Enrollment for the second phase of Covered California got underway two weeks ago with Los Angeles County expected to again lead all state regions in sign-ups. In March, more than 200,000 persons in the county had enrolled, far outpacing the nearest region, the San Francisco Bay area, which saw 164,000 consumers opt for state-run heath care coverage. Since Nov. 15, more than 100,000 additional Californians have submitted coverage applications for the latest enrollment period.

Covered California officials expect to enroll at least 500,000 eligible residents by the Feb. 15, 2015 deadline. Officials in Sacramento say the latest open enrollment period is off to a fast start. Slightly more than one-half of the 100,000 persons applying—some 52,000 individuals—were eligible for coverage through the individual marketplace at the exchange. Approximately 25,000 Californians have selected one of four plans offered during the past two weeks. This will be a shorter enrollment period, therefore consumers must sign up by Dec. 15, if they want benefits to begin on Jan. 1, 2015. The program will broaden its outreach this winter and expand service-center staffing and hours to accommodate expected surges in demand.

Peter Lee, executive director of Covered California, said the latest numbers are a dramatic increase over the first open enrollment period. “We’re seeing more Californians informed and ready to sign up,” he said. Another 34,000 persons who have applied were found to be eligible for Medi-Cal, the decades-old health service which offers year-round enrollment. Californians who do not qualify for Medi-Cal and still need insurance may opt for a healthcare plan under Covered California.

Low African American turnout

But one demographic, African Americans, remains largely invisible in terms of enrollment. At the end of the first open enrollment period from October 2013 to March 2014, only 30,774 Black persons signed up for coverage. Statewide 371,000 Blacks may have been eligible to enroll. The Black enrollment compares with 350,000 White, 253,000 Latino and 211,000 Asian enrollees who signed up by the spring deadline. African Americans comprised only 2.7 percent of statewide enrollees, despite high hopes that Covered California would reach some 220,000 Black residents. Covered California last winter partnered with statewide and community-based organizations specifically to support African American outreach, including such bodies as the California Black Health Network and the California NAACP. The two organizations received a combined $1.6 million in grants, with some 30 community groups receiving about $1.3 million from that total to reach African Americans.

Health researchers have pointed to numerous historical reasons why so many African Americans have had difficulty accessing healthcare, chief among them being financial constraints, little if any interaction with a regular family physician, logistics (few family practitioners in the inner-city), travel expense (seniors may find it difficult financially to commute across town to a doctor) and, generally, a lack of hospitals and medical facilities in urban communities.

“I think there was somewhat of an underestimation on the part of Covered California on what it would take as far as an investment in [introducing the practice accessing regular healthcare] to historically disenfranchised communities,” said Jim Mangia, president and CEO of St. John’s Well Child and Family Center which operates a number of healthcare facilities in Los Angeles County. “I don’t think there was a big enough upfront investment such as with [adding more] certified enrollment counselors. The engagement has to be direct and concerted, culturally relevant and competent. When you are dealing with a community that has not had [health insurance] access and coverage, you have to tailor your message.”

Covered California announced last spring that there were 591 certified enrollment entities stationed primarily within Black communities, representing 78 percent of all certified enrollment centers. The 591 enrollment entities included more than 4,500 certified enrollment counselors. Mangia suggested that more Black representatives would better serve the African American community, as opposed to counselors of other ethnicities. “With all due respect, you can’t have a bunch of White folks going into the Black community and teaching them about Obamacare. You’ll get some sign-ups, but not as many as you need,” he said.

In August, Assemblyman Steven Bradford (D-Gardena), who chairs the California Black Caucus, told the Board of Directors of Covered California that their efforts “… must be committed to outreach” to the Black community. Assemblywoman Cheryl Brown (D-San Bernardino) explained that, because the Black enrollment has been so low statewide, this community could owe more than $8 million in penalties to the IRS for failure to purchase insurance.

By law, individuals are required to purchase health insurance. Those who do not, face a fine from the federal government.

“Covered California boosted its outreach to the Latino community,” Brown told the board, “but there has been a lack of commitment to the Black community.” Brown said the Black Caucus has worked with Covered California for months on boosting outreach. “We gave (a list of) trusted people who have reached the African American community in California for years,” Brown said. “That list was submitted to Covered California staff, but nobody on it was contacted.”

People can be enrollled in Covered California health plans by certified insurances agents, certified enrollment counselors or county eligibility workers.

Physicians, hospitals join forces

This week, Covered California, the California Medical Association and leaders of 13 physician, pharmacist, hospital and health care provider groups announced a new partnership to promote the open enrollment period. More than 100,000 physicians, pharmacists and 400 hospitals statewide will receive materials to help publicize the open-enrollment opportunity in an effort to get more non-insured persons connected with a general practitioner. Among the groups now participating in the publicity campaign are the California Academy of Family Physicians, the California Latino Medical Association, the California Academy of Physician Assistants, the California Pharmacists Association and the California Hospital Association.

