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Food Keeps Illinois Families Healthy: Help Illinois Reduce the SNAP Gap

Forty-eight million Americans live in food insecure households, meaning they worry about where and how to find their next meal. Many of these individuals and families are covered by Medicaid but are not receiving critical nutritional support. They are eligible for SNAP which could help support their nutrition and improve their health, but they are not enrolled.

What is SNAP?

The Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps) helps low-income households purchase adequate, nutritious food. Benefits are distributed monthly on an Electronic Benefits Transfer card, known as “Link” in Illinois, which acts much like a debit card. Money from SNAP can be spent at authorized retailers, and some farmers markets, on any foods that recipients prepare and eat at home. SNAP recipients nationally spend over 85 percent of benefits on fruits and vegetables, grains, dairy, meat and meat alternatives. Beneficiaries also increase the amount of money they spend on groceries each month, instead of simply replacing their food budget with SNAP dollars. By supplementing, not replacing, grocery budgets and allowing for the purchase of more nutritious food, SNAP reduces food insecurity in low-income households. This is particularly true of households with children.

Why Help Consumers Apply for SNAP Benefits?

Connecting more Medicaid recipients with SNAP benefits can address food insecurity and inadequate nutrition, which this population experiences at high rates, and improve health outcomes. In addition to helping a family afford healthier food, children who receive nutrition supports are healthier and more likely to finish school while participating in the program. A report recently released by the White House Council of Economic Advisers details the long-term benefits of this program, including: for mother’s receiving support during pregnancy, reductions in incidences of low birth-weights; and for adults who received support when they were children, reductions in obesity rates and metabolic syndrome, increased likelihood of having completed high school, and significant improvements in overall health and economic self-sufficiency among women.

New Opportunities in Illinois to Reduce the SNAP Gap

The Affordable Care Act has made it easier for low-income individuals and families to access public benefits by helping states pay for electronic systems to apply for benefits. In Illinois, the new Application for Benefits Eligibility enables applicants to submit a single application for both SNAP and Medicaid. However, despite this improved online application, we have not fully reduced the “SNAP Gap”—the number of Medicaid clients who are income-eligible for SNAP but do not receive this benefit.  We need to work with medical providers, medical plans, social service organizations and other partners to make sure that everyone who is eligible for SNAP gets the help they need to pay for healthy food.

The newest change to the Illinois SNAP program is that on January 1, 2016, Illinois raised the gross income limit for SNAP from 130% to 165% of the federal poverty level, making nearly 40,000 low-income working families newly eligible for SNAP. With more families in Illinois now eligible for SNAP and the ability to submit a single application for both SNAP and Medicaid benefits, it’s time to close the SNAP Gap and make sure families have the food they need to stay healthy. If you’re not familiar with SNAP’s application process join us on HelpHub for more information and resources for both providers and consumers.

MacKenzie Speer
Advocacy Program Associate
Sargent Shriver National Center on Poverty Law


Clarifying, Eliminating and Enforcing Special Enrollment Periods

As the Health Insurance Marketplace grows and matures, we continue to listen and learn to find ways to make it work even better for consumers and those who serve consumers. We know that each year, as the Marketplace evolves, we must seek to continually adapt and refine the way we operate. In addition to continually improving the consumer experience, we also must make changes to keep the Marketplace vibrant, stable and strong.

The fundamental principles to achieve this are simple: the Marketplace must be attractive for consumers, and the Marketplace must be attractive for insurance companies that offer plans on it.

Consumers need to know that affordable options are available and that insurers are competing for their business. We know that consumers want affordable health care and value the insurance they’re finding at the Health Insurance Marketplaces. This Open Enrollment we’ve seen a significant influx of new consumers – many of them young – making it clear there is still a large untapped market for insurance companies to serve.

The Marketplace must also be attractive to insurers, so that they make quality plans available at affordable prices and continue to drive innovation, and so consumers can find plans that meet their health and budget needs. Building an attractive Marketplace starts with establishing a predictable, stable set of rules that help to keep the risk pool balanced. As the Marketplace grows and evolves, we continue to analyze data to understand how our rules are impacting insurers and consumers and to make sure they are working to sustain a stable Marketplace. By having clear rules for how the Marketplace operates and making adjustments when needed, we are creating a more stable rate environment with more affordable plan choices for consumers.

One of the areas we have been reviewing closely is the special enrollment periods we offer. Special enrollment periods are an important way to make sure that people who lose their health insurance during the year or who experience a major life change like getting married or having a child, have the opportunity to enroll in coverage through the Marketplaces. People who experience these qualifying events have the opportunity to enroll in coverage outside of the normal Open Enrollment period from November 1 to January 31, similar to how enrollment works in the employer market. In addition, in the first two years of the Marketplace, a number of special enrollment periods were created for consumers who were still learning how to enroll in coverage for the first time.

As the Marketplace matures and consumers learn more about how and when to enroll, we continue to review the rules around special enrollment periods in order to keep them fair for consumers and for issuers. We are taking initial steps in adjusting how special enrollment periods work – and will continue to make further adjustments in the future based on what we learn from continued monitoring and analysis of special enrollment period usage and compliance.

The action we are taking today announces the elimination of several unnecessary special enrollment periods, clarifies the definitions of other special enrollment periods, and provides stronger enforcement so that special enrollment periods serve the purpose for which they are intended and do not provide unintended loopholes.

