♪ ♪ >> cheryl: welcome to "beyond the headlines," i'm cheryl jennings. today we are talking about health insurance, the affordable care act has back lightning rod for polarizing for political rhetoric. what does it mean? we're going to explain what it means, what is good about it and

how it impacts seniors and women's health care services and what it meanings to you and me. we'll begin with our first guest. a ceo of nonprofit, nonpartisan charitable foundation and support to keep seniors self-sufficient. i know you came from long beach. >> pleasure to have you here. >> this is big subject. can you help us focus in what is health affordable care act? >> the affordable health care act, if you look at its name is the patient protection and affordable care act. both parts are important. what is so important about the affordable care act is that it allows americans to have access to health care coverage. that is so important. frankly it's the most important piece of legislation for health care in the united states since the passage of medicare and

medicaid. >> cheryl: i think people realize it's been in effect for a couple of years? >> the law went into effect in 2010 after it was passed. there are things that are implemented, not that everybody knows about. there are things that will be implemented in the future. so we're on the path. foe for me as a physician there are two important things. the first it creates health care as a right in this country. that is something we should all have access to that. >> right is created through a cultural of coverage. we should all have health care coverage. it protects when we are ill. we all need it eventually. the other thing i mentioned the full name it protects families. for families one of the most important causes of personal bankruptcies are unexpected medical costs particularly for

people that don't have insurance. having insurance is a protection for families. in difficult times, its wonderful thing to have. >> cheryl: and people may be sick, healthy today but an accident and anything can happen. about the weaknesses? >> i think the acted makes enormous strides for access and coverage. think it makes smaller steps with respect to increasing the value of the healthcare we purchase and decree go the amount of fragmentation in the healthcare system. there are gngs in the affordable care act there are places we are likely need to do more work. >> cheryl: how about things that haven't been implemented, right? >> there have a lot of things that have been implemented. next more step is creation of health exchangess where people can buy insurance. >> cheryl: we did reach out to folks on facebook.

we have some questions. first one, how does the affordable care act affect people with preexisting conditions, are they fully covered or does it depends on circumstances? >> the key to that -- it's an excellent question. one of the most important things about the affordable care act, it actually works to eliminate preexisting conditions as a barrier to health insurance. that means today as a result of the affordable care act children young children have access to health care coverage even with preexisting conditions. today people with serious medical approximate and serious preexisting conditions can actually buy insurance. starting in 2014 all adults will have access to healthcare insurance regardless of preexisting conditions. >> cheryl: what happens if somebody is claiming, we're not going to abide by this? >> they will have to. there will be ways to get everybody covered.

>> another question, some medicines are covered and some are not. some of my friends have to look elsewhere for medicines because their coverage paid for part of the coverage? >> it's more the result of the fragments of the health care system. it's what we're trying to improve. every health care program. in the future system we'll have a-l of drugs that are available, drugs that are not available, how much we need to pay for those medications. that will be there in some form or fashion. what needs to be clearer is the kinds of information, the kind of transparency we all wanted so we can only pair choices and make good decisions. affordable care act does allow that kind of transparency when we need to take drugs. >> cheryl: it sounds like a lot of work?

>> it's underway right now but the exchanges and health insurance products that will be available will go a long way to that kind of clarity. >> cheryl: it's so interesting, preexisting conditions, that is one question that everybody keeps coming back to me. the one our facebook viewers said to us. i wanted to get back to that because people need the guarantees to feel secure? >> i couldn't agree with you more. the single biggest challenge for people is the risk of being ill. the risk of being ill in a way where your insurance isn't there when you really need it. that is when everybody is rick, your personal life, family life, work environment. getting that preexisting conditions piece nailed down is really one of cornerstones of the affordable care act. >> cheryl: we have to take a break. when we continued we're going to have more with the doctor. we're going to continue our discussion about the affordable care and act and talk about the impact this law will have on

senior citizens. stay with us. remember you can join the conversation reach out to us at abc7news.com/community. find us on facebook also and i invited you to follow me on twitter. ñcús

