David Reichard and Tyller Williamson

Dr. David Reichard, left, was Tyller Williamson's adviser on his capstone project.

CSUMB comes together to help community understand and prepare for Affordable Care Act

By James Tinney

Passage of the Affordable Care Act was a signature event of Barack Obama’s first presidential term. It touched off a continuing, heated political debate and was upheld as constitutional in a much-awaited ruling by the U.S. Supreme Court.

But, in talking to his classmates, Cal State Monterey Bay senior Tyller Williamson found they knew little about the law, also known as Obamacare.

Although the participation of young adults is widely acknowledged to be critical in making Obamacare work, polls show little understanding of the law among that age group – or most other age groups, for that matter.“When you develop an understanding of a topic, you think other people also will have some level of understanding. But it is surprising how much information is just not getting out there,” said Williamson, a Human Communication major finishing his undergraduate degree this fall.

For Williamson, the run-up to the law became a perfect subject for his capstone, the final project for graduating seniors to bring together what they have learned in the course of their studies at CSUMB.

For CSUMB health officials, the act offers a renewed opportunity to stress the importance of prevention, early treatment, and preparing for the unexpected.

Meanwhile, CSUMB researchers are helping the local health care community prepare as well.

“Health care is a vexing issue. That is why it is a good issue for a capstone,” said Professor David Reichard, Williamson’s capstone adviser. “It really calls for collaboration, listening to people with multiple points of view.

“Collaborative problem solving is one of the things that students take with them when they leave here. And it is a critical part of the HComm major.”

It is a critical part of the political process, as well.

“You feel a certain way about it, I feel a certain way about it, the person next door feels a certain way about it,” Williamson said. “We are all part of this system. So how do we go from all of our individual thoughts to a collective solution?

“The best way to do that is democracy.”

Young adults are a key to helping make the Affordable Care Act successful. Under the act, they can be covered by their parents’ insurance through age 26. Those who are not will need to sign up for health insurance on their own and may qualify for two programs designed to facilitate coverage for the uninsured under the ACA.

A health care provider at the Campus Health Center examines a patient.For the uninsured who have a yearly income below 138 percent of the poverty line, the law expands coverage under Medi-Cal. For the uninsured who make more than 138 percent but less than 400 percent of the federal poverty line, California has created a state exchange program, Covered California, through which people can obtain insurance with the assistance of a sliding scale of tax subsidies.

Including more young adults in the overall pool is expected to keep insurance rates down. The law imposes fines on those who don’t get insured.

A child of a military family, Williamson has spent much of his life on the move, but has been consistently covered by health insurance. He found, however, that some other young adults had far different experiences.

This spring, he put together a town hall meeting, which included a presentation by a young woman who had suffered a traumatic brain injury as the result of a fall, then had to deal with the difficult physical and financial aftermath.

The town hall also included a wide spectrum of people involved in the system – including county officials, an insurance agent, a health-care advocate and representatives of Health and Wellness Services on the CSUMB campus.

Based on the feedback from those who attended, the town hall was effective in informing people about the legislation. However, Williamson said one of the lasting lessons he learned was the importance of one-on-one communication. 

“I know this sounds crazy, because it is so unachievable,” Williamson said. “But I almost think you have to go door-to-door.”

Emma Spellman, a 2013 CSUMB graduate, is coordinating outreach to Otter students regarding the Affordable Care Act. Working with a grant from Covered California, she and student educators will be engaged in exactly that kind of personal communication.

“We are all part of this system. So how do we go from all of our individual thoughts to a collective solution? The best way to do that is democracy.”

“We are going to have students talking to students. That should bring the message to a more personal level,” Spellman said.

Spellman said the student educators will have materials that will allow them to tell students exactly what their insurance costs would be under Covered California.

For campus health officials, the law’s focus on access to health care and preparing for the unexpected goes hand-in-hand with their ongoing message to students.

Gary Rodriguez, health promotion and prevention specialist at Cal State Monterey Bay, said it is a challenge to convince students that it is in their best interests to be insured.

“What we have to do – not to be Debbie Downer here – is to let them know that you never know what might happen in your life, you could have an accident or some medical condition that could be pretty catastrophic,” Rodriguez said. “If you don’t have health insurance, it can really have an impact on you financially.”

CSUMB students pay a $63 per semester health fee, which entitles them to basic medical care through the campus health center, run by Doctors on Duty.

“But if you break a bone and have to get an X-ray, that is not a basic service; that will have to be paid for out of pocket if you don’t have health insurance,” Rodriguez said.

While the CSUMB campus health center deals with a finite – and relatively healthy – clientele, health authorities for Monterey County face different, and even more complex, issues with the advent of the Affordable Care Act.

Dr. Kim Judson and Dr. Ignacio Navarro of CSUMB’s Institute for Community Collaborative Studies were contracted by the Monterey County Health Department to help prepare the county for the new law.
“We worked on an analysis of the clinical safety net system. That turned into a study of how ready the system will be when the Affordable Care Act goes into effect [Jan. 1, 2014],” Dr. Navarro said.

CSUMB researchers used census data and surveys of doctors, emergency rooms and clinics to estimate how many new doctors the county would need to staff safety-net clinics once Obamacare is in effect. They estimated that 10 more doctors would be needed to handle the increased demand. Currently, the county’s safety net clinics have about 36 full-time doctors providing care to more than 85,000 patients.
However, even after working on this study, Navarro said it is difficult to predict how such a sweeping change will affect demand for health care.

“The United States spends on health care an amount almost as big as the [gross domestic product] of France,” Dr. Navarro said. “That is huge. Try to reform it, that is a major undertaking. You can’t do it in one or two years; it is going to take 10 to 20 years for this to change.”  


Sidebar: ACA Timeline

March 2010
President Obama signs the Affordable Care Act into law.

The act’s goals are to increase the quality and affordability of health care while significantly reducing the number of uninsured Americans.

It works through mandates on employers and individuals, expansion of eligibility for state Medicaid plans, tax credits for low- and middle-income Americans to pay for insurance and insurance exchanges in each state, through which the uninsured can obtain insurance.

June 2012
The United States Supreme Court upheld the constitutionality of most of the ACA in the case of the National Federation of Independent
Business v. Sebelius.

The court upheld the individual mandate to purchase health insurance. In 2014, every adult who doesn’t have health insurance will have to pay a $95 penalty. The rate of the penalty rises in both 2015 and 2016.

July 2013
The Obama Administration announced that the employer mandate – which requires employers with more than 50 employees to offer health insurance to their full-time workers – would be delayed by one year, until 2015.

October 2013
State health-insurance exchanges open for business to provide health plans.

January 2014
Insurance coverage requirements for individuals go into effect.