This month, the U.S. Supreme Court will announce its decision in King v. Burwell, a case challenging the premium tax credits provided through the Federally Facilitated Marketplace (FFM) to residents of the 34 states that do not operate their own Affordable Care Act Marketplaces. The plaintiffs (challengers) claim that 4 words in the ACA limit subsidies to people purchasing health insurance in an exchange (Marketplace) set up by a state, and that users of the federal marketplace are not entitled to subsidies.
What’s at stake if the Court rules in favor of the plaintiffs? According to the Kaiser Family Foundation, as many as 13.4 million people in 37 states could lose subsidies if the Supreme Court rules against the federal government in King. Of the 235,000 Ohioans receiving health coverage through the federal marketplace, an estimated 80% receive premium tax credits to make the coverage affordable and most will be forced to drop coverage without those tax credits.
According to a new report by the American Academy of Actuaries , a decision against the federal government in King would:
King is a challenge to the heart of the ACA and its outcome will determine the fate of millions of Americans who have been able to get quality, affordable health insurance thanks to premium tax credits.
If the court rules for the challengers, there’s no quick fix. The current Congress is not likely to pass an amendment to the ACA to clarify that subsidies are available to people using the federal Marketplace. Proposals being floated by Republicans in Congress extend subsidies only through the next election. It’s also hard to imagine that states such as Ohio will suddenly decide to establish a state exchange. And setting up an exchange takes a long time.
Does the challenge to the ACA have legal merit? When Congress wrote and passed the ACA, everybody – Republicans, Democrats, and the Congressional Budget Office alike – agreed that the tax credits would be available in all states.
Everyone involved in the health care system, including hospitals, providers, and insurance companies, strongly disagree with the challengers’ position.
Insurance companies and the health care industry have adapted their business models to work with the ACA, and have done so successfully for nearly five years. A diverse array of more than 30 amicus (friend of the court) briefs filed in support of the ACA underscore the depth and breadth of backing for the government’s position, while challengers are primarily backed by conservative ideologues seeking to destroy the law.
The lawsuit is yet another political tactic from opponents of the ACA to dismantle the law. In fact, Republican leaders in Congress have openly admitted that they are counting on the Supreme Court to “take down” the ACA by dealing it a “body blow” that will cause it to “unravel” “pretty darn quickly.”
For now, we’re focused on making sure that consumers understand the facts: right now, and until the decision is announced, absolutely nothing has changed, and consumers who enrolled in health insurance still have health care and financial help from their tax credits. The bottom line is that no matter how much political jockeying continues to happen around the Affordable Care Act, people still need and want access to affordable, quality health care. Now that 11.7 million people have found coverage through the Marketplace, it’s time to move past these divisive arguments to make the law work for all Americans.
Submitted by achenault on Mon, 05/04/2015 – 3:07pm
In March, the Ohio Consumer Voice for Integrated Care (OCVIC) published a news article detailing the outcry of consumers and Independent Providers (IPs) on the proposed elimination of IPs. After the outcry and testimony from consumers, IPs, and advocates, the language was removed, the timeline changed and a stakeholder advisory group will help the state make consumer self-direction (allowing consumers to hire IPs) available to all Ohioans. Our voices were heard.
But, now we are hearing a new, related outcry.
OCVIC has received several messages on the proposed new rates for Independent Providers and Agencies. Providers were told that Ohio Medicaid, in an effort to modernize the way it pays, engaged in a long term study to analyze factors such as labor market data, education, licensure status, and length of service visits to assist in developing a new rate structure for Home Health services. The results of that study resulted in a new proposed rate structure that will be effective July 1, 2015 if accepted. The new rate structure, providers are told, will ensure that all providers are present and providing services for a minimum of 35 minutes in order to get the higher base rate, increase reimbursement for RNs (since they have a higher skill level), and adjust the rates for all providers.
But, OCVIC manager John Arnold has heard comments from IPs on this proposed change, such as:
A public hearing on the proposed rule actions will be held on May 15, 2015, starting at 12:00 p.m. and continuing until all persons in attendance have had an opportunity to testify. The hearing will be held at 50 W. Town St., Room A501, Columbus, Ohio 43215. At this hearing, the Department will accept verbal and/or written testimony on the proposed rule actions under consideration.
