As Affordable Care Act opponents continue grasping at straws to find fault with the law, an assertion perpetuated by the insurance industry that the ACA’s coverage expansions will significantly increase premiums has gained prominence. Lately, many insurance industry-funded studies and the resulting news coverage of them have focused on the potential for “rate shock” for the young and healthy, fear mongering young adults and others into thinking their rates will skyrocket come 2014. None of these reports address all of the protections written into the bill to prevent steep rate changes and many fail to accurately represent the true scope of benefits and costs. Community Catalyst has prepared this fact sheet to help cut through some of the confusing arguments swirling around.
Very few people will be affected by significant rate changes. To give a sense of how small this number is, more than half of employed 19-44 year-olds were covered through their employers. Of those who are not offered insurance through an employer, 92 percent of young adults expected to enroll in individual plans with subsidies through the Exchanges would not be subject to premium increases. This is not to say that nobody will experience rate changes, but it is important to understand the relative impact of increases and the small number of people affected.
Rate changes will primarily impact young men between the ages of 19-27, who have incomes higher than 400 percent of the federal poverty level (more than $45 thousand per year) and are not covered through their employers. And even these individuals will only experience moderate changes – on average an increase of 10-13 percent compared to current non-group rates, according to the Congressional Budget Office.
Most importantly, the ACA means everyone will gain increased value per health care dollar through better benefit packages and limits on how much patients can pay out-of-pocket. New plans will be required to meet certain standards of benefits, including covering maternity, mental health, prescription drug coverage, and charging no co-pay or deductible for preventive services including cancer screenings and contraception. These new standard benefits ensure that consumers will get greater value and better protections than many plans currently provide. Young adults will also have the option of enrolling in a catastrophic coverage plan that covers the same benefits but offers lower premiums with a higher deductible.
The law also makes the system fairer across gender and age groups. Currently, insurers commonly charge women more than men, simply because they have the potential to incur more costs through maternity care. This unfair practice costs women in the private market approximately $1 billion per year, but is outlawed under the ACA starting in 2014. Similarly, insurers are allowed to charge older adults significantly higher rates. The ACA places limits on this practice so older adults can only be charged a maximum of three times as much as younger adults. This change reflects a more accurate approximation of the health cost differences between young and old, correcting years of overcharging adults for their health care services. Finally, the ACA ends discrimination against those who have preexisting conditions. This is not irrelevant for young adults, since 16 percent of 16-24 year olds have preexisting conditions and either are unable to gain coverage or are pay higher rates because of their medical history.
When it all shakes out, the benefits of the ACA for young adults far outweigh any costs. The impact of premium changes will be limited, will help make the health insurance system fairer, and will ensure consumers get more bang for their buck.
Sarah Gordon, Private Insurance Team Intern
Community Catalyst
(Blog originally appeared here on the Health Policy Hub)
Showing posts with label Myths. Show all posts
Showing posts with label Myths. Show all posts
Friday, 26 April 2013
Monday, 17 December 2012
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
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
Wednesday, 3 October 2012
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!
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!
Wednesday, 18 July 2012
Ages 55-64 and Uninsured...Where Can We Go for Help?
The number of people without health insurance in the United States has increased steadily over the last several years, from 43 million in 2007 to 49 million in 2010. Individuals between the ages of 55 and 64 make up 11% of this uninsured population. This age group is particularly vulnerable when uninsured: people age 55-64 are more likely than younger people to be in fair or poor health, and people age 55-64 who are uninsured are twice as likely to be in fair or poor health than their counterparts with health insurance coverage.
Regardless of health status, individuals in this group do not qualify for coverage through Medicare or Medicaid unless they have a serious disability (i.e., one that meets Social Security’s definition of disability for purposes of awarding Social Security Disability Insurance). Therefore, most people age 55-64 who do not have employer coverage are forced to seek coverage in the individual insurance market, where they may currently be denied a plan or charged exorbitantly high premiums for having pre-existing conditions.
