Submitted by kgmeiner on Tue, 02/04/2014 – 2:56pm
By: Kathleen Gmeiner, Project Director, OCHC
Three Republican Senators – Orrin Hatch, Tom Coburn and Richard Burr – introduced on January 27, 2014 the Republican replacement plan to go with their party’s call to “repeal and replace Obamacare.” It’s called the “Patient Choice, Affordability, Responsibility, and Empowerment Act (CARE Act).” It would be a very poor replacement for the ACA. It makes health care affordable for far fewer people and at the expense of comprehensive benefits and covering those excluded from the market by pre-existing conditions. Here is what it does:
People would have protection from insurance company discrimination based on pre-existing conditions ONLY IF they were continuously insured. Otherwise their option would be state high risk pools that the law would aid. [Note: State-run high risk pools have never been effective in covering the millions with pre-existing conditions].
Young adults could still remain on their parents’ insurance policies.
Prohibition on lifetime limits in what an insurance company will pay out remains.
People who fail to choose a health plan would be passively enrolled in a plan at the subsidy to which they are entitled; they could drop it.
It would encourage malpractice reform.
It would give states Medicaid dollars based on the number of people enrolled in Medicaid, not based on what the state spent on Medicaid. The ACA provision that subsidizes states at 100% and then down to 90% would be gone. Persons eligible for Medicaid could take Medicaid or buy private insurance instead with a subsidy.
It would keep the changes to Medicare in the ACA.
It would prevent insurance companies from canceling insurance policies except for fraud or misrepresentation.
What’s missing from the Republican plan?
The mandated set of benefits (The ACA requires policies to have ten essential health benefits)
The prohibition against gender discrimination
Protection for pre-Medicare age older adults –Under the ACA, a 60-year-old cannot be charged more than 3 times what a 20–year-old is charged. Under the Republican plan, the older person could be charged 5 times as much. And, states could even opt out and charge greater than five to one.
Tax subsidies are cut off at 300% of the federal poverty level, not 400% as under the ACA
Financing – the insurance, hospital and medical device provider taxes that support the ACA are gone; the replacement is a reduction on what employers who provide insurance can deduct from their taxes.
The Center for Health and Economy, a newly-created think tank by former Congressional Budget Office and Republican Douglas Holtz-Eakin, issued a fiscal analysis of the plan January 30th. Of note, the Center says that “there will be a significant increase in individual market participation, but that is “expected to be offset by large reductions in the Medicaid population.” (emphasis added)
And that’s the rub. While the plan would provide subsidies, it would greatly reduce Medicaid. And it leaves all of the people with pre-existing conditions who are unable to maintain continuous coverage at the mercy of state high risk pools, which have a terrible track record for helping large numbers of those with pre-existing conditions. Those who could maintain coverage would likely do so with higher deductible plans that would not be required to provide mental health and substance use disorder services, maternity coverage, women’s health benefits and the preventive services – all now firmly established in the ACA.
Let’s take a look at the subsidy in the ACA and the CARE Act by looking at a hypothetical.
Tricia is 26-year-old single adult living in Franklin County with annual income of $22,000, or 191% of the federal poverty level. Under the newly proposed “CARE” Act she would get a subsidy of $1,560 for a year. Applied to the lowest cost silver plan in the current Ohio Marketplace, she would pay $125 per month under CARE, while under the ACA she is paying $105. But, under the ACA she can receive, without co-pay or deductible, an annual well woman visit and a routine Pap test. Under the ACA, if she gets pregnant she’s covered. If she is diagnosed with a mental illness, she’s covered. Under Tricia’s silver plan she can see her doctor for a $10 co-pay. None of these benefits is guaranteed in the CARE plan. And without the ACA, she may be paying more for her insurance than a 26 year old male living in her same city.
There is one silver lining in the introduction of this new plan. It shows that Republicans recognize that they can’t keep calling for the ACA’s repeal without an alternative and that to have a chance at passing a “replacement” bill, they cannot totally roll back the ACA. But that is about the only positive that can be said about it.
