The Brief

For millions of Americans who buy their own health insurance through the Affordable Care Act marketplace, the end of the year brings a day of reckoning: It's time to compare benefits and prices, and consider changing to a new plan, or enroll for the first time.

Open enrollment starts Wednesday for the ACA's federal and state exchanges. Consumers can go online, call, or seek help from a broker or other assister to learn their 2024 coverage options, calculate their potential subsidies, or change plans.

In most states, open enrollment lasts through Jan. 15, although some states have different time periods. California's, for example, is longer, open until Jan. 31, but Idaho's runs from Oct. 15 to Dec. 15. In most states enrollment must occur by Dec. 15 to get coverage that begins Jan. 1.

Health policy experts and brokers recommend all ACA policyholders at least look at next year's options, because prices — and the doctors and hospitals in plans' networks — may have changed. Here's what else you need to know.

People bumped from Medicaid may be eligible, and could make it another record year for signups

ACA plans are now well entrenched — an estimated 16.3 million people signed up during open enrollment last year. This year may see even larger numbers. Enhanced subsidies first approved during the height of the COVID pandemic remain available, and some states have boosted financial help in other ways.

In addition, millions of people nationwide are losing Medicaid coverage as states reassess their eligibility for the first time since early in the pandemic. If you're one of those ousted, be aware you could be eligible for an ACA plan. You can sign up as soon as you know you're losing Medicaid coverage — even outside of the open enrollment season.

Assistance from brokers comes with new strings

An important caution: Don't wait until the last minute, especially if you are seeking help from a broker. Consumers this year will be asked to certify that they voluntarily agreed to brokers' assistance and that their income and other information provided by brokers is accurate.

It's a good protection for both parties, said broker Joshua Brooker, founder of PA Health Advocates in Pennsylvania. But brokers are concerned the requirement could cause delays, especially if clients wait until right before the end of open enrollment to apply.

"Brokers will need to stop what they are doing right at the end before they click 'submit' and wait for the consumer to sign a statement saying they reviewed the policy," Brooker said.

Your premiums could go up — shop around

While some health plans are lowering premiums for next year, many are increasing them, often by 2% to 10%, according to a Peterson-KFF Health System Tracker initial review of rate requests. The median increase, based on a weighted average across its plans for each insurer, was 6%.

Premiums, and whether they go up or down, vary widely by region and insurer.

Experts say that's a big reason to log on to the federal website, healthcare.gov, in the 32 states that use it, or on to the insurance marketplace for one of the 18 states and the District of Columbia that run their own. Changing insurers might mean a lower premium.

"It's very localized," said Sabrina Corlette, research professor and co-director of the Center on Health Insurance Reforms at Georgetown University. "People should shop to maximize their premium tax credit, although that might require not only changing to a new insurance plan, but potentially also a new network of providers."

Most people buying their own coverage qualify for the tax credit, which is a subsidy to offset some, or even all, of their monthly premium. Subsidies are based partly on the premium of the second-lowest-priced silver-level plan in a region. When those go up or down, possibly from a new insurer entering the market with low initial rates, it affects the subsidy amount.

Household income is also a factor. Subsidies are on a sliding scale based on income.

Subsidies were enhanced during the pandemic, both to increase the amount enrollees could receive and to allow more families to qualify. Those enhancements were extended through 2025 by President Joe Biden's Inflation Reduction Act, passed last year.

Online calculators, including one at healthcare.gov, can provide subsidy estimates.

You may qualify for lower deductibles and copays

In addition to the premium subsidies, most ACA enrollees qualify for reduced deductibles, copayments, and other types of cost sharing if their income is no more than 2.5 times the federal poverty level, or about $75,000 for a family of four, or about $36,450 for a single-person household.

ACA plans are grouped into colored tiers — bronze, silver, gold, and platinum — based largely on how much cost sharing they require. Bronze plans offer the lowest premiums but usually the highest copayments and deductibles. Platinum plans carry the highest premiums but the lowest out-of-pocket expenses for care.

Cost-sharing reductions are available only in silver-level plans and are more generous for those on the lower end of the income scale. New this year: To help more people qualify, the federal marketplace will automatically switch eligible people to a silver plan for next year if they are currently enrolled in a bronze plan, as long as the enrollee has not made an adjustment in coverage themselves.