>> cheryl: welcome back. we're talking about health insurance and the affordable care act. the doctor is back with us and joining us in the sturd yeo is greg garret. he is the chief strategy and government affairs office. thank you for joining us. one of our questions from facebook viewers. see if the question comes up on the screen. how does it affect persons unemployed and not receiving benefits? >> the affordable care act is an important act that expands coverage to individuals and specifically to individuals as you described or as the facebook

writer described. it will expand coverage from where currently is for families that are making approximately $14,000 a year for a family of four. it will expand coverage to families making about $20,000. for the unemployed person, the person who is not as fortunate to be employed or have other opportunities for health care, it will expand coverage to a broader degree. >> cheryl: do you have anything to add to that? >> i think he did a terrific job. it's about coverage that will follow you as you change employment status. it's a critical piece of the act. >> cheryl: what does the law mean for small businesses and students and young adult, uninsured children? >> my area of specialty is with low income individuals and specifically with seniors.

in those areas but again it's expanding coverage and is covering individuals a broader range and coverings benefits. individuals that are currently in a system of care that is disorganized where their doctor and other service providers may not have access to information about what the pharmaceuticals is prescribing, nay not know about one is prescribing. this coordinates that delivery of care. it organizes that delivery of care and that will help raise health outcome. >> cheryl: my confusion, it sounds so good, who do you talk to to make this all clear? >> i think here in california it's going to be much more clearer for a couple of reasons. first of all, california is leading the nation with respect to implementing the affordable care act. in particular we've done a better job than any state in the

country developing what will be called a health insurance exchange. that will start early next year. when many more choices that currently don't have insurance now, people that have preexisting conditions. that will be an important step. another really critical thing that the state is doing is pulling down other parts of law that allow for more coordination of care particularly for people that are older, really sing, have function limitations. we're going to see less fragmentation and better system of care. all of that should be much more evident to folks early next year. >> cheryl: you work with seniors and you see how great the need is. can you tell us more about your organization? >> there are two groups of seniors that will be impacted by the legislation. the first group have already been moved into manage care systems. those are seniors and persons of

disability who are eligible for medicaid. in california we call that medi-cal. they have been moved into managed care systems generally operated by their county. a second movement of individuals ex expansion of coverage will occur for individuals who are dual eligible, they are eligible for medicare and medi-cal. those individuals will movement into managed care programs. so again managed care programs are coordinated organized systems of care versus the current system that is fragmented and less organized. all seniors and persons with disabilities that are both duly eligible and medi-cal only eligible will be in the systems. >> cheryl: it sounds too good to be true. one of the controversies i heard was end of rights care. can you talk about that?

>> i think one of the important things about the affordable care act it allows us to move beyond living a good life discussion. we build systems that actually coordinate care and help people live to their fullest degree, dignity, choice and independence even when they have serious illness and even when they have function limitation. the great thing about the programs we're just described they will lead toys a better more integrated system of care, one that is frankly a lot more person centered and helps people live in communities and homes of their choice. >> cheryl: earlier about drug costs, higher drug costs? >> actually the opposite. you may have heard the term donut hole. there is a coverage gap. without getting into details, basically the federal government through the part "d" program pays for pharmaceutical costs up to a point.

then it stops paying coverage and individuals are required to then pay that out of pocket. after a certain point, thousands of dollars later, the government picks up again. that coverage gap is being closed under the current, under the administration. individuals are already receiving benefits in that the legislation required pharmaceutical companies to lower costs to beneficiaries immediately and then in the future the government will paying that coverage gap. over time that will lower and lower but the government will always be paying for that gap to a significant degree. beneficiaries as you said, social security beneficiaries will see their drug costs lowered. >> cheryl: gentlemen, thank you so much for being here. it's confusing but you made it a lot more clearer. when "beyond the headlines" continues we're going to turn our attention health care overhaul means to women.

stay with us. we'll be right back.

today american women win. congress has finally done something right.

