Cover Me!: Enrollment opens for a new era of health insurance


- START IT ROLLING:  To get the process started, visit or call toll-free 1-800-300-1506. -
  • START IT ROLLING: To get the process started, visit or call toll-free 1-800-300-1506.

If you don’t have health insurance by March 31, 2014, you’ll be breaking the law. But don’t worry; it’s good for you. And it’s good for society at large.

At least that’s the spirit behind the law.

By now, most people seem to know where they fall when it comes to the Affordable Care Act, commonly known as Obamacare. After a long, dirty, and divisive fight for its passage, the law has legs. For California residents, it means a wider eligibility net for those applying for Medi-Cal and a more user-friendly interface for those who want to buy health insurance.

That’s part of the deal for the Affordable Care Act (ACA), which intends to strike a balance between making health insurance more affordable and accessible, and in turn requiring people to be covered to broaden the scale of those paying for insurance, thus stabilizing overall costs. The law requires people to get health insurance or pay a penalty on their taxes—known as the “individual mandate”—and creates a health insurance exchange that will supposedly make it easier to compare plans and find coverage that fits. With that comes the “guaranteed issue” provision, where providers are no longer allowed to use pre-existing conditions as a reason to deny coverage or charge more for premiums.

As part of an ongoing public effort involving elected officials, government departments, and other organizations and care providers to get the word out about the ACA and what it means for people, the Latino Outreach Council played host to a panel discussion on Sept. 25 in San Luis Obispo. The panel featured local officials and experts, including State Sen. Bill Monning (D-Carmel), who represents SLO County.

“There is a public benefit to broadening the net of people carrying insurance,” Monning said at the event.

Among the examples Monning detailed was the notion that better access to medical insurance would mean more regular check ups, an increase in preventative care, and more attention to general health and wellness. In turn, this could mean an increase in overall health and early diagnoses, and a decrease in emergency treatment and treatments for serious illnesses, both of which are the most costly. The latter is especially common for the working poor and those without insurance, who may be more vulnerable to serious health problems and often don’t seek treatment until it becomes serious or an emergency. That’s where a wider net to coverage that’s more accessible and available to people with pre-existing conditions becomes crucial.

“This, historically in our country and in our state, has been one of the leading causes of bankruptcy and family tragedy,” Monning said.

The legislation comes at a particularly critical time for California, where a series of state budget shortfalls has led to the elimination of many medical and mental health programs that have served as the only safety net for millions of residents.

“Part of that dynamic is that we lost the ability to embrace a vision for healthy communities,” Monning added.

According to the senator, about 8 million Californians currently live without health insurance. But with the new laws and financial assistance from the federal government, approximately 4 to 5 million of those will be able to obtain insurance, said Joel Diringer, an attorney who specializes in health-coverage issues, including years of working to increase access for farm workers and other communities that are largely without coverage.

Diringer, who also spoke at the Latino Outreach Council forum, told New Times that of those who will still go without insurance, a quarter will be undocumented immigrants. One of the key provisions in the passage of the ACA was undocumented immigrants’ ineligibility to receive subsidized medical coverage or accessing the medical exchange, meaning they will be excluded nationwide.

Other people who will still go without coverage include those who are eligible but can’t afford it or don’t apply; those with an income that sits below the taxable threshold, who aren’t required to get insurance; and those who are churning—or in between—jobs, have seasonal work, are moving from one state to another, and so on.

Diringer and other experts in the field hold that the ACA will make coverage more affordable and accessible overall. The federal government will be providing California with assistance in order to extend Medi-Cal to everyone at 138 percent of or below the federal poverty level for annual income, or about $15,856 for an individual and $32,449 for a family of four. People who can’t afford insurance or may previously have not been eligible for Medi-Cal can apply for Medi-Cal through the SLO County Department of Social Services, which will be setting up a call center to handle and respond to inquiries from residents.

For people above that line, subsidies are still offered. And anyone can still apply for medical insurance at Filling out an application will give you access to the health insurance exchange, where options can be compared with a clear explanation of the different levels of coverage available. Some parts of the state will have a larger variety of options than others. In SLO County, the two providers will be Blue Shield and Anthem Blue Cross.

The initial open enrollment began on Oct. 1 and will end March 31. For those six months, individuals who want to change their coverage or don’t have insurance can sign up with the “guaranteed issue” protection. From April 1 on, people can sign up but won’t necessarily be protected against denial for a preexisting condition.

There are a few exceptions that will allow for the guaranteed issue after the window’s closure, including such life events as getting divorced, getting married, or losing a job, all of which might mean a severance in existing coverage or a change in a coverage plan. For those circumstances, a 60-day window is opened to obtain insurance. If you missed out on the first round, open enrollment for 2015 coverage will be Oct. 15 to Dec. 7.

While penalties for not having insurance may be much less than the cost of insurance, in general, Monning, Diringer, and many others strongly believe in the importance of buying in to the program—especially by young people, who are often quite healthy.

“We really need young people to share in the system, to both protect themselves and to try to protect the broader public health,” Diringer said.

Besides, while younger people may be healthy and require less care, they’re also among those at the highest risk of a sudden need for expensive treatment—e.g. and emergency—due to being particularly active, inexperience behind the wheel, and other factors.

“The young invincibles are still vincible,” Diringer told New Times.


Contributing Writer Jono Kinkade can be reached through Managing Editor Ashley Schwellenbach at

-- Melody DeMeritt - former city council member, Morro Bay


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