The implementation of the Affordable Care Act makes a big difference for this population. Right now, the ACA is providing incentives to small business owners to keep providing employer coverage for people between the ages of 55 and 64. In 2014, insurance companies will no longer be able to deny people coverage due to a pre-existing condition, and premiums and cost-sharing subsidies from the government will help to ensure that people can afford to pay for coverage.
But what can people in this age group do until 2014? With support from the Chicago Community Trust, AgeOptions has put together a toolkit, “No Insurance? Health Care Options for Individuals Age 55-64 Without Insurance”:
This toolkit contains information about health care resources for individuals without insurance coverage, including:
Erin Weir
Manager of Health Care Access
AgeOptions
Regardless of health status, individuals in this group do not qualify for coverage through Medicare or Medicaid unless they have a serious disability (i.e., one that meets Social Security’s definition of disability for purposes of awarding Social Security Disability Insurance). Therefore, most people age 55-64 who do not have employer coverage are forced to seek coverage in the individual insurance market, where they may currently be denied a plan or charged exorbitantly high premiums for having pre-existing conditions.
The implementation of the Affordable Care Act makes a big difference for this population. Right now, the ACA is providing incentives to small business owners to keep providing employer coverage for people between the ages of 55 and 64. In 2014, insurance companies will no longer be able to deny people coverage due to a pre-existing condition, and premiums and cost-sharing subsidies from the government will help to ensure that people can afford to pay for coverage.
But what can people in this age group do until 2014? With support from the Chicago Community Trust, AgeOptions has put together a toolkit, “No Insurance? Health Care Options for Individuals Age 55-64 Without Insurance”:
This toolkit contains information about health care resources for individuals without insurance coverage, including:
- “Safety net” organizations and programs that provide access to health care
- Affordable Care Act provisions that will assist these individuals in obtaining coverage
- Where to go for information and assistance in finding health care options
Erin Weir
Manager of Health Care Access
AgeOptions
Wednesday, 21 December 2011
What lies ahead for the Patient Protection and Affordable Care Act in 2012?
2011, the first full year for the Patient Protection and Affordable Care Act (ACA), is coming to a close. As we’ve written about in the past blog posts, Facebook posts, tweets or on our home page, the year saw many ACA developments, from the announcement of the definition of “essential health benefits” that are guaranteed under the law, to the initial stages of Illinois’ health insurance exchange legislation, to the rescission of the CLASS Act. This year also saw the early effects of the law’s impact – from the young adults who can now stay on their parents’ health insurance plan, to the seniors whose prescription drug costs in the Medicare “doughnut hole” are shrinking, to the people with chronic conditions who are no longer uninsured due to the availability of the state’s federally funded pre-existing condition insurance plan.
Of course, many provisions of the ACA will not take effect until 2014, but several provisions of the law are slated to start in 2012, including:
- A series of demonstration projects designed to strengthen Medicare by eliminating fraud, waste, and abuse;
- The Medicare Independence at Home demonstration, which will test out coordinated care medical teams providing care to certain high-need Medicare patients in their own homes;
Also in 2012, it will be important to watch how the implementation of pieces of the ACA that are already in effect will continue, most notably, the establishment of a health benefits exchange in each state. Many states, have already begun the implementation, and are at various stages in the process, such as the 15 states (like Illinois) that have already enacted an exchange or intent of establishment legislature. Other states are working to pass such legislation, and others have not taken any steps towards establishing an exchange, either deferring to the federal government to run their exchanges, or riding on the assumption that the ACA will be struck down in the upcoming Supreme Court case. (See here for a recent news article about the status of the Illinois Exchange).
There are still many unknowns about the future of the ACA; however, what’s clear from our eight-part Neighborhood Stories series is that we have a lot of work to do to educate the communities in Illinois about the benefits of the law for small businesses, individuals/families and community organizations. Stay tuned to Illinois Health Matters for interactive features in early 2012, to help YOU understand how health care reform will impact you, your family and your community.
Happy, Healthy Holidays!
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