In the Northern San Joaquin Valley, tens of thousands of residents have lived without insurance to cover medical bills.
Next month, those people can start enrolling in insurance plans through the federal health reform overhaul and cant be denied for pre-existing health conditions. An estimated 108,000 people in a designated region including Stanislaus, San Joaquin, Merced, Mariposa and Tulare counties will be eligible for tax credits to lower their premiums. Coverage will begin Jan. 1.
Covered California, the states health exchange created through the Affordable Care Act, approved four health plans for the region: Anthem Blue Cross, Blue Shield, Health Net and Kaiser Permanente.
In Stanislaus County, most hospitals and some physician groups said last week they will participate in the Covered California plans, though provider directories for the plans wont be available until next month, officials have said.
Premiums will vary depending on the persons age, level of coverage and insurer. But tax credits can reduce the premiums for low-wage earners to as little as $30 a month. A family of four with annual income of $50,000 can obtain insurance covering 70 percent of medical costs for around $280 a month.
The Affordable Care Act also raises the income eligibility limit next year for the Medi-Cal program, which will accept childless adults for the first time. An adult with annual income of $15,860 or less will be eligible for the state program.
People will be able to enroll in health plans through Covered California call centers, Internet sites, certified brokers and insurers. Some of the plans are starting to market their offerings in the region, and grant-funded outreach campaigns are underway.
Doctors Medical Center of Modesto said the Blue Shield, Health Net and Anthem plans offered on the exchange should allow patients to receive care at the hospital at in-network rates.
We encourage consumers to pay close attention to the list of facilities included in the network for each plan when they make their enrollment choices, spokeswoman Carin Sarkis said.
She suggested they call the hospital or physician offices if they have questions.
Memorial Medical Center of Modesto and the Sutter Gould physician group will participate in the Blue Shield individual plan, but are taking a wait-and-see attitude with other plans, a spokesman said. The Blue Shield provider list is expected to include Sutter Tracy Community Hospital and Memorial Hospital Los Banos. All four of the providers are affiliated with Sutter Health of Sacramento.
In the future, we may be included in other health plan networks as they firm up the details of their participation in the Covered California exchange, Central Valley Sutter spokesman Craig Baize wrote in an email.
Baize said Memorial and the three other Sutter affiliates are not in the plans available through the Small Business Health Options Program for businesses with one to 50 employees.
Consumers who enroll with Kaiser Permanente will receive health care at Kaiser facilities in Modesto, Manteca and Stockton. The nonprofit health system plans to open a retail office next month at 3848 McHenry Ave. in Modesto, where uninsured people and current members can learn about options for coverage in the new marketplace, said Corwin Harper, area manager for Kaiser.
Harper said Kaisers projections for membership growth are proprietary. The health system has 264,500 members in Stanislaus and San Joaquin counties. The executive said there are no plans to expand staff or facilities to prepare for the influx of new patients.
We feel we have the appropriate number of staff to accommodate a reasonable increase in membership, Harper said.
Turlocks Emanuel Medical Center accepts most insurance plans and expects to participate in the plans purchased through the exchange, Chief Executive Officer John Sigsbury said. The parent company of Doctors Medical Center is in the process of acquiring Emanuel and plans to merge the two hospitals, pending regulatory approval.
One challenge is spreading the word about affordable coverage and the penalty for not being insured in a valley with many low-income and seasonal workers who live in culturally diverse communities. Starting next year, the government will assess a tax penalty of $95 on the uninsured, and the tax is scheduled to increase to $695 or 2.5 percent of income by 2016.
United Way of Stanislaus County has focused an education campaign on college students and other young adults. It received funding through a $1 million grant awarded this year to its statewide parent organization. The federal government needs millions of so-called young invincibles to pay into the health system to counterbalance the costs of health care for older adults in the 18-to-64 age bracket.
United Way staff members, an intern and volunteers have set up information tables at Modesto Junior College and California State University, Stanislaus, said Estrella Garcia, vice president of program development. She said many students indicate theyre covered by their parents, while others dont feel health insurance is essential.
They dont get sick very often and they dont have that much money, Garcia said. They are willing to take risks with their health.
United Way also is using its contacts with businesses to educate seasonal and part-time workers who are not insured.
The nonprofit is not serving as an enrollment entity, but collects lead cards with a persons name and contact info, Garcia said. The leads will be sent to Covered California so enrollment counselors can call the individuals.
Bee staff writer Ken Carlson can be reached at firstname.lastname@example.org or (209) 578-2321.