By Mary O’KEEFE

Love it or hate it the Affordable Care Act is the healthcare the United States has presently, though that is expected to change with the election of Donald Trump as President and both Houses in Republican hands. “Repeal and Replace” was stated by President-elect Trump at several of his rallies concerning the Affordable Care Act. What will be replaced in healthcare is not clear but it is expected the new administration will change ACA. For now those who get their health insurance via the ACA it is time to choose a new plan or stay with the old. Whatever the decision, Californians will see an increase in premiums though not nearly as high as other parts of the country. Since open enrollment began on Nov. 1, there has been a lot of information released about ACA; however, more information does not always equate to more comprehension.

The federal government did announce that health insurance premiums on the Affordable Care Act’s marketplaces would increase in 2017. The number given as an average for the second-lowest Silver plan, the most popular plan chosen, is a 22% increase. Some states are considerably more and some are considerably lower. Luckily California will see one of the lowest increases in premiums.

“Statewide the mid-level plans in the exchange will [increase] 7% and in L.A. County it increases only 5%,” said Rep. Adam Schiff.

In Arizona the rate is reported to be increased as much as 116%. Schiff explained this discrepancy between the states is how the ACA was rolled out in the beginning.

“It is how receptive the state was [to the plan] and whether [it] tried to enroll people in the [marketplace],” he said.

Arizona did not take an approach to outreach that was as aggressive as California with its Covered California exchange. The way ACA will work is through competition. If older people or those who have greater healthcare needs are the only ones who sign up and younger and healthier people do not, insurance companies will back out of the system thereby reducing competition and increasing costs.

In California the outreach was to all ages and populations. In addition, Covered California, the state’s ACA healthcare program, has become one of the easiest to navigate.

Health insurance competition in California is – well, healthy.

“There are up to 11 [carriers] offering [healthcare insurance] in 2017. More than 92% of [those in Covered California] will be able to choose from three or more plans,” said James Scullary, spokesman for Covered California.

In Crescenta Valley, residents will have up to six carriers from which to choose. California companies include Molina Healthcare, L.A. Care, Health Net, Blue Shield, Anthem, Blue Cross and Kaiser. Some offer both PPOs and HMOs.

Scullary advises those currently enrolled in Covered California or those who are getting health insurance for the first time to shop around.

“Just like you would do your research before buying a television or a car. We have the tools in place that allow you to do that research,” he said.

It is true that those in the
exchange who will feel the increase in premiums will be those who do not receive financial subsidies.

Most people in California, and across the country, are able to get their health insurance through their employer.

“But for those people who do not, about 85% get subsidies for the exchange. Of the 15% who don’t, that can be expensive,” Schiff said.

He admitted he has seen that increase as a substantial hardship for those who do not get subsidies, and he knows personally how much those premiums can rise.

“I get my health insurance off the exchange and I have had high increases as well,” Schiff said.

Part of the ACA agreement was that members of Congress had to go on the ACA exchange but, unfortunately, Schiff cannot go through Covered California.

“We are all required to get it through the DC exchange,” he added.

With all the negative information about premiums increasing, there is good news regarding ACA. Twenty million people throughout the U.S. are now insured, people cannot be denied insurance due to a pre-existing condition, and young adults can stay on their parent’s insurance until they are 26 years old. This latter issue is an advantage since many of those are students with thousands of dollars in school loans, so saving on insurance is an advantage.

There are penalties for not having health insurance but some would rather pay the penalty than pay for insurance.

“If you go that route and pay the penalty, [it is] either a flat rate of $695 or higher [because] the penalty is based upon a percentage of your [income],” Scullary said. “The money they are paying to the government would be better served paying [for health insurance].”

Scullary again reminded those who are in the exchange or are looking at it for the first time to shop around and to use all the resources offered by Covered California.

“You can find local help to enroll,” he said.

Those interested can go to the website www.coveredca.com and enter their zip code. There they will find companies with trained personnel who are certified by Covered California who will provide free and confidential advice and will help navigate the Covered California site.

Scullary repeated that people do not have to pay for insurance assistance. Companies offering help that are found on the website as well as by calling Covered California centers at (800) 300-1506 can provide consumers with information at no cost.

“Consumers should not be paying out of pocket to sign up for insurance,” he added.

The exchange opened on Nov. 1 and will close on Jan. 31, 2017; however, to be covered with health insurance by Jan. 1, 2017 consumers must choose a plan and sign up by Dec. 15.

For more information go to www.coveredca.com or call (800) 300-1506.