The Obamacare Lady: What made me want this job?

Last year, I accepted a position to be an In-Person Counselor with the State of Illinois. You may also have heard the terms Navigator or Assister used to describe this job. I help people with the Affordable Care Act. A few people have called me, “The Obamacare Lady.”  Yes, I help people understand “Obamacare” and help them determine what help they may qualify for in obtaining health insurance.

What made me want this job you ask? Well, I was drawn to this job for a number of reasons:

First, I like helping people. Prior to starting the training for this job, the only thing I knew about the Affordable Care Act was that it would help people like my Mother get cheaper healthcare. My Mom had a heart attack a few years ago and since then, her health insurance premiums went through the roof. And by roof, I mean they were more than a mortgage payment on a 3 bedroom house!! Yikes! That seemed crazy to me. So, I wanted to do this job to help people like my Mother and clients like Kathy. Kathy* is a small business owner and has a pre-existing condition. Her business has been quite profitable in the past, but since 2008, things have been rough. Due to the high costs of health insurance, especially with her pre-existing condition, she could not afford to pay her rent and eat if she purchased a health plan. So, she hasn’t had health insurance for years. She has been going without her medication and has just been hoping that her condition has not progressed. We met and completed an application together and found out that she is eligible for a tax credit and reduced out of pocket expenses.  She is thrilled to be able to purchase a health insurance plan for $ 150 a month. These stories are my every day.

Second, I’m all about saving money. I love to shop for the best price for everything. I wait for sales, clip coupons and save my money for a rainy day. I get a little thrill out of helping someone save hundreds of dollars on their health insurance. It’s fun for me.

Third, I like to know the facts. This has been quite the topic of conversation. Almost everyone has an opinion. Over the years, it seems our news sources now always have a particular slant one direction or another. It is pretty difficult to find someone that will give you both sides to a problem or issue. So, my solution was to get boots on the ground and learn about the ACA myself and make my own decisions.

This job is not for the faint of heart. The reason that I have kept this job is that I am persistent and resilient. On a typical day, I get to see a formerly stressed, worried and confused individual walk out of my office with a little less weight on their shoulders, a little more money in their pocket and much more confident about their future. But getting there isn’t always easy. The rules to the Affordable Care Act are complex and each person’s situation is different, but that has been the fun part of being “The Obamacare Lady.” I meet so many interesting people and have a bird’s eye view of the diversity in our state. Illinoisans are beautiful, generous and hard-working.

Back in October, when the website wasn’t working very well, every person asked me if people were treating me okay. They were concerned that someone would take their anger and frustration out on me. Not a single person did. Then, people were concerned about all “those people” that might be taking advantage and defrauding the system. They wanted to make sure there were ways in place to catch the “cheaters.” After a while, all these questions made me laugh. No. Everyone I meet with is just like you. We want the same things. We want to provide things like health insurance for ourselves and our family. We are willing to sacrifice and work hard to do it. We want to obey the law. We want to be honest and tell our truth. We want to pay our own way and don’t want anything for free. Our politics and opinions on this Affordable Care Act are varied to be sure, but the similarities among us are so close. We are too hung up on headlines and sensationalism to see it.    

By Barb Silnes

In-Person Counselor

An Illinois Navigator's Experience Finding Lower Premiums in the Marketplace

I decided I might as well enroll myself with a Qualified Health Plan on the Marketplace before I sat down as an In Person Counselor (with a client) so I tried for a few days right after Oct. 1.

Since the site was so slow, I decided to wait until some of the excitement wore off and tried again in mid-October. I sat down after dinner and put in an hour on the computer. I quickly verified my identity, similar to the online process for requesting your free credit report. I answered simple questions about what streets I have lived on, former cities I lived in, etc. They were all multiple choice questions, and I got them all right!

Then I was able to compare the plans for my county and sort them based on certain features: metal, HSA eligible, out-of-pocket costs, etc. At that point there are fewer plans to choose from and I checked off the "compare box" on three that I thought seemed to be a good fit. After looking at the plans, side by side I was able to click on a link with each that took me to the website for each plan so I could do a provider search. I entered my current doctor and to see if my doctor was in-network. This made it pretty easy for me to decide. The pages did load slowly so I folded laundry while they loaded.

