Health care coverage coming to valley

kcarlson@modbee.comApril 9, 2013 

An estimated 20,110 residents in Merced County will be among nearly 3 million uninsured or poorly insured Californians eligible for tax credits to help them buy insurance before the federal health care law kicks in next year, according to a report released Tuesday.

In the Northern San Joaquin Valley, almost 40 percent of those people are young adults, ages 18 to 35, who have no insurance or are offered substandard coverage by employers. About half are families with incomes between 200 percent and 400 percent of the federal poverty level, or $47,100 to $94,200 for a family of four, according the Families USA report.

An estimated 43,390 people in Stanislaus County and 53,000 in San Joaquin County will be eligible for subsidized coverage under the Affordable Care Act.

Families USA, a health consumer group that supports the federal law, commissioned the Lewin Group consulting firm to provide the estimates for most of the 58 counties in California. The report shows a significant need for health coverage in the San Joaquin Valley, where the health care law divides people along party lines.

"The Central Valley will particularly benefit from this assistance," said Anthony Wright, a leading health care advocate. "The Central Valley has some of the highest uninsured rates in the nation, and folks there are more likely to benefit from this help than other places in the state or nation."

The health care overhaul will require most U.S. residents to have health insurance in 2014 or pay a penalty, but it includes tax credits to lower premiums for people who buy coverage through the Covered California health exchange.

The credits will be based on a sliding scale, with the largest amount of assistance going to those with lower incomes. Those eligible include single people with annual incomes between $15,860 and $45,960 and four-member families earning between $32,500 and $94,200.

To receive the credits, people won't need to complete income-tax returns. Instead, the government will advance the credits to health insurers when people buy insurance through Covered California starting in October.

An enrollment period is set to run from Oct. 1 through March 31.

Rep. Henry Waxman, D-Beverly Hills, said in a Families USA teleconference that the uninsured won't need to jump through insurance company hoops to buy affordable coverage through the exchange.

For a single person with $15,860 in annual income, the tax credit will lower premiums to $44 a month for a one-year health plan costing $5,000, the report says. An individual earning $45,960 a year would see a $364-a-month premium.

Subsidized premiums will range from $90 to $745 a month for four-member families earning between $32,500 and $94,200 annually.

Four plans to be offered

The exchange will offer four plans with maximum yearly out-of-pocket costs of $4,000 for a person and $8,000 for a family, or $6,400 for a person and $12,800 for a family.

The nearly 3 million eligible Californians include the uninsured and workers who are offered inferior benefits by employers, but the report does not have specific estimates for each group. Under the law, workers required to pay more than 40 percent of the cost of health benefits, or who would have to pay more than 9.5 percent of their wages for benefits, are eligible for coverage through the exchange.

Kathleen Stoll, health policy director for Families USA and co-author of the report, said the numbers were derived from a simulation model including census data and inputs from well-used federal databases, along with information from insurers.

She said a robust effort is needed to inform people about the requirements and benefits of the Affordable Care Act. "We have a tremendous challenge between now and January to let people know help is available," Stoll said.

According to the Families USA report, slightly more than half of the eligible people in Stanislaus County are Latino, 37 percent are white, 2.5 percent are black and 8 percent are in other ethnic groups.

Covered California is establishing call centers, online application systems and offices in the state to assist people who will seek coverage in the fall.

Modesto Bee staff writer Ken Carlson can be reached at or (209) 578-2321.

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