR).\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Stephanie O'Neill, \u003ca href=\"http://www.npr.org/blogs/health/2014/04/25/306440333/confusion-cost-lead-some-californians-to-go-uninsured\" target=\"_blank\">NPR\u003c/a>\u003c/strong>\u003c/p>\n\u003cp>Despite a surge in enrollment in the two weeks before the April 15 deadline to enroll for health insurance under the federal health law, many more Californians still haven't signed up, and they're unlikely to.\u003c/p>\n\u003cp>Many people are uninterested, confused or skeptical.\u003c/p>\n\u003cp>Scott Belsha, from Long Beach, Calif., falls in the skeptical category.\u003c/p>\n\u003cp>\"I've been consumed with living my life, and I'm fortunate to be healthy,\" he says. He works as a musician and carpenter, and he's never had health insurance. His parents, who own a small business, always paid cash for medical care, most of which they were able to get from a doctor friend.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"I haven't ever been to the hospital or broken a bone,\" he says. \"But I'm 34, and I should probably start thinking about it.\"\u003c!--more-->\u003c/p>\n\u003cp>Steven Petersen, 40, of Los Angeles, says he looked into his options but couldn't afford $240 a month, the lowest premium he could find. He'd prefer a cheap, catastrophic plan. \"I just take care of myself every day, and eat well and try to stay healthy,\" he says.\u003c/p>\n\u003cp>The Affordable Care Act's individual mandate requires nearly every American to have insurance or pay a tax penalty of either $95 or up to 1 percent of income, whichever is greater.\u003c/p>\n\u003cp>But Larry Levitt, senior vice president at the nonprofit Kaiser Family Foundation, says he wasn't expecting every uninsured person to sign up during this first year. \"The expectations are that enrollment will ramp up over a period of years,\" he says.\u003c/p>\n\u003cp>State of Health \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/04/23/expert-millions-more-uninsured-will-get-coverage-during-the-next-three-years/\" target=\"_blank\">reported\u003c/a> earlier this week that California health policy experts say it will take three years to get complete picture of enrollment in the state.\u003c/p>\n\u003cp>The Congressional Budget Office estimates that even years from now the number of uninsured will be large: about 30 million nationwide. Some of those people will be living in states that have opted not to expand Medicaid to adults without dependent children. Others will be immigrants who don't qualify for coverage under the law. \"But the biggest category are people who simply will choose not to enroll,\" Levitt says.\u003c/p>\n\u003cp>Beth Engel, in Ventura County, Calif., is a 32-year-old mother of a nearly 3-year-old daughter and describes herself as an early supporter of the Affordable Care Act.\u003c/p>\n\u003cp>\"I was very hopeful,\" she says. \"I thought, 'Wow! I can have a job that I love that doesn't necessarily have insurance but I get insurance affordably.'\"\u003c/p>\n\u003cp>Engel works part time as a hotel clerk and qualifies for tax subsidies that reduce premiums for her and her toddler to about $200 a month. But she chose not to buy insurance for herself this year. \"I found that the premiums were still very high, and I just couldn't afford them,\" she says.\u003c/p>\n\u003cp>Even though now she's armed with the knowledge that she can take the subsidy upfront in the form of a reduced insurance premium, she says she's reluctant to do that without thoroughly understanding the plans offered through the state-run marketplace,\u003c/p>\n\u003cp>\"Maybe I'm reading these incorrectly,\" she says, \"but it just didn't make sense, and I thought I'm not going to put money I don't really have to spend into a program that I don't really understand.\"\u003c/p>\n\u003cp>Engel did get her daughter health coverage through Medicaid. People in California and other states that expanded can enroll year-round. As for her own medical needs? She'll go without health insurance and pay the penalty, which for her is less than the cost of insurance. She says she'll reconsider her options when enrollment opens again in November.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>This story is part of a partnership with NPR, KPCC and \u003cem>Kaiser Health News\u003c/em>, an editorially independent program of the Kaiser Family Foundation.\u003c/p>\n\n",
