Things to know about the Affordable Care Act

Elaine Wong reported this story for Sing Tao Daily as a 2013 California Endowment Health Journalism Fellow.

Editor's Note: The article was originally written in Chinese and has been translated into English.

Many Chinese residents do not buy insurance because it is too expensive or they do not know where to get health care. A lot of immigrants even choose to wait until they have a chance to go back to their home country to have check ups. But starting next year, there will be penalty for people who do not have health insurance. The requirement to for individuals to buy health care is one of the most well-known mandates in the Affordable Care Act. However, there are also many other different changes that are often unheard of in the Chinese community. Hence, let this article lead you through each one of them. 

Can health Care really be affordable?

One of the first health insurance markets in the nation, Covered California is going to provide a platform for people to make apple-to-apple comparisons.

According to a survey, the reason for most of the Chinese to not buy medical insurance is the high cost. Hence, if the government wants to encourage them to buy medical insurance, the biggest motivation should be that people can save money.

The Affordable Care Act states that since 2014, people older than 18 are mandated to have health insurance, otherwise they have to pay a penalty of $95, or 1 % of their annual income. Starting from 2016, the penalty would raise to $695, or 2.5 % of the annual income.

California is one of the first states to create a health care market place. This market places is called Covered California, with enrollment starting this fall. The goal is to provide affordable and quality health care for individuals and small businesses.

Also, when people buy health care insurance through Covered California, they can get federal tax credits to help ease the cost. For example, individuals with annual income lower than $44,680, or 4 people family with annual income lower than $92,200, can each get $1060 or $2028 federal tax credits.

Healthy San Francisco Program director Tangerine Brigham said, according to the survey by Department of Public Health, most of the Chinese wouldn’t get insurance because it is too expensive, so lowering the cost is definitely a good way to get people interested.

She said, “People who are interested can go to, and use the calculator on the site. For example, a 25 year old with annual income $25,000, the insurance would be $318 per month. But with a $174 tax credit, monthly payment would be lowered to $144."

Spokesperson Dana Howard says, Covered California’s goal is to make it easy for people, so it will limit the numbers of participating companies. Currently, there are 33 insurance companies who are willing to participate. Covered California will announce the final 10 or more companies around June.  

The Implication of Covered California to the employers and employees

Having Covered California and the generous federal credits it offered, would employers opt out from providing employee health insurance?

The Although Affordable Care act aims to control the premium costs, but many insurance companies all try to raise the premiums before many of the ACA implementation take effect next year. For many companies, the increases are above 20%. In California, Aetna, Anthem Blue Cross and Blue Shield of California are planning to raise 22%, 26% and 20% respectively. 

Because of this, many medium and small businesses are worried. Some employers even plan to opt out of employees insurance, and rather pay the penalty and allow the employee to buy the insurance themselves through Covered California. Is it really cheaper this way for the employers?

Under the new law, any company which hires over 50 full time employees (work 30 hours a week) and not provide health insurance, it would be penalized $2000 for each employee after the 30th employee. The formula is: 2000 x (numbers of employees – 30) = full penalty.

Some shrewd employers would start calculating the price and then they might realize, the price of paying the penalty and then reimbursing the employee getting insurance through Covered California, might actually be less than the price of paying all employees with insurance.

However, with the complicated procedure, employers might not be willing to save money through this method.

Covered California spokesperson Dana Howard responded that they are not worried that Covered California would lure the employers to opt out of employee insurance, because the point of providing healthcare to employees is to attract talent.  

Still, within the Chinese and ethnic companies, employers do not worry about losing talent any more than the employees worry about losing their jobs, because the market is much smaller than the mainstream market.

This leads to many employees to be concerned about the future. For example, if the company chooses to ask them to buy through Covered California, would they have the same quality health care? Also, is the out-of-pocket cost higher? And if the employees need to ask the company for reimbursement, would they have to lose their privacy by providing spouse income?  

But fortunately, according to new survey, most of the companies are not planning to opt out of employee insurance in the upcoming year. 70% says they will continue to provide insurance, only 1% says they will not anymore.

Anyhow, in the short term, Affordable Care Act had more of a negative than positive impact to the employees. As the cost of buying medical insurance is higher and higher, many employers, though continue to provide insurance, will choose lower the salary or never give a raise, because they already see the insurance as a part of the compensation for employees.

Healthy San Francisco: Continues to be a safety net for undocumented

With the implementation of Affordable care act, is there still usage and demand for Healthy San Francisco?

As California legislators already agreed to expand Medi-Cal, the service need for Healthy San Francisco might decrease next year.

In San Francisco, many people with income higher than Medi-Cal qualifications, but not high enough to buy their own insurance, would choose to get health care through Healthy San Francisco. In the past five years, Healthy San Francisco already helped 85% non-insured residents get health care. There are approximately 116,000 people who have benefited from Health San Francisco.

