No rush to see doctors as provisions of Affordable Care Act go into effect

kcarlson@modbee.comJanuary 2, 2014 

Thursday might have been a big day for the newly insured to see a doctor or get long-awaited blood work done, but health reform in California remained focused on dealing with a backlog of people trying to make their first premium payments so their insurance kicks in.

Covered California, the exchange created to offer health plans to the uninsured, issued a statement that participating health insurance companies were willing to extend a Jan. 6 payment deadline for their enrollees. But it is up to the individual insurers, and consumers were advised to contact their plans to confirm when their first payment is due.

“The early enrollment of hundreds of thousands of Californians is a clear indication of the strong interest consumers have in taking advantage of the Affordable Care Act,” said Peter Lee, director of the exchange. “But we need to remind customers that they have to take that last step and pay their premium for coverage to kick in.”

Sandi Walsh of Turlock had yet to use her insurance card to schedule an appointment with a doctor. The self-employed tax preparer canceled her policy a year ago because she could no longer afford the premium, she said. The health plan she chose through Covered California sent her an insurance card and packet in mid-December, in contrast to numerous people who have complained about a faulty enrollment system.

“Now I can get my blood work done regularly,” Walsh said. “It’s not like I’m in my 20s and believe I’ll never get sick. I am 60 and happy I am not sick.”

Kaiser Permanente released a statement Thursday saying the seasonal flu – not health reform – was causing an increase in appointments and patient visits at its Modesto clinics. “With coverage under the ACA taking effect yesterday, it’s far too early to estimate new member utilization,” Kaiser said in a statement.

Plenty of waiting-room seats were available Thursday at the Golden Valley Health Center on Sixth Street in Modesto, a safety-net clinic that expects to eventually serve more patients who enroll in Medi-Cal through the Affordable Care Act.

It was the first normal business day that people could see a physician after getting enrolled through health reform.

“It’s early,” Golden Valley’s Interim CEO Christine Noguera said. Enrollment counselors at the Golden Valley clinics in Stanislaus and Merced counties were booked with appointments through mid-January to help eligible residents sign up for Medi-Cal, she said.

Noguera said it was difficult to get certification for enrollment counselors, so they weren’t able to start assisting low-income residents until mid-November.

A less-publicized aspect of the Affordable Care Act is the Medi-Cal expansion, which lifted the income eligibility for Medi-Cal to 138 percent of poverty level, or $15,860 for a single adult and $32,500 for a family of four.

In Stanislaus County, with its high unemployment and poverty, many hope it will expand preventive medicine and access to health care for up to 30,000 residents.

“We think enrollment will be slow over the coming year,” Noguera said. “We won’t see a rush. People will enroll as they have a health-care event. Those who already have a health-care need are at the front of the line.”

Since the enrollment kickoff in October, Stanislaus County’s Community Services Agency has handled almost 2,900 calls from people seeking Medi-Cal benefits. It also has processed about 3,000 applications from people in the county’s indigent health services program who are expected to shift to Medi-Cal.

The county agency is running a customer service center to handle Medi-Cal calls transferred from Covered California. Sandra Williams, health reform project lead for the county, said she expects the numbers to increase in two weeks when there’s an accurate tally from Covered California and other offices that have handled enrollments.

Williams noted that Medi-Cal enrollment is year-round. There are no deadlines, as there are with health insurance offered through Covered California.

Al Diaz, chief financial officer for Oak Valley Hospital in Oakdale, said the hospital district and its community clinics were gearing up for expanded Medi-Cal enrollment. The district plans to open a Waterford clinic in April, and weekend hours were added at clinics in Oakdale, Riverbank and Escalon.

Besides the improving access to primary care, Diaz said, the hospital hopes more patients will make appointments at the clinics rather than going to the emergency room with routine health issues.

Local residents continued to report frustration with completing enrollment in insurance plans with Covered California and getting their insurance cards.

Clifton Britt of Ceres said he’s trying to obtain coverage for his wife, who has been uninsured since losing a job in 2007. He said he was pulling his hair out trying to make the initial payment to Anthem Blue Cross.

Britt said he tried on New Year’s Eve to use a credit card and other forms of payment over the phone, but the system would not receive the payments. “I have been on the phone for seven or eight hours,” he said.

Nick Bavarro, a Modesto insurance agent, said his office workers were spending hours on the phone Thursday advocating for clients. Despite enrolling customers starting in October, Bavarro said he didn’t know of any clients who had received their insurance cards.

Bee staff writer Ken Carlson can be reached at or (209) 578-2321.

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