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The HHS Secretary Visits Chicago

This week, U.S. Health and Human Services Secretary Kathleen Sebelius visited Chicago to speak about the Illinois Health Insurance Marketplace, a key provision of the Affordable Care Act.

Secretary Sebelius, accompanied by Governor Pat Quinn, announced on Wednesday that the Illinois Blueprint Application for a State-Partnership health exchange had been accepted by the federal government. The exchange will run as a federal-state partnership model until 2015, when the state may take over operations, depending on the State Legislature’s ability to pass a state exchange bill. Enrollment in the partnership exchange/marketplace opens in October, only eight months (229 days!) away.

Secretary Sebelius speaks to a full house at the Chicago Cultural Center

On Thursday, Sec. Sebelius spoke at the Chicago Cultural Center. Preceding her was Bechara Choucair, Commissioner of the Chicago Department of Public Health, who presented an overview of the Healthy Chicago program and its impact thus far. Sebelius delivered a call to action to those in attendance, citing the need for affordable, accessible health insurance for all as a crucial step in the national public health strategy. With only eight months before the state health marketplace is open for enrollment, and ten months before it is fully operational, promoting awareness of the health insurance exchange is the focus of HHS.

Five Myths about the Medicaid Expansion

The Supreme Court's June 2012 Affordable Care Act ruling was decisive about the implications of the individual mandate; however, it was less decisive about the ACA's Medicaid expansion. The court gave flexibility to each state to decide whether to expand Medicaid to its low income uninsured (below 138% FPL) residents. This flexibility has caused some confusion (some legitimate and some purposeful) about the implications of the Supreme Court decision. Below we address some of the myths vs. realities of the Medicaid Expansion and what it means for Illinois residents:

Medicaid Myth #1: Few states will expand their Medicaid programs.
Reality: As of 12/12/12, according to health care experts Avalere Health, 18 states have signaled that they will expand, 10 have said that they won't and 23 are undecided. Another health care expert, the Advisory Board Company, shows 14 states in the "not participating" or "leaning toward not participating" group while 18 states are in the participating or leaning toward participating group. Notably, this week, Nevada's Republican Governor and GOP leaders just signaled that they will opt in.

Medicaid Myth #2: Many low-income residents would be eligible for federal subsidies on the exchange if a state does not expand Medicaid. Expanding Medicaid takes away their opportunity to purchase private insurance.
Reality: The reality is that people living under 100% FPL WILL NOT qualify for subsidies to buy health insurance on the Exchanges and will be the only ones (besides undocumented immigrants) left out in the cold if Illinois doesn't expand Medicaid. Without the new Medicaid eligibility category, these individuals are in a new “donut hole” and will likely be priced out of affordable health insurance through the Exchange because they won’t qualify for the federal financial help. The Urban Institute estimates that of the newly eligible population, approximately 431,000 Illinoisans with household incomes less than 100% FPL will be left in the cold if Illinois does not implement the new Medicaid eligibility category. They will have to continue to access safety-net providers and emergency rooms for care, driving up costs for these providers and showing up sicker. In addition, we all pay more when others are uninsured: according to a study conducted by Millman, Inc., an independent actuarial consulting firm, every family with health insurance pays an additional $1,000 per year to pay for care for the uninsured.

The only "low-income" residents that are either eligible for subsidies on the Exchange OR can participate in Medicaid if Illinois expands Medicaid are people living between 100% -138% FPL. This is a small number of people. Even among those small numbers who DO qualify for exchange subsidies and take up that coverage, the greater cost-sharing requirements for exchange coverage than in Medicaid means that these adults will experience greater financial burdens associated with meeting their health care needs.

Medicaid Myth #3: The state will pay for the Medicaid expansion but will not pay for federal insurance subsidies.
Reality: Not true. The state will not pay for Medicaid Expansion from 2014 through 2016. The federal government pays 100% of the expansion. From 2017 through 2020, the state will slowly start picking up a very small percentage that will slowly increase from 5% to 10% by 2020. In 2020 and beyond, the state will only be responsible for 10% of the cost of the Expansion population.

