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
Same-Sex Couples Celebrate New Marriage and Healthcare Rights
Small Employers: Take Another Look at Wellness Programs
Small employers want a healthy workforce but wonder how and if they should promote healthy
behaviors among their employees. Trends show that larger employers, who typically self-fund their health insurance programs, find a direct link between the benefits of wellness programs and their health insurance bottom line. This provides clear motivation for internal programming and incentives to keep employees fit, eating healthy and smoke-free. For small employers who traditionally provide fully insured health insurance programs, the direct return on investment from implementing a wellness program may be less obvious.
The Return on Investment
Research has consistently shown that unhealthy employees are less productive and take more sick days. In 2010, The Harvard Business Review made a compelling argument in favor of worksite wellness programs. In the programs they highlighted, they found improved health status, fewer sick days and workers' compensation premiums declining by as much as 50%. Even though small employers are faced with a highly regulated premium environment because of the Affordable Care Act (ACA), wellness programs might allow small businesses a solution for lowering workers' compensation costs.
Healthy Employees, Happy Employees
The Centers for Disease Control and Prevention (CDC) identifies several ways that both employers and employees can benefit from work-based health programs. At the top of their list for employees: increased well-being, self-image and self esteem. This kind of indirect impact on the employee psyche can boost morale, reduce turnover and ultimately improve productivity. Calculating the cost of employee turnover can be tricky for a small business, but some estimate it to be between 150 – 175% of the annual salary depending on the job level.
The question for small employers comes down to the bottom line. The actual cost of employer wellness programs can vary greatly. Questions to consider as you begin exploring the feasibility include:
• Will the program be run in house or using an external vendor?
• How extensive will the health interventions be?
• Will you include health screenings?
• What type of employee incentives will be provided?
In addition, small businesses may not be aware that the ACA has created new tax-based incentives for qualified employer wellness programs. There are rules to comply with, as plans must be reasonably designed to “promote health or prevent disease.” Additionally they must be made available to all “similarly situated” employees. For more details see this Department of Labor Fact Sheet.
Small Scale Ideas Make a Big Difference
Still unsure about incorporating a more comprehensive wellness initiative into your business model? Some small scale initiatives can make a big difference. Even something as simple as extending lunch hours can give employees time to make lunchtime fitness practical and possible. Rather than allowing employees 30 minutes to grab a burger and fries, 90 minute lunch slots offer employees time to hit the gym. Small changes like this can give a boost to employees and the small business as a whole.
Worth the Time to Investigate
Small employers have a lot to consider when it comes to how to allocate their health related workforce dollars. Finding a little room in the budget now as well as spending some time re-thinking a few basic workplace rules could ultimately pay off. Proven reductions in workers' compensation premiums, employee turnover rates and new ACA tax incentives make it the perfect time for small employers to give worksite wellness programs a closer look.
Michele Thornton MBA
Insurance and Benefits Consultant
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
What Really Happens After Enrolling in Medicaid Managed Care?
Health & Disability Advocates (HDA) is monitoring the rollout of the Medicare-Medicaid Alignment Initiative (MMAI) and has heard from frustrated case managers working with consumers who are confused about the enrollment process and their rights. In response, HDA developed an enrollment timeline that explains what new enrollees can expect from Managed Care Organizations (MCOs) and plan representatives upon enrollment. To produce the timeline, HDA researched the MMAI demonstration contract developed by the State of Illinois and approved by the Center for Medicare and Medicaid Services (CMS) HDA also solicited input from health plans on whether their on-the-ground practices were accurately reflected in the timeline.
The finished product outlines important points for case managers and their clients to consider.
One Day Changes Everything
Consumers who are enrolled in a managed care plan after the 12th day of the month will not see their coverage start until the month after next. This is relevant for consumers choosing a specific managed care plan in order to see a particular provider or specialist in that plan’s network. Submitting paperwork after the cut-off date means consumers would have to wait longer than expected for necessary treatment. Helping consumers submit required documents in a timely manner can guarantee they are connected to the medical treatment they need, which promotes continuity of care.
Stratification Sets Up Future Contact Standards
Once enrolled in a plan, all enrollees can expect to complete a Health Risk Screening within 60 days. The screen collects information on the enrollee’s physical and mental health conditions and identifies their current medical providers. This is what IlliniCare’s Health Screen looks like. Health plans use the screen to establish intensity of services and frequency of contact with Care Coordinators by stratifying the enrollee as low, moderate or high risk.
Enrollees stratified as low risk will receive annual follow-ups from their Care Coordinators while those stratified as moderate or high risk will have quarterly follow-ups. Moderate and high risk enrollees will also complete a Health Risk Assessment and create an Individualized Care Plan within 90 days. These enrollees will help form their own Interdisciplinary Care Team of healthcare providers that meets quarterly to review the Individualized Care Plan.
The Care Coordinators’ Role
Care Coordinators focus on enrollees’ healthcare needs by connecting them to necessary tests, doctors and treatment. They also facilitate information sharing among providers by leading the Interdisciplinary Care Team. Addressing enrollees’ medical needs is their priority. Care Coordinators direct less attention to linking enrollees to social supports, like housing and public benefits.