Submitted by achenault on Wed, 01/14/2015 – 1:51pm
Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane. – Reverend Dr. Martin Luther King Jr.
Dr. King recognized that health care is a matter of justice. As we celebrate his birthday next week, consider honoring his legacy by getting yourself enrolled in health coverage and encouraging others to do the same. The deadline for signing up for insurance through the Marketplace is February 15th.
UHCAN Ohio is calling on all Ohioans to continue the work of Dr. King by getting as many Ohioans enrolled in coverage as possible. We’re providing the following materials to local MLK Day events to make it easy to incorporate Dr. King’s message into an event:
Click here to view the toolkit.
If you’re hosting an MLK Day event or know of an event happening in your community, please email achenault@uhcanohio.org to share your event information and request materials to use at your event.
Submitted by achenault on Wed, 01/14/2015 – 1:50pm
As we move through the current Open Enrollment period, many Ohioans are seeking out assistance to help them understand the enrollment process and get covered. In the first month of the current open enrollment period, 89,000 Ohioans signed up for coverage through the Marketplace.
UHCAN Ohio Certified Application Counselors (CACs), who are located in churches and community-based organizations across the state, are seeing another aspect of Open Enrollment as well. In addition to new enrollees, our CAC sites are also seeing an increase in the numbers of people with existing coverage who are now coming back with questions on re-enrollment and how to use their coverage. Marsha Riley, one of our Columbus-based CACs, states that about 40-50% of those she sees are people she helped last year.
“This is very encouraging, because it shows that our system of using trusted messengers located at community based sites to provide enrollment assistance and follow-up is working,” says Nita Carter, UHCAN Ohio’s Director of outreach and enrollment.
The goal of our project that builds enrollment assistance capacity in African American and other underserved communities is to make sure that people not only get covered but use their coverage to get connected to needed care. “Having people with questions about how to use their insurance is exciting. That means they are not just placing that card on a shelf someplace. They are really using it,” says Carter.
With funding from the Robert Wood Johnson Foundation, UHCAN Ohio has partnered with churches and community based organizations as well as Enroll America to open 22 sites in Cleveland, Columbus and Cincinnati. These sites will remain open after the enrollment period ends to provide follow-up, assist with Medicaid enrollments, answer questions, and help people understand how to use their coverage and get the right care at the right time and place.
For more information on the sites, go to enrollmenthelp.
Submitted by achenault on Tue, 01/27/2015 – 5:49pm
In November of 2014, the U.S. Supreme Court agreed to hear the case of King v. Burwell. The case challenges the subsidies paid to those enrolled in Qualified Health Plans in states with a Federally-Facilitated Marketplace (FFM), such as Ohio. Subsidies help make health insurance affordable for those with low and moderate incomes.
The Court did not have to review this case. The case does not present a constitutional issue, and there was no disagreement among the federal Courts of Appeals that first heard the case. Why did four justices (the minimum number needed to accept a case) decide to take this case? Many think the Supreme Court wants to reverse the Court of Appeals ruling that protected the subsidies in the majority of the states.
If so, will they find their 5th vote to throw the subsidies of over 150,000 Ohioans into doubt? Not if UHCAN Ohio and thousands of consumer activists across the country can persuade them otherwise, through the powerful stories of people currently getting subsidies in Ohio and the 26 other affected states. If you are a person who is getting a subsidy in the Marketplace or know someone who is, we want to hear from you. Email us at kgmeiner@uhcanohio.org
The Supreme Court will hear oral arguments on March 4, 2015, and a decision is anticipated by the end of June 2015.
The following Q&A will help you understand what this case is all about.
1. Who is King and who is Burwell?
David King is the first among four plaintiffs who are Virginia residents. These plaintiffs, for whatever reason, do not wish to purchase comprehensive health insurance and do not want to pay a penalty. According to the opinion written by the federal Fourth Circuit Court of Appeals (that handles cases coming out of Virginia), “Without the premium tax credits [subsidies], the plaintiffs would be exempt from the individual mandate under the unaffordability exemption.”