Eliminating Unnecessary Special Enrollment Periods

Last month, we announced that the Tax Season special enrollment period will no longer be offered. Today we are announcing the elimination of six other special enrollment periods that are no longer needed. Just as the Marketplace evolves, so too does consumer behavior. The rules we use to operate the Marketplace need to keep up with these changes. As such, special enrollment periods are no longer available for:

  • Consumers who enrolled with too much in advance payments of the premium tax credit because of a redundant or duplicate policy
  • Consumers who were affected by an error in the treatment of Social Security Income for tax dependents
  • Lawfully present non-citizens that were affected by a system error in determination of their advance payments of the premium tax credit
  • Lawfully present non-citizens with incomes below 100% FPL who experienced certain processing delays
  • Consumers who were eligible for or enrolled in COBRA and not sufficiently informed about their coverage options
  • Consumers who were previously enrolled in the Pre-Existing Condition Health Insurance Program
We’ll continue to monitor how special enrollment periods are used and may make changes in the future as Marketplace systems and operations continue to improve.

Clarifying Eligibility

Our review of current special enrollment periods also showed that some of the eligibility guidelines need to be further clarified so consumers can understand the intent and so they will not be abused. Today we are updating guidance to more clearly define the special enrollment period that is available to consumers who permanently moved, and as a result, gained access to new health plans. Specifically, we clarify that this special enrollment period cannot be used for a short-term or temporary move where the consumer doesn’t plan to stay in their new location, including situations in which a consumer is admitted to a hospital for treatment in a different area. This clarification is intended to assist consumers, brokers, issuers and others in understanding who is eligible for this special enrollment period.

If we identify other areas where the rules for special enrollment periods are unclear, we will issue additional clarifying guidance as needed.

Enforcing the Rules

Finally, we will take steps to make sure that consumers understand and comply with the rules. We will conduct an assessment of plan selections that are made through certain special enrollment periods to evaluate whether consumers properly accessed coverage. Our program integrity team will pull samples of consumer records nationally and may request additional information from some consumers or take other steps to validate that consumers properly qualified for these special enrollment periods. The findings from the assessment will help us to inform future policy and operational improvements to enhance program integrity. Additional details will be provided in the coming weeks.

We will also emphasize more strongly to applicants that the law requires that consumers provide accurate information to the Marketplace, and they may be subject to penalties under federal law if they intentionally provide false or untrue information.

There is still time for consumers who need coverage to enroll during the Open Enrollment period that ends on January 31st. While there will continue to be special enrollment periods for people who lose coverage mid-year or experience other life changes, this channel for enrollment will not be available for the vast majority of consumers. For example, special enrollment periods are not allowed for people who choose to remain uninsured and then decide they need health insurance when they get sick.  Consumers who do not currently have other health insurance coverage should enroll through the Marketplace now during these last two weeks of Open Enrollment, to make sure they have coverage if they get sick and to avoid the tax penalty.

This was originally posted on the CMS Blog.

Kevin Counihan
CEO
Health Insurance Marketplace 

Same-Sex Couples Celebrate New Marriage and Healthcare Rights


The Supreme Court of the United States has been awfully busy lately—after last week’s landmark
rulings to uphold the Affordable Care Act and legalizing same-sex marriage, SCOTUS is certainly living up to its name. And while these decisions have massive implications in completely different realms of the American social and political landscape, they both improve the future of healthcare for same-sex couples. After facing decades of coverage ineligibility and discriminatory practices, achieving marriage equality means that same-sex couples will finally receive equitable treatment in a number of different areas of the healthcare arena.

New Options for Enrollment and Coverage

Because same-sex marriage is now recognized under federal law, LGBT couples are entitled to utilize insurance enrollment and coverage options designated for married spouses. One such opportunity now available to same-sex couples is the special enrollment period. Newly married same-sex spouses previously needed to wait to apply for coverage until the open enrollment period but these couples are now eligible to apply for coverage within 60 days of their union. These special enrollment periods are available to applicants who have recently experienced a major life event, a category which now incorporates same-sex marriages in light of the Supreme Court ruling.

Same-sex partners across the nation are now eligible to receive coverage under their spouse’s employer. A recent study by the Kaiser Family Foundation showed that less than half of employers offer insurance to non-married same-sex couples. Now that same-sex marriages are recognized under federal law, married same-sex couples across the nation will be able to access the same coverage benefits as heterosexual couples.  Although coverage for same-sex spouses was previously available through many insurance providers, same-sex couples will now have equal opportunity to access these benefits.

Spousal Rights

Friday’s Supreme Court decision also marks a huge step towards equal rights for same-sex spouses in healthcare settings. Couples who were previously denied basic spousal rights such as default power of attorney will be entitled to the same privileges as heterosexual couples in healthcare settings.

Although this may seem like a small victory to couples that have faced this type of discrimination, this decision marks a giant leap forward in the fight for equality. Take the story of LGBT rights activist Janice Langbehn: while vacationing with their family in Florida in 2009, Janice’s partner of 18 years Lisa Marie Pond suddenly collapsed and was rushed to a local trauma center. Because they were not Lisa’s blood relatives, Janice and their three adopted children were not allowed to see Lisa and were in the waiting room while she received treatment. Although Janice had power of attorney and the documentation was faxed to the hospital within an hour of Lisa’s arrival, it was too late: Lisa had suffered a brain aneurysm and slipped into a coma, and died without her partner or her children by her side.

Unfortunately, Lisa and Janice’s story is not unique—hundreds of same-sex couples have similar heart-wrenching stories of being denied basic spousal rights in hospitals and other healthcare systems. This landmark ruling will hopefully put an end to these discriminatory practices and allow same-sex couples the same fundamental rights to which all married couples are entitled.

An End to Discrimination

The recent ruling will hopefully mark an end to the prejudicial practices often employed by hospitals and healthcare facilities in serving same-sex couples and their families. As illustrated by Lisa and Janice’s story, unequal treatment of same-sex couples has been an unfortunate part of our nation’s healthcare history. These practices will hopefully be left in the past with this monumental decision.