"disqusIdentifier": "18905 http://blogs.kqed.org/stateofhealth/?p=18905",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_18906\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/scott-belsha_wide-a87f62e61a76732bf9dfab9cef2e11f13fc600ee-s40-c85.jpg\">\u003cimg class=\"size-large wp-image-18906\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/scott-belsha_wide-a87f62e61a76732bf9dfab9cef2e11f13fc600ee-s40-c85-640x360.jpg\" alt=\"Scott Belsha says he opted out of buying health insurance because he has never had it and has managed to stay healthy (Stephanie O'Neill/NPR).\" width=\"640\" height=\"360\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Scott Belsha says he opted out of buying health insurance because he has never had it and has managed to stay healthy (Stephanie O'Neill/NPR).\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Stephanie O'Neill, \u003ca href=\"http://www.npr.org/blogs/health/2014/04/25/306440333/confusion-cost-lead-some-californians-to-go-uninsured\" target=\"_blank\">NPR\u003c/a>\u003c/strong>\u003c/p>\n\u003cp>Despite a surge in enrollment in the two weeks before the April 15 deadline to enroll for health insurance under the federal health law, many more Californians still haven't signed up, and they're unlikely to.\u003c/p>\n\u003cp>Many people are uninterested, confused or skeptical.\u003c/p>\n\u003cp>Scott Belsha, from Long Beach, Calif., falls in the skeptical category.\u003c/p>\n\u003cp>\"I've been consumed with living my life, and I'm fortunate to be healthy,\" he says. He works as a musician and carpenter, and he's never had health insurance. His parents, who own a small business, always paid cash for medical care, most of which they were able to get from a doctor friend.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"I haven't ever been to the hospital or broken a bone,\" he says. \"But I'm 34, and I should probably start thinking about it.\"\u003c!--more-->\u003c/p>\n\u003cp>Steven Petersen, 40, of Los Angeles, says he looked into his options but couldn't afford $240 a month, the lowest premium he could find. He'd prefer a cheap, catastrophic plan. \"I just take care of myself every day, and eat well and try to stay healthy,\" he says.\u003c/p>\n\u003cp>The Affordable Care Act's individual mandate requires nearly every American to have insurance or pay a tax penalty of either $95 or up to 1 percent of income, whichever is greater.\u003c/p>\n\u003cp>But Larry Levitt, senior vice president at the nonprofit Kaiser Family Foundation, says he wasn't expecting every uninsured person to sign up during this first year. \"The expectations are that enrollment will ramp up over a period of years,\" he says.\u003c/p>\n\u003cp>State of Health \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/04/23/expert-millions-more-uninsured-will-get-coverage-during-the-next-three-years/\" target=\"_blank\">reported\u003c/a> earlier this week that California health policy experts say it will take three years to get complete picture of enrollment in the state.\u003c/p>\n\u003cp>The Congressional Budget Office estimates that even years from now the number of uninsured will be large: about 30 million nationwide. Some of those people will be living in states that have opted not to expand Medicaid to adults without dependent children. Others will be immigrants who don't qualify for coverage under the law. \"But the biggest category are people who simply will choose not to enroll,\" Levitt says.\u003c/p>\n\u003cp>Beth Engel, in Ventura County, Calif., is a 32-year-old mother of a nearly 3-year-old daughter and describes herself as an early supporter of the Affordable Care Act.\u003c/p>\n\u003cp>\"I was very hopeful,\" she says. \"I thought, 'Wow! I can have a job that I love that doesn't necessarily have insurance but I get insurance affordably.'\"\u003c/p>\n\u003cp>Engel works part time as a hotel clerk and qualifies for tax subsidies that reduce premiums for her and her toddler to about $200 a month. But she chose not to buy insurance for herself this year. \"I found that the premiums were still very high, and I just couldn't afford them,\" she says.