Once I enrolled in health coverage, I had to decide to elect or not to elect to access dental. I went through the same process with the dental coverage, but did find that the links did not work for all the dental plans. I eventually decided on a plan and enrolled. Then I put the laundry away while it loaded and waited.

At the end, I got the page where it said my application was complete. I printed out the page along with my application ID# and am excited to let people know that my premiums are going down!

I self-pay for insurance now and will still do so in 2014. I currently pay just over $340 a month for health and dental. Starting in January, I will only pay $185.10 for health and dental. I make too much money for any tax subsidy, so even without assistance I am seeing a huge benefit. I still get to see the same doctor and dentist that I have had since I was a kid and really cannot complain too much. Buying insurance before privately took more time as I would have to research and deal with the insurance brokers and then the underwriters questioning of any of my possible health issues.

I look forward to helping my clients find affordable options on the Marketplace, too.

Joann Boblick
Certified In Person Counselor
La Grange, IL

Primary Care Doctors Need Connections to ACA Information and to Navigators, Counselors

As the effort to promote the Health Insurance Marketplace and enroll consumers gears up, and clinics and community organizations hire, train and deploy the various “assisters” who will help patients and families get coverage, we shouldn’t ignore one of the most important touchpoints between the health care system and consumers – patient/physician interaction. Patients trust their doctors and may look to them for guidance about the Affordable Care Act (ACA). Unfortunately, many doctors haven’t been well educated about the ACA or what’s going to happen once the Marketplace is live.

The national American Academy of Pediatrics recently conducted a survey of its members and found that improvement is needed in pediatrician awareness of the Affordable Care Act (ACA). The survey, conducted in late 2012, showed that nearly half of pediatricians are vaguely or not at all familiar with key components of the ACA. Specifically, they lacked knowledge of some components that could directly benefit their practices – such as the temporary increase in payment from Medicaid to Medicare levels, and coverage of Bright Futures services with no cost-sharing for children enrolled in new insurance plans.

Pediatricians also cited low confidence in their ability to respond to parents’ questions regarding the new law. Only 5% of pediatricians reported that they are very confident in their ability, while 33% reported that they are not at all confident, with the rest somewhat or moderately confident. Clinicians such as pediatricians are not yet being asked many questions by their patients and parents, so they have not been motivated to learn their own key points or prepare their office staff to provide information. In the AAP survey, 86% of pediatricians reported that they are seldom or never asked questions concerning the ACA. Most of their knowledge to date comes from what they see in the media, so they are very much aware of aspects such as the ban on pre-existing condition exclusions, the requirements to have health insurance by 2014 or pay a fine, and the provision allowing young adults to stay on parents’ health insurance up to age 26. But once the Marketplace is up and running, and public relations campaigns about enrollment are in full swing, and assisters are everywhere, what will they need to know so they can effectively advise their patients?

Locally, two major primary care provider associations did an assessment of members which confirmed an interest in more support and information. In May 2013, the Illinois Chapter of the American Academy of Pediatrics (ICAAP) and the Illinois Academy of Family Physicians (IAFP) conducted an informal survey asking pediatricians and family physicians to estimate need for Marketplace information among patients, patient’s parents and family members, and clinic staff. Responses were received from nearly 40 unique medical practice sites employing over 500 physicians. Only 3 responded that they would not be interested in any education or services related to the Marketplace. Nearly all (85%) want information on the Marketplace to post or handout to patients, and almost as many (75%) want a counselor or assister to speak to their practice staff.

While the number of medical practices that are independent, small business is dwindling, and most staff have insurance coverage via a hospital or health system, staff may still need information for friends and family members or to make new choices if products through the Marketplace are better for their families. Only about a quarter of physicians responding expected their health system to provide information on the Marketplace for patients and staff, and most (65%) said their health system was definitely not planning to employ navigators or counselors, which may be more available in the safety net clinics than in private systems. But the need for information – even in private practices – is there! Many physicians attested to seeing their patients lose insurance due to the economy, and pediatricians regularly note that while their patients are insured via All Kids or private insurance, many of their parents or primary caregivers are not. Children also age out of All Kids or their parents’ insurance and so many young adults will seek help in securing coverage.

