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Health Insurance California Exchange Question & Answers

2013 August 16
by Sarah Fields

Robert asks…

Is it safe to visit the United States?

A relative of mine has been offered a student exchange in the US for a year (probably California). The impression we have from the media in our country is that the United States is falling apart socially and economically, with the dollar in freefall, many people losing their homes, no public health insurance, an administration that is out of control, and one in a hundred people in prison.

Is it safe for a foreigner to visit the United States, and what precautions are advisable?


Sarah Fields answers:

Of course it is safe to send someone here. My school has about 5 exchanged students, and they all seem to love it here. Cali isn’t the best place to send them but if you send the person to a small state, like Pennsylvania, then they will be okay.

Laura asks…

What probably are the causes for increasing health insurance rates?

Is it due to inflation, lowering standards of medical care, insufficient government control, deteriorating human health, environmental degradation or other factors?

Sarah Fields answers:

Last week, Health and Human Services Secretary Kathleen Sebelius sent a letter to Anthem Blue Cross. She asked the health insurer to justify premium increases of up to 39 percent on individual policies in California. Now, the company is temporarily postponing some rate increases for people in that state.

But what about everyone else?

Such hefty premium increases aren’t confined to the Golden State. Nearly 20 million Americans purchase health insurance in the so-called “individual” market. They don’t have the bargaining power or protections that come with employer-based health insurance. They are the people who are unemployed or self-employed or work for a business that doesn’t offer insurance.

They are on their own shopping for coverage. And they frequently pay a small fortune for it – if they’re lucky enough to get decent coverage at all.

These are some of the very Americans lawmakers had in mind when they crafted health reform legislation – and a reminder of why Congress needs to finish the job.

Bills passed by both the House and Senate would set up “insurance exchanges” where Americans could buy coverage. These plans would be required to adhere to minimum standards, such as covering emergency room visits. The government would provide subsidies to some Americans to help pay for coverage.

Ideally, final legislation should allow those shopping in the exchange to purchase insurance from the government. Such a “public option” would ensure people’s choices for an insurer aren’t limited to private sector companies – the same companies that may try to jack up rates 39 percent in one year.

Reform legislation also prohibits insurers from discriminating against people because they have preexisting health conditions. It limits how much companies can charge older Americans, who may have more health expenses.

These are exactly the reforms Americans need. They are the kind of reforms Iowans need.

Wellmark Blue Cross and Blue Shield is the largest health insurer in Iowa. It sells individual policies to about 80,000 Iowans. Though Wellmark estimates the average increase on individual plans to be about 18 percent this year, some Iowans will see premiums go up about 25 percent.

About 16,000 Wellmark customers will pay 22 percent more for their individual policies – on top of premium increases of about 12 percent per year the past three years.

The truth is, there is no scarier place to get health-care coverage than in the individual health insurance market. Insurers review your health history. If there’s even a hint of a health problem, they may charge you higher premiums. If you have heart problems or cancer or diabetes, they may not sell you coverage at all. Companies may cancel your policy if you get sick.

As much as people may complain about employer-based insurance, these are the lucky Americans compared to those buying coverage on their own. According to a survey from David P. Lind & Associates in Clive, employers pay about 81 percent of the cost of premiums for single coverage plans and 66 percent of the cost for family plans.

Those in the individual market pay the entire cost themselves.

The letter from Secretary Sebelius to Anthem is yet another reminder that millions of Americans are caught between a rock and a hard place: Join the ranks of the uninsured or pay whatever the insurance company is charging. It’s a reminder that Congress needs to finally deliver some help to these Americans.

Sandy asks…

How much are states or local governments responsible for paying for the health care bill?

I heard states have to pay for the new health care law, how much do they have to pay?

Also do local governments or cities have to pay as well? or just stat governments?
I am also curious if this will hurt local/ or state government hiring.

Sarah Fields answers:

Governments at all levels have employees and they will need heath care insurance if they are not already covered. Federal employees don’t get health care, but participate in a federal insurance exchange where they can shop for what they want, a very successful program. In 2014 states will set up insurance exchanges that will be open to all.

Each state runs its own Medicaid system. In California it’s called MediCal. They chose what mix of federal and state funds are spent on Medicaid. The supreme court struck down the requirement that they expand Medicaid coupled with a corresponding increase of federal funds. So some states will simply run Medicaid as usual. Basic Medicaid covers families under the poverty line, and those on SSI workers disability. Expanded Medicaid would extend elegibility to 133% of poverty line.

People that make more than the Medicaid limit will qualify for subsidy to get insurance if not provided by employer. That will be paid federally.

I doubt this will affect local government appreciably although state run hospitals will benefit from the lessening of free floater care.

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