\u003c/p>\n\u003cp>Even though now she's armed with the knowledge that she can take the subsidy upfront in the form of a reduced insurance premium, she says she's reluctant to do that without thoroughly understanding the plans offered through the state-run marketplace,\u003c/p>\n\u003cp>\"Maybe I'm reading these incorrectly,\" she says, \"but it just didn't make sense, and I thought I'm not going to put money I don't really have to spend into a program that I don't really understand.\"\u003c/p>\n\u003cp>Engel did get her daughter health coverage through Medicaid. People in California and other states that expanded can enroll year-round. As for her own medical needs? She'll go without health insurance and pay the penalty, which for her is less than the cost of insurance. She says she'll reconsider her options when enrollment opens again in November.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>This story is part of a partnership with NPR, KPCC and \u003cem>Kaiser Health News\u003c/em>, an editorially independent program of the Kaiser Family Foundation.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_18823\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/teresa.jpg\">\u003cimg class=\"size-large wp-image-18823\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/teresa-640x516.jpg\" alt=\"Teresa Martinez, 62, works as a hairdresser at a Koreatown hair salon. She earns about $10,000 per year and cannot afford to buy private health coverage (Photo by Heidi de Marco/KHN).\" width=\"640\" height=\"516\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Teresa Martinez, 62, works as a hairdresser at a Koreatown hair salon. She earns about $10,000 per year and cannot afford to buy private health coverage (Photo by Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>by Anna Gorman, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/April/21/Teresa-the-hairdresser.aspx\" target=\"_blank\">KHN\u003c/a>\u003c/strong>\u003c/p>\n\u003cp>For most of Teresa Martinez’s life, buying health insurance has been out of the question. She works at a Koreatown hair salon, earning about $10 per cut – not nearly enough to afford private coverage.\u003c/p>\n\u003cp>With a long list of ailments including dizziness, blurry vision and leg pain, she eagerly applied last year for a county program that would cover her for free until Obamacare set in.\u003c/p>\n\u003cp>“I thought at long last, I would be able to go to the doctor and get what I need,” said Martinez, 62, who lives in East Los Angeles. “I was so excited. But that was short lived.”\u003c/p>\n\u003caside class=\"pullquote alignleft\">The state has 45 days to process the Medi-Cal applications but it often takes longer and the waiting period varies -- sometimes widely -- by county.\u003c/aside>\n\u003cp>Without any explanation, Martinez received a denial letter from the Healthy Way Los Angeles, a temporary coverage program for low-income people. Later she applied for Medicaid -- known as Medi-Cal in California -- which was expanded under the Affordable Care Act to include people like Martinez without dependent children.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But a health clinic worker told her she may have to wait months for approval -- and to hold off on appointments until she has her official card.\u003c/p>\n\u003cp>Nearly 2 million Californians have gained coverage with the expansion of the Medi-Cal program for poor and disabled people, including those who transitioned from temporary programs like Healthy Way LA.\u003c!--more-->\u003c/p>\n\u003cp>But roughly 800,000 more applications are pending from people presumed to be eligible for the program. While hospitals are required to accept patients with emergencies, private doctors, health clinics, pharmacies and specialists have discretion over whether to treat patients for non-urgent health needs while they await acceptance into the program.\u003c/p>\n\u003cp>“If they don’t have final determination of their eligibility, they are probably not able to get care,” said Catherine Teare, senior program officer at the California HealthCare Foundation. That can be frustrating for people who, like Martinez, have long put off for treatment for lack of coverage.\u003c/p>\n\u003cp>The state has 45 days to process the Medi-Cal applications but it often takes longer and the waiting period varies -- sometimes widely -- by county. Medi-Cal will pay providers retroactively for care provided to eligible candidates during the waiting period.\u003c/p>\n\u003cp>The sheer volume of applications is slowing the process, said Norman Williams, spokesman for the California Department of Health Care Services. Adding to the delays are new requirements on verifying income, and the number of incomplete or duplicate applications.