For the ACA roll out to work, consumers need to get quality, consistent messages about the need to enroll and how to use the health care system, no matter where they are. Targeting efforts in low income communities and in clinics that currently serve the uninsured makes sense, but the ACA effects everyone, and all primary care offices should be able to connect a patient or family who needs coverage to someone who can help them.

Scott G. Allen, MS, Executive Director
Illinois Chapter, American Academy of Pediatrics

Training for In Person Counselors and Navigators in Illinois

The State is preparing to award grants in early July to community based entities who will employ helpers to educate consumers about their new health care options under the Affordable Care Act and to assist people in enrolling in the new Medicaid expansion and Health Insurance Marketplace when open enrollment begins on October 1. These helpers will be called In Person Counselors (IPCs); however, there will also be other enrollment "helpers" called Navigators and Certified Application Counselors. The different names just refer to how the assister is funded; all of the assisters will help people choose and enroll in coverage.

In order to train these assisters, the State has partnered with the University of Illinois at Chicago School of Public Health to develop a curriculum and training program to begin by the end of July and go through the middle of September. The curriculum will consist of both online and in person learning modules. The training will be ongoing and will consist of a testing and certification process as required under state law. There will be continuing education and a backup technical assistance call center for individual questions.

In addition to the state training, IPCs and Navigators will also take a federal online Navigator training by the fall which will inform them about using the federal Marketplace portal. This is important, because all assisters in Illinois must be familiar with both the state Medicaid system as well as the federal Marketplace system since Illinois has chosen to be a partnership state and administer its health care reform programs jointly for the first year with the federal government. We are waiting on federal guidance regarding the Certified Application Counselors' training requirements.

Many other community based providers will help their clients understand and access health care coverage, even if they aren't designated "assisters" or "Navigators." These front line workers also need information on the ACA but may not need as intensive a training program as the certified assisters. There are training materials and presentations available to these organizations/ entities throughout the state including the Starting Strong Webinar Series and other events on the Illinois Health Matters events page.

Stephanie Altman
Health & Disability Advocates

The ACA is Coming – How Can I Help Enroll People?

The past few weeks have brought a flurry of activity from the federal and state government agencies who are reaching out to community-based entities to solicit their assistance in Affordable Care Act outreach, education and enrollment. In Illinois, it’s even more confusing because there are three possible “helper” groups: Navigators, In Person Counselors and Certified Application Counselors. 

This blog is intended to answer some of your frequently asked questions about these enrollment helpers and how you can get involved.

What’s a Navigator and How Can I Be One? 
“Navigator” is the term that has been given to people or organizations charged with providing guidance to individuals enrolling in the Health Insurance Marketplaces created by the Affordable Care Act. Many of you have been wondering how you can become one of these entities. Unfortunately, there are no actual “navigator positions” right now. This is because various entities have to apply for funding (grant application due June 7) to become navigators and receive training.

What do you mean by “entity”?
Many types of groups/entities can be Navigators. Self-employed persons and public or private organizations are eligible to apply for funding to operate as Navigators (see the FAQ here). In each Marketplace there must be at least two sub-sets of entities and at least one will be a community and consumer-focused nonprofit. There are some restrictions, however: navigators cannot have conflicts of interest. Therefore, navigators cannot be health insurers, have affiliations with health insurers, or accept any form of payment from insurers that is related to enrollment inside or outside of the marketplaces.

What if I don’t want to or am not eligible to apply for these Navigator grants?
If you don't think you or your organization would qualify for this funding alone, you could consider reaching out to another organization in your area that might be applying. Check out this consumer assistance matchmaking spreadsheet to meet up with other groups. Another option would be to wait until the grants have been decided upon and then reach out to see if the recipient organizations need any additional staff.

