The Affordable Care Act: Helping Women Prevent Cervical Cancer

January is National Cervical Cancer Health Awareness month. One goal this month is to bring awareness to the preventative role that routine Pap tests play. The American Cancer Society states that Pap tests can actually prevent the disease and that early detection allows for more successful treatment, making it a matter of life and death for some women. Unfortunately, this does not bring peace of mind to the millions of uninsured women who lack access to primary care doctors and OB-GYNs. 

Almost 1 in 5, or 19 million women in America reported being uninsured in 2010; more than 17 million, almost 1 in 6, fell victim to poverty. These women are your neighbors, your co-workers, your loved ones and your community members, and they are at a heightened risk of developing serious illnesses like cervical cancer simply because they cannot afford basic and necessary preventive health care. Dr. Martin Luther King Jr., whose legacy we recently celebrated, once said, “Of all the forms of injustice, inequality in health care is the most shocking and inhumane.” This is an injustice that the Affordable Care Act—commonly referred to as “Obamacare”—is working diligently to fix.

In 2014, the Affordable Care Act will expand the Medicaid program to cover all Americans living at or below 133% of the federal poverty level ($14,483.70 a year for a single person). This expansion will bring comprehensive health care, including primary care providers, to an estimated 16 million people nationwide. Here in Illinois, 700,000 people, including many low-income women will gain access to basic and effective preventive health services like routine Pap tests.

The Affordable Care Act recognizes that the cost of insurance policies and medical bills are not just problems for those living in poverty; they are also significant sources of stress for middle-class families. Fortunately, in 2014, the health reform law will provide tax credits and cost-sharing subsidies for individuals and families living below 400 percent of the federal poverty level ($89,400 for a family of four) to offset the cost of obtaining health coverage and maintaining a healthy lifestyle. This kind of financial relief is estimated to make a huge impact on women’s access to health care and greatly decrease the number of women who are uninsured or “underinsured” (women who have health insurance but don’t get medical care because they cannot afford their policies’ big deductibles or co-payments or because the services they need are not covered by their policies).

A 2009 study reported that seven out of ten women are uninsured or underinsured, have trouble paying for medical bills, or avoid seeking health care because of the cost. With record breaking numbers of women living in poverty and the fact that women have historically been charged higher premiums than men simply for being women—a discriminatory practice that health reform has banned—this should come as no surprise. Women need access to basic preventive health care now in order to prevent life-threatening diseases like cervical cancer in the future. That’s why, right now, the Affordable Care Act is helping insured women gain access to affordable health care by mandating that insurance companies provide preventive services free of cost-sharing to anybody with a new or “non-grandfathered” plan. Furthermore, in August of this year, a significant number of women’s preventive health services, including annual well-woman visits and Food and Drug Administration-approved contraceptives, will be free of co-payment for women who have insurance policies that are considered to be “non-grandfathered” status. 

Finally, health reform is effectively eliminating barriers between women and OB-GYNs by banning the old, status-quo requirement that women must get a referral from a primary care physician before seeing a gynecologist. This consumer protection has been in effect since the fall of 2010 so women all over the United States are already finding it easier and more affordable to get the necessary preventive care they need as a result of health reform.

On behalf of women everywhere, thank you, Affordable Care Act, for increasing access to affordable health care and for helping women stay ahead of cervical cancer.

For information on what the government is already doing to help women prevent cervical cancer, check out the National Breast and Cervical Cancer Detection Program online. This program provides access to free breast and cervical cancer screening and treatment for millions of uninsured women.

Also, see the American Cancer Society for in-depth information on what cervical cancer is, the risks and treatment options, as well as support.  

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This blog post was coauthored by Rachel Gielau, and was originally posted at The Shriver Brief. It is part of a weekly “Did You Know” blog series that highlights important, but not well known features of the health reform law about prevention, wellness, and personal responsibility for our health. 

New Fact Sheet: How the Health Reform Law Helps People with HIV

Still wondering how the Affordable Care Act helps people living with HIV/AIDS? Well, there’s no need to wonder anymore!