\u003c/p>\n\u003cp>“It is just a big number that has a lot of moving parts,” he said. “We are working very quickly and very diligently to get these people into coverage.”\u003c/p>\n\u003cp>The delays in confirming eligibility aren’t unique to California. “In practically every state, there are backlogs,” said Matt Salo, executive director of the National Association of Medicaid Directors.\u003cs> \u003c/s>\u003c/p>\n\u003cp>The number of Medicaid applicants nationwide who are in limbo is unclear, said Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities. Solomon ascribed much of the problem to inadequacies in technology. Many of the uninsured are seeking coverage through subsidized insurance marketplace websites. When they are deemed eligible for free coverage under Medicaid, their information is not always transferred seamlessly.\u003c/p>\n\u003cp>The system still is playing “catchup,” Solomon said.\u003c/p>\n\u003cp>\u003cstrong>Living ‘Day to Day’\u003c/strong>\u003c/p>\n\u003cp>At Chela’s Hair Fashions in Koreatown, customers trickle in, some from the neighborhood and others from across town. Friendly and upbeat, Martinez chats with them, affectionately calling them, “mi hija, mi hijo” -- my daughter, my son.\u003c/p>\n\u003cp>After giving the owner a commission, Martinez said she earns just enough to pay her bills – about $10,000 a year. She relies on her boyfriend to pay the rent on their apartment. “I live day to day,” she said.\u003c/p>\n\u003cp>Originally from Mexico, Martinez said that she fled an abusive husband when she was 17 and crossed the border with a false identification. She became a U.S. citizen under the 1986 amnesty law and learned English while working -- as a babysitter, a waitress, a receptionist and eventually a hair stylist. She briefly had insurance while working for a bank.\u003c/p>\n\u003cp>In her youth, Martinez said, the last thing on her mind was going to the doctor. She went years without a mammogram and a physical and can’t remember the last time she saw a dentist. When she was in pain, she applied Menthol or used herbal remedies.\u003c/p>\n\u003cp>“I have always self-diagnosed and self-medicated,” she said. “I pray for everything, especially my good health.”\u003c/p>\n\u003cp>But Martinez said now that she is getting older, she needs to see a doctor. A fall caused lingering ankle and hip pain. She feared she might have diabetes – a doctor in Mexico once told her she was on the borderline.\u003c/p>\n\u003cp>In December, she went to a community clinic in Hollywood run by QueensCare Health Centers to get a long-awaited physical. At the suggestion of a health center employee, she applied for the free county coverage program while she was there. After helping her complete the application, an enrollment counselor told her she would likely qualify and Martinez said she felt great. “What a difference a day could make.”\u003c/p>\n\u003cp>A few hours later in a spacious exam room, nurse practitioner Wendy Davidson introduced herself. “What concerns you about your health?” she asked as she conducted a brief exam.\u003c/p>\n\u003cp>Martinez told her she hadn’t seen a doctor in at least 10 years. Her mouth was dry and her right eye blurry. She had swelling in her knee and frequent headaches.\u003c/p>\n\u003cp>“Do you have any chronic diseases?” Davidson asked.\u003c/p>\n\u003cp>“Not that I know,” she said. Davidson ordered blood work and encouraged her to make a follow-up appointment.\u003c/p>\n\u003cp>\u003cstrong>Going back to ‘herbal stuff’\u003c/strong>\u003c/p>\n\u003cp>About a month later, Martinez returned for her lab results. Her blood sugar was a little high.\u003c/p>\n\u003cp>“We want to make sure you don’t get diabetes,” Davidson said. “With extra weight and high blood sugar, you’re at risk.”\u003c/p>\n\u003cp>The nurse practitioner urged her to exercise and watch what she ate. “Let’s see if the dry mouth and the dizziness get better with a little bit of exercise,” she said. “I can tell you’re motivated.”\u003c/p>\n\u003cp>Martinez left with follow-up appointments, including for a mammogram and an eye exam. But then in February, she received the denial letter from Healthy Way Los Angeles and social worker told her to cancel the appointments until she had Medi-Cal.