What is the In-Person Counselor (IPC) Program?
In-Person Counselors (IPCs) are the same as Navigators, in that they will educate people about the new system, help them understand their health plan choices, and facilitate their selection of the plan that is right for them. They are different than Navigators because funding for these entities comes from the state instead of the federal government and they will receive training directly from the state.

The IPC grant application just came out and applications are due May 30th. Entities in Illinois can apply for these funds and hire new personnel or use existing staff as In-Person Counselors in the community. Find more information and access to the application here. The Illinois Health Insurance Marketplace will be conducting a webinar for those interested in the IPC program on Thursday, May 9 at 10 am. You must register to participate. 

But how is a Navigator and In Person Counselor different from a Certified Application Counselor (CAC)?
CAC's have been defined as “trusted community-based organizations, providers, or other organizations with expertise in social service programs.” CACs allow organizations that would likely aid consumers anyway (such as hospitals or clinics) be involved more formally in the process of finding health coverage. Unlike Navigators and IPCs, CACs are not eligible for public funding but the Marketplace will be required to certify CACs to help people apply for Medicaid and plans sold through the exchange.

So what should I do now if I want to be one of these helpers?

• Read the IPC application
• Look at the Illinois Consumer Assistance Matchmaking Spreadsheet to see who else wants to apply to be a Navigator or IPC
• Participate in the webinar on May 9th about the IPC program
• Stay tuned for more information about the CAC program in Illinois 

Feel free to email us at info@illinoishealthmatters.org with any questions!

Stephani Becker & Alexa Herzog
Illinois Health Matters

Update on SB 1194 (The Insurance Navigator Act)

Starting October 2013, an estimated 1.6 million Illinois residents will be eligible for new and affordable forms of public and private health insurance coverage under the Affordable Care Act. But the overwhelming majority of the newly eligible have no idea how to access these options. Many Illinoisans will need more information and guidance through the enrollment process.

The Affordable Care Act requires each state’s Health Insurance Marketplace to establish a Navigator Program that will guide these individuals through their new coverage and enrollment options. These Navigators will serve an important role in ensuring that individuals benefit from the ACA.

On January 30th, the potential efficacy of the Navigator program was threatened by the introduction of Illinois Senate Bill 1194, which would create overly restrictive criteria for organizations applying for and performing navigator functions.

Here are the issues with SB1194 (as it was introduced):

• SB1194 placed unnecessary restrictions on Illinois Navigators and In-Person Assistors, making it more difficult for low-income and hard-to-reach populations to connect to the application assistance that they need.  
• Illinois is currently preparing a Navigator training and oversight system that makes SB 1194 unnecessary. 
• Federal law already mandates some of what is outlined in SB1194, such as prohibiting Navigators from recommending specific insurance products. Once again, SB1194 is unnecessary.  
• Language in SB1194 prohibited Navigators from facilitating enrollment in a Federally Qualified Health Plan, (QHP), one of the five Navigator duties already specified by the ACA.

Consumer advocates and community based-providers recognized these issues, and successfully lobbied state Senators to make changes in the bill.

Here’s what changed:

• SB1194 now includes the Navigator duties as spelled out in the ACA.
• SB1194 now includes a certification, instead of a licensure, requirement.
• SB1194 excludes all prior language that restricted Navigator duties, (such as the ability to facilitate enrollment in a QHP).
• SB1194 is now in alignment with Federal regulations regarding the training and responsibilities of Navigators.
• SB1194 now allows for the training of Certified Application Counselors, (another type of Navigator not directly compensated by the Exchange), to be defined at a later date. This means that CAC training will align with federal guidelines.

What’s happening now?

These amendments were filed on April 22nd, passed in the Senate on the 24th, and were referred to the House Rules Committee earlier today. You can follow SB 1194’s status here.Thanks to all of the advocates for raising your voices against restricting the navigators in this new health care system.

Nadeen Israel
Policy Associate, Heartland Alliance for Human Needs & Human Rights

Please contact Nadeen at nisrael@heartlandalliance.org for more information on SB1194.

Don't Restrict the Navigators!