There are safeguards built in, said insurance expert and broker Louise Norris, so that people are auto-enrolled in a plan with the same network of medical providers and a similar or lower premium. Additionally, nine of the states that run their own marketplaces — California, Colorado, Connecticut, Maryland, Massachusetts, New Jersey, New Mexico, Vermont, and Washington — have enhanced their cost-sharing reduction programs by extending eligibility or increasing benefits.

Some 26-year-olds will get to stay on parents' plans longer

Happy birthday! Existing federal marketplace rules allowing adult children to stay on their parents' plans though the calendar year in which they turn 26, rather than lose coverage on their 26th birthday, were codified into regulation.

States that run their own markets can set similar rules, and some already allow for longer periods on a parent's plan.

Networks may be small — check that your doctors are covered

Insurance plans often try to reduce premiums by partnering with a limited set of doctors, hospitals, and other providers. Those can change year to year, which is why insurance experts like Norris say enrollees should always check their plans during open enrollment to ensure their preferred physicians and medical centers are included in the network.

It's also a good idea, Norris said, to look closely for changes in prescription drug coverage or copayments.

"The general message is, don't assume anything and make sure you check to see who is in the network," Norris said.

Last year, the Biden administration set rules requiring health plans to have enough in-network providers to meet specific driving time and distance standards. A proposal to limit how long patients wait for a routine appointment has been delayed until 2025.

What we still don't know

A few things remain uncertain as the end of the year approaches. For example, the Biden administration proposed this summer to reverse a Trump-era rule that allowed short-term insurance plans to be sold for coverage periods of up to a year.

Short-term plans are not ACA-compliant, and many have fewer benefits and can set restrictions on coverage, including barring people with health conditions from purchasing them. As a result, they are far less expensive than ACA plans. The Biden proposal would restrict them to coverage periods of four months, but the rule isn't final.

Also pending: a final rule that would allow people to sign up for ACA coverage if they were brought to the U.S. as children by parents lacking permanent legal status — a group known as "Dreamers."

KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

This story was originally published by CalMatters. Sign up for their newsletters.

California regulators ordered Health Net to fix how it’s handling the termination of assisted living services for low-income residents after the insurer’s abrupt decision left patients and providers scrambling. The state’s corrective action plan requires Health Net to extend services for all members until the end of the year, rather than stopping some as soon as October.

Health Net, one of the largest Medicaid insurers in the country, notified providers several months ago that it was ending its assisted living and home care services contracts. The services are optional under Medi-Cal — California’s version of Medicaid — meaning an insurer can decide annually whether it will continue coverage. Providers and family members said they got little or no warning, leaving them confused and panicked about finding other arrangements.

In an August letter to Health Net, the Department of Health Care Services cited eight deficiencies in the insurer’s handling of the change, including failure to submit transition plans for members, failure to move members to other medically appropriate care, and denying services to members. Regulators wrote that violations “jeopardize member safety, disrupt continuity of care, and endanger medically vulnerable members.”

If Health Net does not extend benefits and create individualized transition plans for each affected member, the state may fine them $25,000 per member per day of violation, the letter states.

Advocates and providers estimate about 3,500 Medi-Cal patients rely on Health Net to pay for assisted living costs. Most are elderly, and many have cognitive issues like dementia. Health Net operates Medi-Cal plans in 10 counties: Amador, Calaveras, Fresno, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus and Tulare.

In a statement to CalMatters, Health Net spokesperson Beatriz Lopez said the company still plans to end the services next year, but will now cover all members through the end of the year.

“Health Net and DHCS share a commitment to advancing the health and well-being of Medi-Cal members,” Lopez said.

Health Net has previously told CalMatters the assisted living benefit “has not led to better care” in terms of fewer emergency room visits or days hospitalized. The benefit is part of CalAIM, a broad state initiative to improve Medi-Cal services and save money by stabilizing high-cost users who frequently end up in emergency rooms. Lopez said Health Net would continue analyzing data and supporting services that result in better health outcomes.

Providers confirmed to CalMatters that their contracts would run through the end of the year.

Thousands still face January deadline

Hagar Dickman, director of long-term services and supports at Justice In Aging, said the state’s corrective action plan resolves the immediate crisis but fails to address the long-term problem: “Thousands of older Californians are still set to lose their housing on January 1st.”