Although Illinois was ahead of the curve in officially recognizing same-sex marriage, our statewide healthcare institutions have not all been sensitive to the specific care needs of LGBT patients. In an effort to hold healthcare organization accountable for their policies and practices for serving LGBT communities, the Human Rights Campaign launched their Healthcare Equality Index (HEI), which evaluates the equitable treatment of LGBT patients in healthcare settings based on the presence of four criteria: providing staff training in LGBT patient-centered care, equal visitation rights for LGBT patients and their visitors and written patient and employment non-discrimination policies. Although 16 Illinois hospitals and healthcare systems ranked among the 427 national leaders in LGBT healthcare equality, 12 of the 50 Illinois facilities surveyed in 2014 failed to meet the majority of equality criteria.

Despite this, equitable healthcare treatment for the LGBT community on a national scale is closer now than ever before. The 2014 HEI survey found that 84% of the hospitals met all four criteria for LGBT patient-centered care. This is a 101% increase in the number of healthcare systems designated as national leaders in promoting LGBT equality in 2013.

The Supreme Court's legalization of same-sex marriage symbolizes a new era of equality, while the upholding of the Affordable Care Act marks a huge stride towards equal healthcare for same-sex couples nationwide. Now that the federal government has done its part in recognizing same-sex marriage, it’s up to healthcare systems across the nation to follow suit and ensure that their practices promote equitable treatment for LGBT patients and their families.

Dena Balk
Policy Intern
Health & Disability Advocates

Illinois Dodges Disaster on Supreme Court's Obamacare Ruling

The following originally appeared on Crain's Chicago Business.


Illinois just dodged a bullet with the outcome of King v. Burwell. If the Supreme Court had ruled against subsidies being challenged in the case, working people and families in the state collectively would have lost more than $49 million a month to help purchase health insurance.

In its decision, the court affirmed the legality of the provision of premium tax credits under the Patient Protection and Affordable Care Act in all states, whether they established their own health insurance marketplace or used the federal marketplace. On average, working poor and middle-class Illinoisans are getting $211 monthly to help pay their health insurance premiums. A different decision would have meant a 169 percent increase in out-of-pocket expense on the average premium.

Recent data by the Kaiser Family Foundation show nearly 73 percent of the remaining uninsured in Illinois eligible for Get Covered Illinois, the state's health insurance marketplace—roughly 597,473 people—live and work in metropolitan Chicago. In the Chicago area, more than 100,000 of the remaining uninsured reside in areas where English is not the predominant spoken language. While concise data are not available of how many of the uninsured are working, American Community Survey data indicate that as many as 62 percent of the uninsured in Illinois are working at least part time and more than likely work for small businesses.

The most recent year for which U.S. Census data on businesses are available, 2012, show 314,199 business establishments in Illinois. However, 94 percent of these companies employ fewer than 50 employees and thus are not required to provide health insurance via the ACA. Cook County alone accounts for 41 percent of the state's total small businesses.

NOW WHAT?

Now that the King v. Burwell decision has put the legality of subsidies to rest, Illinois needs to get busy enrolling the remaining 597,473 uninsured individuals eligible for a path to coverage in the Get Covered Illinois marketplace. Of these uninsured, 283,629 are eligible for a tax credit or subsidy.

It's a matter of economic security for our residents and for Illinois' economic environment. The math tells us that the business community—especially small businesses—needs to be at the heart of efforts to enroll the remaining uninsured. Crain's and Health & Disability Advocates surveyed small businesses last fall and learned that Chicago-area companies still face increasing health care costs; are confused by the requirements of the ACA; and are unlikely to enroll themselves and their employees online. In fact, more than 80 percent of those surveyed said they shop for health insurance for themselves and their employees using health insurance brokers and agents.

Now that federal funding for ACA assisters and navigators is ending, a public-private partnership for enrollment in Get Covered Illinois is critical. We need to double down on engaging health insurance brokers and agents. While the state did an amazing job in enrolling 633,757 adults in Medicaid as part of ACA, Illinois ranked well behind others in marketplace enrollment, coming in 20th out of 37 states that operate marketplaces using HealthCare.gov.

Get Covered Illinois is key to helping Illinois businesses thrive, enabling them to better attract and retain talent. The marketplace also encourages entrepreneurship by ending the reliance of individuals on larger employer-sponsored coverage.

A strong ACA marketplace is a win-win for the business community and the state. We urge Springfield, City Hall and county governments to make enrollment of the remaining uninsured a top priority and engage the business community, health insurance brokers and agents in the process.

Barbara Otto                                          
CEO                                                        
Health & Disability Advocates           

Erica Salem
Director of Strategic Health Initiatives
Health & Disability Advocates

ACA, Medicaid and Unintended Consequences for People with Disabilities

People with disabilities who are eligible for healthcare through Medicaid may experience painful gaps in coverage during transitions. There are groups of people with disabilities that are particularly vulnerable: those who need long-term care services, those who apply but are not yet found eligible for SSI in 209b states with expanded Medicaid and youth transitioning to the adult system.

Long-term care services and supports, such as personal assistance services or durable medical equipment, are critically important to some people with disabilities. Medicaid packages for people with blindness and disabilities, or AABD or SSI Related Medicaid, offer comprehensive coverage, including long-term care supports and services. For those who need them, these services are a lifeline to independence, living in the community and employment.  Either not affordable or available through the private insurance market, Medicaid has been the sole access point for people with disabilities who need long-term care services. The Adult ACA Medicaid group, or expansion group, is a Medicaid program that may or may not provide an individual with long-term care services in any given state.

