| The latest news from and for state health care advocates |
August 2012
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In each edition, we'll feature an action, victory, campaign, or interesting tactic shared by a state advocate. Send us your updates. |
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In This Issue:
Buzz around the States
On August 1, women across the nation were able to breathe a little easier as preventive care benefits became available thanks to the Affordable Care Act. Advocates with the Colorado Consumer Health Initiative are helping consumers learn more about this important feature of the law as part of their “Thanks Obamacare” effort.
Advocates in Texas landed some press coverage with a terrific op-ed to the Austin Statesman. The editorial demonstrates the need for Texas to take up the Medicaid Expansion by showing how many people will receive coverage, the benefits of having health coverage, and how expanding Medicaid will help the state economy.
Advocates from Virginia Organizing paid a surprise visit to Anthem CEO C. Burke King, thanking him for the rebate check they recently received from Anthem. While nobody answered the door, advocates intended to present Mr. King with balloons, flowers, and a thank you letter, while encouraging him to push Virginia Gov. Bob McDonnell to support the Affordable Care Act.
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States in Focus
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Written by Barbara Yondorf, board member of Colorado Consumer Health Initiative and consumer representative to National Association of Insurance Commissioners
Originally posted on Full Coverage on August 15, 2012
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Colorado: Making Obamacare Insurance Reforms Work for Consumers
The main goals of the Patient Protection and Affordable Care Act (ACA) are to increase access, improve quality, and reduce waste in our health care system, in part by reforming the private health insurance market. The National Association of Insurance Commissioners (NAIC) has a lead role in providing advice to the federal government on ACA private insurance reform implementation. It is developing model regulations and laws for states to use to align their laws with the ACA’s health insurance requirements (e.g., coverage of dependent children to age 26, first-dollar coverage of certain preventive services, etc.).
The NAIC has 26 officially designated representatives from state and national consumer health organizations who serve as liaisons to the NAIC to ensure the consumer voice is heard. We serve as a counterweight to the hundreds of insurance industry representatives who regularly attend and provide input at NAIC’s meetings and hearings. We meet regularly with state insurance commissioners and their staffs, testify, provide data and analysis, and submit written comments on NAIC drafts of model laws and regulations, white papers, and resolutions.
To help states and state insurance regulators, the consumer representatives recently issued a report, Implementing the Affordable Care Act’s Insurance Reforms: Consumer Recommendations for Regulators and Lawmakers. The report outlines the issues consumers may face as the insurance provisions are being implemented and provides policymakers with a roadmap to ensure the reforms meet consumers’ needs. It covers a wide range of ACA insurance reforms, including guarantee issue and renewal requirements, the ban on pre-existing condition exclusions, new restrictions on health status, age and gender rating, essential health benefits, and minimum actuarial value standards. The report outlines the issues consumers may face as these provisions are being implemented, and provides policymakers with a roadmap to ensure the reforms meet consumers’ needs.
Key recommendations in the report include establishing standard open enrollment periods inside and outside state health exchanges, setting national standards for adjusting premiums based on age, limiting insurers’ ability to use benefit design to discriminate against people with health conditions, and closing potential loopholes.
Making sure Coloradans have access to quality health insurance required by the ACA will take collaboration from many stakeholders, including state insurance regulators, state leaders working to establish our state exchange, consumers, consumer advocates, our business community, the insurance industry, community-based organizations, and many more. These efforts will result in better access to better health insurance for more Coloradans.
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Written by Adam Searing, director of the Health Access Coalition, North Carolina Justice Center
Originally posted on Say Ahh! Blog and The Progressive Pulse on August 8, 2012
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North Carolina: Video Advocacy from Coast to Coast
It’s really exciting to write here again about the Kidswell project video trainings that Adam Linker, Russ Baggett, and I have continued around the country, while also drastically increasing our frequent flyer miles out of North Carolina. Thanks to Atlantic Philanthropies and CCF (Georgetown University’s Center for Children and Families), we’ve hit three more states with four more workshops (California really counts as two states). As always, we had an absolutely wonderful time meeting more of our fellow advocates and learning about different ways we are all using video to accomplish our goals.
From the Mississippi Justice Center’s soon-to-be-released student production where kids interviewed adults about the effects of having—or not having—health coverage to Florida CHAIN’s video featuring a pro-ACA small business owner, we’re already seeing evidence of groups putting their new knowledge and equipment to good use. New York’s Community Service Society of New York started by celebrating the Supreme Court’s ACA decision. (Our New York friends even created a video of Adam Linker and me explaining iMovie basics, but that one is probably the most boring of the lot.)
