The federal Affordable Care Act is not a perfect law, but it’s a giant step in the right direction. It has already helped Californians by allowing them to keep their kids on their health insurance until age 26, eliminating “lifetime” caps in coverage, banning health insurers from discriminating against kids with pre-existing conditions — the list of benefits in place since 2011 goes on and on.
But here are a few examples of what must improve: There are new pressures being placed on employer-employee health benefit trusts. Although President Obama suspended the employer mandate for one year so employers are not required by law to provide health insurance or pay a penalty until 2015, some unionized employers wonder whether they should exit the employer-employee health benefit trusts they have negotiated with unions, pay the penalty in 2015, and have their employees obtain health insurance through Covered CA. While there is no mandate yet, some are using the Affordable Care Act as an excuse to cut health insurance benefits this year that they were already planning to cut.
I believe the Obama Administration and Congress should take steps to make sure that employer-employee health benefit trusts can continue to provide good health benefits to employees.
Now for the positive side: In October 2013 we opened the next phase of the Affordable Care Act, which is the Health Insurance Exchange called Covered California. Subsidies are available to reduce the price of private health insurance bought through Covered CA for income eligible individuals and families. Over 400,000 Californians have signed up so far, for coverage that started January 1st. Enrollment is open until March 31, 2014. The other big change is that health insurers can no longer deny adults health insurance due to pre-existing conditions.
If your employer or union provides health insurance coverage, you don’t have to do anything different this year. If you are on Medi-Cal or MediCare, you don’t have to do anything — your coverage under these government programs will continue. Under the Affordable Care Act, California is also expanding Medi-Cal to single adults making less than $15,000 a year, which will add about 1.4 Million Californians to Medi-Cal. Those newly eligible for Medi-Cal can sign up through their County health and human services office or through Covered CA. Another issue that needs attention is the provision that bases the employer penalty on the number of full time equivalent employees. Most large employers already offer health insurance coverage to their full time employees and will continue to do so. But some that do not are considering reducing full time work to part time work in order to evade the penalty for failing to offer affordable coverage to full time employees. The law needs to include disincentives for this type of anti-worker action. I will continue to urge the Obama Administration and Congress to fix these problems and others in the Affordable Care Act.
On the state level, another big missing piece is the absence of any direct authority to regulate health insurance rates. This problem is one that we can fix We need to change state law to give the Insurance Commissioner the authority to reject excessive health insurance rates, which will continue to rise despite the Affordable Care Act. I am supporting a ballot measure which would give me that authority – to regulate individual market and small business health insurance and HMO rates. The ballot measure will be on the November 2014 ballot.
If you have a complaint about your insurance company, whether it is health, auto, home, rental or any other insurance, please call our consumer hotline at the Department of Insurance, which is 1-800-927-4357.
*Individuals, families and small businesses can purchase health insurance by going to CoveredCA.com or calling 1-800-300-1506.
Dave Jones is the California Insurance Commissioner
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Great to see California taking the lead in expanding affordable health insurance!