209(b) Expansion States Facing Challenges with Transitions 

One key difference across states is the option to automatically provide SSI Related Medicaid to recipients of the federally-administered state supplementary payments though the Supplemental Security Income (SSI) program. Ten states use at least one eligibility criterion that is more restrictive than the SSI program for Medicaid eligibility and are referred to as 209(b) states. This means that an individual in these states who applies and is found eligible for SSI must make a separate application for Medicaid coverage.

The following states are currently 209(b) states: Connecticut, Hawaii, Illinois, Minnesota, Missouri, New Hampshire, North Dakota, Ohio, Oklahoma and Virginia. All but Missouri, Oklahoma and Virginia have expanded Medicaid eligibility through the ACA.

Limited Access to Long-Term Care and Providers in the ACA Adult Group

Because many SSI applications take longer to process than Medicaid applications, people with disabilities can frequently be found eligible for ACA Adult Medicaid while waiting for SSI eligibility to be approved. While this group of individuals who have been approved as ACA Adult Medicaid eligible has access to healthcare, they may not have access to long-term care services.

Once SSI eligibility is approved, however, the beneficiary is no longer eligible for the category of Medicaid (ACA Adult) they are currently receiving. When they are put into the correct category for coverage (SSI Related Medicaid), they are sometimes dropped from one health plan and put into another without their knowledge. The end result is a current Medicaid beneficiary who is denied or faces delayed access to long-term care services he or she should be receiving under SSI Related Medicaid, as well as potentially losing access to providers and being forced to reapply altogether.

In addition to the lack of access to needed long-term care services, people may also experience challenges related to accessing medical service providers. In some states, the integration of the ACA and managed care has vastly changed provider infrastructure, with managed care plans for SSI Related Medicaid offering different provider networks and services than ACA Adult Medicaid managed care plans.

Many individuals, especially those new to SSI Related Medicaid, will not be aware that they are in a different category until another action is taken, such applying for a Medicaid waiver service, attempting to contact their managed care plan or going to see their providers. Both of these issues can result from the timing of an individual’s Medicaid application and approval.

Youth with Disabilities Facing Challenges with Transitions

Youth with disabilities can also potentially face significant unintended consequences around access to appropriate healthcare coverage. Children with disabilities are found eligible for SSI due to a reduction in both Activities of Daily Living and Instrumental Activities of Daily Living. This means a youth can be eligible for SSI under a broader context of criteria, like an inability to socialize or play with others.

Adult disability determinations, by contrast, are made based on a disabling condition that impacts employment—not only current employment, any employment in the country that may be available to someone with such impairments. These are vastly different criteria.

As a result, many children are found eligible and begin receiving childhood SSI and SSI Related Medicaid. However, when they turn 18, they are required to meet the adult disability guidelines in order to remain eligible. Many children fail to meet those adult requirements and their benefits are terminated. Of those that are found ineligible when they turn 18, a number are later found to be eligible in further review or appeal processes. Because Medicaid waiver programs are available only to individuals who are current Medicaid recipients, a child may have waited years to be eligible for Medicaid waivers, be found eligible, only later to be denied eligibility for adult disability—which results in losing benefits under SSI Related Medicaid and SSI eligibility. If, upon later application, the individual is once again found eligible for both adult SSI and SSI Related Medicaid, he or she must now go to the back of the waiting list for the same waiver services previously lost under a youth determination. This can result in years without necessary, critical services and care.

Experiences in the States

Health & Disability Advocates conducted a short, informal survey of seven 209(b) states that have expanded Medicaid to learn more about how states identify people who are in the “wrong” eligibility category and the processes states have in place to prevent this from happening. With six of the seven states responding to the survey, HDA found that:

Three of six respondents offer Medicaid provider packages that are different depending on whether you are in SSI Related Medicaid or ACA Related Medicaid.

Three of the six responding states offer some variety of waivers to individuals even if they are placed in ACA Related Medicaid.

None of the responding states have a formal process for coordinating information about individuals who transition eligibility from one service package to another.

Four of six states are unaware of whether individuals have been improperly placed in the wrong Medicaid eligibility package; the remaining 33% have implemented trainings, but know that individuals continue to get placed into the wrong eligibility group.

Five states (all but North Dakota) were not aware of specific alerts that notify the Medicaid beneficiary that their eligibility for one program has ended and another started.

Upon further contact, roughly half of the states were in the early stages of identifying the issue of individuals being inappropriately placed and noted a need to develop a process for re-engaging the beneficiary to get them connected to appropriate providers for maximized health.

Recommendations Going Forward

While states are currently uncertain about the scope and breadth of these issues, it is important to identify individuals who have fallen through the cracks and may experience a significant disruption in services and eligibility. At a minimum, requiring states to create an automated notification system for changes to eligibility would provide beneficiaries greater clarity and time to plan.  In North Dakota, for example, individuals receive a notice as they leave eligibility under one Medicaid group and become eligible for another. Notice of and clear information about the ramifications of the change is critical.

Another recommendation for states is to look at integration of its systems and data tracking of disability populations. Data exchanges between the state and federal systems, along with the differing eligibility criteria among various programs, should make tracking persons with disabilities a high priority for states. Minnesota, for example, is developing a new integrated system with the capacity to match data sets to a broader context of information, such as employment status. This will greatly enhance the ability of the state to make sure that people with serious health needs receive the proper services and have access to the supports they need for the greatest possible independence.

Joe Entwisle, MS, CLCP
Sr. Policy Analyst
Health & Disability Advocates

The Future of Enrollment in Illinois: Where We’ve Been and Where We’re Going

When Get Covered America came to Illinois before the first open enrollment period for the Affordable Care Act in 2013, there was a lot of work to be done. At that time 78% of the uninsured had not heard of the health insurance marketplace and were unaware of the new health coverage options or opportunities for financial help available to them for the first time. The initial awareness gap was daunting, but hundreds of thousands of Illinoisans stood to benefit from the marketplace and needed to know how the Affordable Care Act could help them.

