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Articles / 2013

Health reform problems, goals dissected in Ventura seminar

Ventura County Star
By Tom Kisken

The 27-year-old man wearing camouflage shorts came to a seminar on health care reform Tuesday because of the notice from his insurance company that his policy is being canceled.

Eric Fogelstrom, who lives in Thousand Oaks and works in a pet store, wants to know his options. He's worried his rates will go up.

"I work in retail," said Fogelstrom, who is no fan of President Barack Obama or his health care overhaul. "I can't afford much."

Supporters, opponents and people wanting to know more came to a forum at the Museum of Ventura County to listen to speakers dissect the hottest issue going: the Affordable Care Act.

Enrollment in the law's new insurance marketplace began Oct. 1. Its goal to provide affordable care and cover the uninsured has been shadowed by cancellation notices for policies in a tide that could affect 1 million Californians. There also have been problems with a federal website that have had little impact in California, where people can enroll in a state-run exchange, but has dramatically slowed enrollment nationwide.

Some of the questions offered up at a seminar sponsored by Community Memorial Health System reflected anxiety about reform. One query focused on the requirement that all individual and small group policies cover certain benefits such as maternity and mental health care.

Why, the person asked, do people in their 60s have to pay for things they will never use, like pregnancy care?

Dylan Roby, a reform expert and a professor from the UCLA Center for Health Policy Research, noted other people could ask why they have to pay for benefits that are more important to older people.

"That's how insurance works," he said, explaining balanced risk pools. "It's kind of contributing to this large pool of benefits."

Roby noted that every aspect of reform has become politically charged. Rather than trying to fix the glitches, people on both sides try to make political hay, he said.

"They refuse to meet in the middle," he said.

Much of the event focused on explaining the program.

Gary Wilde, CEO for the Community Memorial Health System, noted that insurance in the new exchange is sold in four metallic tiers, with bronze offering the lowest premiums but the highest co-pays. On the other end, platinum offers the highest premiums but much lower out-of-pocket costs.

Wilde noted that people who don't enroll in insurance will face an initial penalty in 2014 of $95 or 1 percent of household income, whichever is larger. The penalty rises in 2015 and again the next year.

People must be enrolled by March 31.

Obama announced a plan last week aimed at policies canceled because they don't meet the law's standards. The plan would allow insurers to keep selling the policies for another year. Roby said it's not clear how or if that plan will be implemented in California. with more information expected from the Covered California exchange later this week.

Roby also noted that people who are offered insurance through an employer can opt out and go to the exchange. But they are not eligible for subsidies regardless of income unless the employer's offered plan doesn't meet reform's standards such as not costing more than 9.5 percent of the worker's household income.

The seminar was the second in a series sponsored by the Community Memorial Health System. It brought people ready to express their opinions.

JoAnne Story, a Ventura retiree in a Medicare Advantage plan, doesn't like the changes.

"I think it's awful," she said. "I just don't believe government should this involved in my life or anyone else's."

Lisa Schwarz, of Camarillo, is a self-employed graphic designer with medical needs. Reform will mean she will be insured for the first time in three years. The reform helps her but she wants it to go further.

"I think we need single-payer," she said. "I think the fact that insurance companies are still in the game is unconscionable."

In the back row, a 64-year-old woman said she went to a prior seminar but didn't think reform really affected her. Then she received a cancellation notice from her insurance company.

It meant she needed coverage for the first three months of 2014 until she qualifies for Medicare. She found a policy outside of the exchange. She'll be covered but won't forget how the cancellation made her feel.

"It was terrible," she said.

On the Net: For more on health care reform, visit