Medicaid Myth #4: The federal government is already trying to shift more Medicaid expansion costs to the states as a major part of the fiscal year 2013 budget.
Reality: We have no reason to believe that this will happen and the reality is that President Obama is committed to ensuring full implementation of the Medicaid Expansion by states. On December 10, the Obama administration backed away from roughly $100 billion in Medicaid savings it had proposed during deficit-reduction talks earlier this year. In its December 10, 2012 FAQ to states, CMS notes: "The Supreme Court decision has made the higher matching rates available in the Affordable Care Act for the new groups covered even more important to incentivize states to expand Medicaid coverage. The Administration is focused on implementing the Affordable Care Act and providing assistance to states in their efforts to expand Medicaid to these new groups." We have no reason to believe that the federal government will change its mind about the 90% match in the year 2020 and beyond for the Expansion population.

Medicaid Myth #5: Overloading a broken Medicaid program hurts the most vulnerable. Adding so many more people to the Medicaid program will only make these problems worse.
Reality: The poor who are also uninsured right now still get sick and use health care services. They just don't receive care when they need in the appropriate setting because they end up waiting until their conditions worsens or becomes an emergency. The Medicaid Expansion will allow this group for the first time to have health insurance, and therefore greater access to care at the right time, in the right setting. In addition, in a report released by the GAO (Government Accountability Office) last month, the GAO found that "in calendar years 2008 and 2009, less than 4 percent of beneficiaries who had Medicaid coverage for a full year reported difficulty obtaining medical care, which was similar to individuals with full-year private insurance." In fact, IL received a bonus payment of over $15 million last year for meeting quality and other standards in the CHIP program

The current Illinois Medicaid program is not broken; it is efficiently run. Nationally, the per enrollee cost growth in Medicaid (6.1%) is lower than the per enrollee cost growth in comparable coverage under Medicare (6.9%), private health insurance (10.6%), and monthly premiums for employer-sponsored coverage (12.6%). Illinois’ average annual growth in Medicaid spending for FY2007-FY2010 was 6.6%. While it is true that Medicaid in Illinois pays providers less than they typically receive from private insurance (and therefore fewer providers accept patients with Medicaid), to address this issue, beginning January 2013, the Affordable Care Act will be increasing Medicaid payments for primary care doctors.

These aren't the only myths about the Medicaid expansion; the opponents are so bereft of data that they have to result to myth-making. The reality is that the Medicaid expansion makes good fiscal sense and will make a huge difference in the lives of literally hundreds of thousands of Illinois residents. The reality is that the Medicaid expansion is an excellent deal for the state of Illinois.

Health & Disability Advocates
Heartland Alliance for Human Needs and Human Rights
Sargent Shriver National Center on Poverty Law

Affordable Care Act ("Obamacare"): Things Businesses Should Know

Either as an individual or the owner of a small business, you may be affected by the Affordable Care Act tax provisions. The Affordable Care Act (also known as Obamacare) was signed into law by President Obama on March 23, 2010, and recently survived a challenge in the United States Supreme Court. While the main focus of the Affordable Care Act is health reform legislation, there are several tax provisions that will take effect as different parts of the legislation are implemented. The following is an outline of some of the important tax-related consequences of the Affordable Care Act that have already been implemented and some information for what you can expect as the legislation is fully rolled out between now and 2014.

In addition to making sweeping changes to the U.S. health care system, the health care reform legislation added a number of new taxes and made various other revenue-increasing changes to the Code to help finance health care reform.

One of the provisions that were enacted in 2010 was the Small Business Health Insurance Tax Credit. For tax years from 2010 through 2013, the maximum credit is 35% of health insurance premiums paid by small business employers. A small employer is one that has fewer than 25 full-time equivalent employees, pays an average wage of less than $50,000 a year, and pays at least half of the employee’s health insurance premiums. The credit is scheduled to increase to 50% for small business employers after 2013. However, in tax years that begin after 2013, an employer must participate in an insurance exchange in order to claim the credit, and other modifications and restrictions on the credit apply.

In 2011, insurance companies were required to prove they spent at least 80% of the premium payments on medical services, rather than on things like advertising and executive salaries. Those that didn’t were required to provide rebates to policyholders. You may have seen letters, or even rebate checks, hitting your mailboxes recently stipulating to these facts. These rebates may be taxable income to you if you previously received a tax benefit from a deduction for the insurance premiums paid. Your tax advisor should be consulted.

In 2012, employers are required to disclose the aggregate cost of applicable employer-sponsored coverage on an employee’s annual Form W-2. Reporting is for informational purposes only. However, for 2012 Forms W-2 (and W-2s issued in later years, unless and until further guidance is issued), an employer is not subject to reporting for any calendar year if the employer was required to file fewer than 250 Forms W-2 for the preceding year.