“We want customers to know there is broad access to physicians and hospitals across the plans offered by the exchange,” Lee said on Tuesday at the Ronald Reagan UCLA Medical Center. “More than 61,000 unique physicians are available—or more than 75 percent of all licensed, active non-hospital physicians.”

Although Covered California, which is the state’s version of the federally-mandated Affordable Care Act (popularly known as Obamacare), is not available to noncitizens or undocumented immigrants, State Sen. Ricardo Lara (D-Bell Gardens) this week introduced a “Health4All” bill to make available Medi-Cal benefits to this population. The proposal, which previously carried a price tag of up to $1.3 billion a year, stalled last year in committee as Republican lawmakers criticized its high cost. There are an estimated 2.6 million persons living illegally in California. Lara cites President Barack Obama’s recent executive order to provide amnesty to more than 5 million undocumented immigrants nationwide as impetus for his bill.

“The president’s action covers almost half of California’s undocumented population, but that still leaves over a million people with no access to healthcare. We can do better,” Lara said. “This bill will cover those remaining uninsured that will not benefit from Obama’s actions.”

Lara’s idea has not gone over well with Californians for Population Stabilization, a Santa Barbara-based group that advocates for lower population. They believe that since California is reportedly “more generous” toward immigrants than most other states, adding healthcare coverage may attract more people to cross into California illegally.

“There are millions of Californians who don’t have health care insurance or have to pay for their healthcare insurance out of their own pockets,” said Joe Guzzardi, a spokesperson for the group. “It seems unfair to have legislation that provides for people who came to the United States unlawfully to be rewarded with a health care plan.”

Undocumented immigrants and health care

California has its own policy of providing health coverage with state money to low-income persons and undocumented immigrants with so-called “deferred action” status that allows them to avoid deportation. Immigrant and healthcare advocates say that means Obama’s executive order will enable hundreds of thousands of low-income immigrants in California to apply for Medi-Cal. So far, the California Department of Health Care Services has not received formal guidance in accepting immigrants into Medi-Cal, California’s version of Medicaid. State officials still do not know how the new immigration order will impact the overall Medi-Cal program which is consuming an increasing share of state funds.

Anthony Wright, executive director of the healthcare watch dog group Health Access California, said allowing this expanded group of immigrants to participate in Medi-Cal may enable more people to receive primary and preventive care, “rather than just going to the emergency room.”

Medi-Cal is a health program primarily for the poor and is paid for by the federal government and the state. It has grown by about 3 million people in California under federal healthcare reform and now covers more than 11 million people statewide, or about 30 percent of the state’s population. The federal government is paying for the expansion, but the state will eventually have to pay 10 percent of additional costs to cover low-income adults, many of whom are undocumented immigrants. California expects to spend more than $17 million of its own money on the program this year—up by 3.5 percent from last year—according to the state Legislative Analyst’s Office.

This week, a number of leading national and California immigrant rights organizations joined with Covered California to announce a partnership to further publicize to immigrant communities that their residency status should not interfere with obtaining coverage under the Patient Protection and Affordable Care Act. MALDEF (Mexican American Legal Defense and Educational Fund), the National Immigration Law Center, the Coalition for Humane Immigrant Rights of Los Angeles and the California Immigrant Policy Center are among the partners.

“Families need adequate health coverage, so no family should have to avoid seeking coverage because of understandable concerns about a political atmosphere that continues to demonize certain immigrants,” said Thomas A. Saenz, MALDEF president and general council. “We are thankful that Covered California and the Department of Homeland Security have made it crystal clear that immigration enforcement and health coverage should not and will not mix.”

Four levels of coverage

Covered California offers four levels of coverage: Bronze, Silver, Gold and Platinum. At each level, all insurance plans offer the same benefits including essential health benefits such as doctor visits; hospital care; emergency room care; care for pregnant women, infants and children, as well as prescription drugs. Consumers can determine which level is best for them based on their expected use of medical services.

Platinum plans feature the highest monthly premium, but they also pay 90 percent of covered health expenses. Bronze plans have the lowest monthly premium but pay only 60 percent of covered health expenses.

There is also a minimum coverage plan available to persons under age 30 and may help reduce costs for health service in case of a serious and expensive medical emergency. This plans covers three doctor visits per year at no cost, and also provides free preventive benefits. Consumers must pay the full cost of most other services until they reach their annual out-of-pocket maximum.

Palmdale residents interested in applying for Covered California healthcare services may schedule an appointment with Chris Keene Insurance Services at (661) 942-6755. Individuals can also go to www.coveredca.com to find local help or enrollment opportunities.