March cover story: Health care issues take centerstage

With the deadline looming for open enrollment in the Health Insurance Marketplace, the announcement of a new health agency chief in Ventura County and a positive status report on a previously troubled health plan, health care is certainly in the news both nationally and right here in the 805 region.

 

Open enrollment deadline nears

The days are counting down until the end of the open enrollment period on March 31 for the Health Insurance Marketplace under the Affordable Care Act.

Those who decline to obtain any kind of insurance face a $95 fine, or 1 percent of their taxable income.

The plan, also known as Obamacare, is designed to provide affordable health-care services to those in need. The plan has survived 50 repeal attempts by Republicans in the House of Representatives and a disastrous health care website rollout. Representatives from the Obama administration have been out in force to try to increase enrollment, especially in the Latino community, where there are an estimated 10.2 million people eligible for coverage.

While those not in the United States legally are not eligible for coverage under the act, their children who are born in this country are eligible and required to obtain coverage.

However, relationships between the Obama administration and the undocumented community are strained at best, with the National Council of La Raza among others who have recently called the president the “Deporter-in-Chief” for the record number of 2 million deportations during his term of office.

During a recent town hall meeting Obama said he supports comprehensive immigration reform, but he does have to enforce the laws passed by Congress. Republicans, meanwhile, say they can’t work with the president on comprehensive immigration reform because they can’t trust him to enforce immigration laws.

“Seriously? Failing to enforce our laws? For us, this president has been the deporter-in-chief,” NCLR President Janet Murguía was quoted recently in an NBC News story. She made her remarks during the organization’s gala event.

As a result of the deportations, many in the undocumented community are fearful to sign up for the Health Insurance Marketplace, believing they will then come to the attention of the Immigration and Naturalization Service and be deported, leaving their U.S.-born children to fend for themselves or be cared for by other relatives or friends living in the U.S.

The Pew Research Center reports there are about 9 million people in the U.S. who live in families of mixed legal status. As a result, many are refusing to sign up.

“Our community is about family, so protecting the family comes first,” Jane Delgado, executive director of the National Alliance for Hispanic Health in Washington, was quoted earlier this year in a Christian Science Monitor article. “This is very personal information that they’re being asked to share.”

Health-service providers such as the Ventura County Health Care Agency, Clinicas del Camino Real Inc. in Ventura, the Gold Coast Health Plan and others have been busy providing information on Covered California, the state’s Health Insurance Marketplace program.

As one example, Ventura County Fifth District Supervisor John Zaragoza and the El Rio Municipal Advisory Council, will host a free informational and educational community health-care forum about Covered California from 7 to 8:30 p.m. Thursday, March 20 at the Roger Jones Community Center, 2868 Jourdan St., Oxnard.

For the plan to succeed nationwide, it must have the buy-in of Latino and other minority communities, who make up a large percentage of the nation’s uninsured population. The more people who sign up for the program, the lower the health insurance plan costs will be for everyone, officials report.

Subsidies are offered to qualified enrollees, while many very-low-income residents are eligible for health care services year round through state assistance programs.

The next open enrollment is scheduled to begin Nov. 15, 2014 for health insurance coverage that begins Jan. 1, 2015.

 

 Ventura County Health Care Agency gets new boss

Barry Fisher has been appointed director of the Ventura County Health Care Agency, replacing current director Dr. Robert Gonzalez.

Gonzalez announced in November that he was stepping down as director to return to medical practice and spend more time with his family.

Gonzalez will assist Fisher with the transition through early April, Ventura County Executive Officer Mike Powers stated in a media release.

Fisher has served as the agency’s chief deputy director since January 2013 and previously served as director of the county’s Public Health Department.

He was selected from among a group of internal and external candidates following an extensive competitive recruitment, Powers said.

“The pool of applicants for the position was outstanding, as each brought excellent credentials and experience,” he said.

Fisher was selected based on his extensive private and public health care management experiences, record of accomplishments and demonstrated passion for the agency’s mission, Powers said.

“Mr. Fisher has a passionate commitment to the agency’s mission of providing access to top-quality health care within our community, especially those facing barriers to access,” he said. “These are certainly challenging times in health care, with many hurdles along with great opportunities. In light of his collaborative approach, and the importance he places on listening to the needs of our providers and our community, Mr. Fisher is the right person to lead the agency during this challenging and exciting era.”

