| The latest news from and for state health care advocates |
December 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
Advocates in Georgia produced a great infographic illustrating the coverage gap that would ensue if the state does not expand its Medicaid program.
South Carolina Appleseed Legal Justice Center Director Sue Berkowitz explained the current state of the Medicaid expansion in the state in a radio interview, outlining how advocates are moving to push the expansion foward.
Nevada Governor Brian Sandoval became the first Republican governor to announce support for the Medicaid expansion. Bob Fulkerson of the Progressive Leadership Alliance of Nevada discussed this decision on a local television news program and advocated against proposals to increase cost-sharing in the program.
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States in Focus
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Written by Anne Dunkelberg, Associate Director, Center for Public Policy Priorities
Originally posted on the Better Texas Blog, Tuesday, December 4, 2012
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ACA Medicaid Coverage Opportunity Best Deal for Texas Taxpayers
Texans aren’t the only ones thinking about the great fiscal deal the now-optional ACA Medicaid expansion would be for our state. The Atlantic’s Jordan Weissman blogged last week, using Texas to illustrate the huge expansion of coverage and bargain price tag the opportunity offers.
If you have read CPPP’s county-level fact ACA fact sheets, then you know Texas Medicaid officials predict we would spend $1.3 billion from 2014-2017, and gain $25.3 billion in federal dollars to cover over a million low-income adults (parents of the 2.6 million kids now covered in Texas Medicaid, plus other poor adults without children at home). Texas officials also say over 400,000 already-eligible but now-uninsured children will also sign up for Medicaid during those years, costing the state another $1.8 billion because the federal match for them is at the lower “regular” Texas Medicaid match rate, where we pay about 39 cents on dollar. Weissman comments on a new 50-state report from the Kaiser Foundation, with numbers that don’t precisely match but are very much in line with the HHSC predictions.
Here the story takes a surprising twist. Both national experts and Texas HHSC say that a large part—maybe even ALL—of the “welcome mat” surge in children who sign up for Medicaid when the big ACA coverage expansions start in 2014 will sign up whether or not a state allows the Medicaid expansion for adults! While most experts agree that kids’ sign-up will be largest if the whole family can enroll, the welcome mat research is strong enough that Texas Medicaid officials built the increase in children into their budget for 2014-2015, even though they do not assume the adult coverage expansion or ask for any funds for those adults.
So the KFF focus is this: states will get these new Medicaid kids anyway, but if the state also accepts the adult expansion it can cover well over a million uninsured at a lower per-capita cost. Why? Mainly the over nine-to-one federal dollar match for the adults—with zero state costs for 3 years and a maximum 10% share starting 2020—a much better deal than the current 39%. But in Texas we will also see savings in locally-funded uncompensated care for hospitals, reduced local and state mental health spending, reduced criminal justice costs, and higher insurance premium tax and drug manufacturer rebate revenues for the state.
Key to understanding this argument is the fact that very few if any other states will pass on this opportunity, and Texans will not get a break on our federal taxes if our lawmakers stop these federal funds from coming to our communities. As Weissman says, even lawmakers who don’t much believe in government’s role in access to affordable care or building a strong safety net might still believe “in retrieving as much of their citizens’ tax dollars as they can.”
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Written by Jon Whiten, Director of Communications and Technology, New Jersey Policy Perspective
Originally posted on NJPP Blog: As a Matter of Fact... on December 5, 2012
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Employer-Sponsored Health Coverage Continues its Slide in New Jersey
Long before “Obamacare” entered our lexicon, American (and New Jersey) employers began shedding health insurance for their employees. The Great Recession accelerated the trend. And, the fastest-expanding job sector (services) is the sector least likely to provide its workers with health insurance.
Over 1 in 3 New Jerseyans under 65 do not receive health insurance coverage from their employers, a large jump from a decade ago, when 1 in 4 Garden State residents lacked this type of coverage.
The decrease in employer-sponsored health insurance coverage in 2010/2011 is largely the result of many businesses feeling the squeeze on both sides: while the Great Recession and its laggard recovery in New Jersey have given businesses a little less money to spread around, insurance premiums continue to rise, forcing many businesses to stop offering this once-common benefit. In addition, large numbers of New Jerseyans remain completely out of work and, obviously, don’t have employer-sponsored coverage.
From 2000/2001 to 2010/2011, the share of New Jerseyans with employer-sponsored insurance decreased by 11.8 percentage points, from 76.9 percent to 65.1 percent. That’s a larger proportional decrease than the nation as a whole, which saw a decrease of 10 percentage points. The actual number of New Jerseyans with this type of coverage decreased over the same time period from 5.6 million people to 4.9 million. In other words, 684,099 fewer residents have health insurance coverage from their employers than did just a decade ago.
