Chris Caskey, The Union Democrat

With the national election in the past and little change in power at the White House or U.S. Congress, the national health care overhaul that was the focus of many campaign debates is pretty much a guarantee. And that means changes in coverage, options and requirements for thousands of uninsured and insured Mother Lode residents.

Signed in 2010, the national Patient Protection and Affordable Care Act will begin to really take hold in 2014. The health care plan, which has been tied to President Barack Obama throughout the campaign with its "Obamacare" nickname, was put in place as an attempt to offer coverage for the almost 50 million Americans without health insurance.

Though the legislation is complex and its total effects won't be known until fully implemented, studies and officials are starting to paint a picture of what it will mean for Tuolumne and Calaveras counties. And should the predictions pan out, local counties will have even fewer uninsured residents than many others in the state.

"The good news is we're looking quite good," said Todd Stolp, public health officer for Tuolumne County.

According to research by the UCLA Center for Health Policy, 47.4 percent of people younger than 65 have job-based health care coverage all year in central Sierra Nevada counties including Tuolumne, Calaveras, Alpine, Inyo, Amador, Mono and Mariposa. The same study shows that 21.2 percent of people in the area are covered by Medi-Cal public health programs, and about 11 percent have other coverage.

About 16 percent of Calaveras County's 45,000 residents and 17 percent of Tuolumne County's 50,530 are uninsured. The Affordable Care Act attempts to fill that gap by expanding Medi-Cal and Healthy Family plans in the state, offering a new insurance exchange program and adding insurance coverage requirements for businesses and individuals.

By 2014, about 41.6 percent of the area's uninsured younger than 65 will be Medi-Cal eligible, 33 percent will be able to receive tax credits or subsidies to get coverage on the insurance exchange, and 16.8 percent can join the exchange without aid, according to the UCLA study. Tax credits will also be available to small businesses with fewer than 25 employees that offer health care through the exchange, which will be a pool of providers from which individuals and organizations can "shop" for health plans.

That leaves almost 9 percent of area residents who will not be eligible for any of the expanded programs due to citizenship.

Stolp said there's still debate over exactly how many of the residents with job-provided coverage could see changes, whether small businesses will opt for the exchange program. And we still don't know how long some proposed tax benefits for businesses offering insurance through the exchange will be in place.

"There's still a lot of speculation," he said.

But with the expansion of the safety net programs, and mountain counties' smaller undocumented immigrant population, "We will end up with a lower percentage of uninsured than other counties in California," Stolp said.

Contact Chris Caskey at or 588-4527.