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Affordable Care Act’s effects in Alameda County explained
The Oakland Tribune

SAN LORENZO — Alameda County has begun assessing the effect of the Affordable Care Act, the most sweeping federal legislation since Medicare was created in 1965, the director of the county’s Health Care Services Agency said.

During a presentation Friday [March 2, 2012] in San Lorenzo, Alex Briscoe, a frequent public speaker on health care in the county, struck a balance between criticizing some aspects of the act and praising it for expanding health insurance coverage to millions of Americans. Briscoe spoke at a forum co-sponsored by the League of Women Voters Eden Area and the American Association of University Women-Hayward/Castro Valley Branch. A mostly older crowd of about 60 people attended.

The complex 2,000-page Affordable Care Act was signed by President Barack Obama in 2010. Briscoe attempted to explain some of its main features and laid out some of the effects the act will have on the county.

“We spend more of our gross domestic product on health care than any nation in the world, and we continue to see some of the worst outcomes by population of any industrialized nation,” Briscoe said. For example, in 1960 in Alameda County, whites lived on average about 2.3 years longer than African-Americans. That gap had increased by 7.8 years in 2005, he said.

The United States is the only industrialized nation in the world with no medical safety net for indigent adults, he said. “It’s a great moral and ethical failure of American society. This bill ends that failure.”

The law will add about 16 million Americans to the Medicaid roles, and the Congressional Budget Office has estimated its cost at about $940 billion over the next 10 years, he said. Most provisions of the law will begin in 2014, with full implementation and financing operational by 2018. Some of the act’s provisions have already gone into effect, such as allowing young adults up to age 26 to remain covered under their parents’ health insurance plans. In 2014, health insurance companies will no longer be able to deny coverage to people with pre-existing medical conditions.

Briscoe said of the 1.45 million residents in Alameda County, 17.6 percent were uninsured in 2006, totaling 229,252 people. Given economic pressures, he estimated the number of uninsured in the county now to be about 250,000. After full implementation of the act in 2018, 56,200 Alameda residents will be eligible for Medi-Cal. About 107,000 county residents will be eligible for subsidies to purchase private, individual insurance through health care exchanges required by the law.

Assuming full enrollment, Alameda County would see a 95.5 percent insurance rate, with 65,000 individuals remaining uninsured – mostly undocumented immigrants and those who qualify for a religious exemption, he said.

The act has three main components, Briscoe explained. First, it expands health insurance coverage through an individual mandate that requires every American citizen to have health insurance. Second, it expands eligibility for Medicaid, called Medi-Cal in California, to adults earning less than 133 percent of the federal poverty level, or about $15,000 for a one-person household, according to the U.S. Health and Human Services Department. Third, it requires states to set up health insurance exchanges in which individuals can buy insurance, and it increases employer participation.

The individual mandate will be enforced through fines when the uninsured pay their income taxes, Briscoe explained. The constitutionality of the individual mandate provision has been challenged in the courts and will be reviewed by the Supreme Court, with a ruling possibly this summer.

Briscoe described the state health insurance exchanges as a kind of “eBay for health care,” where people will be able to purchase health insurance online. Californians earning from 133 to 400 percent of the federal poverty level will receive subsidies to purchase insurance; however, the amount has not been determined, he said.

Briscoe said “the great unanswered question of the act” is how much health insurance will cost for those at the lower end of the income scale.

“Right now, it’s being projected at $750 per year,” he said. “To me, that’s really borderline. You’re making $15,000 to $16,000 a year. That $75 to $80 bucks a month actually means something. You’ve got to get that number right because if it’s too expensive, people just won’t buy it if you’re asking them to choose between food and bus fare.

“If they don’t buy it, then we perpetuate the hidden tax of health care where the uninsured and underinsured go into our emergency rooms and cost us a huge amount of money. And remember, the current enforcement mechanism of the act is to fine you through your income taxes.” And, Briscoe said, some low-income people may not even file a tax return.

Briscoe said an upcoming challenge for the county will be a lack of primary care infrastructure to serve a greater number of people who may be seeking primary and preventive care once they are covered under the act.

One method that the county is looking at, he said, would set up clinics at schools, community colleges, fire stations and day labor centers.

During a question-and-answer period, some attendees asked about the act’s effect on Medicare. Briscoe said it was “mostly not impacted,” but added that Medicare was not his area of expertise. He said he would attempt to organize future talks on the impact of the law on Medicare recipients and on small business owners.

San Lorenzo resident Elaine Sandau, who grew up in Canada, said she found the talk informative and supported the act, despite some reservations, such as a requirement that health insurance plans pay for birth control, even in plans provided by religious organizations. “I believe strongly in the separation of church and state and don’t believe this should force employers to violate their beliefs,” she said.

“In the United States, the health care is the best in the world, but not the system,” Sandau said. “I do think (the Affordable Care Act) is only a first step. I think just doing nothing is setting us back.”

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