The HSS Office of Health Reform has developed a new fact sheet about how the Affordable Care Act (ACA) is particularly important for people living with HIV/AIDS, as well as other people living with serious medical conditions. The law has made significant progress in addressing the concerns and advancing the rights of people with HIV consistent with the goals of the President’s National HIV/AIDS Strategy.

Among the ways the new health law is helping people with HIV are the following:

• Ensuring that AIDS Drug Assistance Program (ADAP) benefits are now considered as contributions toward a Medicare beneficiary’s true Out of Pocket Spending Limit for drug coverage.
• Improving access to coverage and protecting people with HIV/AIDS now by making available a Pre-Existing Condition Insurance Plan in every state and making important insurance reforms to protect people from insurance company abuses;
• Offering quality coverage and care to every person with HIV/AIDS in 2014 and beyond via Medicaid expansion, additional insurance reforms, and closing the “Donut Hole”, and
• Increasing opportunities for health, well-being, and cultural competency.

So, whether you are just learning about the Affordable Care Act or looking for updated information, this fact sheet gives you the tools you need to make informed choices about your health. Read more details in the fact sheet (PDF) about what the health care law does to help people with HIV/AIDS.

This post originally appeared on the HIVHealthReform.org Blog.

The Affordable Care Act: A New Tool in the Fight Against Breast Cancer

Did you know that the Affordable Care Act is upping the ante on breast cancer awareness and prevention efforts?

According to breastcancer.org, about one in eight U.S. women (just under 12%) will develop invasive breast cancer over the course of their lifetimes. In 2011 alone, it was estimated that nearly 230,000 women were diagnosed with some form of the disease, and tens of thousands of women lost their lives to it. Breast cancer is the second most common type of cancer in women and one of the most deadly cancers among our mothers, sisters, and grandmothers. But it doesn’t have to be. Raising awareness about breast cancer, educating women about effective preventive health practices and increasing access to doctors and routine mammograms can reduce the cost, hardship, and lives lost to this all-too-common form of cancer. And this is precisely what theAffordable Care Act is doing for women all across the country.

The Affordable Care Act (ACA) authorizes the Centers for Disease Control and Prevention (CDC) toaward grants to fund breast cancer education and awareness campaigns across the country. The Act also directs the Secretary of Health and Human Services, along with the CDC, to establish an advisory committee on breast cancer and to launch a breast cancer awareness and education campaign, targeting young women with information about prevention and early detection. The law also authorizes the CDC to conduct research to better understand the disease, as well as the most effective prevention and awareness-raising efforts.

The CDC states that mammograms can detect breast cancer up to three years before it can be felt. And according to Health and Human Services, 3,700 lives would be saved every year if 90 percent of women 40 years old and up received routine breast cancer screenings. It is no secret that educating women about the importance and effectiveness of early detection is crucial to reducing the prevalence and mortality rates of breast cancer. 

However, this isn’t just an awareness issue. Especially in today’s economy, the financial cost of a routine mammogram—let alone making a visit to the doctor—is high enough to deter women from getting their necessary check-ups. The Affordable Care Act works to solve this problem for many American women. The health reform law is making women’s preventive health care affordable by requiring health insurance companies to cover certain preventive health services, like routine mammograms, free of co-pay for individuals with new or “non-grandfathered” plans. This means that any woman with a health insurance plan that is new or has changed significantly since March 23, 2010, can receive necessary routine mammograms without having to pay any money out of pocket for the procedure. Yearly well-woman check-ups will soon be free, too, giving women a chance to speak to their doctors about their health without worrying about their bank accounts.

The Affordable Care Act, referred to in the media by “Obamacare”, is also making strides for women who currently battling breast cancer and those who are survivors. Thanks to “Obamacare’s” many new consumer protections, insurance companies are no longer able to place lifetime limitson insurance policies, and in 2014, they will no longer be able to place annual limits on coverage, meaning people everywhere can rest easy knowing that the health insurance they pay for will be there for them when they need it most. Also in 2014, insurance companies will no longer be able to discriminate against anybody for having a pre-existing condition, like breast cancer, which means that women will no longer be denied coverage or charged a higher rate because they’ve fallen victim to cancer.