Allowing health insurers to cancel housing-related benefits creates problems, Dickman said, because most assisted living residents have no other home to return to. Additionally, the Department of Health Care Services has stated that if a member moves to another insurer that still covers assisted living, continuity of care protections would no longer apply, meaning the new insurer might not approve the member's assisted living costs.

"It’s disingenuous to say there are protections and then say the protections don’t apply,” Dickman said. "So the option is skilled nursing or homelessness.”

Pauline Shatara, deputy director of California Advocates for Nursing Home Reform, agreed that state protections are inadequate.

“It doesn’t sound like we found a solution to help pay for these people to remain where they are,” Shatara said.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.

This story first appeared on Long Beach Post.

Long Beach will make a slew of parking tickets more expensive and charge higher cannabis taxes to avoid cutting library hours and some specialized police officers. The last-minute change, proposed hours before a City Council vote, reversed a controversial plan city leaders laid out in June to lay off nearly a dozen library employees to help balance its budget.

Facing a $58 million shortfall, the city will still lay off roughly 180 other employees and cut hundreds more vacant positions. But it will spare library staffing and hours, after the original budget — which would have cut Monday hours at five city libraries, the only ones open that day — prompted fierce public backlash.

Long Beach City Council members voted 7 to 2 on Tuesday for the revised $4-billion city budget.

Councilmember Cindy Allen, who objected, called the increased parking fines “predatory fees,” arguing that library funding shouldn’t come at the expense of unfairly targeting people already struggling financially. Allen represents a district that includes the densely populated Alamitos Beach and Rose Park neighborhoods, where parking is already scarce. “We don’t have driveways,” she said.

Kristina Duggan, who represents southeast Long Beach neighborhoods like Belmont Shore, also voted against the budget because it cut Fire Engine 14 near Colorado Lagoon, a move that’s expected to save $3.88 million but drive up response times.

Duggan and Allen both tried but failed to delay the budget vote, with Allen saying the changes were put together in a “slapdash manner” without a chance for the public to weigh in.

She warned her colleagues before the vote that if they approved the budget “without substantial discussion” then they were “complicit in rubber-stamping” a plan that would “affect people’s livelihoods.”

Under the plan, 18 categories of parking citations — including for blocking bike lanes, hydrants, double parking and crosswalks — will rise to a flat $100, up from $74 or $90, to generate $1.5 million. Street sweeping tickets would also get a $5 bump, to $80 — a difference that raises $700,000 in revenue.

In the last fiscal year, which ran Oct. 1 to Sept. 30, the city issued more than 100,000 parking citations and 201,000 street-sweeping tickets, Public Works Director Josh Hickman said. More than a fifth of street-sweeping tickets were written in Allen’s district, and more than half of all parking tickets citywide were issued in the first two council districts, which include downtown and Alamitos Beach.

John Edmond, a local lobbyist who sits on the board for the Library Foundation and spoke in support of the plan, said the $100 rates are on par with cities like San Francisco ($108), Oakland ($110), San Diego ($117). He argued this applies to the “most serious parking violations.”

“We can’t say we’re serious about pedestrian and bicycle safety without accountability,” he said.

The budget also raises the city’s cannabis retail tax from 7% to 8% and increases the cultivation tax to more than $15 per square foot, changes expected to bring in roughly $1.15 million.

The proposals came from Councilmember Joni Ricks-Oddie, who chairs the city’s Budget Oversight Committee. Ricks-Oddie said earlier Tuesday she had spent weeks preparing these and dozens of other recommendations in concert with city staff, continuously updating them to accommodate new requests that came in from the public and fellow council members.

“If we can’t do this … then we can’t fund the libraries,” Ricks-Oddie said in response to Allen’s concerns about pricier parking citations. “If we reject that, we’re saying no to our library hours on a Monday.”

The budget also sets aside $1 million for the city’s immigration legal defense fund, the Long Beach Justice Fund. That’s well short of the $2.2 million immigration attorneys and local immigrant rights groups say is needed to sustain it amid rising caseloads. Gina Amato Lough of Public Counsel’s Immigrants’ Rights Project said “the need has never been greater,” citing prolonged detentions, warrantless raids and difficulty accessing counsel.

Since Public Counsel’s $919,000, one-year contract to provide legal services began in November, the group has taken on more than 55 consultations and 46 full-scope cases through the Justice Fund.