Many Milestones Through Collaboration

Fortunately, there were a number of stakeholders like Health & Disability Advocates (HDA), the Campaign for Better Health Care (CBHC), Alivio Medical Center and the AIDS Foundation of Chicago, among others, eager and ready for the challenge ahead. This commitment helped achieve many of the goals laid out in the beginning. After two successful open enrollment periods, nearly 350,000 Illinoisans have enrolled in health insurance through the marketplace, and hundreds of thousands more have received coverage through expanded Medicaid and CHIP. Working together towards the same mission, Get Covered America and its partner organizations increased awareness and provided enrollment resources for consumers across the state.

Stepping Back to Move Forward

Because of the great work that has happened on the ground in Illinois, Get Covered America will be stepping back with full confidence in capable partners like HDA, CBHC and many others—such as Family Guidance Centers and Ada S. McKinley—to continue this important work to make health care enrollment a permanent part of communities. It’s clear that the coalition of partners who have come together on this issue have made great strides over the past two years. As the insurance landscape changes and the number of uninsured Illinoisans continues to decrease, Get Covered America wants to make sure that resources are allocated in the smartest and most effective way.

While Get Covered America won’t have an active outreach presence on-the-ground in Illinois moving forward, the organization will continue to support partners in the state with cutting edge data, best practices, tools and resources. Get Covered America will refine and continue to offer digital tools like the Get Covered Connector while also introducing new programs, like  training and support for local partners and health insurance literacy resources for the newly insured.

The Enrollment Challenge Ahead

Just released by Get Covered America, the State of Enrollment Report takes a critical look at the lessons  learned and what still needs to be done to get Illinois covered. Using on-the-ground knowledge and data analysis, the report identified several key initiatives integral to maximizing the number of Illinoisans who enroll in coverage. This is a great resource for partners on the ground and the foundation for a sustainable coalition for years to come.

The Get Covered America team is thrilled at what has been accomplished in Illinois so far, but there’s still important work to be done. While more Illinoisans have health coverage than ever before, there are still too many who remain uninsured and need the facts about how the Affordable Care Act can help them and their families.  On-the-ground partners like CBHC, Family Guidance Centers and Alivio Medical Center will continue this work and make health care enrollment an institutional reality for years to come.  And Get Covered America  looks forward to supporting their efforts.

David Elin
National Fundraising Director
Enroll America

People with Disabilities and the ACA

The Affordable Care Act (ACA) is making health insurance coverage more affordable and accessible for millions of Americans. With the passage of this law, individuals and families have more control over their care – especially individuals with disabilities. The ACA provides people with disabilities a basic protection – they can no longer be denied access to health insurance simply because of their health history.

Under the ACA, individuals like myself can no longer be denied health care because of a pre-existing condition. This is significant for the up to 129 million non-elderly Americans living with some type of pre-existing health condition such as asthma or diabetes, including 17.6 million children.

We have come a long way over the past year. All combined, in just one year, we’ve reduced the number of uninsured adults by 26%. Additionally, 76 million Americans with private health insurance are getting preventive services such as vaccines, cancer screenings, and yearly wellness visits for free. Finally, more than 7 million Americans are enrolled in the Marketplace and more than 8 million additional individuals are enrolled in Medicaid and CHIP, compared to last fall.

We have much to celebrate but there is work to be done. November 15 marks the beginning of the second enrollment period, which will run until February 15. The Administration is committed to ensuring that all Americans have access to coverage. The open enrollment period is a time for Americans already enrolled to re-enroll. It is also a chance for those without coverage to enroll for the first time.

Take a few minutes to watch Joey talk about what the ACA has meant for him and millions of others:



To learn more about getting covered, please visit HealthCare.gov.
By Taryn Williams
Associate Director of the White House Office of Public Engagement.

Posted with permission from The White House Blog 

Obamacare Enters Its Big Year for Fighting Poverty

Obamacare, the Affordable Care Act (ACA), had its third birthday over this past weekend. So this is its first work week in its most important year. This is the year for the ACA’s heavy lifting, bringing affordable health coverage to 36 million uninsured Americans and ending discrimination against adults with pre-existing conditions, all effective as of January 2014. This is the year that the ACA becomes the biggest single measure in the fight against poverty in the last 50 years.
 
The ACA, of course, is usually discussed in terms of its impact on the health care system. And it is already doing a significant job on that front. In its birthday editorial, the New York Times aptly summarized the important contributions to reform of the health care system that the ACA has already produced:


That is a substantial list of accomplishments; moreover, the health care system is due for its most important improvements in the coming year. The upcoming big changes, however, will have an impact that should be understood in more than just health care terms. The progress that will be made in the fight against poverty will be truly remarkable.  


Half of the gain in covering the uninsured will be directed at people in the deepest poverty in our country. Since Medicaid began in 1965, it has had a gap. It never offered coverage to people aged 19-64 who are not officially disabled and not caring for a child in their home. 

These are young adults leaving high school or college (whose parents do not have employer-supported coverage); empty nest parents whose children are over 18; tens of thousands of veterans not covered by VA health programs (over 12,000 would gain Medicaid coverage just in my home state of Illinois); chronically unemployed people with serious mental and physical impairments who are not officially disabled; many of the homeless; and others. The ACA will fill that gap in Medicaid , providing coverage to all with income under 138% of the Federal Poverty Line ($15,415 per year for an individual and $26,344 for a family of three) in the states that choose to take the federal money that the ACA offers them to pay for it.