According to Department of Public Health, Healthy San Francisco gets its main funding from San Francisco city and county. Other funding sources include premiums from individuals, and the penalty from companies who don’t provide health care. But as the ACA rolls out next year, more people will be eligible for Medi-Cal, or would buy insurance through Covered California. The funding that Healthy San Francisco gets would decrease.

However, Tangerine Brigham, the program director, states that Healthy San Francisco still has a strong reason to stay, because approximately 40% Healthy San Francisco participants are going to be without insurance still.

Also, there still going to be 70,000 people who are not going to be insured under ACA, including 4500 undocumented students who are waiting for deferred action to grant them work permit.

Undocumented residents who are waiting for deferred action are allowed to have two years of work permit, but they wouldn’t be getting health care. However, if they live in San Francisco, they can still rely on Healthy San Francisco to get basic healthcare service.     

Small Business Tax Credits: Not as utilized as the government would like

The federal government wants to encourage small business owners to provide health care by providing healthcare tax credits, but are small businesses making use of the credits?

Under the ACA, many small businesses are eligible for the new small business health care tax credits. According to IRS, businesses hiring fewer than 25 employees, with their annual salary below $50,000 dollars, can be qualified to receive healthcare tax credits, just by paying half of the premiums fees.

California Chamber of Commerce Accountant and Tax expert Conrad Davis says, “Currently, people are not making use of this tax credit. There are many research studies showing that many of the qualified small businesses have not participated.”

For many bay area small businesses, providing health care still poses a very high cost that they cannot afford. The owner of a nutritious-centered sandwich shop in Palo Alto downtown, Mr. Wong, says he definitely has thought about providing healthcare for the 7 fulltime employees in his shop.

“For fulltime workers, it doesn’t feel right to not provide them with health care.” Mr. Wong said.

But co-owner Shally Park concedes that they simply cannot afford providing health care for employees, and she said she hasn’t heard of the health care tax credits.

In San Francisco clement street, a Chinese barbecue shop store owner Mrs. Lam said, the tax credits are not suitable for small business to apply, because the cost is still very high.

“Even if we pay 51% of the premiums, the employees still have to pay the 49%, and that 49% I don’t think they can afford,” Lam said.

She pointed out that even if she would have provide health care options, the coverage won’t be very good because she would only be able to afford the cheapest ones.

For other employees working along Sunset district 19th Ave corridor, many of them said they have never asked their employers to provide health care, because they already have insurance from their spouse.

According to Lewin Group for Families USA and Small Business Majority, California has over 375,000 small businesses, who qualified for over 1.8 billion worth of tax credits. Currently ,those credits can cover 35% of the premiums cost, and starting from 2014 January, the credits can even cover over 50% of the cost.

“This is a very good opportunity. People should use it,” said George Runner, board of equalization. 

Health Care Interpreters: Much needed in the next 10 years

ACA is going to covered many multi-lingual communities, but are there enough health care interpreters?

Amongst the people who will be newly enrollee of medical and other insurance in California, 40% of those people are with limited English proficiency. Therefore, training and providing more healthcare interpreters, are one of the most pressing challenges.

Nora Goodfriend-Koven, San Francisco City College Health Care Interpreter Certificate Coordinator stated that, when the ACA rolls out gradually, there will be 39% more people coming into the health care system, and most of them are with Limited English Proficiency. To fulfill the need, there need to be more healthcare interpreters.

The program at CCSF, graduates about 65 people each year, including students who speak 13 different languages. Other than English, graduates mostly speak Cantonese, Spanish, Vietnamese, and Arabic.

The program was founded 15 years ago, is one of the few healthcare certificate programs in Northern California. Graduates usually are able to find work at San Francisco General Hospital, Stanford medical center, Kaiser Permanente medical center, etc. Koren noted that graduates from the program, would have adequate knowledge in medical vocabularies. Aside from speaking another language fluently, she said that students with hospitals background would be preferred, since interpreters often need to work in Emergency room, and often need to meet many people who are under great pain.

In recent years, to solve the problem of having not enough interpreters, many hospitals have started using interpreting machine. For example, in San Francisco General Hospital, in order to save time and resources, interpreters are able to sit in a room, and use a video chat machine called Video Medical Interpreter to help interpret between doctors and patients.

Other than helping ease the interpreters’ burdens, the machine also helps other medical personnel who speak another languages. A Chinese-speaking medical assistant Hua Zi Chong said, even though she isn’t an interpreter, before the machine was available, she often needed to act as an interpreter, which added on her daily workload.

However, this machine isn’t perfect.

“Interpreting through video chat is still very different than interpreting face to face. It especially doesn’t help those who are hearing-impaired, have mental illness, or people who just received really bad news about their health,” Koren said.  

Currently, California state assembly is also discussing several bills regarding healthcare interpreters. AB1263 hopes to standardized health care interpreters industry, and establish a system to register all interpreters with certificates.

Union AFSCME states in a statement that in the following 10 years, there will be over 7000 healthcare interpreters related jobs opportunities in the bay area. These positions offer fulltime hourly salaries from $18 to $25; freelance hourly wages from $25 to $45.