It’s also important for case managers to know that Care Coordinators must manage a substantial caseload of up to 600 enrollees. Caseloads include a blend of low, moderate and high risk enrollees, with each risk level weighted differently.
Understanding what a care coordinator can—and cannot—be expected to do is advantageous to case managers. When roles are clearly recognized, case managers know how care coordinators can be used as a resource. And in what instances an alternative referral would be more appropriate. This establishes a stronger professional relationship between case managers and care coordinators, which ultimately benefits the enrollee.
Case managers and Care Coordinators are on the front lines of healthcare reform and fostering solid working relationships between these two players will be a critical component of the success or failure of these efforts. Knowing what case managers and their clients can expect from managed care plans can lay the foundation for a strong relationship that supports the health of individuals while also furthering the goals of healthcare reform.
Bryce Marable MSW
Health Policy Analyst
Health & Disability Advocates
People With Disabilities Who Opt Out of ‘Voluntary’ Wellness Programs Will Pay the Price, and the EEOC’s Okay With That.
The following originally appeared on the American Civil Liberties Union's Speak Freely Blog.
Voluntary wellness programs at work can provide benefits to employees, but employers are increasingly adopting “voluntary” wellness programs that unfairly burden workers with disabilities the most of all. Worse, the Equal Employment Opportunity Commission seems to think that’s okay, undermining core antidiscrimination protections it used to defend.
Here’s why.
Redoing Redes: Strengthening Communication Procedures in the Illinois Medicaid Redetermination Project
The Illinois Medicaid Redetermination Project (IMRP) is erroneously suspending vital medical care for people who remain eligible. Since the rollout of the IMRP in early 2013, the program has been plagued by inadequate communication from the state that leaves consumers confused and ultimately without healthcare. Consumers report that they are not receiving the required notices by mail and when they call with questions, frontline state staff cannot provide answers. Because of the state’s ineffective communication protocols and inadequate employee training, rightful Medicaid beneficiaries are in the precarious situation of being unable to fill their prescriptions, go to the doctor or receive treatment. The purpose of the IMRP is to save state dollars by trimming the Medicaid program of those who are no longer eligible, not cut people who still deserve services.
Letters Lost in the Mail
Medicaid beneficiaries are cut simply because they never received their redetermination notices in the mail. For example, Health & Disability Advocates worked with a mother whose child had been dropped from Medicaid because IMRP sent the notice to a non-existent address. The fact that IRMP sent the letter to an incorrect address on the same street where the family lived suggests that it was a clerical error. In this situation, a young adult dealing with serious mental illness could not access medication and treatment, because the state, not the individual made an error. Sudden lapses in care can pose serious consequences for people who rely on these supports for their physical and mental health.
This is not an isolated instance. A survey of case managers working with older adults and people with disabilities found that the IMRP fails to adequately notify people of their redetermination responsibilities and inform them when they are bounced from the program. Many get the bad news when they attempt to fill prescription or go to the doctor and are told that they are no longer covered. People deserve clear communication from the state telling them they are no longer covered and the steps to get reinstated.
Confused and Not Covered
Even in cases where Medicaid recipients do receive notices, many consumers find the letters are hard to understand and filled with jargon. Given that the intended audience has never before been required to submit to annual redeterminations and may also have lower literacy levels, the letters must be crystal clear. Reports from case managers suggest the letters are confusing. One case manager surveyed noted “clients do not understand what documents they need to submit with the form and whether they need to submit anything.” With the potential for people to lose their health coverage, the consequences of this confusion are severe.
IMRP’s own data reveal their communication shortcomings. According to May’s Medicaid redetermination numbers, 81% of cancellations are due to a lack of response. Being cancelled doesn’t mean a person is ineligible. In fact, a substantial portion of these clients should still be receiving services. Of those dropped, 1/3 were reinstated within three months. In FY 2015 alone, this translates into 238,025 people being incorrectly cut from Medicaid, and this number could be even higher. People who are less frequent healthcare users may learn of their cancellation when they attempt to schedule a doctor’s appointment. With people who deserve Medicaid cut from the program, the IMRP is not achieving its main objective of reducing state expenditures by eliminating those who no longer qualify. Cutting eligible people will actually result in higher costs. Without access to primary medical treatment, people will resort to more costly emergency room care for conditions that could have been managed or even prevented.
Matters get worse when consumers call state workers for clarification, because frontline staff members are often not fully informed themselves. In the above-mentioned case of the mother fighting for her son’s coverage to be reinstated, her interaction with the IMRP hotline was unhelpful and hurtful. The representative said there was nothing more she could do and blamed the family. Stateline workers should be fully trained to provide answers; anything less only increases confusion and frustration.
