A few days after the extension to enroll in Covered California, the state health plan, ends, some consumers have mixed feelings about access to this medical insurance, even with the new state subsidies.

Friday, January 31 is the deadline to enroll and get a health plan, which will cover you in 2020.

This year, the state offers new subsidies to make insurance more affordable for families and middle class individuals.

And, it is fine those who do not have coverage. It should be noted that users eligible to enroll in Medi-Cal can do so at any time.

Most Californians get health insurance from their employer. Others receive Medi-Cal, the state medical service for low-income people or Medicare, the government medical service for the elderly. And another portion of consumers, who earn more than the minimum income, buy insurance in the individual market or through the state's insurance exchange, Covered California.

Although the Affordable Health Act (ACA) to obtain continuous medical coverage in force at the federal level, President Trump annulled the fine for people who do not get it, as of January 2019.

However, in California the mandate will continue on foot from January 1, 2020. This was thanks to SB 78 signed by Governor Gavin Newsom.

The law states that all people must have medical coverage in 2020 or otherwise pay a fine when they file their taxes in the spring of 2021.

It is estimated that in California there are currently about 1.4 million residents enrolled in a health plan through Covered California. Of these, 27.5% are of Latin origin, according to the latest statistics of March 2019.

"About 9 out of 10 people who are enrolled in Covered California have financial help so their savings are approximately 80% of the cost of their coverage," said Peter V. Lee, executive director of Covered California.

Help comes through state subsidies and federal credits. California has included $ 429 million in the 2019-2020 budget to be used in state subsidies to help middle class consumers.

Peter V. Lee, director of Covered California explains the importance of having health insurance by 2020. (Aurelia Ventura / La Opinion)

The subsidies began to take effect as of January 1, 2020. It is estimated that approximately one million Californians could benefit and consumers have until January 31 to request insurance that will take effect in February this year.

It remains to be seen if the new subsidies will make a difference for Californians without insurance. Before the new subsidies went into effect, four out of 10 residents without insurance, or 37%, said the price of insurance was the main reason for not having coverage, according to the California Health Survey conducted by UCLA.

Subsidies are not enough for some

Miguel García is a Spanish teacher and works approximately 32 hours a week at a private high school in Hermosa Beach. This makes him a part-time and ineligible employee to obtain medical insurance from his employer.

Garcia, 37, who is single and who lives in a house with his relatives in the Exposition Park area of ​​Los Angeles, said he has already tried to get health insurance on his own but the monthly premium is so high — even with the new state subsidies — you can't afford it.

Since the Affordable Care Act (ACA) took effect in 2014, Garcia has chosen to pay the fine, which in the last two years has amounted to almost $ 700.

However, he believes that it is still cheaper to pay the fine

You pay around $ 284 per month for the cheapest health insurance — bronze — with the HealthNet company.

Although you would save $ 49 a month with the state subsidy, your visit to the doctor would require a $ 65 copayment and a $ 6,300 deductible.

"It doesn't suit me, I prefer to go to the doctor to Tijuana (Mexico)," Garcia said.

That's something he was about to do last year when he hurt his back while working out in the gym.

Although the pain was intense and relatively severe — since it could not move for several days — he refused to go to the doctor in Los Angeles.

"I know that if I went to the hospital I would get too expensive and I would rather stay home until the pain passed," recalled the original from Jalisco, Mexico.

He said he was already determined to go to Tijuana, Mexico to have an injection for pain but as the days went by he began to improve and gave up the idea.

However, the teacher assured that situations like these reaffirm that the health system is not perfect for everyone. In your case, it doesn't matter how much you work, because being single and earning more than the minimum wage, disadvantages you when you ask for help for your own health.

"I know people (undocumented) and have the Medi-Cal," said Garcia, who is a US citizen, referring to low-income undocumented immigrants who have Medi-Cal.

This benefit currently includes young people 25 years of age and under and some DACA recipients.

"I have nothing against them and if I feel bad for them because they need it, but I feel more sorry than when I needed the medical service I could not receive it for not being able to pay it," Garcia added.

In search of the best price

The high costs of the health service have led people with medical conditions to be forced to change insurance companies in order to obtain the necessary coverage.

One of them is María Fernanda Romero, who has struggled for more than a decade following companies that can offer her affordable health insurance.

Romero, who works as a secretary and lives in Torrance with her husband, was diagnosed with lupus in 2008. This is a chronic autoimmune disease that affects the joints of the skin, brain, lungs, kidneys and blood vessels and since then his visits to the doctor and the prescribed medicine are constant.

Maria Fernanda Romero has changed her health insurance plan four times in search of a better price. (Supplied)

Recently Romero changed his medical insurance company for the fourth time since the one he had, he raised his monthly premium from $ 300 to $ 890.

"For me that was impossible to pay," said the 54-year-old woman who, during Covered California's open enrollment – which began in October – was changed again.

"Now I'm going to pay $ 480 with Kaiser Permanente," said Romero, who shares medical coverage with her husband. The couple has two children of legal age who have their own medical coverage.

Romero said that due to his condition it is imperative to have medical access at all times.

However, the change has not been very favorable since Romero has had to change his family doctor again.

"That is a bit complicated because I live in Torrance and my primary doctor is in Glendale," Romero said. "But I chose it that way, because I like (that doctor)."

She said her visits are every one or two months regularly and if she has a medical emergency, her health plan requires her to go to the emergency room at Kaiser hospitals in Los Angeles or Glendale.

Yadira López, a certified agent in Covered California, said the total monthly premium price is based on income, age and number of family members.

"There are cases of people who do not have money to get a better coverage and I recommend that they take the cheapest plan because it is better to have nothing," said Lopez.

Peace of mind knowing that they are covered

Lopez said that for some people it is cheaper to pay the fine but this could have them on the verge of worry.

"In case of emergency they will not have options and medical insurance is to have a peace knowing that it is covered," said López.

California is going to make history this year by becoming the first state to provide subsidies for middle-income families that includes small business entrepreneurs and contractors.

"On the first day of registration one of our clients received a state subsidy of $ 630 per month," said Lee. "That's why it's very important for people to see if they qualify for a state subsidy."

Covered California gave as an example, a 60 and 61 year old couple earning $ 70,000 a year. In 2019, they did not qualify for subsidies because their income exceeded 400% of the federal poverty percentage. This left them with a plan of $ 1,400 per month.

In this open enrollment, the couple reviewed their plan and managed to qualify for the 2020 subsidies that will give them $ 887 per month leaving their plan with a premium of $ 567.

On the other hand, it is estimated that a family of four who meet to have health insurance can pay more than $ 2,000 in fines.

Some people may be exempt from the fine if they were without health insurance for less than three consecutive months, if they belong to an indigenous-American tribe, if they are enrolled in a protected plan or belong to a Ministry of Shared Health Care (HCSM).

Covered California experts urge the community to register during the open period that will continue until January 31 for people to get their coverage as of February 1, 2020.

To find out if you qualify for subsidies and how much you could pay monthly premium visit www.coveredca.com

Uncovered California (California without coverage) is a project of the USC Center for Health Journalism in collaboration with California print and television media, reporting on people without health insurance.

The media includes the McClatchy Corp., Gannett Co., Southern California News Group and La Opinion newspapers, as well as Univision and Capital Public Radio stations.


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