Persons unable to attend the public hearing may submit written comments on the proposed rule actions. Any written comments received on or before the public hearing date will be treated as testimony and made available for public review.
If you would like to submit your testimony to be heard by this committee you may do so by following this link. There is a template provided, but in order for it to be effective you should provide as many details as possible about how this will affect you and your consumers.
OCVIC will evaluate the new proposed rates and will determine the next steps in our advocacy.
Submitted by achenault on Tue, 04/07/2015 – 6:11pm
How can you select a health plan or obtain services without knowing what providers are in the plans’ networks?
Ohioans have complained about not being able to access the health care provider information they need to choose a health plan and not being able to confirm that a provider is in their network once they have enrolled in a health plan. That’s why Ohio Consumers for Health Coverage was initially pleased that the Ohio Department of Insurance published a draft rule on network disclosure. However, as we read through it, we also had some concerns, leading us to file written comments on both the first and second drafts of the rule (on Feb 20 and Mar 27th respectively).
Many provisions represent a step forward. The draft rule requires insurance plans to ensure that the format and content of a provider directory is not deceptive or misleading by complying with specific requirements. Insurers must update directories quarterly and within 15 days of getting notice that a provider is being added or leaving a plan or changing hospital affiliation. The rule also states that an enrollee shall not be required to enter an ID number to access the directory and defines “enrollee” broadly. It establishes certain reports that the Insurance Commissioner can request from insurance companies to measure compliance.
However, OCHC made several recommendations to the first draft. We would like the review and updates to be more frequent. The rule states that the Commissioner “may” request certain data from the insurance company. We urged that “may” be changed to “shall” and that more extensive data be requested.
In the second draft of the rule, a provision was added that makes the reports filed by insurance companies confidential and not available to the public. OCHC protested strongly against that addition in its second comments. There is no purpose to be served by this lack of transparency.
Submitted by achenault on Tue, 04/07/2015 – 5:27pm
People on Medicaid need to keep a watchful eye out for an eligibility re-determination notice coming from the County Department of Job and Family Services (ODJFS). Consumers missing the notice risk having their benefits terminated! (a lawsuit challenging the redetermination process is now pending – see other article).
The annual redetermination process has resumed in January 2015, after being halted for the entire year of 2014 to allow for the Medicaid expansion and other changes to be implemented. The delayed 2014 notices and annual notices for January through April 2015 have now been sent out to Medicaid recipients, which includes MyCare Ohio (dually eligible) enrollees as well as all others on Medicaid for more than one year. The Ohio Consumer Voice for Integrated Care (OCVIC) has heard from enrollees wanting to understand the significance of this document. All Medicaid enrollees receiving Food Assistance, cash, medical, or any other benefit must go through this eligibility redetermination. It is very important to follow the instructions provided, or seek assistance. If you do not, your benefits may stop. Please take the necessary steps to avoid any service disruptions in food or medical assistance.
Need help with your Medicaid renewal?
Submitted by achenault on Tue, 04/07/2015 – 5:21pm
UHCAN Ohio has been building outreach and enrollment capacity in communities of color by working with churches and community organizations to strengthen their ability to navigate the uninsured from their congregations and communities to coverage. We would like to highlight two of these programs: Horn of Africa Voluntary Youth Committee (HAVOYOCO), in Columbus, and University Settlement, Cleveland. HAVOYOCO primarily serves Africans, including the Somali population. University Settlement serves primarily African Americans and, through its partners, also serves Hispanic populations.
With funding from UHCAN Ohio’s Robert Wood Johnson Foundation Consumer Voices for Coverage grant, these two programs operated multiple enrollment sites and were able to hire and provide stipends to Certified Application Counselors (CACs) from their communities to provide outreach, enrollment, and post-enrollment activities for the communities they serve. The stipends allowed the programs to recruit people who had a passion for working in their own community. “We tried to do this work last year with volunteers. We had some volunteers, but did not have the quality of people who provided regular hours we could count on. We had much more success using stipends. Our CACs’ enrollment hours were more consistent, they conducted regular outreach and enrollment, and they came up with innovative places to conduct outreach and enrollment,” said Belinda Harris, CTSOC Lead Parent Advocate at University Settlement.
