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Sonoma County ramps up for launch of new health insurance exchange

New Sonoma County benefits eligibility workers study the details of the Affordable Care Act at a training center off Airport Boulevard in Santa Rosa last month. The walls are lined with posters bearing information on filling out application forms for the new health care program. (Kent Porter / PD)

New Sonoma County benefits eligibility workers study the details of the Affordable Care Act at a training center off Airport Boulevard in Santa Rosa last month. The walls are lined with posters bearing information on filling out application forms for the new health care program. (Kent Porter / PD)

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.





13 Responses to “Sonoma County ramps up for launch of new health insurance exchange”

  1. Reality Check says:

    LBR,

    No, the pre-Obamacare system isn’t working well, but that doesn’t foretell that Obamacare will be better.

    Sorry if you’re having trouble with your insurance carrier. If govt hadn’t already taken over so much of medical care, you’d switch companies, just as you do for any other service or product. But that’s not possible. It should be.

    But my main point was that profits are not evil. They motivate. The last century, if anything, was a worthwhile lesson in the relative merits of two economic systems. The outcome, I thought, was not in doubt.

    Thumb up 1 Thumb down 3

  2. Dan Drummond Sr says:

    “In 2014, Obamacare will give us a universal health care system of the individual mandate type.”

    I like this guy …

    “Thirty-two of the thirty-three developed nations have universal health care, with the United States being the lone exception. The following list, compiled from WHO sources where possible, shows the start date and type of system used to implement universal health care in each developed country. Note that universal health care does not imply government-only health care, as many countries implementing a universal health care plan continue to have both public and private insurance and medical providers.”
    http://truecostblog.com/2009/08/09/countries-with-universal-healthcare-by-date/

    Mockingbird, I know Fox News and the Heritage Foundation are principally conservative organizations, but their cost estimates are intriguing.

    In FY2012, the federal government spent about $800 billion on Medicare and Medicaid. I think the Heritage Foundation says it will cost about $170 billion more per year for Obamacare. So starting in 2014, that will total about $970 billion a year for Medicare, Medicaid and the American version of an insurance mandated universal health care system. Way to go America! You made it. But you can do better, Congress. Or we will keep trying via new representatives.

    Thumb up 3 Thumb down 1

  3. Dan Drummond Sr says:

    Congress should stop Obamacare by passing a world class American universal health care system. One that proves we can accomplish the mission better than … pick one of the following countries:

    Australia, Austria, Bahrain, Belgium, Brunei, Canada, Cyprus, Denmark, Finland, France, Germany, Greece, Hong Kong, Iceland, Ireland, Israel, Italy, Japan, Kuwait, Luxembourg, Netherlands, New Zealand, Norway, Portugal, Singapore, Slovenia, South Korea, Spain, Sweden, Switzerland, United Arab Emirates, United Kingdom.

    Thumb up 6 Thumb down 3

  4. Lets be Reasonable says:

    @RC, you can’t say that the pre-Obama care system was actually working can you? I spend so much time trying to get my insurance to pay what they owe, it is ridiculous. Profit here means doing all they can do not to pay claims. Doctors get paid for keeping appointments short, not for getting patients better. And I’m one of the lucky ones. For those without insurance, the system jacks up the cost for everything – medicines, hospital stays, lab work. For those without insurance, the infant mortality rate in the US is similar to that of a developing country.

    Thumb up 7 Thumb down 3

  5. MOCKINGBIRD says:

    Dan Drummond-don’t quote Faux Fiction News or the Heritage Foundation. Faux is a mouthpiece for very rightwing Republicans. The Heritage foundation is all about the rich.

    You have to really do comparisons to what’s already happening elsewhere in the world. There are some good universal healthcare and we should be examining that. The fact that we spend more than twice any other country on healthcare and not covering everyone says that SOMETHING we are doing is IN NOT RIGHT.

    Thumb up 6 Thumb down 6

  6. Reality Check says:

    That the profit motive is thought to be the enemy to so many Americans is testimony to economic ignorance. Long ago, the relation between profits and efficiency was documented. The profit motive provides the incentive that gets people to think about doing things better and cheaper. It’s the driving force of inovation.

    As to longevity and nationalized health care, it’s a simplistic correlation that confuses correlation with causation. Why do the Japanese live longer? Is it likely because of nationalized health care or the lifestyles most Japanese live? The answer is obvious.

    To the extent that nationalized health care works, it’s because it borrows the medical advances developed in countries that still spend R&D capital in pursuit of profits. When they’re all gone, we’ll be left with Britain’s sad excuse for health care.

    Thumb up 4 Thumb down 4

  7. Larry Watkins says:

    Obomber care is unaffordable, cannot be sustained and unmanageable. What else is there that you don’t understand about this total disaster for the economy and our current health care system?

    Congress needs to immediately defund it and leave our health care system alone.