The Affordable Care Act requires each Health Insurance Exchange to establish a Navigator program that will help people who are eligible to purchase coverage through the Exchange learn about their new coverage and enrollment options, including Medicaid, tax credits, and private insurance. In Illinois, the Navigator program will be paired with an In Person Assistor Program to help the 1.7 million uninsured residents in Illinois find coverage. The success of the ACA hinges on the ability of Navigators and In Person Assistors to reach eligible residents and provide culturally competent services. 

Two pieces of legislation currently being heard in the Illinois General Assembly - SB1194 & HB2608 – create barriers to this massive enrollment effort. The two pieces of legislation establish overly restrictive criteria for organizations and agencies that wish to serve as Navigators, making it more difficult for vulnerable populations to be connected with their new options for affordable health insurance coverage. For example, the bills require that Navigators be licensed by the state despite the fact that the Federal regulations specifically do not require licensing.

Additionally, SB1194/HB2608 are written to address a Navigator program operated by a state-based Health Insurance Marketplace. However, in 2014, Illinois will run its exchange in partnership with the federal government. Therefore, this legislation is unnecessary because HHS, not the Illinois Department of Insurance, retains ultimate authority over the Navigator grant process, including selecting Navigator grantees and awarding Navigator grants, and the approval of grantee activities and budgets.

Over a million Illinois residents will be eligible for new health insurance starting October 2013. For a successful marketplace, rather than putting into place restrictions that would deter and prevent community-based organizations from serving as Navigators, we should work to ensure that broad efforts are in place to connect these individuals with coverage. For that reason, we ask that you OPPOSE SB 1194 & HB 2608. See here for a fact sheet on the bills.

SB 1194 will likely be called for a vote in the Senate Insurance Committee on Wednesday, March 20th @ 5 pm. Don’t restrict the Navigators; please slip in opposition to SB 1194 and HB2608.

Kathy Chan, Illinois Maternal and Child Health Coalition
Nadeen Israel, Heartland Alliance for Human Needs & Human Rights
Ramon Gardenhire, AIDS Foundation of Chicago
Stephanie Altman, Health & Disability Advocates

Finding the Pot of Gold at the End of the Navigator Rainbow!

News that a new proposed rule on Navigators is under review at the Office of Management and Budget (OMB) hopefully means it won’t be long before we see model navigator training, conflict of interest and privacy standards. With any luck, release of the proposed standards should pave the way for the federal navigator grant solicitation.

The navigator funding opportunity announcement (FOA) will seek proposals from qualified organizations in the 33 states where the federal government will operate the exchange, including states that have opted for State Partnership Exchanges. Navigator grants in the 17 states (and D.C.) that are building their own state-based exchanges will not be included in this solicitation. The level of funding has not been disclosed but CMS officials have said the total amount will be allocated to states based on a formula that establishes a state minimum and factors in the number of uninsured people in the state. So there will be a larger pot of money for navigator grants in states with higher uninsured rates.

Any organization considering applying for a navigator grant should complete the registration process as soon as possible. Given the dwindling timeline, it’s not clear how long applicants will have to prepare their proposals but potential applicants – particularly those who have never applied for a federal grant – can register now. This doesn’t obligate you to apply but it gets the basics out of the way so you can concentrate on the substance of your response to the grant solicitation once it is announced. While applying for a federal grant might seem as daunting as finding a four-leaf clover, www.grants.gov provides step-by-step registration instructions in this checklist. There are five steps for registration and while most of the steps can be completed online the same day, Step 2 – registering with the System for Award Management (SAM) – can take up to two weeks.

A word of encouragement to small community-based organizations. Keep in mind that federal regulations require there to be at least two types of entities selected as navigators in any given state and one of those types must be a community or consumer-focused nonprofit organization. Capitalizing on the experience and passion in organizations that assist people with Medicaid and CHIP coverage is the best way to build a network of navigators to reach key populations of vulnerable and uninsured people and connect them to coverage. CMS officials have emphasized that all proposals – small and large – will be considered, so securing a grant could be a lot easier than catching a leprechaun!