HAVOYOCO operated two community sites and funded two African enrollment assistors. University Settlement operated four community sites and funded three African American assistors. During the months of November through January, HAVOYOCO and University Settlement CACs provided face-to-face enrollment assistance to over 300 persons, many of whom spoke English as a second language, and conducted outreach to more than 500. More important than the numbers is the fact that there are now five trained CACs who are providing continuing enrollment assistance, following up with those they assist to make sure they got the coverage they need and understand how to use it, and who are prepared to steer people from their communities to coverage during the current special enrollment period and the next open enrollment period.
If you or someone you know needs coverage, contact us at 614 456-0060 ext. 233 or click here.
Submitted by achenault on Tue, 07/07/2015 – 11:24am
The Affordable Care Act has led to historically low rates of uninsured. Over 750,000 Ohioans have enrolled since it went into effect. However, in Ohio, health care still looks different for people with low to moderate incomes (and especially for people of color) than it does for those with more money to pay for services. This is the first in a series of articles written by UHCAN Ohio’s Health Equity Director, Nita Carter, to help us understand how our current system of health care helps to create disparities in health care that lead to disparities in health outcomes.
As a health care advocate, an African American woman, and a member of the middle class, I want to begin by sharing my own story about my recent trip to my primary care doctor for my free annual exam, to illustrate continuing barriers to health care based on income and race.
In March, I went to the doctor for my annual exam, which included a pap exam and a colonoscopy. When I arrived, my doctor, who I have been seeing for years, starts to talk about what has been going on with me since my last visit and over the year. I talk about the fact that I gained some weight this year and share other things about what I think has changed. She does her exam and orders a number of tests – the usual things, like checking my cholesterol levels and my “sugar” levels (in my community, we say “sugar,” not technical terms like “A1C”). She includes a test to check my thyroid to make sure I am having no thyroid problems, as thyroid problems run in my family and weight gain is an indicator. She also checks my vitamin levels as mine have been low in the past. She gives me a pap exam, and on another day in March I have a colonoscopy – one of the free preventive screenings under the ACA. From these 2 visits, my free colonoscopy, and my free annual exam, I received bills totaling over $500.00.
When I called to ask my provider and the insurance company about these bills, I was told that the test for my thyroid and the Vitamin D were not covered. In addition, the biopsy on the polyp (to rule out cancer) removed during the colonoscopy and some of the tests on the tissue taken during the pap exam were not covered.
Here is where money counts. If I have money none of this is a problem. I might try and appeal, but ultimately, I’m going to pay for the tests if the appeal does not work. Of course I want my thyroid checked, and I want my polyp tested to make sure it is not cancer, and I want to know if there is anything abnormal about my pap exam. But if I have no money for these extra costs, I am most likely only going to do the things that are free, even though the doctors recommends the tests that cost money. And if I am not told these tests will bear significant costs ahead of time and I get bills for them – as happened to me – I am going to be more than upset. If I have to pay these bills, I may have to skip some other important expense, like a utility bill or a prescription, or set up a payment plan using money I do not have, because I only budgeted for my monthly premium. This one visit teaches me I can’t afford “free” preventive and routine care from my primary care doctor. Next year and the years after, I am going to think twice about scheduling an annual exam, the pap exam, or any other free preventive screening that might cost me money. I may avoid routine care until I have a problem I can’t ignore – and that’s why we see big inequities in health, based on income, which disproportionately impacts people in my community.
Affordability is the main reason many currently uninsured people cite for not enrolling in coverage under the ACA. And we know that many of the uninsured are from some of our most at-risk populations, living in communities where health disparities are high. So how do we change this and create access to more affordable, quality health care? We have our work cut out for us. There is more than one answer to this question. For example, we could:
Most of all, we need to understand the problems people are having getting and paying for health care. Then we need to figure out what policy changes we should advocate for so that health insurance makes needed health care more affordable. These are the questions UHCAN Ohio struggles with every day and the questions I am going to explore in the next articles in this series on creating health equity in our health care system.