Upcoming changes in 2013 include an increase in the deduction for medical expenses. Under prior law, medical expenses had to exceed 7.5% of adjusted gross income in order to be deductible for regular tax purposes, and 10% of adjusted gross income for Alternative Minimum Tax (AMT). The Affordable Care Act increases the regular tax limitation to 10% of adjusted gross income for those who are under the age of 65, bringing it in line with the AMT limitation.

The Medicare Surtax will also kick-in in 2013. For single taxpayers making more than $200,000 and married filing jointly taxpayers making more than $250,000, an additional 3.8% Medicare tax on dividends, capital gains, and rental and royalty income will apply. The KOS Bottom Line Bulletin September 2012 edition included an article titled “Get Ready for the Medicare Surtax in 2013.” To read this article, click here or go to the KOS website at www.koscpa.com/announcements.

If you contribute to a Flexible Savings Plan that your employer provides, beginning in 2013 the amount you may contribute annually to that plan will be limited to $2,500. This is down from the $5,000 prior limitation and will be adjusted annually for inflation.

In 2014, the state-run health exchanges will be set up and the penalties for individuals who do not purchase insurance will kick-in. The penalty will increase over the three year period from 2014 to 2017 as follows:

2014 – The greater of $95 or 1% of income.
2015 – $325 or 2% of income.
2016 – $695 or 2.5% of income

Businesses with 50 or more workers will be subject to a $2,000 per worker penalty if they don’t offer health insurance. Those that do receive a tax credit of 50% of the premium cost.

Nearly all businesses will have to make changes in order to comply with the Affordable Care Act. Do you have questions about how this act affects you? As an employer, are you aware of what changes you need to make? If so, you should attend our breakfast seminar on November 14 titled “What Does the Affordable Healthcare Act (AKA “Obamacare”) Mean for Employers?” This FREE program takes place from 8:30 until 10:30 a.m. at the KOS office at 1101 Lake Cook Road, Suite C in Deerfield, Illinois. To reserve a space, contact Kelly Wallaert at 847.580.4100 or kwallaert@koscpa.com.

Christie Butcher, CPA, MST
Manager, KOS Public Accountants

(This article was originally posted on the Kessler Orlean Silver website here)

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!

Community Health Workers in Illinois - What Should Certification Include?

Community Health Workers make a difference in communities. They’re frontline public health workers who are trusted members of their community. This trusting relationship enables them to serve as a liaison/link/intermediary between health and social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.

Illinois is home to a diverse Community Health Worker (CHW) workforce (which includes outreach workers, peer educators, promotor(a)s de salud, community-based doulas, health aides, home visitors, peer educators and advocates). Currently, CHWs are trained at a variety of organizations and in a variety of ways, making it difficult for their training to be transferrable to other organizations throughout their careers. Funding is also piecemeal, based on grant funding from year to year. In order to create a more sustainable and well-funded community health workforce, the Chicago CHW Local Network and many other stakeholders, including Health & Medicine Policy Research Group, are considering ways in which CHW training can be standardized while being open to all people regardless of race, age, gender, sexual orientation, education, language, immigration status and physical ability.

As part of the CHW Certification policy development process, the CHW Local Network is seeking input from CHWs and people who hire, train, and employ CHWs on what the certification process should look like in Illinois. To share your voice and contribute to this movement, take the 15 minute survey by October 8^th, 2012. Haz clic aquí para completar una encuesta en español. We thank you for your input.

Janna Stansell, MPH*

Health & Medicine Policy Research Group

*A member of the CHW Local Network CHW Policy Development Workgroup

The University of Chicago Medicine is Implementing Health Care Reform

Dean Kenneth S. Polonsky, MD The University of Chicago Medicine, along with other health care providers, is moving ahead with changes under health care reform following the U.S. Supreme Court’s decision in June upholding the Patient Safety and Affordable Care Act of 2010. Not since 1965, when the Medicare and Medicaid programs became law, has the nation faced a more monumental shift in health care.

Fulfillment of the Affordable Care Act will produce many changes. Among the first is a significant reduction in the number of uninsured Americans, which eventually will improve public health and lower costs. As more people obtain health coverage, there is a responsibility for providers to use scarce resources in the most cost-effective manner possible. In Illinois, where a state fiscal crisis recently led to reductions in Medicaid payments to providers, it is critical that we focus on delivering appropriate care in the right places and at the right time.