To sum up our recent travels, I put together the following short video (what else?) highlighting our travels and some of the work of our fellow advocates. We look forward to continuing the journey!
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Oklahoma: Avoiding the Medicaid “Coverage Crater”
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Written by David Blatt, director of Oklahoma Policy Institute
Originally posted on OK Policy Blog on August 13, 2012
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When Congress approved a prescription drug benefit for the Medicare program in the mid-2000s, it created the infamous “Medicare donut hole”—a large gap in coverage of prescription drug costs.
The Affordable Care Act (ACA), the landmark health care law, brought about important changes that gradually eliminate the “donut hole” by 2020. But now, as a result of the Supreme Court’s recent ruling, low-income Oklahomans could find themselves in a similar situation, stuck in a “coverage crater,” without access to public or private coverage and consigned to the ranks of the uninsured.
The ACA adopts two primary mechanisms to cover the uninsured. The first is to expand Medicaid, the federal-state insurance program that primarily covers low-income children, seniors, and persons with disabilities. In Oklahoma, like in many states, Medicaid coverage for working-age adults is extremely limited. Only parents of dependent children with incomes below roughly $7,000 per year for a family of three (37 percent of the federal poverty level) are eligible. Working-age adults without children are ineligible for Medicaid regardless of how little they earn. The uninsured rate for this population is extremely high, nearing 50 percent in Oklahoma. This population is especially likely to suffer from chronic physical and mental health conditions that make earning a steady income difficult.
The ACA makes adults with income up to 133 percent of poverty eligible for Medicaid as of January 1, 2014. To ensure that states go along with the expansion, the law provided both a large carrot and a heavy stick. The incentive is a federal commitment to cover the lion’s share of the costs of the newly eligible Medicaid population—100 percent for three years, then phasing down to 90 percent in 2020 and subsequent years. For states that didn’t adopt the expansion, the federal government could withdraw all federal funds for the Medicaid program.
The Supreme Court, however, ruled that the threat of withholding all federal Medicaid funds for a state that does not expand coverage for low-income adults was unconstitutional. As SCOTUSblog explains:
- The result is that states can choose to participate in the expansion, must comply with the conditions attached to the new expansion funds if they take that new money, but states can also choose to continue to participate only in the unexpanded version of the program if they want.
The second mechanism for expanding coverage to the uninsured is by providing tax credits to subsidize the purchase of insurance through the newly created health insurance exchanges that are set to launch in January 2014. These credits will be available on a sliding scale for individuals with income between 100 percent and 400 percent of the federal poverty level. Between expanded Medicaid coverage and subsidies for private coverage through the exchange, the expectation was that everyone would have access to affordable coverage.
A major consequence of the Supreme Court’s ruling is that in a state that chooses not to expand Medicaid, most adults living in poverty will be left without coverage options. They will earn too little to be eligible for premium credits that will make individual coverage affordable through the exchange. Yet they will remain ineligible for Medicaid unless they fit the narrow categorical and income requirements (parents of dependent children under 37 percent of poverty). Some 130,000 uninsured Oklahomans could remain stuck in the “coverage crater.”
Expanding Medicaid to this population would help them access timely and appropriate health care, leading to better health status and improved economic prospects. It would reduce uncompensated care costs for hospitals and other providers, and reduce state spending on mental health care and other services for the uninsured. To turn down this opportunity to lift 130,000 Oklahomans out of the coverage crater would be contrary to the state’s interests and lacking in basic compassion and common sense.
See our 1-page fact sheet on Medicaid and the Affordable Care Act
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Beat of the Month
Just a few weeks of summer left. Celebrate them by listening to the Beach Boys’ classic, All Summer Long.
Advocate Tip:
What does #150dollars mean to you?
Thanks to the health care law’s 80/20 rule, consumers across the nation are receiving rebate checks. On average, consumers are receiving $150. Spread the word on Twitter using the hashtag #150dollars to demonstrate the impact the rebates make on consumers’ daily lives. Here’s a sample tweet: Tell us what #150dollars means to YOU! Thanks to #Obamacare's 80/20 rule, some consumers are receiving money back!
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New Resources from Families USA and Stand Up for Health Carey
Take me to back issues of the Beat!
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