no more co-pays for contraception. no more co-pays for mammograms. no more co-pays for well women visits. no more could pays for diabetes screening, hpv or hiv screening. >> cheryl: that was congresswoman jackie speier talking about the landmark provisions to the affordable care act. joining me now is oppress dr. clair brin dis. this is such a big deal. and what they were talking about free access to preventative care? >> it's a huge win to women because in our country, it's important to understand that the affordable care act not only covers issues such as what they spoke about but a huge

investment prosecute vehicles. oftentimes it's women that are last into line getting preventative services because they have to pay out of pocket for many of these services. >> cheryl: you are saying women have pay out of pocket costs and men did not? >> for many of services we are now incorporating, many deal with the unique aspects of women's health. and they deal around reproductive health and pregnancy and htv and hiv and domestic violence screening as well. >> cheryl: so there was a penalty to be a woman? >> exactly. and when we don't care of these issues up and front and directly not only are we providing for the services in reproductive health but the whole aca, is

very committed to incorprate medicine around the services. >> cheryl: it's cheaper in the long run? >> if we don't go upstream we would have to take these costs, health conditions much more later o o cheryl: specific questions, will women have a choice of their doctor under referral? >> they will have a chance to be enrolled in a medical home. it means oftentimes women seek care from many different areas. what we are hoping when these individuals become enrolled in the program they actually have a medical anchor. i mean that in a positive way. the medical home is a place which helps coordinate care. helps provide references and referrals but also provides primary care services. what we are trying to avoid unnecessary medical costs and

overreliance on the emergency department. so women and men should benefit for having this. >> cheryl: i want to get about the costs now. is it true that mammograms, breast exams will be free of charge? >> they will be free of charge to women in terms of not having to pay a co-payment. they are part of the premium costs, still part of the benefit package that the insurance companies are going to be negotiating on. what we'll find is that people are concerned, sometimes i've been asked, this is going to raise premiums. in reality many of services are aiming at reducing costs. for example, if you are screened for diabetes or screened for obesity that eventually will save our health care system a substantial amount have dollars if it can prevent those conditions. >> cheryl: five to ten years what affect is it going to have on women's health?

>> ideally if everything goes well, if we are a able to implement it, i think we'll find the country will change its perspective on the importance of investing in health and health care as well as health and well-being. >> cheryl: that is fantastic. dr. brindis, thank you so much for coming. when "beyond the headlines" continues, michael finney will join us. he will talk about what the new

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now? >> we have come a long way. as far as i'm concerned we have a very long way to go. this is very modest proposal despite what you hear out there in the world compared to what is happening in other countries. this is very modest. >> cheryl: as our guests were saying, everybody has the right to affordable health care do we have something is going to work and work in the future? >> i do. it's piecemeal. i'm happy with it, but it is piecemeal. it's not an overriding plan. whenever you hear socialized medicine, it's not that exactly. it's not anywhere near. that the government is not hiring any doctors. they own no hospitals other than the v.a., so this is modest. >> cheryl: for people are concerned about higher taxes, t hav those that have health insurance through employers? >> those people will not be touched by this. some are going to pay a lot more

in taxes. if you make $200,000 a year as an individual, $250,000 a year as a couple, you are going to pay about 1% more in medicare tax. that means every dollar you earn they are going to be taxed about a buck on it on every hundred dollars. those that high earners for unearned income, that is stocks and dividends and such, they are going to pay 3.8% more. nearly 4% more in taxes on that portion of their income. there are some people in united states are going to pay slightly less than 5% of the year but those are the fortunate people. >> cheryl: but people making more can afford it. >> you have to be high income before it affects you. >> cheryl: so the low income people will be benefited by this? >> absolutely. they will do extremely well. they get medicare get tax credits. this excellent deal.

>> cheryl: i think a lot of people now we have to have health insurance. what does that really mean when the politician goes into effect? >> what that means, young people who are the ones that tend to skip by without health insurance they generally aren't going to need it. they will be in the system. so that everyone is going to pay all the way along. here is how it works. you will have to pay the government or buy health insurance. it starts off at 1% a year or $95 whichever is more. then it will go up to 2% a year and eventually up to 2.5% a year or two grand, whichever is less. >> what are the penalties if they don't get the health shoonks buy hea if you don't bu, the government says hand over 1-2% of your income. >> but nobody is going to send you to jail. >> under a mark it off on your income tax form. that is how the government knows.

you are going to say, i have insurance, i don't need to this fe this fee, i don't have it and must pay. >> what do you think people scares people the most? >> change. a few years everybody will be in love with this program. >> cheryl: thank you for all your hard work ahead of time. that is all the time we have, thanks to all of our special guests today for joining us to talk about this incredibly important issue. we have information for you about everything we talked about today on our website at abc7news.com/community and find us on facebook and i invited you to follow me on twitter at khiarls at abc7. have a great week. we'll see you next time. bye-bye. ♪