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Report: 70,000 county residents to get health insurance in health care overhaul

Published: Monday, April 8, 2013 at 3:00 a.m.
Last Modified: Tuesday, April 9, 2013 at 11:22 a.m.

An expansion of Medicaid in President Barack Obama's massive health care overhaul is expected to bring health coverage to 70,000 uninsured Sonoma County residents, according to a comprehensive assessment of the law's local impacts.

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The Affordable Care Act and Health Care Reform in Sonoma County: www.sonoma-county.org/healthcarereform

The report, which will be presented this afternoon to the Sonoma County Board of Supervisors, summarizes the effects of the law and was prepared by county health officials several months ahead of the Oct. 1 deadline for the state to begin enrolling patients in its health benefit exchange.

Other issues the report highlights include details on the launching of the state's exchange; health insurance mandates for individuals and employers; the incremental reduction of federal payments to local hospitals; and greater funding for preventative medicine.

The supervisors' hearing launches a dramatic education campaign in which the county health services agency will educate the public about health care enrollment requirements and deadlines.

"From our perspective, we want people to be able to enroll anywhere in our community, their church, their community centers, Boys & Girls Clubs, schools and other community partners," said Peter Rumble, director of health policy for the Sonoma County Department of Health Services.

Rumble said the report will show how "far ahead" California and Sonoma County are "in being prepared for health care reform."

In 2012, thousands of low-income Sonoma County residents got an early taste of Obama's health care law through the early expansion of Medicaid in California. Dubbed the "California Bridge to Reform," the state authorized counties to expand coverage to adults without children through the state's Low Income Health Program.

In Sonoma County, the early expansion program is called Path2Health, which currently has 7,000 people enrolled. Come next year, all of these residents will be transitioned to Medi-Cal, the state's Medicaid program.

Sonoma County Supervisor Shirlee Zane said today's report would help the county develop "strategies to maximize the improvements" that the Affordable Care Act will ultimately provide. These include better screening, more residents receiving coverage, eliminating denial of insurance due to pre-existing conditions and creating health care homes for families rather than defaulting to expensive emergency care.

According to the report, the Affordable Care Act:

Expands Medicaid coverage to all individuals with incomes up to 138 percent of the federal poverty level. The cutoff is $15,856 for an individual or $32,499 for a family of four.

Eliminates assets tests to determine eligibility.

Imposes penalties on employers with more than 50 full-time employees who do not offer health insurance to their employees. There are no penalties for part-time employees not offered health coverage.

Denies legal immigrants expanded Medicaid coverage for five years, but they may receive health care tax credits.

Other changes include an increase in the Medicaid payment rate for primary care physicians to 100 percent of Medicare for 2013 and 2104 only. Primary care doctors will receive a 10 percent bonus payment rate through 2015.

The report also stated that some local hospitals could see a decrease in payments they receive from the federal government for treating large numbers of Medicaid patients and for treating those with no insurance.

These reductions, the report states, "may threaten the financial sustainability of some Sonoma County hospitals" and new "sources of revenue gained from coverage expansions may not be sufficient for the hospitals to sustain and meet the needs of vulnerable populations."

The state's health benefit exchanges, dubbed Covered California, will be fully operational on Jan. 1, but the exchange must be ready to being enrolling consumers on Oct. 1.

Aside from early expansion of Medicaid in California, some portions of the Patient Protection and Affordable Care Act, which was signed into law in March 2010, have already been implemented across the country.

In 2010, the government banned lifetime dollar limits on most health benefits, and dependents up to age 26 were allowed to remain on their parents' health care coverage. Also, in 2011, the government began closing the so-called Medicare prescription drug doughnut hole.

Rumble said the county has a lot of work to do before Oct. 1, when the state's health benefit exchange begins enrolling residents. He said county health officials want to create a scenario where there is "no wrong door" for those seeking enrollment.

"Our big push now on that front is to make sure everybody knows what the effects are, what the impacts are and what they need to do to prepare," he said. "For that we have only a few months, truly."

You can reach Staff Writer Martin Espinoza at 521-5213 or martin.espinoza@pressdemocrat.com.

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