Navigating the Affordable Care Act

Health insurance companies would categorize Nora Vigil as “high risk.” And for the past three years, she has been without health insurance.

“My mother has breast cancer, so I have to go take my mammogram test every year,” she said. “Now, because mammogram tests are one of the benefits [of the Affordable Care Act], I don’t have to pay extra money to take a test.”

Vigil, a native of Peru who now lives in North Richmond, is one of thousands of uninsured Contra Costa County residents who will now be able to obtain health care through Covered California, the state’s new health-care marketplace. And she is excited, because her entire household – her husband, daughter, grandson, and mother – will also get health insurance through Covered California.

Despite the government shutdown, open enrollment for health insurance begins today. About 5 million uninsured people are going to be newly eligible for insurance through Covered California, according to Morgan Westfall, a project coordinator with the Community Clinic Consortium, a group that advocates for nonprofit health clinics in Contra Costa and Solano counties. Another 2.6 million will qualify for subsidies.

Because the new health-care law broadens Medicaid, more than 20,000 Contra Costa County residents are now eligible for expanded coverage through Medi-Cal, the state’s Medicaid program for low-income residents, Westfall said.

The Community Clinic Consortium has partnered with the Alliance of Californians for Community Empowerment to host several presentations to inform Richmond residents about how to make the most of the Affordable Care Act.

“We’re just trying to outreach to community members in general, particularly those who will be affected by Medi-Cal and Covered California, so that would be adults from 19 to 64,” Westfall said.

“During these meetings, we tend to have large audiences, but it’s difficult to say what each person’s current circumstance is,” Westfall said. “Our impression is that a lot of people are either going to be eligible for these programs or know someone in their community who is. So in some way they’re getting the information out to the people who directly benefit from the Affordable Care Act.”

Westfall recommends that Richmond residents learn about Covered California — either on the web or by phone — to learn about their options. Beginning today, people will be able to fill out applications on the Covered California website.

Residents will have access to four levels of coverage: bronze, silver, gold or platinum. Higher monthly payments translate to lower costs when people seek medical care. 

“The biggest message is for people to find out if they might be eligible for some sort of coverage,” Westfall says. “If they’re currently insured and they feel their coverage is unaffordable, or if they’re uninsured, particularly, they should try to find out if they’re eligible for new coverage.”

Even those who have been turned down for health insurance in the past can sign up for coverage. Part of the Affordable Care Act ensures that insurance companies cannot deny coverage, or even charge more, to people with pre-existing conditions. In the past, for example some insurance companies denied women coverage, considering a history of domestic violence and cesarean sections pre-existing conditions.

Like Westfall, Vigil is also helping to educate Richmond residents about the Affordable Care Act. She works for Vision y Compromiso, an organization that provides healthcare outreach and education for Latinos. It’s more difficult for non-English speakers to find out about the Affordable Care Act, she said.

 “First, they think that Covered California is an insurance company,” she said. “They don’t understand that there’s a marketplace where you can go and shop and compare plans.”

Seniors who lack Internet access call Vigil and ask what Affordable Care Act means for them, Vigil said. “They need assistance one-on-one to answer all the questions,” she said.

Open enrollment runs through March 31, 2014. Starting in January 2014, people without health insurance may have to pay a penalty — one percent of their annual income or $95 (whichever is higher). People who do not make enough money to file taxes, members of Native American tribes, inmates, and undocumented immigrants will be exempt from the penalty.