\u003c/p>\n\u003cp>QueensCare is continuing to see longtime patients awaiting approval but is asking new patients to come back when they have an official card, said spokeswoman Bianca Rodas.\u003c/p>\n\u003cp>Martinez is frustrated that she still doesn’t have health insurance, nearly four months after her first application. She also fears her blood sugar levels are getting worse.\u003c/p>\n\u003cp>“I’m really worried,” she said. For now, “I will go back to my herbal stuff as I always have.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cobject id=\"flashObj\" width=\"486\" height=\"412\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashVars\" value=\"videoId=3483575297001&playerID=1875349721&playerKey=AQ~~,AAAAAG_HivY~,sgDjaI7wvsueyxYvBTnH9ElGyGMdLEbW&domain=embed&dynamicStreaming=true\">\u003cparam name=\"base\" value=\"http://admin.brightcove.com\">\u003cparam name=\"seamlesstabbing\" value=\"false\">\u003cparam name=\"allowFullScreen\" value=\"true\">\u003cparam name=\"swLiveConnect\" value=\"true\">\u003cparam name=\"allowScriptAccess\" value=\"always\">\u003cparam name=\"src\" value=\"http://c.brightcove.com/services/viewer/federated_f9?isVid=1\">\u003cparam name=\"flashvars\" value=\"videoId=3483575297001&playerID=1875349721&playerKey=AQ~~,AAAAAG_HivY~,sgDjaI7wvsueyxYvBTnH9ElGyGMdLEbW&domain=embed&dynamicStreaming=true\">\u003cparam name=\"pluginspage\" value=\"http://www.macromedia.com/shockwave/download/index.cgi?P1_Prod_Version=ShockwaveFlash\">\u003cembed id=\"flashObj\" width=\"486\" height=\"412\" type=\"application/x-shockwave-flash\" src=\"http://c.brightcove.com/services/viewer/federated_f9?isVid=1\" flashvars=\"videoId=3483575297001&playerID=1875349721&playerKey=AQ~~,AAAAAG_HivY~,sgDjaI7wvsueyxYvBTnH9ElGyGMdLEbW&domain=embed&dynamicStreaming=true\" base=\"http://admin.brightcove.com\" seamlesstabbing=\"false\" pluginspage=\"http://www.macromedia.com/shockwave/download/index.cgi?P1_Prod_Version=ShockwaveFlash\" bgcolor=\"#FFFFFF\">\u003c/embed>\u003c/object>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_18823\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/teresa.jpg\">\u003cimg class=\"size-large wp-image-18823\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/teresa-640x516.jpg\" alt=\"Teresa Martinez, 62, works as a hairdresser at a Koreatown hair salon. She earns about $10,000 per year and cannot afford to buy private health coverage (Photo by Heidi de Marco/KHN).\" width=\"640\" height=\"516\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Teresa Martinez, 62, works as a hairdresser at a Koreatown hair salon. She earns about $10,000 per year and cannot afford to buy private health coverage (Photo by Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>by Anna Gorman, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/April/21/Teresa-the-hairdresser.aspx\" target=\"_blank\">KHN\u003c/a>\u003c/strong>\u003c/p>\n\u003cp>For most of Teresa Martinez’s life, buying health insurance has been out of the question. She works at a Koreatown hair salon, earning about $10 per cut – not nearly enough to afford private coverage.\u003c/p>\n\u003cp>With a long list of ailments including dizziness, blurry vision and leg pain, she eagerly applied last year for a county program that would cover her for free until Obamacare set in.\u003c/p>\n\u003cp>“I thought at long last, I would be able to go to the doctor and get what I need,” said Martinez, 62, who lives in East Los Angeles. “I was so excited. But that was short lived.”\u003c/p>\n\u003caside class=\"pullquote alignleft\">The state has 45 days to process the Medi-Cal applications but it often takes longer and the waiting period varies -- sometimes widely -- by county.\u003c/aside>\n\u003cp>Without any explanation, Martinez received a denial letter from the Healthy Way Los Angeles, a temporary coverage program for low-income people. Later she applied for Medicaid -- known as Medi-Cal in California -- which was expanded under the Affordable Care Act to include people like Martinez without dependent children.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But a health clinic worker told her she may have to wait months for approval -- and to hold off on appointments until she has her official card.\u003c/p>\n\u003cp>Nearly 2 million Californians have gained coverage with the expansion of the Medi-Cal program for poor and disabled people, including those who transitioned from temporary programs like Healthy Way LA.