    Thumb up 4 Thumb down 9

  8. James Bennett says:

    We have to forfeit our personal responsibility as provided for in our Constitution, is what I meant to write.

    Be response-able.

    Obamacare IS Agenda 21.

    It will crash in so many ways.

    As intended.

    It’s almost luciferian, really.

    Thumb up 3 Thumb down 9

  9. James Bennett says:

    Follower:
    I hate labels, but there is a funda-mental difference in different people.

    In order to be receptive to an ‘ism’, you have to be willing to forfeit your personal power and be response-able.

    To take on the scope of truth we are faced with.

    Not everyone has that…capacity.

    Instead, they figure someone else will make sure it’s OK.

    Or, they would never do anything that bad.

    Or, there’s a good reason. making some more gullible.

    We’re all the same, we just want to be free.

    Just, some of us have the discernment to see the writing on the wall.

    Thumb up 2 Thumb down 5

  10. Dan Drummond Sr says:

    It sure seems that universal health care would save tax dollars and at last cover everyone.

    $150 billion / year covering everyone:
    Fox News says, “Health policy experts say guaranteeing coverage for all Americans may cost about $1.5 trillion over the next decade.” That would be only about $150 billion a year to cover everyone. http://www.foxnews.com/politics/2009/03/18/universal-health-care-cost-trillion/

    $170 billion / year without covering everyone:
    The Heritage Foundation says, “Obamacare will spend $1.7 trillion (over 10 years) on its coverage expansion provisions alone, including a massive expansion of Medicaid and federal subsidies for the new health insurance exchanges.” http://www.heritage.org/research/reports/2012/10/federal-spending-by-the-numbers-2012

    $800 billion / year without covering everyone:
    FY 2012 federal spending for Medicare and Medicaid per Wikipedia. http://en.wikipedia.org/wiki/Expenditures_in_the_United_States_federal_budget

    Thumb up 4 Thumb down 5

  11. bear says:

    @follower

    I suggest you run for public office and single-handedly correct the flaws in our government that so annoy you.

    We’re not yet a dictatorship, so you may find this a challenge worthy of your talents.

    Thumb up 5 Thumb down 2

  12. Follower says:

    Every time I meet a Liberal now I can’t help but see someone who is spiritually, intellectually and/or psychologically too weak to resist the cradle to grave Nanny State lie and too cowardice to just come steal my wealth themselves, face to face.

    It’s kind of ironic that the “greed” the left loves to hate and the “out of my womb” oppression they claim fight is now called “Public Employee Union Contracts” and Obamacare respectively.

    So guess the “take way” from the era of the baby boom generation is “greed and oppression is actually OK… as long as it’s a Democrat controlled Government doing it”.

    Nice legacy.

    Well I have some VERY BAD NEWS for you sunshine… one day Republicans will run the show again and God forbid they be as extreme right as you are left.
    THAT won’t be good for any of us.

    I know you don’t believe it but it WILL happen. That’s not an “opinion”, that’s a historical FACT!

    And all this power you are giving to “your guy” will be in the hands of “the other guy” and you can kiss Roe –v- Wave goodbye! (Among other things)

    Did you REALLY think a Republican controlled Obamacare would include Abortions?

    So yuk it up all you Obamabots, your day is coming.
    The pendulum never swings back slowly from such extreme heights. But it always swings back.

    I can’t wait to see the look on your face when you realize that the next “Nixon Administration” is now running your Health Care!

    fools

    Thumb up 8 Thumb down 14

  13. Martha Harper says:

    As someone who works with health insurance and government health plans I don’t think the Affordable Care Act (I refuse to call it Obamacare because CONGRESS created this mess)is going to be the plan that is best for America. I believe strongly that anytime we contract with FOR PROFIT insurance company their bottom line profit margin will be the goal and that means shortchanging consumers, high premiums and copays for fewer services. That’s how it’s been and that how it will continue.

    I think the best model would be Medicare for all or for California to contract with Kaiser Permanente because their model is working well. Having physicians as employees receiving salaries, healthcare for their families, vacation and sick leave, and no overhead saves money. I have Kaiser and have never had to wait long for anything and have chosen my own doctors. In fact, many of the specialists in the county have now joined Kaiser. Kaiser does excellent well care.

    A friend of mine who lives in Australia said Australia’s costs went down again on their government plan and so she’s received a decrease in her premium which she thought was already low.

    Healthcare in this country is only the best for those who have money. Here’s the US rankings with all other countries both for cost and health rankings:

    http://www.pbs.org/newshour/rundown/2012/10/health-costs-how-the-us-compares-with-other-countries.html

    http://www.worldlifeexpectancy.com/country-health-profile/united-states

    So think again if we are the best. We are the most expensive-that’s the reality.

    Thumb up 9 Thumb down 5

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