With health care reform expected to take full effect later this year, the greatest risk that faces Sonoma County residents and business owners is an affliction known as analysis paralysis. It's a common ailment often associated with complex government programs — such as anything having to do with the Internal Revenue Service.
But there is a cure. And Sonoma County is trying to provide it.
But before we get into that, here's why this will be significant for all county residents:
; The Patient Protection and Affordable Care Act is expected to provide health coverage to 70,000 Sonoma County residents who are currently uninsured.
; In addition, it will provide relief for many who could not find affordable care through existing coverage. For example, under health care reform, those insured will no longer lose their coverage due to pre-existing conditions, and parents will be able to keep their children on their health care plan through the age of 26.
; Those working for companies that do not provide coverage, will, by Jan. 1, 2014, be able to access coverage through a health care benefit exchange, which is required to start enrolling people by Oct. 1. Businesses with more than 50 full-time employees will be charged a penalty if they do not offer health insurance. There's no penalty for companies that do not cover part-time employees.
; The Affordable Care Act expands Medicaid coverage to all individuals with incomes of up to 138 percent of the federal poverty level. For Sonoma County, that means annual incomes of up to $32,500 for a family of four and $15,856 for an individual.
; Assets tests to determine eligibility will be eliminated.
; Illegal immigrants are not eligible for the expanded Medicaid benefit for five years.
But with the Affordable Care Act will come a number of unknowns. Chief among them is the impact the changes will have on funding for local hospitals.
Hospitals, such as Santa Rosa Memorial, that serve a high number of low-income and uninsured patients currently get additional funding from the state. But those payments are expected to be ratcheted down between 2014 and 2020. "The reduction of (this) funding may threaten the financial sustainability of some Sonoma County hospitals that serve (a) disproportionate share of uninsured and/or undocumented patients," noted officials in a presentation to the Board of Supervisors last week. "New sources of revenue gained from coverage expansions may not be sufficient for the hospitals to sustain and meet the need of vulnerable populations."
These and other unknowns, such as full impact on local business, require close monitoring. Other known impacts need to be packaged and presented in an easy-to-understand format. Fortunately, the county has gotten a head start.
Individuals and businesses wanting more information will find it at www.sonoma-county.org/healthcarereform.
It's the antidote to uncertainty.