For many people in poverty, health coverage not only means health, reduction in pain, and expansion of life expectancy, it also means employability and productivity and upward mobility. It can improve learning capacity. It reduces family stress. It can be a major factor in reducing family and community violence. It is a vast improvement in quality of life and quality of opportunity.

The ACA also ends the high cost for Medicaid beneficiaries of making more money. Currently, when a Medicaid beneficiary succeeds in the workplace and escapes poverty, there is a penalty: the loss of health coverage when earnings exceed allowed Medicaid levels. Starting in January, though, the Healthcare Marketplaces in every state will offer affordable private insurance coverage to replace Medicaid when earnings call for termination of Medicaid eligibility. This private coverage removes a barrier to upward mobility. It also acts as a net to keep workers in the middle class if they lose employer-supported insurance, when a health emergency might otherwise mean a free-fall into poverty. And it is there to provide coverage for budding entrepreneurs who want to try for the American Dream and start their own businesses, but who currently are blocked because they cannot risk losing either Medicaid or employer-supported coverage.     

Obamacare already fights poverty by helping seniors on Medicare make ends meet and by helping young adults make their way in the workforce by staying on their parents’ insurance. And in the coming year, at least in the states that implement it thoroughly, Obamacare will make its biggest inroads against poverty.  

John Bouman
President, Sargent Shriver National Center on Poverty Law

(This guest blog was originally posted here in the Shriver Brief) 

After The Election: A Consumer's Guide To The Health Law


This post originally appeared on Kaiser Health News; bMary Agnes Carey and Jenny Gold