Breast cancer affects women and men of all races and ethnicities, but did you know that African American women are at a greater risk than any other race of dying from breast cancer in America? Find information on how the Affordable Care Act is working to reduce health disparities like this one across the country online.

For information on what you can do to stay ahead of breast cancer and on top of your health, visit the American Cancer Society online. For more in-depth information about breast cancer, like risks, treatments, and support, visit the National Breast Cancer Foundation website.

Coauthored by Rachel Gielau and Caitlin Padula

This post was originally posted at The Shriver Brief, as a part of their weekly "Did You Know?" blog series that highlights important, but not well known, features of the health reform law about prevention, wellness, and personal responsibility for our health.

The Affordable Care Act & Nursing Home Abuse

A Look at Nursing Home Abuse  

Elder abuse in nursing homes is largely due to the inadequate staff levels. According to a 2001 Health and Human Services (HHS) study, 90 percent of nursing homes are understaffed. Lack of adequate staffing is known to lead to:

• An over-worked staff.
• An under-trained staff.
• High staff turnover.
• Mistakes in patient care.
• Inadequate time with patients. (Most nursing homes do not meet the federal government’s recommendation for 4 hours of patients care with every patient, daily.)
• Staff exhaustion, burn-out and stress
• Inadequate staff-to-patient ratios
• Inadequate staff background checks.

Before the Affordable Care Act, the federal government did not require nursing homes to complete staff background checks. According to an HHS report:

• 90 percent of nursing homes employ at least one staff member with a criminal background.
• Almost 50 percent employ 5 or more staff members with at least one conviction.
• 5 percent of nursing home staff members have at least one criminal conviction.

Ultimately, all of these are potential causes of abuse, and intentional and negligent neglect.

A Look at The Patient Protection and Affordable Care Act and Nursing Home Abuse

The Affordable Care Act (ACA) will affect nursing homes in a positive way and, if successful, curb the rate of abuse in these facilities. According to Families USA, the ACA will establish important programs, committees, and grants that will increase the effectiveness of the long-term care workforce and care. These numerous establishments aim to:

Improve the long-term facility workforce through:

• Increasing the size of the long-term care workforce to meet the needs of long-term care residents.
• Understanding and analyzing workforce supply and demand.
• Encouraging people to enter the long-term care workforce.
• Curbing the long-term care workforce’s staff turnover rate through retention efforts.
• Improve the quality of staff training by educating staff about demanding resident conditions, such as dementia; proper ethics; the importance of reporting staff abuses of residentsm identifying signs of elder abuse and identifying administrative abuse.

Improve elder care by:

• Increasing the at-home care and decreasing long-term care facility usage; at-home care is less expensive to state and federal governments
• Increasing the knowledge of caregivers by providing resources concerning finances, care, etc.
• Increasing consumer knowledge of nursing home facility deficiencies and staffing levels.
• Improving long-term facility environments.

Decrease elder abuse through:

• Increasing resources to increase how quickly elder abuse cases are investigated.
• Establishing quality staffs through mandatory nationwide staff background checks and education.

Amber Paley, Blogger/Writer
Nursing Home Abuse.net

Essential Health Benefits: What’s it mean for people with HIV?

On December 16, 2011, the U.S. Department of Health and Human Services (HHS) announced that states would decide what essential health benefits will be provided under health care reform.  Although we had urged HHS to adopt a uniform, national benefits floor that states could build on, the federal proposal offers important flexibility for states. (Check out our essential health benefits archive.)

So, what does the essential health benefits announcement mean for people with HIV?  The short answer is that we’re working on it.  Here are some of the hoops we’ll have to jump through just to figure out what the benefits might look like in a state.

Which plans are we talking about?  HHS gives states the choice of:

(1) the largest plan by enrollment in any of the three largest small group insurance products in the State’s small group market;
(2) any of the largest three State employee health benefit plans by enrollment;
(3) any of the largest three national FEHBP [Federal Employee Health Benefit Plan] plan options by enrollment; or
(4) the largest insured commercial non-Medicaid Health Maintenance Organization (HMO) operating in the State.

Yeah, we weren’t sure where to start either.  There’s no centralized federal repository of health plan data, since states regulate health insurance.  Every state publishes plan information online differently, or not at all.  We’ll probably have to submit a special data request to each of the 50 state insurance departments.

What benefits does each plan offer?  Once advocates identify the largest plans, the next step is to determine exactly what benefits they offer.  You can bet that Blue Cross doesn’t publish on their website a description of each of their hundreds of plans offered in a state.  We’ll might have to ask companies directly for plan descriptions, or pour through regulatory filings at state insurance departments.

Once we have this information, we can start to figure out what the plans will look like for people with HIV.  Of course, we’ll partner with national and state advocates to gather and analyze information.  At the state level, it’s more essential than ever that advocates work together to figure out the benefit puzzle and don’t duplicate effort.

And here’s an idea:  Could advocates, employers and insurance companies collaborate to gather all this information?  Sure, old adversaries would have to sit at the same conference table to share opinions and information – but that might be just “what the doctor ordered” in the new world of health care.

Read the federal fact sheet
Read the HHS Essential Health Benefits Bulletin
Federal white paper on benefits in small group and state and federal plans
Federal fact sheet on individual market benefits

John Peller, VP of Policy
AIDS Foundation of Chicago
jpeller@aidschicago.org

Originally posted here on HIVHealthReform.org 

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;
• A Medicaid demonstration, which will allow bundled payments for medical care that include hospitalizations, as well as extending the Medicaid Accountable Care Organizations savings to pediatric providers within those organizations; 
• A new annual tax on pharmaceutical companies; and
• On October 2012, Medicare payments for hospital readmissions will be reduced, to offset excessive readmissions to hospitals, such as early discharges from a hospital, which could result in a return visit.
   

What will undoubtedly become the biggest news of 2012 will be the Supreme Court case on the constitutionality of the ACA, beginning on March 26, 2011. Due to the number of different arguments against the ACA – ranging from the validity of the individual mandate to the constitutionality of the Medicaid expansion - the outcome of the case could take many different forms, from keeping the law in its entirely, striking down the whole law or portions of the law. The decision is expected in June 2012.

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! 

Ensuring Young Adults’ Coverage Now Saves Us All Money Down the Line

Because of the Affordable Care Act, millions of Americans now have access to affordable health care and millions more will soon have coverage, as well. One group of Americans that is especially benefiting from our new law is young adults.

According to the Obama administration, 2.5 million previously uninsured young adults ages 19 through 25 are now covered. The majority of those who have recently gained coverage took advantage of a provision in the Affordable Care Act that allows young adults to stay on their parents’ plan until age 26.

Historically, young adults have been the age group most likely to go without health insurance. Almost 28 percent of 18- to 25-year-olds were uninsured in 2010 compared to only 9.8 percent of children under 18 years of age and 20.5 percent of 26- to 64-year-olds. For young adults, the recession hit particularly hard.

In fact, many recent college graduates had a hard time finding a job with health insurance, or finding a job at all. As a result, even more young adults went without health coverage.

Thanks to the health reform law, young adults no longer have to take this gamble. And, millions of parents have peace of mind, knowing that their young adult children will get good, affordable health care when they need it. For millions of parents around the country, this provides a huge sigh of relief:

They don’t have to worry about going bankrupt if disaster strikes and their child winds up in the emergency room with piles and piles of costly medical bills.

Insuring young adults is not only good for parents and kids; it’s good for us all. Because young adults are typically healthier and are less likely to need expensive medical services, their presence in the insurance pool means that costs for everyone are lower.

Without health reform, millions of young adults would be uninsured once they left college or even high school and the costs of their health care would ultimately be paid for by the insured when they eventually do seek medical attention.

Ensuring young adults are covered now saves us all money down the line and gives parents and their kids the peace of mind that they’ll have coverage they can count on when they need it the most.

By Ron Pollack
Originally posted here on the Health Insurance Resource Center
Ron Pollack is the Founding Executive Director of Families USA, the national organization working to achieve high-quality, affordable health coverage for everyone in the U.S. The Hill, a weekly newspaper covering Congress, named Mr. Pollack one of the nine top nonprofit lobbyists. Modern Healthcare named him one of the 100 Most Powerful People in Health Care.