After hearing repeated pleas for more money Tuesday, Allen proposed reallocating all the funding for Long Beach’s new Vibe City marketing campaign — which some have derided as a waste of money — to the Justice Fund. She was quickly shot down, with a representative from the City Attorney’s office saying they’re not sure that would be legal, considering the Vibe City campaign is funded by tax revenue earmarked for advertising and promoting the city.

City Council leaders called the budget cuts a necessary, if painful, step toward stabilizing Long Beach’s finances after years of instability papered over with one-time cash — a bet that higher fees now will spare deeper cuts later.

“It’s hard, and it’s personal for everyone, and it will be really difficult on families across this community,” said Councilmember Megan Kerr.

This story first appeared on The LA Local.

Colorful parade floats, charros on horseback and live music will take over Cesar E. Chavez Avenue on Sunday for the 80th East L.A. Mexican Independence Day Parade.

For decades, organizers have brought together community leaders, performers, businesses and organizations to celebrate culture, community and tradition. This year, the parade will culminate in a festival with family-friendly activations, including live music, local vendors and lucha libre. 

This year’s co-grand marshals are singer and actor Dasahev López Saavedra, better known as El Dasa, and Los Angeles County Supervisor Hilda Solis.

Here’s everything you need to know.

When is the parade and festival?

The parade runs from 10 a.m. to 1 p.m. on Sunday, Sept. 13. The festival takes place from 11 a.m. to 4 p.m. on First Street and Mednik Avenue. 

What’s the parade route? 

The 1.5-mile route will run along Cesar E. Chavez Avenue, starting at Mednik Avenue and ending on Gage Avenue. You can find a map of the parade route and other festivities on the festival’s webpage here. Early arrival is suggested to secure a viewing spot for the parade. 

A map of the East LA Mexican Independence Day Parade route.

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Courtesy of the organizers

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What streets will be closed?

• Mednik Avenue: Between 1st Street and Cesar E. Chavez from 5 p.m. Saturday, Sept. 12 to 9 p.m. Sunday, Sept. 13.
• Cesar E. Chavez Avenue: Between Vancouver Avenue and Gage Avenue from 6  a.m. to 3 p.m. Sunday, Sept. 13.

What can I expect at the festivities?

The parade will feature floats, show cars, representatives from Eastside organizations, equestrian teams, marching bands and folklórico dancers. 

The festival will include vendors, musical performances, resource booths, a pop-up from local boutique The Goddess Mercado, a free pet vaccination clinic that will administer free vaccines for the first 200 pets, and a free lucha libre showcase by East Los Lucha. 

Where can I park? 

Limited free parking will be available at the East L.A. Civic Center lot located on E. 3rd Street and Civic Center Way. Attendees can also find street parking in the surrounding area. 

Can I take public transit to the event? 

The Metro E Line’s East L.A. Civic Center station is just a short walk from the event. 

What if I don’t want to attend in person? 

If you’re unable to attend or want to watch the parade from home, you can tune in to the live broadcast on ABC7. 

For more information, check out the website here. 

This story first appeared on The LA Local.

Robbie Hall has a record of the people she has treated for overdoses at MacArthur Park.

The photos of many of the people she has treated are saved on her phone. She can scroll through them and remember each one.

Hall, an ambassador with the nonprofit Five Keys, has been doing this work for about four years and is at the park almost every day, carrying Naloxone, a medication used to reverse opioid overdoses.

She typically responds when someone stops breathing.

“I stopped counting when I got up in my 40s, because it started being gradually three of them, four of them,” Hall said. 

On a recent September morning at the park, Hall said she found a 14-year-old girl in a bathroom who was experiencing an overdose. Tears welled up as she talked about the people she encounters at the park.

“They need help, they need help,” she said. “This is every day.” 

She believes the city needs to address the problem. When asked about the plans to fence the park, she said she sees the fence as one way to improve the conditions she sees on the ground.

“They need to put something up here,” she said.

For Hall and others who work around the park, the fence is less a solution than a stopgap, something concrete to try amid problems that have proven harder to solve.

The Department of Recreation and Parks says the fence will be temporary and is still on track for construction this fall, but has not provided a specific date, cost estimate or explained what conditions would need to change before the fence comes down.

Marco Pacheco, president of the MacArthur Park Park Advisory Board, does not believe the fence will be temporary. 