Now that President Barack Obama has won a second term, the Affordable Care Act is back on a fast track.
Some analysts argue that there could be modifications to reduce federal spending as part of a broader deficit deal; for now, this is just speculation. What is clear is that the law will have sweeping ramifications for consumers, state officials, employers and health care providers, including hospitals and doctors.
While some of the key features don't kick in until 2014, the law has already altered the health care industry and established a number of consumer benefits.
Here's a primer on parts of the law already up and running, what's to come and ways that provisions could still be altered.
I don't have health insurance. Under the law, will I have to buy it and what happens if I don’t?
Today, you are not required to have health insurance. But beginning in 2014, most people will have to have it or pay a fine. For individuals, the penalty would start at $95 a year, or up to 1 percent of income, whichever is greater, and rise to $695, or 2.5 percent of income, by 2016.
For families the penalty would be $2,085 or 2.5 percent of household income, whichever is greater. The requirement to have coverage can be waived for several reasons, including financial hardship or religious beliefs.
Millions of additional people will qualify for Medicaid or federal subsidies to buy insurance under the law.
While some states, including most recently Alabama, Wyoming and Montana, have passed laws to block the requirement to carry health insurance, those provisions do not override federal law.
I get my health coverage at work and want to keep my current plan. Will I be able to do that? How will my plan be affected by the health law?
If you get insurance through your job, it is likely to stay that way. But, just as before the law was passed, your employer is not obligated to keep the current plan and may change premiums, deductibles, co-pays and network coverage.
You may have seen some law-related changes already. For example, most plans now ban lifetime coverage limits and include a guarantee that an adult child up to age 26 who can't get health insurance at a job can stay on her parents' health plan.
What other parts of the law are now in place?
You are likely to be eligible for preventive services with no out-of-pocket costs, such as breast cancer screenings and cholesterol tests.
Health plans can't cancel your coverage once you get sick – a practice known as "rescission" – unless you committed fraud when you applied for coverage.
Children with pre-existing conditions cannot be denied coverage. This will apply to adults in 2014.
Insurers will have to provide rebates to consumers if they spend less than 80 to 85 percent of premium dollars on medical care.
Some existing plans, if they haven't changed significantly since passage of the law, do not have to abide by certain parts of the law. For example, these "grandfathered" planscan still charge beneficiaries part of the cost of preventive services.
If you're currently in one of these plans, and your employer makes significant changes, such as raising your out-of-pocket costs, the plan would then have to abide by all aspects of the health law.
I want health insurance but I can’t afford it. What will I do?
Depending on your income, you might be eligible for Medicaid. Currently, in most states nonelderly adults without minor children don't qualify for Medicaid. But beginning in 2014, the federal government is offering to pay the cost of an expansion in the programs so that anyone with an income at or lower than 133 percent of the federal poverty level, (which based on current guidelines would be $14,856 for an individual or $30,656 for a family of four) will be eligible for Medicaid.
The Supreme Court, however, ruled in June that states cannot be forced to make that change. Republican governors in several states have said that they will refuse the expansion, though that may change now that Obama has been re-elected.
What if I make too much money for Medicaid but still can't afford to buy insurance?
You might be eligible for government subsidies to help you pay for private insurance sold in the state-based insurance marketplaces, called exchanges, slated to begin operation in 2014. Exchanges will sell insurance plans to individuals and small businesses.
These premium subsidies will be available for individuals and families with incomes between 133 percent and 400 percent of the poverty level, or $14,856 to $44,680 for individuals and $30,656 to $92,200 for a family of four (based on current guidelines).
Will it be easier for me to get coverage even if I have health problems?
Insurers will be barred from rejecting applicants based on health status once the exchanges are operating in 2014.
I own a small business. Will I have to buy health insurance for my workers?
No employer is required to provide insurance. But starting in 2014, businesses with 50 or more employees that don't provide health care coverage and have at least one full-time worker who receives subsidized coverage in the health insurance exchange will have to pay a fee of $2,000 per full-time employee. The firm's first 30 workers would be excluded from the fee.
However, firms with  50 or fewer people won't face any penalties.
In addition, if you own a small business, the health law offers a tax credit to help cover the cost. Employers with 25 or fewer full-time workers who earn an average yearly salary of $50,000 or less today can get tax credits of up 35 percent of the cost of premiums. The credit increases to 50 percent in 2014.
I'm over 65. How does the legislation affect seniors?
The law is narrowing a gap in the Medicare Part D prescription drug plan known as the "doughnut hole." That's when seniors who have paid a certain initial amount in prescription costs have to pay for all of their drug costs until they spend a total of $4,700 for the year. Then the plan coverage begins again.
That coverage gap will be closed entirely by 2020. Seniors will still be responsible for 25 percent of their prescription drug costs. So far, 5.6 million seniors have saved $4.8 billion on prescription drugs, according to the Department of Health and Human Services.
The law also expanded Medicare's coverage of preventive services, such as screenings for colon, prostate and breast cancer, which are now free to beneficiaries. Medicare will also pay for an annual wellness visit to the doctor. HHS reports that during the first nine months of 2012, more than 20.7 million Medicare beneficiaries have received preventive services at no cost.
The health law reduced the federal government's payments to Medicare Advantage plans, run by private insurers as an alternative to the traditional Medicare. Medicare Advantage costs more per beneficiary than traditional Medicare. Critics of those payment cuts say that could mean the private plans may not offer many extra benefits, such as free eyeglasses, hearing aids and gym memberships, that they now provide.
Will I have to pay more for my health care because of the law?
No one knows for sure. Even supporters of the law acknowledge its steps to control health costs, such as incentives to coordinate care better, may take a while to show significant savings. Opponents say the law’s additional coverage requirements will make health insurance more expensive for individuals and for the government.
That said, there are some new taxes and fees. For example, starting in 2013, individuals with earnings above $200,000 and married couples making more than $250,000 will paya Medicare payroll tax of 2.35 percent, up from the current 1.45 percent, on income over those thresholds. In addition, higher-income people will face a 3.8 percent tax on unearned income, such as dividends and interest.
Starting in 2018, the law also will impose a 40 percent excise tax on the portion of most employer-sponsored health coverage (excluding dental and vision) that exceeds $10,200 a year and $27,500 for families. The tax has been dubbed a "Cadillac" tax because it hits the most generous plans.
In addition, the law also imposes taxes and fees on several major health industries. Beginning in 2013, medical device manufacturers and importers must pay a 2.3 percent tax on the sale of any taxable medical device to raise $29 billion over 10 years. An annual fee for health insurers is expected to raise more than $100 billion over 10 years, while a fee for brand name drugs will bring in another $34 billion.
Those fees will likely be passed onto consumers in the form of higher premiums.
Has the law hit some bumps in the road?
Yes. For example, the law created high-risk insurance pools to help people purchase health insurance. But enrollment in the pools has been less than expected. As of Aug. 31, 86,072 people had signed up for the high-risk pools, but the program, which began in June 2010, was initially expected to enroll between 200,000 and  400,000 people. The cost and the requirements have been difficult for some to meet.
Applicants must be uninsured for six months because of a pre-existing medical condition before they can join a pool. And because participants are sicker than the general population, the premiums are higher.
Enrollment has increased since the summer, after the premiums were lowered in some states by as much as 40 percent and some states stepped up advertising.
A long-term care provision of the law is dead for now. The Community Living Assistance Services and Supports program (CLASS Act) was designed for people to buy federally guaranteed insurance that would have helped consumers eventually cover some long-term-care costs. But last fall, federal officials effectively suspended the program even before it was to begin, saying they could not find a way to make it work financially.
Are there more changes ahead for the law?
Some observers think there could be pressure in Congress to make some changes to the law as a larger package to reduce the deficit. Among those options is scaling back the subsidies that help low-income Americans buy health insurance coverage. The amount of the subsidies, and possibly the Medicaid expansion as well, could be reduced.  
It’s also possible that some of the taxes on the health care industry, which help pay for the new benefits in the health law, could be rolled back. For example, legislation to repeal the tax on medical device manufacturers passed the House with support from 37 Democrats (it is not expected to receive Senate consideration this year). Nine House Democrats are co-sponsoring legislation to repeal the law’s annual fee on health insurers.
Meanwhile, the Independent Payment Advisory Board (IPAB), one of the most contentious provisions of the health law, is also under continued attack by lawmakers. IPAB is a 15-member panel charged with making recommendations to reduce Medicare spending if the amount the government spends grows beyond a target rate. If Congress chooses not to accept the recommendations, lawmakers must pass alternative cuts of the same size.
Some Republicans argue that the board amounts to health care rationing and some Democrats have said that they think the panel would transfer power that belongs on Capitol Hill to the executive branch. In March, the House voted to repeal IPAB.

The Outlook for "Obamacare" in Two Maps

By Tracy Weber and Charles Ornstein; originally posted at ProPublica, Nov. 8, 2012, 10:30 a.m.

It wasn't just President Barack Obama who won Tuesday. His signature health care plan did as well. But while the Affordable Care Act remains alive, less clear is how its various mandates will proceed and who will participate.
To a large extent, the success of the health overhaul lies in how many of the nation's uninsured get coverage. And that is largely in the hands of the states, which have been all over the map in their willingness to cooperate.
We mean that literally. The maps here show the lack of consensus on two key parts of the act: Creating insurance exchanges and expanding Medicaid.
Here's why each map matters.

Map 1: Where Will We Buy Insurance?


Source: Kaiser Family Foundation, current as of Sept. 27, 2012.

