Lots of eyes roll when the Democratic presidential candidates go on and on about Medicare-for-All and who’s going to pay for it. Who cares, say presumably invincible young voters, checking their latest text messages, convinced their age is a guarantee of invincibility.
Well, California residents of all ages need to care or suffer a state tax penalty. As of Jan. 1, 2020, it’s the law (SB 78) requiring every state resident to maintain minimum essential coverage for themselves and their dependents. California passed the law requiring the individual mandate after Congress zeroed it out while trying to kill the Affordable Care Act.
But the California law also provides a three-year program to help certain people in need with subsidies through Covered California, the state’s public exchange where a variety of insurance plans can be purchased. And, says Peter V. Lee, the gay director of Covered California, there is culturally competent help to choose the insurance plan right for individual LGBTQ residents.
“Every year, open enrollment is the time that people that don’t have coverage through their employer or Medicare can sign up to get covered through Covered California,” Lee tells the Los Angeles Blade. “This year is the biggest change since we launched in 2014 because first, there’s now a state requirement to have coverage. So people that decide to go without it are going to pay a penalty [depending on income].
“But more importantly, there are new state subsidies that make healthcare even more affordable for over a million Californians,” Lee continues. “From day one, we’ve been committed to reaching out to the fabulous diversity of California, including the LGBTQ community. So we want to make sure that this community, which actually has health disparities and a history of discrimination, knows that those days of discrimination is now a thing of the past.”
Lee emphasizes that applicants cannot be turned away because of a pre-existing condition and notes his belief that “all of our plans cover appropriate medically indicated gender re-assignment surgery,” as well.
“My early work in healthcare was during the height of the AIDS epidemic when our community was denied health insurance coverage,” says Lee in a phone interview with the Los Angeles Blade. “And the AIDS epidemic is not over, even though it’s now largely manageable. We have issues of mental illness at a different rate than the general population, substance abuse, hepatitis, other issues. So, in many ways the issues that the LGBTQ community face are the same as in our general population—which is finding healthcare that’s truly affordable. We want to make sure that the disparities can be addressed by people having coverage that works for them.”
Lee is blunt. “The starting point for barriers to coverage is dollars. And the fact that there are new subsidies is a core piece,” he says. “We know that three quarters of the general population—but I would add dollars for donuts it’s the same in the LGBTQ community—are people who are eligible for financial health don’t know it, and don’t realize it.”
About 7-10% of those enrolled in Covered California already identify as LGBTQ. That’s good but there are more who aren’t covered. “We’re talking about somewhere between 30,000 and 40,000 LGBTQ people in LA eligible to sign it up. And that’s the problem, he says.
Lee wants to be clear: “You cannot be treated differently because of some previous condition,” including being denied doctor prescribed treatment for PrEP or Hep C or PTSD. Additionally, though staff will not automatically ask the caller how they might want to be addressed, Lee says, “We speak to people in the way they prefer to be spoken to.”
There is still a question regarding the new California law allowing pharmacists to dispense HIV medication over-the-counter without a prescription or prior approval of an insurance company.
Every healthcare plan has a formulary “so the issue of which version of PrEP is different from the formulary is going to depend on which health plan you’re enrolled in,” Lee says. “These are pharmacists or pharmacies we have relationships with. The issue isn’t just getting a prescription—it’s getting one as a covered benefit….The fact that it’s state law—that pharmacists can give it to you— doesn’t mean necessarily it would be reimbursed by your plan…,There’s no question that PrEP is a covered benefit, so the issue is, a pharmacist may not be part of a network, part of that health plans network.”
The “brass tacks issue” is making sure to sign up by December 15th to get covered by January 1 and therefore avoid any penalty tax.
“That’s a big deal,” Lee says. “California is making the Affordable Care Act work and protecting the rights of LGBTQ people getting access to affordable healthcare.”
For more information and to get help selecting a healthcare plan, go to www.coveredca.com.