By MARTIN ESPINOZA
THE PRESS DEMOCRAT
In a bland industrial office building off Airport Boulevard, dozens of newly hired county employees have been logging what must seem like endless hours of training in preparation for the launch of President Barack Obama’s health care law.
At one end of the room, overlooking rows and rows of computer stations, an instructor walks trainees through each line of an application for health care coverage and subsidies. Computer screen after computer screen, the instructor navigates the bureaucratic minutiae that will determine what kind of health insurance thousands of North Coast residents will be eligible for on Oct. 1, when the state’s health insurance marketplace opens for business.
These 42 benefits eligibility workers are part of a massive, national campaign that involves a diverse cast of characters, from county employees to doctors, nurses, private insurance brokers and Internet entrepreneurs — even as some members of Congress wage a last-ditch effort to kill Obamacare.
“It took Medicare a number of years to roll out,” said Rita Scardaci, director of the Sonoma County Department of Health Services. “Our goal is that everyone will not only get coverage, but will get access to care.”
Under the Patient Protection and Affordable Care Act of 2010, millions of uninsured Americans will be eligible for medical insurance through several major changes in the health care landscape.
The law will require most individuals to have health insurance coverage or face a penalty beginning Jan. 1, though some will be exempted from the requirement, including those who choose not to comply for religious reasons.
There are approximately 70,000 Sonoma County residents who do not have health insurance. Of these, 50,000 individuals will be eligible for insurance under the health care law’s expanded coverage provisions.
In a move that affects millions of Americans, the federal government is also lowering eligibility requirements for its Medicaid program, known as Medi-Cal in California. That alone is expected to add another 18,000 Medi-Cal members to the county’s existing 60,000, said Jerry Dunn, director of the county Department of Human Services.
On Oct. 1, the state also will launch its health insurance marketplace, called Covered California, which will offer qualified health plans to people of various income levels. Tax credits will be available to those with incomes between 139 to 400 percent of federal poverty guidelines. County officials estimate that 21,000 uninsured local residents will be eligible for tax subsidies available through Covered California.
Government agencies, health clinics and insurance companies across the North Coast are hiring new workers and training existing employees to help businesses and individuals understand their health insurance options and prepare for the new wave of patients.
Spreading the word about who qualifies for what, where to get help and how to apply has been at the forefront of preparation efforts leading up to open enrollment, which runs from Oct. 1 through March 31, 2014.
The county’s eligibility workers not only will be expected to assist people who qualify for government tax credits or subsidies, but also will be charged with helping anyone who wants to buy insurance through the Covered California marketplace.
The county has hired the equivalent of 54 full-time positions, with more to come. It is revamping its Medi-Cal enrollment process and overhauling its economic assistance phone center by expanding the hours of operation and upgrading phone systems and other technology.
“Up until now, you could not apply on the phone for Medi-Cal. Starting Oct. 1, you will be able to do that,” Dunn said.
If Covered California gets a call from a Sonoma County resident who is eligible for Medi-Cal, that call will be transferred to the county’s phone center. To accommodate those calls, the county’s phone center will operate one hour later than Covered California’s call center, which closes at 8 p.m. The local center will also be open from 8 a.m. to 7 p.m. Saturdays.
The county Human Services Department also is expanding its footprint at its economic assistance service center at 520 Mendocino Ave. in Santa Rosa.
Both current and new county eligibility workers are undergoing 56 hours of training related to the state’s new health insurance marketplace.
Meanwhile, a platoon of certified enrollment counselors is being groomed to work with community health centers, which provide health care to 36,000 patients in Sonoma County.
Pedro Toledo, a spokesman for the Redwood Community Health Coalition, a regional consortium of health clinics, said a framework for much-needed enrollment outreach and education already is in place within the local network of community clinics.
The coalition is trying to become certified as one of the state’s 3,200 enrollment entities, agencies that will unleash some 16,000 enrollment counselors on Oct. 1.
For more than a decade, the health coalition has been responsible for enrolling about 12,000 kids into the state’s Healthy Families low-cost insurance program, a federally funded program. The infusion of federal reimbursements under Healthy Families have been vital to local health centers.
“For most entities, outreach is new to them. It’s not new to us,” Toledo said. “Our goal is to enroll everyone who is eligible for coverage.”
Toledo said the coalition has 45 application assistants who currently are going through criminal background checks and applying to become certified enrollment counselors. The coalition has trained more than 200 people as certified educators through Covered California.
With millions of Americans now being required to enter the health insurance market, insurance brokers and agents also are scrambling to become certified through Covered California.
David Hodges, a Santa Rosa health insurance broker, has become well-versed in many of the details of the new health care law. Using a 74-page PowerPoint presentation, Hodges has been holding seminars to educate people and employers of the seismic shift that’s about to take place.
Michael Mahoney, senior vice president of consumer marketing for GoHealth, a national online health insurance exchange, said the individual mandate could bring the online health insurance market to full maturity. The company, which is based in Chicago, began in 2001 and launched the first search engine for pricing health insurance options.
“We were asking ‘Why isn’t this like Orbitz or Travelocity,’” he said, referring to two popular travel search engines. The mandates under Obamacare will spur that evolution, he said.
“That just takes the market that we focus on from a small niche to a massive market,” Mahoney said.
Like almost everyone else involved in the medical industry, GoHealth has been ramping up over the past year in advance of the final implementation of Obamacare. The company has beefed up its software and engineering capacity to handle a greater volume of clients. By the end of 2013, the company will have doubled its workforce, adding an additional 450 workers.
Doctors and nurses also are preparing for the change.
In Santa Rosa, Sutter Health has chosen a Sutter Pacific Medical Foundation physician office to pilot an integrated model of care aimed at achieving the health care goals of the Affordable Care Act.
As a “medical home,” the practice has been beefed up with additional resources and staff, including an advice nurse, an office-based care manager who coordinates care between the hospital, ER and skilled nursing facilities. The nurse also assists patients at risk with chronic diseases and complicated care. Other staff members include a pharmacist who assists with medication management issues.
The office, at 510 Doyle Park Drive, has expanded evening hours to accommodate patient work schedules. It also has implemented scheduling changes that allow for more appointments to be filled on a daily basis.
“The successes of that office are due in large part to enthusiasm and excitement” of those who are participating in the model, said Dr. Bill Black, chief medical officer for Physician Foundation Medical Associates, which is part of Sutter Pacific Medical Foundation.
“We find that by taking this team approach to patient care, we can provide care for more patients,” Black said.
Sonoma County Supervisor Shirlee Zane, one of the county’s strongest advocates of Obama’s health care law, said the county is “way ahead of the curve.”
“We’ve been working on this for four to six months,” she said.
Zane scoffed at efforts to repeal or de-fund the law. Some members of Congress have threatened to shut down government when open enrollment begins on Oct. 1, the same day the federal budget cycle starts.
Zane pointed out that Jan. 1 only represents the last phase of a law that has been rolling out since 2010, the year it was passed. Since 2010, the law has prohibited insurers from denying coverage to children with pre-existing conditions, and it has already begun closing the prescription drug “donut hole.”
Zane said Obamacare also has expanded coverage for preventative medical services, such as mammograms, and has extended the cutoff for covering dependents to age 26.
“This has been the law for three years. It ain’t going away,” she said.