The health care act requires all Americans who aren't already insured to buy coverage. But where? That's where insurance exchanges come in.
States have to decide whether to set up these online marketplaces, where individuals can choose among different insurance plans. Setting up an exchange allows states to customize the offerings to the needs of their residents.
States can also partner with the federal government on exchanges. But if they elect not to, the federal government will take over with its one-size-fits all exchange. States are supposed to decide which course to take by Nov. 16.
Along the West coast, legislatures have already voted to set up exchanges. Other states, including Texas, Maine and Alaska, have decided to punt.
But many states in the Midwest and South haven't committed either way. Some governors, such as New Jersey's Gov. Chris Christie, have held off setting up a state insurance exchange until after the election.
A health care consultant group predicted yesterday that 20 states will elect to operate exchanges.

Map 2: Will States Cover More Poor People?

Source: The Advisory Board Company
Obamacare hopes to expand coverage to 30 million of the country's 48 million uninsured residents. A big part of that would come though Medicaid.
States must also decide whether to expand Medicaid to all residents under 133 percent of the federal poverty line (about $14,893 for an individual and $30,657 for a family of four).  Medicaid currently covers poor children, pregnant women, seniors and some disabled adults. The federal government will pay the full cost for the expanded coverage for three years, and then gradually reduce its contribution to 90 percent over the next three years.
As passed in 2010, the Affordable Care Act required states to expand Medicaid or risk losing all federal matching funds for the program. But the U.S. Supreme Court ruled in June that it was coercive to force states to expand their program just to keep money they were already getting.
Now, states that don't opt in will keep their current funding, but residents who might have qualified under an expansion will likely remain uninsured. There isn't a deadline for the expansion, but the federal government says states will receive less federal help if they decide to expand later, according to The New York Times.
As with exchanges, the states are divided.
So far, a handful u2013 including California, Washington and Illinois u2013 have already embraced the expansion. Florida, South Carolina, Mississippi and Louisiana have opted out.
(The states marked with scales participated in litigation against the Act that culminated in June's U.S. Supreme Court decision.)

Too Murky to Map  
Not everything is left to states. Other issues remain murky about the law, perhaps because the deadlines are further in the future.
The requirement for individuals to either buy insurance or pay a fee to the IRS begins Jan. 14, 2014. But the federal government has not made clear how vigorously it plans to pursue those who don't comply.
Here's a flow chart showing who has to pay and who doesn't.
Also unclear is the impact on employers, who will be required to provide health insurance to full-time workers beginning in 2014. Some, according to The Wall Street Journal, are responding by moving employees to part-time positions.
Finally, the Act's opponents in Congress and on the grassroots level will likely do what they can to delay or dilute these requirements, which are among its most unpopular.
If you're interested in comparing the politics further, here's a link to the final presidential election results by state.
Help Us Investigate Patient Safety Have you or a loved one been harmed in a medical facility? Share your story with us. Are you a provider? Tell us your observations about patient harm.

Debunking Obamacare Myths

Dr. Barbara Bellar, a senate candidate from Burr Ridge, Illinois, has become a recent YouTube sensation with her humorous critique of the health reform law. In her "Obamacare Summed Up in One Sentence" speech, Bellar raised some serious complaints about the Affordable Care Act. Since Dr. Bellar is running for office in our home state, we decided that some myth-busting was in order. Christopher Wills' article in SFGate does a great job of fact checking Bellars' video, so we'll summarize his article here:  

What exactly did this senate candidate say about the Affordable Care Act?

We're going to be gifted with a health care plan we are forced to purchase and fined if we don't
 
Fact: For those who already have health insurance, there will be no change, and will not be forced to buy any additional coverage. For those who can afford and refuse to purchase coverage will be forced to buy health insurance or pay a tax.Those who can't afford insurance will not be required to pay a fine.
 


The ACA doesn't add a single new doctor

Fact: Let there be doctors! The Kaiser Family Foundation estimates the addition of 15,000 new providers by 2015. The ACA also incentivizes a career in primary care by offering primary care doctors higher medicare payments. Still, Dr. Bellar is right that expanding coverage will put some new demands on the health care system.


The law provides for 16,000 new IRS agents

Fact: No. This claim has been proven to be wildly inaccurate. According to FactCheck.org: "The law requires the IRS mostly to hand out tax credits, not collect penalties. The claim of 16,500 new agents stems from a partisan analysis based on guesswork and false assumptions, and compounded by outright misrepresentation."

Congress exempted themselves from the ACA
 
Fact: Congress members are REQUIRED to buy their insurance through the exchanges created by the Affordable Care Act, thus, not exempting themselves at all.
 
We will be taxed for four years before any ACA benefits take effect

Fact: Some taxes have been put in place since 2010 (when the ACA became law); according to the Kaiser Family Foundation, the taxes taking effect before 2014 affect specific groups such as drug makers, medical device manufacturers, couples earning over $250,000/year and indoor tanners.

Fact: The pre-2014 benefits have been pouring in and are already positively impacting millions of people, right here in Illinois. They include: young adults who are able to stay on their parents' insurance plan until age 26; small businesses who now can use tax credits to provide health care to employees; seniors who are receiving refund checks to fill the gap in their Medicare drug coverage; uninsured people with pre-existing conditions who are now covered by the Illinois Pre-Existing Condition Insurance Plan; and people with private insurance whose preventive services are covered with no deductible or co-pay.

These initial changes are just a small example of what's to come in 2014.

If you want to see how the expansions will impact the uninsured in Illinois in 2014, take a look at our Visualizing Health Reform map with census data. You can even zoom into Dr. Bellar's community, Burr Ridge (a town that spans DuPage and Cook Counties), and see who in her district will be newly eligible for Medicaid and affordable private insurance in the Health Insurance Exchange.

And that's a fact.
 
Dana Rabkin & Stephani Becker
Illinois Health Matters

For more myth-busting about the ACA, you can go to www.illinoishealthmatters.org. You can also submit a question and one of our ACA experts will answer it for you!







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