“I think this is going to be permanent,” Pacheco said. “This is going to be a permanent fixture of some sort because first of all, you don’t put up a fence that costs millions of dollars to take it down. It doesn’t make any sense.”

Pacheco isn’t the only one who has doubts.

Richard Barron, who served on the Cultural Heritage Commission for 22 years before departing in July, also questioned whether the city would follow through on its promise to remove the fence.

“I doubt that the fence is going to come down,” Barron said, “especially when they’ve spent all that money. Even taking it down costs a lot of money, you know, and you’re going to throw all that material away?”

The Board of Recreation and Park Commissioners approved $2.3 million in funding for the project. The city has not said how much money will ultimately be spent on the fence.

Everyone has a different idea of what the fence will do

The city’s consultants have described a fence that would be transparent, reversible and designed to blend into the park.

Leila Hamroun, a senior preservation architect with Tetra Tech, the consulting firm working with the city on the project’s design, said the fence won’t be a dominant feature.

“The whole intent here is to guarantee that it just blends in, that it’s seamless,” Hamroun said. “It’s reversible, transparent, minimalist, consistent with the evolution of urban parks over time.”

A rendering shows the proposed green metal fence around MacArthur Park.

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Courtesy L.A. Recreation and Parks

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The fence is expected to be about 8 feet tall, with gates at eight existing entrances. Decorative elements would be considered separately, with community input expected next year.

For Michelle Garcia, who has been a vendor around MacArthur Park since 2015, it could help distinguish vendors from the people living in the park.

“I support it if they could get the homeless people out,” Garcia said. “They are the ones that make MacArthur Park look bad. But they also make us look bad, because we sell around the area, so they think we’re like them, which we’re not.”

Garcia was among a group of vendors at MacArthur Park who held a Sept. 2 press conference to call attention to what they described as police harassment and citations that pushed vendors away from the park.

“Like us, we’re trying to work and get money for our bills, our rent,” she said.

Police have their own expectations for what a fenced park could accomplish.

The Los Angeles Police Department has stepped up enforcement around the park through a joint task force with the Drug Enforcement Administration focused on drug dealing in the area. In July, Rampart Division Capt. Benedict Fernandes said the operation had significantly disrupted the drug trade, but that drug users were spreading into surrounding neighborhoods in search of narcotics.

“We know that all the communities around have been impacted because it got spread this way, sort of like a shotgun blast,” he said. “It went south, it went east, it went north, it went west.”

Fernandes said the next phase of the enforcement effort would focus on connecting unhoused people and drug users with shelter and recovery services.

The fence, he said, is meant to make the park less convenient for drug activity and “prevent crime” inside the park.

“Because that’s the problem,” Fernandes said. “The Alvarado corridor at MacArthur Park has been convenient for drug users for years. We’re just trying to make those things stop.”

Fernandes said the temporary fence along Alvarado and now the orange bollards installed in the area, have worked to disrupt that activity. 

But Hall, the outreach worker administering Narcan at the park, has not seen those types of improvements on the ground.

“Since they did that big bust? No, it got worse,” Hall said when asked whether she had seen fewer overdoses in the area.

She said people wait for police to leave the park before returning.

“If it wasn’t for Five Keys, there would be a lot more dead bodies here,” she said.

Some residents say that adding a fence around MacArthur Park would change the makeup of the neighborhood. Others welcome a change to the troubled park.

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Gary Coronado

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The LA Local

)

How the fence is supposed to work

The plan calls for the park to remain open during the day, with eight entry points, and close overnight from 10 p.m. to 6 a.m. LAPD would close the gates at night, and Recreation and Parks maintenance workers would reopen them each morning.

The department says the fence is intended to make the park easier to maintain. Illegal dumping, littering, vandalism and graffiti have made routine maintenance difficult, according to the department, which has said MacArthur Park generates more graffiti cleanup requests than nearby Lafayette Park.

The city has pointed to nearby Lafayette Park, which is fenced and closed at night, as a model for MacArthur Park.

Pacheco, the president of the park’s advisory board, said he has heard general support for the fence among community members. 

“In many cases, community members alluded to Lafayette Park having been fenced for a long time, the difference between the two parks, Lafayette being a lot safer and a lot cleaner and less of a problem than MacArthur Park,” he said. 

The fence still needs final approval from the five-person commission that approved the project’s conceptual phase in October. The commission has not yet set a date to consider the final plans.