The news is a little worse for New Jersey’s children. Sixty-four percent of New Jerseyans under 18 do not have employer-sponsored insurance (most often from a parent or guardian), a decrease of 13.5 percentage points from a decade ago.
The new data, released today by NJPP’s national partners at the Economic Policy Institute, clearly shows that the system of employer-based insurance is failing many New Jersey families. Luckily, public insurance programs like Medicaid and New Jersey FamilyCare are covering the most vulnerable, including hundreds of thousands of poor children. But many New Jerseyans – particularly those of working age who earn wages above official poverty levels but below those needed to get by – are falling through the cracks and simply going without health insurance.
Luckily, help is on the way, but New Jersey has to do its part. Federal health care reform – particularly if New Jersey designs its own high-quality, well-run health insurance exchange and expands Medicaid benefits – will ensure that more working New Jerseyans can afford health insurance and no longer have to rely on squeezed or unwilling employers.
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Health Plans Competing for You
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Written by Matthew Valeta, Health Policy Fellow, Colorado Consumer Health Initiative
Originally posted on Full Coverage on Dec. 4, 2012
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The holidays are coming up which of course means you will soon be throwing a holiday party. As any good host knows, there are two essential ingredients that will make your holiday party full of cheer: (1) make sure that everyone gets there at the party time and (2) don’t let the party end too early.
Like a holiday party, Colorado’s Exchange is all about timing for its participants. Colorado is moving full steam ahead with health reform and is planning to open the Colorado Health Benefit Exchange (COHBE) on October 1, 2013. In Colorado’s Exchange individuals and smalls businesses will be able to shop for and compare health insurance plans. Many individuals and businesses will be eligible for tax credits to help them purchase health insurance from the Exchange.
On November 26th the COHBE Board voted on two issues affecting health plans entering the Exchange:
- Should there be a waiting period for plans that do not join the exchange in October 2013? (When the party starts!)
- Should there be a waiting period for plans that voluntarily or involuntarily leave the Exchange? (Leave the party before it’s over!)
Just like your holiday party, COHBE needs to figure out how to get participants and health plans to participate in the Exchange on opening day and to stay so that Exchange consumers have choice and consistency. The Exchange needs enough health plans to join the Exchange in order to foster a competitive marketplace, making it more likely that consumers will find the coverage they need at affordable rates. However, if health plans join the Exchange right away only to avoid a waiting period, they could leave rather quickly if there are no consequences to leaving the Exchange. Health plans leaving the Exchange would leave consumers behind and in need of a new health plan. Unfortunately, a healthy supply of eggnog will not be enough to solve this problem.
Should there be a waiting period for plans that do not join the exchange in October 2013?
The COHBE board decided that these health plans would not be able to sell plans on the Exchange for a year after the Exchange’s next open enrollment, which means October 2015, creating an incentive for plans to join the exchange right away. There are other incentives for plans to sell in the Exchange right away. Many uninsured Coloradans will need insurance to satisfy Obamacare’s individual mandate requirement, so potentially many will go the Exchange where they can get tax credits and subsidies based on their income. Hopefully plans will sell in the exchange immediately for the opportunity to sell to these thousands of new customers.
Should there be a waiting period for plans that voluntarily or involuntarily leave the Exchange?
The COHBE board decided that plans that leave have to wait 3 years before it can return. A plan leaving in 2013 could not sell plans on the Exchange again until October 2016. The reason for this decision is that consumers need a stable Exchange so they can access the coverage they need. If plans are in and out of the Exchange consumers could face price volatility and could be left without an adequate provider network. This 3-year waiting out period will hopefully keep plans from jumping in and out of the Exchange marketplace.
All in all, the COHBE Board’s decision provided a balanced approach to get plans to come to the party, and stay long enough for it to work. These requirements of plans will give consumers a better shopping experience when the Exchange starts making its sales in October 2013.
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Beat of the Month
The holidays are upon us, and to help you get in a rockin' mood, listen to our beat of the month: Jingle Bell Rock! Everyone have a happy holiday!
Enrollment & Eligibility IT Toolkit
As states across the country continue to implement the Affordable Care Act, some states are beginning to modernize their information technology (IT) infrastructures in response to the new law. Technology is needed not only to support coverage for millions, but to modernize administrative procedures, carry out policy decisions, and shape consumer opinion of the Affordable Care Act and public coverage.
Georgetown’s Enrollment and Eligibility IT Toolkit shows consumer advocates why it’s important to get involved and how they can start being engaged in the process now.
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New Resources from Families USA and Stand Up for Health Care
Take me to back issues of the Beat!
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