While serving as director of the county’s Public Health Department, Fisher led the process of creating Ventura County’s first countywide trauma system. He started his career at the county in 2001 as administrator of the county’s Emergency Medical Services (EMS) system, which oversees all pre-hospital emergency care providers across the county.

 

 Health plan provides status report

In its annual report to the community, Gold Coast Health Plan reported it hired experienced leadership and “made operational improvements across all phases of its business” in its second year of operation.

Gold Coast Health Plan serves more than 131,000 Medi-Cal beneficiaries living in Ventura County. The independent public entity is governed by the 10-member Ventura County Medi-Cal Managed Care Commission, comprised of locally elected officials, providers, representatives from area hospitals and clinics, the county healthcare agency and consumer advocates.

Some of the current commission members include outgoing Ventura County Health Care Agency Director Dr. Robert Gonzalez, who is serving as chair of the commission; Roberto S. Juarez, vice-chair, who is CEO of Clinicas del Camino Real Inc., and Ventura County Supervisor Peter Foy.

The health plan was launched in 2011 by the Ventura County Board of Supervisors following a decision by state officials for counties to create locally administered health plans. The plan got off to a shaky start during its first year following the resignation of its interim chief executive officer and chief financial officer, concerns about overpayments to health care providers and a high employee turnover rate. An interim CEO was named and officials said steps have been taken to address past concerns. The health plan is now led by Michael P. Engelhard, chief executive officer.

“I can report to you that over the past year the plan has taken tremendous strides in creating an organization and atmosphere that facilitates our mission,” Engelhard stated in the plan’s “Annual Report to the Community.”

“These improvements have positioned the plan to implement the wide range of changes to the Medi-Cal program arising from federal health care reform legislation (the Affordable Care Act or ACA).

“As a result of this historic time in health care reform, enrollment has surged at Gold Coast Health Plan. In December 2012, the plan had approximately 101,000 members; as of February 2014, it has more than 131,000. We expect this growth to continue as more people become eligible for Medi-Cal due to eligibility changes contained in the ACA. Even with the growth in the size of the plan, the commitment to ensuring access to quality health care remains the same.”

“I am pleased to say that Gold Coast Health Plan is on much firmer financial ground today than it was a year ago and I expect that trend to continue,” Michelle Raleigh, the plan’s chief financial officer, stated in the report. For fiscal year 2012-13, the plan reported revenue of $315 million, health care costs of $280 million, required reserves of $11 million and current reserves of $12 million. Health-care costs are projected to hit $347 million for fiscal year 2013-14, the plan reported.

The plan covers one in six Ventura County residents, including one in three county residents up to the age of 5, and one in nine county seniors.

A total of 43 percent of its members speak Spanish, with 53 percent speaking English and 4 percent speaking other languages. The largest percentage of its members reside in Ventura County Supervisor John Zaragoza’s fifth district (49,250), followed by 20,937 members in Ventura County Supervisor Kathy Long’s third district.

The plan is scored in the 75-90th National Committee for Quality Assurance National Percentile for Childhood Immunization Measure. The plan has also passed the 2013 NCQA HEDIS Compliance Audit, a health plan performance measurement, receiving the 2013 NCQA HEDIS® Compliance Audit Seal, officials reported.

The annual report is available at http://goldcoasthealthplan.flippublication.com/Issue/C9CB18A3-F7DE-4C77-E00006B8B079C6F2/March2014/index.html

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Open Enrollment for the Health Insurance Marketplace

• Open Enrollment for 2014 coverage ends March 31, 2014. Exceptions include qualifying life events. Those who do not have health coverage in 2014 may have to pay a penalty of $95, or 1 percent of their taxable income. The next Open Enrollment begins Nov. 15, 2015 for health insurance coverage that begins Jan. 1, 2015.

For more information on 2014 Open Enrollment, go to https://www.healthcare.gov

• Covered California’s mission is to increase the number of Californians with health insurance, improve the quality of health care for all Californians, reduce health care coverage costs and make sure California’s diverse population has fair and equal access to quality health care. For more information, go to https://www.coveredca.com