\u003c!--more-->\u003c/p>\n\u003cp>But roughly 800,000 more applications are pending from people presumed to be eligible for the program. While hospitals are required to accept patients with emergencies, private doctors, health clinics, pharmacies and specialists have discretion over whether to treat patients for non-urgent health needs while they await acceptance into the program.\u003c/p>\n\u003cp>“If they don’t have final determination of their eligibility, they are probably not able to get care,” said Catherine Teare, senior program officer at the California HealthCare Foundation. That can be frustrating for people who, like Martinez, have long put off for treatment for lack of coverage.\u003c/p>\n\u003cp>The state has 45 days to process the Medi-Cal applications but it often takes longer and the waiting period varies -- sometimes widely -- by county. Medi-Cal will pay providers retroactively for care provided to eligible candidates during the waiting period.\u003c/p>\n\u003cp>The sheer volume of applications is slowing the process, said Norman Williams, spokesman for the California Department of Health Care Services. Adding to the delays are new requirements on verifying income, and the number of incomplete or duplicate applications.\u003c/p>\n\u003cp>“It is just a big number that has a lot of moving parts,” he said. “We are working very quickly and very diligently to get these people into coverage.”\u003c/p>\n\u003cp>The delays in confirming eligibility aren’t unique to California. “In practically every state, there are backlogs,” said Matt Salo, executive director of the National Association of Medicaid Directors.\u003cs> \u003c/s>\u003c/p>\n\u003cp>The number of Medicaid applicants nationwide who are in limbo is unclear, said Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities. Solomon ascribed much of the problem to inadequacies in technology. Many of the uninsured are seeking coverage through subsidized insurance marketplace websites. When they are deemed eligible for free coverage under Medicaid, their information is not always transferred seamlessly.\u003c/p>\n\u003cp>The system still is playing “catchup,” Solomon said.\u003c/p>\n\u003cp>\u003cstrong>Living ‘Day to Day’\u003c/strong>\u003c/p>\n\u003cp>At Chela’s Hair Fashions in Koreatown, customers trickle in, some from the neighborhood and others from across town. Friendly and upbeat, Martinez chats with them, affectionately calling them, “mi hija, mi hijo” -- my daughter, my son.\u003c/p>\n\u003cp>After giving the owner a commission, Martinez said she earns just enough to pay her bills – about $10,000 a year. She relies on her boyfriend to pay the rent on their apartment. “I live day to day,” she said.\u003c/p>\n\u003cp>Originally from Mexico, Martinez said that she fled an abusive husband when she was 17 and crossed the border with a false identification. She became a U.S. citizen under the 1986 amnesty law and learned English while working -- as a babysitter, a waitress, a receptionist and eventually a hair stylist. She briefly had insurance while working for a bank.\u003c/p>\n\u003cp>In her youth, Martinez said, the last thing on her mind was going to the doctor. She went years without a mammogram and a physical and can’t remember the last time she saw a dentist. When she was in pain, she applied Menthol or used herbal remedies.\u003c/p>\n\u003cp>“I have always self-diagnosed and self-medicated,” she said. “I pray for everything, especially my good health.”\u003c/p>\n\u003cp>But Martinez said now that she is getting older, she needs to see a doctor. A fall caused lingering ankle and hip pain. She feared she might have diabetes – a doctor in Mexico once told her she was on the borderline.\u003c/p>\n\u003cp>In December, she went to a community clinic in Hollywood run by QueensCare Health Centers to get a long-awaited physical. At the suggestion of a health center employee, she applied for the free county coverage program while she was there. After helping her complete the application, an enrollment counselor told her she would likely qualify and Martinez said she felt great. “What a difference a day could make.”\u003c/p>\n\u003cp>A few hours later in a spacious exam room, nurse practitioner Wendy Davidson introduced herself. “What concerns you about your health?” she asked as she conducted a brief exam.