The Path Forward
The state must develop plain-language notices that explain redeterminations and their importance while outlining the specific steps to keeping coverage. This would not be a new undertaking. State officials have previously brainstormed ways to create simple, more consumer friendly forms. Unfortunately, the furor around budget deficits and service cut threats has drowned out the push for clear communication standards. Even worse, continuing to deemphasize this issue will leave many rightful Medicaid recipients suddenly without coverage. Communication protocols and state staff should support individuals in maintaining their vital connection to healthcare, not create hurdles that effectively jeopardize emotional and physical health. State officials must restart the discussions on clear notices and broaden the conversation to include improved training for frontline staff. These reforms will go a long way towards supporting the IMRP’s original objective of eliminating wasteful spending while also keeping those who still deserve coverage connected to care.
Joint Commission Mandates Armband to Identify Patients With Too Many Armbands.
"I'm proud The Joint Commission is finally taking a stand against The Joint Commission for continuing to ignore all the unintended consequences of their regulations," said Dr. Chassin.
Doctors and nurses have been telling authorities for years that too many patient armbands are a safety hazard, but those complaints had fallen on deaf ears until last week when 87 year old ICU patient Pat Swanson of Denver, Colorado underwent emergent bilateral upper extremity amputations at Great Scotts Medical Center shortly after 52 armbands cut off circulation during an anasarca storm.
"After a root cause analysis, we determined the PROBABLY A PALLIATIVE CARE CANDIDATE armband placed an hour before the event finally took her arms over the edge," said Dr. Steven Johnson, the Hospitalist on duty when this tragic but totally foreseeable event occurred.
"When she was admitted 24 days ago, she only had three arm bands, but if you do the math, she gained just over 2 armbands per day in the ICU that nobody noticed. In retrospect, the patient telling us 'My arms are too heavy with armbands to lift a spoon and eat' should have clued us into an emerging problem, but we were too busy filling out FMLA papers for multiple family members everyday to head her cry for help," said Dr. Johnson.
In the last four years, The Joint Commission says the average number of patient armbands has skyrocketed from 3 to over 17, as more and more patient characteristics demand armband worthy status, adversely affecting everyone in the hospital. Nursing students are constantly pulling the code blue cord in an abundance of caution after being unable to palpate a radial pulse. Medical students have no idea what pronator drift is anymore. Phlebotomists are being retrained to perform bedside carotid cut-downs for routine blood draws. Even administrators are overwhelmed with committees trying to solve the excessive armband problem.
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| Too many armbands? There's an armband for that! |
"At one point we had 17 committees - all working independently and without communication - each trying to come up with a solution that nobody else liked, resulting in 17 other committees to sort it all out," said Dr Johnson.
What came out of these painful meetings was nothing short of genius at Great Scotts Medical Center. "We hired a hospital seamstress to convert all those armbands into one giant sash for the women and a handsome fashion belt for the men. Patients love it and it's a great conversation piece for family. Plus, as an added bonus, we have the highest satisfaction scores in the universe! Thank you Joint Commission for being so helpful," said Dr Johnson.
Complete list of 52 armbands removed from Pat Swanson.
- Swanson With an O
- Already Outlived Life Expectancy
- Don't Code Her, She Won't Know The Difference
- Allow Natural Life Support
- Risk of Talking Alot
- Risk of Family Filling Out Poor Patient Satisfaction Survey
- Looks Older Than Her Stated Age
- Ambiguous Name Alert
- Suspected Female
- Hard of Understanding
- Hits On Young Male Doctors
- Likes To Talks About Her Bowels
- POA Is A Physician
- Doesn't Believe In Flu Shots
- Family Googles Everything
- Thinks Most Doctors and Nurses Are Too Young
- Risk of Asking Lots of Questions
- Reads Every Consent Word-For-Word
- Family Wants Lawyer To Review All Documents
- Wants a Comfortable Death With Everything Done
- No Known Drug Allergies
- Allergic to All Antibiotics - Anaphylaxis
- Allergic To Wasps, But Not Bumble Bees
- Has Two Daughters Who Never Leave The Room
- Thinks She's The Only Patient In the Hospital
- OK To Go Outside and Smoke
- Has Lots of Great Stories If You Have a Free Moment
- Wants Everything Taken Care Of While She's Here
- Found Cheating at Crossword Puzzles
- Should Be In a Nursing Home
- Can't Remember If She Has Dementia Or Not
- When She Yells 'Bill', Just Say 'Yes,'
- Doesn't Like To Be Called Honey
- It's Fakeasia, Not a Stroke
- Frail like a Babby Bunny
- That's Not a Wig You See
- Was Perfectly Healthy Until A Week Before Getting Sick
- Has Appointment at Mayo Clinic After Discharge To Figure This Out
- Disappoints Easily
- Not Really a Fighter
- Loves a Good Foley
- QHS = 4 PM
- Rides Call Light Like a Rodeo Champ
- 12/10 On The Pain In My Ass Scale
- Direct Eye Contact Should Be Avoided
- OK To Incubate
- Gown and Glove Encouraged
- On Family Meal Plan
- Dilaudid 2 MG IV Push Preferred
- Dysphagia 7 Diet
- Probably a Palliative Care Candidate
- Too Many Armbands
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