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Critical California health insurance coverage

by Donna Benjamin

October 4, 2013 | 10:29 am

As states across the country prepare for the rollout of health insurance coverage the state of California has become a leader. While some states have chosen not to provide a system for their residents to access affordable health care, California has set up Covered California, a market place or exchange where eligible individuals, families and small businesses can choose from a selection of affordable health care plans.

Enrollment for Covered California is now open and the insurance plans become effective on January 1, 2014. According to the California Healthcare Foundation, in 2011, 7.1 million Californians under the age of 65 did not have health insurance. Many of the uninsured want coverage, but cannot afford it; others who have insurance do not have adequate benefits to cover their needs.

As someone who advocates for social change as a volunteer with the National Council of Jewish Women, Los Angeles, as well as a registered nurse, a marriage and family therapist and a former employee of health insurance companies and brokers, I am encouraged by the prospect that many of those 7.1 million uninsured will now have access to health care coverage. Not all Americans agree with health care professionals like myself that believe health care is a right, not a privilege. The United States, despite being the richest nation in the world, suffers greatly, both financially and in public health outcomes, from not having coverage for all its citizens.

Americans pay twice as much for care per person and have a shorter life expectancy than other industrialized nations. And, sadly, the United States is 21st amongst nations in infant mortality. Despite having the best doctors and medical care in the world, babies still die in this country due to a lack of prenatal care, which costs very little and prevents numerous expensive medical problems.

In addition, according to a recent study by NerdWallet Health, nearly 2 million Americans will go bankrupt this year because of medical expenses. This is a non-existent problem in all other democratic countries.

Providing health care for all citizens is consistent with the family values that many Americans espouse. What could be more valuable to individuals or families than knowing that if they or someone they love gets sick, they have access to affordable, quality health care?

Covered California insurance plans will provide much-needed preventative, medical and prescription services. Most importantly, as of January 1, 2014, no enrollee can be denied insurance coverage due to pre-existing conditions.

I believe that everyone should take the time to learn about and enroll in Covered California. Even young adults in their twenties and thirties who usually cannot afford health insurance, and thus rationalize that they do not need health care, will find a basic health care plan in their price range.

Regardless of age, Covered California has plans for everyone who qualifies. For those whose income is below a certain level of the poverty line, the federal government provides premium assistance in the form of either tax credits or cost sharing subsidies. Individuals who have health insurance through their employers can keep that insurance and do not have to change.

In order to keep health insurance affordable it is necessary to spread the financial risk between individuals who are healthy and those who may have to use more health care services. Therefore, enrollment in Covered California is mandatory, and those who do not enroll will be fined.  The fine in 2014 will be low, but it will increase significantly each year thereafter.  Believe it or not, it is advantageous for everyone to have health coverage.

The Covered California website, www.CoveredCA.com, is easy to navigate and has a wealth of information. It also has all kinds of tools to help people figure out if they qualify, what plans are available and what their cost will be.  If you need more help, there are customer service representatives you can call. I urge all Californians to go on-line and learn what citizens of all other democratic countries know: that health care is an essential part of life.


Donna Benjamin is a Registered Nurse, Marriage and Family Therapist, former employee of the insurance industry and an advocate with the National Council of Jewish Women, Los Angeles. She lives in Los Angeles, CA.

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