\u003c/p>\n\u003cp>Martinez told her she hadn’t seen a doctor in at least 10 years. Her mouth was dry and her right eye blurry. She had swelling in her knee and frequent headaches.\u003c/p>\n\u003cp>“Do you have any chronic diseases?” Davidson asked.\u003c/p>\n\u003cp>“Not that I know,” she said. Davidson ordered blood work and encouraged her to make a follow-up appointment.\u003c/p>\n\u003cp>\u003cstrong>Going back to ‘herbal stuff’\u003c/strong>\u003c/p>\n\u003cp>About a month later, Martinez returned for her lab results. Her blood sugar was a little high.\u003c/p>\n\u003cp>“We want to make sure you don’t get diabetes,” Davidson said. “With extra weight and high blood sugar, you’re at risk.”\u003c/p>\n\u003cp>The nurse practitioner urged her to exercise and watch what she ate. “Let’s see if the dry mouth and the dizziness get better with a little bit of exercise,” she said. “I can tell you’re motivated.”\u003c/p>\n\u003cp>Martinez left with follow-up appointments, including for a mammogram and an eye exam. But then in February, she received the denial letter from Healthy Way Los Angeles and social worker told her to cancel the appointments until she had Medi-Cal.\u003c/p>\n\u003cp>QueensCare is continuing to see longtime patients awaiting approval but is asking new patients to come back when they have an official card, said spokeswoman Bianca Rodas.\u003c/p>\n\u003cp>Martinez is frustrated that she still doesn’t have health insurance, nearly four months after her first application. She also fears her blood sugar levels are getting worse.\u003c/p>\n\u003cp>“I’m really worried,” she said. For now, “I will go back to my herbal stuff as I always have.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"marketplace": {
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"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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"planet-money": {
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"politicalbreakdown": {
"id": "politicalbreakdown",
"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
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},
"pri-the-world": {
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"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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},
"reveal": {
"id": "reveal",
"title": "Reveal",
"info": "Created by The Center for Investigative Reporting and PRX, Reveal is public radios first one-hour weekly radio show and podcast dedicated to investigative reporting. Credible, fact based and without a partisan agenda, Reveal combines the power and artistry of driveway moment storytelling with data-rich reporting on critically important issues. The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.",
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"officialWebsiteLink": "https://www.revealnews.org/episodes/",
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"rss": "http://feeds.revealradio.org/revealpodcast"
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},
"rightnowish": {
"id": "rightnowish",
"title": "Rightnowish",
"tagline": "Art is where you find it",
"info": "Rightnowish digs into life in the Bay Area right now… ish. Journalist Pendarvis Harshaw takes us to galleries painted on the sides of liquor stores in West Oakland. We'll dance in warehouses in the Bayview, make smoothies with kids in South Berkeley, and listen to classical music in a 1984 Cutlass Supreme in Richmond. Every week, Pen talks to movers and shakers about how the Bay Area shapes what they create, and how they shape the place we call home.",
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"order": 16
},
"link": "/podcasts/rightnowish",
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},
"science-friday": {
"id": "science-friday",
"title": "Science Friday",
"info": "Science Friday is a weekly science talk show, broadcast live over public radio stations nationwide. Each week, the show focuses on science topics that are in the news and tries to bring an educated, balanced discussion to bear on the scientific issues at hand. Panels of expert guests join host Ira Flatow, a veteran science journalist, to discuss science and to take questions from listeners during the call-in portion of the program.",
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},
"snap-judgment": {
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