If you want to learn more about navigators check out these two briefs:
“Countdown to 2014: Designing Navigator Programs to Meet the Needs of Consumers”
“Designing Navigator Programs to Meet the Needs of Consumers: Duties and Competencies”

For those of you who decide to apply for navigator funding, may the luck of the Irish be with you! Remember, registering now will put you five steps closer to the end of the rainbow.

Tricia Brooks
Senior Fellow
Georgetown University Health Policy Institute, Center for Children & Families

This blog was originally posted on Say Ahhh! a health care policy blog

Navigators, Assisters, and Counselors, Oh My!

By now we know that upwards of 30 million Americans will have new, more affordable health coverage options available to them by January 1, 2014. But what many don’t realize is how incredibly difficult it can be to understand and choose the right health insurance on your own.

The Wizard of Oz’s Dorothy had guides along the way, and the Affordable Care Act (ACA) provides some as well – hopefully, with fewer pitfalls. But not everyone can counsel people about health insurance. There are complex public and private systems to navigate, and most people who will likely get insurance in the new Health Insurance Exchanges, or Marketplaces, will be more racially diverse, less educated, and earn lower income than people in private insurance now. Most will have a high school education or less, and as many as one in four speak a language other than English at home. So it matters that the people who guide consumers along the path to coverage are trusted members of the community and understand their circumstances.

Luckily, the ACA provides different options for guides along yellow brick road.

Navigators are outlined in the ACA as helpers for people to enroll in coverage through the Exchange, and refer or assist with Medicaid enrollment. Navigators are funded through Exchanges, and regulations from the Department of Health and Human Services (HHS) are clear that anyone who gets payments from insurance companies cannot be a Navigator. Navigators also must meet cultural competency standards and go through training and certification. States running their own Exchanges are developing Navigator programs now and must fund these with state Exchange dollars. For Federal Exchanges and Partnership Exchanges, HHS has said that it will fund Navigators directly through an upcoming RFP process. Be on the lookout for this announcement in the next few weeks.

To add even more help on the ground, HHS recently outlined in regulations another program,Assisters (or, In-Person Assistance). Like Navigators, Assisters must meet training and conflict of interest standards. They could fill in gaps in areas that need more enrollment assistance, or provide outreach and education about the ACA’s new options. Funding for Assisters is a key difference from Navigators. States running Exchanges or opting for the Consumer Assistance Partnership can apply for funds for Assisters through their Exchange Establishment grants. A number of states are applying now for these funds. Unfortunately, Assisters currently are not an option for Federal Exchanges.

And when you thought there were enough new health-related terms, HHS regulations added yet another helper to enroll people, Certified Application Counselors. Every Exchange must have a Certified Application Counselor program, with similar training and privacy standards as Navigators and Assisters. A difference in this program is that there is no funding mechanism. It is unclear who will serve this role – although the regulation suggests it could be community-based organizations or health care providers. Stay tuned for further clarification on this new option.

But even these multiple types of help will not be enough to spread the word about the ACA. Helping people understand and choose the right health plan, especially given the amount of misinformation in the media and elsewhere, is going to be a huge task. Nevertheless, these resources in the ACA provide a foundation to start building greater understanding of health care options to get people into the right coverage.

This post originally appeared on Health Policy Hub's the Community Catalyst Blog. 

Written by Christine Barber, Senior Policy Analyst

With A Little Help From My Friends

One of the joys of being an advocate for the Affordable Care Act is getting to help others figure out what help they have available to them and seeing them get the health care they need. As with any large implementation, the array of benefits under Obamacare can be daunting, and there is no shame in looking for help in figuring out what programs or benefits apply to you.

The drafters of Obamacare thought ahead and added a "Navigator"program to provide just that assistance.The Illinois Department of Insurance and the U.S. Department of Health & Human Services will be seeking organizations in the next year to employ people to be trained in all of these options and sent forth to aid wherever they can, especially in hard to reach communities. This is a great source of jobs and a great resource for a community's health care needs.

The way the law is written, the Navigators have to be neutral parties -- uncompensated by insurance companies and providing unbiased assistance -- through the entire process. Then, further down the line, if you have questions, you already have a familiar face to contact for answers.