Sylvia Burwell is the Secretary of the U.S. Department of Health and Human Services (HHS). She is the first defendant, and the other defendants include the Department of HHS, the Secretary of the Treasury, the Treasury Department, the Director of the Internal Revenue Service, and the IRS.
2. What is the legal argument that people in Federally Facilitated Marketplace (FFM) states, such as Virginia and Ohio, should not be entitled to a subsidy under the Affordable Care Act?
The ACA creates subsidies for persons between 100% and 400% of the poverty level in State Exchanges (Marketplaces). The ACA contains a provision for the federal government to run the Exchange in the states that don’t create one. The plaintiffs argue that Congress should have said that the subsidies also apply to the federal marketplaces, and that without having said that, no one in an FFM state can claim a subsidy.
3. What is the legal argument that persons insured in the FFM states should be entitled to a subsidy?
The ACA defines an Exchange as a health insurance marketplace run by the state. The ACA then provides that the federal government will run an Exchange if the state does not. The federal government is acting on behalf of the state when it runs the Exchange, so there is no reason that the subsidy shouldn’t go with it. As Families USA notes on its website, it would make no sense for the federal government to undertake the responsibility of running a state’s Exchange if all the moderate- and low-income residents were not eligible for a subsidy and thus could not afford health insurance.
4. How will King v Burwell affect Ohioans who are getting subsidies in the individual Marketplace?
If the Court rules against David King and the other plaintiffs, everything will continue as is. If the Court rules in favor of King and against the government, the State of Ohio must decide if it will run an Exchange and save the subsidies of more than 160,000 Ohioans. This decision may depend on whether the State could run its own Exchange but still use the federal web site and application processing system. Congress could also amend the language of the ACA, but politically that is a challenge.
5. Would there be any other effects from a bad decision in King v Burwell?
If subsidies go away, it could also hurt the whole individual insurance market. Who would stay in? Primarily those who use a lot of medical services. This would cause health premiums to go up and threaten the stability of the individual market.
6. Should we be worried?
We should pull out all the stops to make sure that decision makers know the stories of those who are getting subsidies. The legal argument in favor of continuing the subsidies is very strong. What is troubling is that the Court took this case, and that is why advocates are being vigilant.
7. Should people continue to enroll before February 15, 2015?
Yes! Ohioans should continue to enroll in coverage up to the February 15th deadline. The Supreme Court’s opinion is expected in June. Anyone not enrolled by the deadline would not get another chance to buy insurance in 2015 and would be subject to a penalty. See Question 4 above as to what might happen after a negative ruling. If the Court rules against the subsidies, consumers will NOT have to pay them back.
8. What are UHCAN Ohio and Ohio Consumers for Health Coverage doing to fight against a bad decision in King v Burwell?
We are looking for stories of people currently receiving subsidies whose health and financial situation would be harmed if they were taken away. We are sharing those stories with the organizations filing “Friend of the Court” briefs and with the media. We will hold a press conference the day before the March 4th oral argument where people who are going to be impacted by this decision can share their stories. Want to help? Contact kgmeiner@uhcanohio.org.
Submitted by achenault on Wed, 03/04/2015 – 10:34am
On March 4, the US Supreme Court will hear oral argument in the case of King v. Burwell. This case challenges the Affordable Care Act’s provision of tax subsidies in states, such as Ohio, using the federally operated Marketplace. If the Court strikes down subsidies, the decision is likely to send shockwaves not only through Ohio and other states using the federal Marketplace, but through individual insurance markets across the country.
What Ohioans – Especially Those Receiving Subsidized Marketplace Insurance – Need to Know:
Thanks to the ACA, millions of Americans – including 734,000 in Ohio – now have quality, affordable health coverage who didn’t have it before. In many states, like Ohio, that didn’t create their own state-run Marketplace, residents purchase coverage and obtain subsidies through the federal Marketplace. 234,000 Ohioans receive coverage through the federal Marketplace.