To address these challenges, health care providers must support innovative approaches to patient care that produce the best outcomes while keeping a lid on costs. The ideal that all Americans should have access to care regardless of health status or income means that near-term logistical and financial realities must be addressed by the public, the state and health care providers.

A number of initiatives at the University of Chicago Medicine will facilitate the delivery of high-quality patient care and improve public health while controlling costs. For example, the South Side Healthcare Collaborative connects patients seen in our hospitals with community health centers. This focus on care coordination meets the needs of patients, improves quality of care and lowers readmission rates.

The Center for Medicare & Medicaid Innovation, established by the Affordable Care Act, is encouraging novel models to transform health care. CMMI recently announced the intention to award grants, including two to University of Chicago Medicine faculty, to support local initiatives that aim to deliver better care and improve health at lower costs.

One initiative, led by David Meltzer, MD, PhD, will focus on Medicare patients at high risk of hospitalization by offering a personal physician to care for them not only when they are hospitalized, but also when they leave the hospital. Under this new Comprehensive Care Program, these patients will receive continuous care from a physician who knows them, which will improve care and patient outcomes while lowering costs.

Another project, CommunityRx, led by Stacy Tessler Lindau, MD, will deliver personalized information about community resources for wellness and disease management as part of the doctor-patient encounter. New health information technology systems will support self-care by promoting use of community resources and linking local health and human services organizations with information they can use to tailor their programs and services.

These kinds of innovative solutions aim to create a healthier, better-resourced population cared for by committed community physicians, rather than those based at hospitals, thus saving Medicare and Medicaid millions of dollars annually.

The resources of an academic medical center, available at the University of Chicago Medicine, allow us to test new models to solve difficult problems. We are working with the communities and people we serve to create a strong health care system that directly addresses the needs of our patients.

Kenneth S. Polonsky, MD
Executive Vice President for Medical Affairs, University of Chicago Dean, Biological Sciences Division and Pritzker School of Medicine

(This blog was originally posted on the University of Chicago Medicine website here).

Chicago Orgs Kick off Project to Educate Asian Americans About the ACA

There remains considerable misinformation and ignorance about the Affordable Care Act (ACA) among limited English-speaking Asian Americans and other immigrant groups regarding ACA and how it will impact them. Provisions of the health care reform law that are already in effect (children covered by parents’ insurance up to age 26, insurance companies prohibited from placing a lifetime limit on essential benefits) are unknown to most immigrant groups.

Key provisions of the law that will have a major impact on uninsured immigrant populations, such as the affordable health insurance exchanges, will not have their desired effect unless the target population understands how these provisions apply to them and how to make the right choices for the health care coverage they need.

Through small employer tax credits and other provisions, the Affordable Care Act will also have a significant impact on small business owners which represent a major portion of the economy and life in ethnic neighborhoods such as Albany Park, Uptown, Rogers Park, and Chinatown. However, many of these ethnic business owners are linguistically isolated or inherently distrustful of government stemming from experiences in their countries of origin. They do not understand or are wary of government programs. Such linguistic and cultural barriers present an important challenge to the implementation of the ACA as 2014 draws near, and will impact the health of the vulnerable Asian immigrant and refugee population, in the Chicago metropolitan area.

In response to the lack of knowledge around the ACA, the Asian Health Coalition (AHC) and Health & Disability Advocates (HDA) have embarked on a project (with generous funding from the Lloyd A. Fry Foundation and The Chicago Community Trust): “Stay Informed!: Education on Health Reform” to provide culturally and linguistically tailored outreach and technical assistance on health reform to the Asian immigrant and refugee communities in the Chicago area. The target audiences for Stay Informed! are Asian community members and small business owners (SBOs).

The goal of Stay Informed! is to provide culturally competent education and outreach on the Affordable Care Act for linguistically isolated and disenfranchised Asian immigrant and refugee consumers and SBOs to enhance understanding of and participation in health care reform. Toward that end, we have created fact sheets and presentations in English, Chinese, Korean, Vietnamese and Khmer. Materials in additional languages will become available over the coming months

We have already conducted trainings at the Cambodian Association of Illinois and Chinese Mutual Aid Association and received many good questions from attendees about the Affordable Care Act. Please don't hesitate to use our fact sheets to educate your own communities and contact either of us with any questions.

Edwin Chandrasekar
Executive Director
Asian Health Coalition
edwin@asianhealth.org

Stephani Becker
Project Director
Health & Disability Advocates

sbecker@hdadvocates.org

HEALTH FOR ALL

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