In a world where we are all used to enraging battles regarding our health care coverage, Congress actually built an insightful program into the ACA. Be sure to send comments on the design of the program to Governor Quinn so that it can be as effective as possible, and be ready to spread the word to those that will need a helping hand.

Sometimes, we all need a little help from our friends.

David Zoltan
Guest Blogger, Illinois Health Matters

Affordable Care Act will greatly benefit women

The Supreme Court’s ruling upholding the Affordable Care Act marks a critical victory for women’s health, and the health of all Americans. Because of this landmark decision, millions of women and families will continue to have access to affordable, quality health care — many of whom previously had inadequate coverage or no coverage at all.

At Planned Parenthood of Illinois, we understand how this law will have an unprecedented effect on women’s health. The law guarantees women direct access to OB/GYN providers without referrals, and ends discriminatory practices against women, such as charging women higher premiums and denying coverage for “pre-existing conditions.” And in just six weeks, women will gain access to birth control without a co-pay — which will have a tremendous economic impact on already stretched family budgets.

Since August 2010, more than 45 million women have already received full coverage for preventive health screenings, including mammograms and Pap tests. Now with this ruling, 17 million more women will have access to health insurance for the first time. And millions more young adults will be able to stay on their parent’s health insurance plans, just like the 3.1 million young adults who have done so since September 2010.

In Illinois alone, 469,469 women of reproductive age will now gain coverage under the Affordable Care Act by 2014.

The increased access to preventive health care and family planning under the Affordable Care Act provides immeasurable economic value to women, families and society. Not only does every dollar invested in federal family planning save taxpayers and families nearly $4, but unintended pregnancies are already costing U.S. taxpayers $11 billion a year.

Women realize that health and wellness are key to prosperity and independence. In times of economic uncertainty, it is more important than ever to stay healthy. For women, birth control isn’t a political or social issue — it’s basic health care and an economic concern. The money — up to $600 on average — that women will save on birth control each year is equal to five weeks of groceries for a family of four, nine tanks of gas in a minivan, or one semester of college textbooks.

Planned Parenthood of Illinois health centers already provide basic health care to nearly 75,000 patients every year, and to 3,321 patients in Springfield alone. Because this landmark law has been upheld, we know we’ll be able to do even more for the communities we serve in the months and years ahead.

Carole Brite

President and CEO

Planned Parenthood of Illinois

(Originally posted on July 10 in the State Journal-Register)

The Economic Toll of Health Disparities

April is National Minority Health Month, and we are commemorating it with this post on health disparities from the Heartland Alliance blog, Heartbeat. The Affordable Care Act's reforms will make a difference in some of these disparities, such as the focus on expansion of access to primary care, innovations in medical delivery models, increased access to health insurance and the Medicaid expansion. 

Health disparities among minority groups account for 30.6% of direct medical expenditures, reflecting the significant toll being African-American, Asian or Hispanic has on one's health and economic well-being.

A study by the Joint Center for Political and Economic Studies found that between 2003 and 2006 almost a third of health care costs for minorities were due to poorer care compared with whites. Minorities face greater barriers to preventive care, acute treatment and chronic disease management.

Eliminating those disparities would have reduced by $229.4 billion direct medical expenditures by minorities, according to the Joint Center's estimate. Minorities could have saved more than $1 trillion on indirect costs -- such as those associated with illness and premature death -- during the four years studied if disparities didn't exist.

The 2010 National Healthcare Disparities Report found that rates of potentially avoidable hospitalizations for blacks are double those of whites. Blacks and Hispanics have higher rates of potentially avoidable hospitalizations for chronic conditions compared with whites.

Differences in access to care, provider biases, poor provider-patient communication and poor health literacy contribute to health disparities, according to the report. It states:
"Unfortunately, Americans too often do not receive care that they need, or they receive care that causes harms. Care can be delivered too late or without full consideration of a patient's preferences or values. Many times, our system of health care distributes services inefficiently and unevenly across populations."

Quoted in an America's Wire article on health disparities, Jennifer Ng'andu of the National Council of La Raza said minority children are particularly impacted by a lack of access to care. Children "will experience developmental setbacks because they are sick or their parents are sick. It makes it harder for them to achieve in school and can have serious consequences on their future."