This lawsuit is another politically motivated attack on the ACA – this time, claiming that the law does not permit people purchasing coverage through the federal Marketplace to receive tax subsidies. Most legal scholars agree that there is no legal basis for the Supreme Court to take away health coverage from millions of Americans. Congress, the Congressional Budget Office, everyone – Republicans and Democrats alike – agreed that subsidies would be available through both the federal and state Marketplaces.
The Court is hearing legal arguments on March 4 and will likely make a decision by June – or even earlier. In the meantime, while the Court considers this case, people receiving subsidies will continue to receive their tax credits. They can continue using their insurance and paying their premiums as usual.
What If the Court Strikes Down the Subsidies?
Even though the lawsuit has no legal merit, the Court could still rule against the ACA. But, a Supreme Court decision in favor of the challengers would be highly political and call into question its historic independence from the political branches of government. A decision by the Supreme Court to take health coverage away from so many Americans would be unprecedented in American history.
If the Court strikes down the federal subsidies, the change will probably go into effect within a month or so. The decision will likely come in June, or even sooner. That means, to be on the safe side, people receiving subsidies through the federal Marketplace should make sure they schedule needed preventive care, tests, and treatments soon, if they cannot afford their insurance without the subsidy.
How Will Access to Affordable Insurance Be Affected?
People in states like Ohio that use the federal Marketplace would lose their subsidies. Those who could not afford to pay the full price of their insurance would soon lose their insurance. “Healthy” people would be more likely to drop their insurance than people with significant health care needs, who might find a way to purchase insurance even without the subsidy. As healthy people leave the market, insurance premiums would rise, driving more relatively healthy people from the market. That’s known in the insurance world as the “Death Spiral,” for obvious reasons. Experts believe that loss of subsidies in states using the federal Marketplace would spill over to the individual insurance markets in all states.
For more on this gloomy scenario, see Julie Rovner’s article in Kaiser Health News.
What Can We Do to Save the Subsidies?
UHCAN Ohio is holding a press conference and using social media to raise the voice of people who care about their subsidies. The first line of defense is making sure the Court knows that the consequences of overturning the subsidies have no easy fix. Secondly, since Congress could pass an amendment clarifying that the ACA provides subsidies to states using the federal Marketplace, it is important to call or write your Representative and Senators. However, opposition to the Affordable Care Act makes Congressional action a major challenge. We can push the Governor and Ohio’s legislature to create a state Exchange – another heavy lift. But UHCAN Ohio will be doing all of this – hopefully with you—when we weigh the outcome of the case. Share your story with us – help us to demonstrate what affordable coverage has meant in the lives of real Ohioans.
Submitted by achenault on Wed, 09/23/2015 – 1:30pm
This article, with the exception of the quote at the end from the Health Affairs Blog, is an abbreviated version of an e-mail sent on September 14, 2015 by Kellan E. Baker , MPH, MA, Senior Fellow of the LGBT Research and Communications Project of the Center for American Progress to the LGBTQ State Exchange List-serve.
A new rule proposed by the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services will implement Section 1557 of the Affordable Care Act. This section includes non-discrimination protections that prohibit any health program or facility that receives federal funds, including insurance companies in the state and federal marketplace, from discriminating on the basis of race, color, national origin, age, disability, or sex. The deadline for comments on the proposed rule is November 9, 2015. In this article we will focus primarily on the provisions related to gender identity and access to services for gender non-conforming people. In our next newsletter we will address the impact of this proposed rule on race, color, national origin, age, disability and sex (other than gender identity issues).
In the proposed rule, OCR confirmed that the sex nondiscrimination protections in Section 1557 prohibit discrimination on the basis of gender identity and sex stereotyping. This rule applies to many “covered entities,” including private health insurers, state Medicaid programs, health facilities that accept federal funding (such as hospitals or clinics that accept Medicare or Medicaid patients), and the Health Insurance Marketplaces. It also applies all of these protections to programs run by HHS itself.
The proposed rule does the following:
