Locals Still Dealing With ‘Obamacare’ Problems

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Despite a new federal law mandating every U.S. citizen obtain health insurance by March 31, some Malibu-based insurance agencies, medical practices and self-employed residents continue struggling with the Affordable Care Act’s fine print and the government’s often-confusing bureaucracy. 

Others, however, have reported a calm after the storm since Covered California, the state’s health insurance administrator, was launched. 

Those with health insurance coverage through an employer or an individual policy that met ACA’s requirements generally did not need to change anything, but those in need of a new plan had to go through Covered California or an insurance agency. 

Bart Baker of B.W. Baker Insurance Services in Malibu said a bureaucratic snafu hit close to home, affecting his sister-in-law. 

“She got cancelled [from her Obamacare plan] and was told to go to Medi-Cal,” he said. Medi- Cal is California’s version of Medicaid, providing health insurance to low-income residents. 

“She was able to get her coverage back, but it was a real pain. Stuff like that is happening through Covered California all the time. 

“Changes in income and enrolling children that were not enrolled before can get you kicked off [a Covered California plan]”, Baker said, explaining that Covered California has a “financial questionnaire” that applicants fill out, and that the laws were written to strictly flag changes in income and the number of household members being supported by that income for anyone receiving the government subsidy. 

He said most people don’t want to go on the state’s Medi-Cal plan because it’s “limited, with a different network of doctors and hospitals. It’s a highly reduced network – a safety net, a last resort.” 

“[The switchover to Obamacare] has been a nightmare,” Baker said. “We’ve been on hold on the phone for hours and hours every day.” 

Many of Malibu’s estimated 1,320 self-employed residents had to find new health insurance after their individual policies were cancelled on January 1 for not meeting “Obamacare” requirements. Others chose to shop around because their insurance rates increased substantially. 

Mark Ball of Mark Ball Insurance, told a different story than Baker, saying that an increase in public awareness about health insurance is a positive. And because the ACA doesn’t allow insurance companies to medically disqualifying anyone, he’s able to get people signed up for healthcare that used to be uninsurable. 

“Now that the open enrollment period ended, it’s very quiet.” Ball said. “It was chaotic, challenging and frustrating for me and my clients, and there were billing and processing issues after the initial sign-ups.” 

Statewide, overall adjustments seem to be going rather smoothly. Affordable Health California reported that in a May 2014 statewide survey that 54 percent of residents believe Covered California is “working well,” up strongly from the previous poll’s 46 percent. Thirty-five percent said it was not working well. Those who indicated Covered California was doing a good job tended to be Democrats (70 percent) versus 50 percent of Republicans. Sixty-five percent of those ages 18 to 34 said they liked what the exchange was doing. 

The biggest issue that Ball’s agency sees now is that the doctor networks for the insurance plans in Covered California are much smaller than for plans available on the open market. 

“That’s an ongoing issue for some people,” Ball said. “I’ve had a couple clients complain that their doctor wasn’t on it. Which networks and plans doctors are on is still a constant evolution.” 

Baker also commented that the new networks were limited in scope, and urges people to find out whether their doctor is on the plan they’re considering before signing up. 

Susan Peters, who handles insurance for local Doctor Jeff Harris said, “Covered California came up with this mysterious selection process for healthcare providers and we haven’t been included in any of their networks yet. It’s based on demographics and how many doctors are in a certain specialty in each area.” 

The LA Times reported similar findings on May 23, writing “Many consumers have encountered difficulty finding a doctor who accepts their new coverage, as well as frustration with inaccurate provider lists, according to the California Department of Managed Health Care … consumer frustration with smaller physician networks has drawn the most attention statewide.”