Financial strains on families due to health care can hinder children's academic success and, in turn, future earnings. At the same time, minority youth are increasingly affected by chronic diseases such as diabetes.

Hispanics in general have higher rates of high blood pressure and obesity than non-Hispanic whites. They are twice as likely to die from diabetes as non-Hispanic whites, according to the Centers for Disease Control and Prevention.

Caring for chronic disease over a lifetime is expensive. With minorities representing more than half of uninsured Americans, the effect on their health and finances can be great. We support efforts to expand access to care -- particularly for preventive services -- to minority communities to eliminate health disparities and the economic costs that come with those disparities.

This article was originally posted on the Heartland Alliance Heartbeat blog. 

The Affordable Care Act: Fulfilling Promises, Cutting Costs

Did you know that the Affordable Care Act has alreadyexpanded affordable preventive health coverage to 54 million Americans?

If you’ve been following the Shriver Brief health care blogs, you probably remember reading about the Affordable Care Act mandate that insurance companies provide a specified list ofpreventive health care services to policy holders without charging a co-payment or deductible. Services like screenings for blood pressure and cholesterol; testing for Type 2 diabetes, obesity, and colorectal cancer; and alcohol and tobacco cessation counseling, among others are included in the mandate. Additional preventive health services like childhood immunizations; screenings for hearing, vision, and oral health; as well as testing for autism, HIV, and obesity, among others must be provided free of co-payment for children’s care. And starting in August of this year, insured women will be able to receive a set of women’s preventive health benefits like well-woman visits, FDA-approved contraception, mammograms, breastfeeding support and supplies, and domestic violence screening and counseling, also without cost-sharing. The health reform law requires that all of these free preventive health services are provided by insurance companies for anybody with a new or a so-called “non-grandfathered” insurance plan. And the mostrecent research shows that people—tens of millions of people—are already receiving these preventive services, for free!

According to a study conducted by the Kaiser Family Foundation, “31% of all workers were covered by plans that expanded their list of covered preventive services due to the Affordable Care Act.” Using this data, the Department of Health and Human Services (HHS) was able to calculate just how many people are benefiting from expanded preventive health coverage across the country.HHS estimates that 54 million Americans—and counting—have received one or more of the Affordable Care Act’s mandated preventive health services free of co-payment or cost-sharing. This number breaks down to over 20 million women, 14 million children, and 19.5 million men making use of their increased access to affordable and essential preventive health care. Illinois was among the top five states to benefit the most, with almost 2.4 million Illinois residents receiving free preventive health care services! And this number will only continue to grow as more and more people choose to enroll in new or “non-grandfathered” health plans, and as the health reform lawrolls out its final stages in 2014, adding 16 million individuals to the private health insurance market.

These kinds of meaningful, money-saving provisions in the Health Reform law are making a real impact at a time of need, when many individuals and families affected by the recession have been resorting to cutting back on basic medical care to make ends meet. A Kaiser Family Foundation study conducted in 2009 found that 53 percent of American families were cutting back on medical care because of the cost. In 2010, the Commonwealth Fund reported that 25 percent of Americans were cutting back on recommended tests like blood pressure tests, colonoscopies, mammograms, and other potentially life-saving cancer screenings. And just recently, a study from the University of North Carolina’s medical school found that, during the height of the recession, adults between the ages of 50 and 64 received 500,000 fewer colonoscopies compared to the couple of years before the economy turned, even though the colonoscopies can cut the risk of dying from colon cancer in half. The good news is the Affordable Care Act is increasing access to many of these preventive health tests and screenings at a price Americans can afford.

Households all over the country are pinching pennies trying to stay afloat during hard economic times. Thank you, Affordable Care Act, for working diligently to make sure that nobody’s health is sacrificed because of the cost of care.

Coauthored by Caitlin Padula and Rachel Gielau.
This post was originally published as part of The Shriver Brief's weekly “Did You Know” blog series, which highlights important, but not well known features of the health reform law about prevention, wellness, and personal responsibility for our health.