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!

Critics are Raving about Escape Fire

The documentary film, Escape Fire:The Fight to Rescue American Healthcare, is opening this weekend in major cities across the US. Right here in Chicago, we are hosting the premiere on Friday, October 5th. Get your tickets before they're gone.

Haven't heard of Escape Fire yet? No worries - you will soon enough.

Here are the basics - it's an award-winning film that won rave reviews at the 2012 Sundance Film Festival. Following dramatic human stories and interviews with health care leaders, it pulls back the curtain on the defects in the American healthcare system and encourages low-cost preventative solutions for fixing the healthcare crisis. Escape Fire is about finding a way out.

In a recent interview with the Washington Post, the director, Matthew Heineman, talks about why he and his co-director Susan Froemke began working on the year three years ago: "Like many Americans, we were confused by everything we were hearing [about healthcare]. It had become such a political football that was being thrown back and forth. Frankly, the issue was dividing our country. We wanted to cut through it all — how our system was broken and why it didn’t want to change."

Here is what some of the movie critics are saying about the film:
 
The Village Voice's Anthony Kaufman says it's "A Must See! 'An Inconvenient Truth' for the healthcare debate."

Famed critic Roger Ebert calls Escape Fire "Extraordinary!" in a very personal blog post that delves into some of the issues the film tackles. In his official review, he gives the film 3.5 out of 4 stars and called the film "Stunning!" In describing America's health care system, Ebert says, "There's more money to be made in making people sick and healing them than in keeping them well in the first place...The documentary makes this argument with stunning clarity."

In the Huffington Post, Wendell Potter says of the film, "If you want to get a clearer understanding not only of why the U.S. health care system fails so many of us but, more importantly, how we can transform it to make it the best in the world, go to the movies this weekend."

Still not convinced? Watch the trailer and decide for yourself!

Stephani Becker
Project Director, Illinois Health Matters
Health & Disability Advocates

Something to Celebrate

What's better than one celebration? Two celebrations. Health & Disability Advocates, the parent organization for Illinois Health Matters, are tossing a party for their 20th anniversary, but they're sharing the stage with the national premiere of a critical documentary on the state of healthcare in America, Escape Fire: The Fight to Rescue American Healthcare. The event is on Friday, Oct. 5th from 5 to 7:30 p.m., at the AMC Loews theater in Chicago, IL. Tickets range from $20 to $120 and can be purchased here.

Most of you know what Health & Disability Advocates does. If you're like me, you've been influenced by their excellent work, directly or indirectly. I've worked with them to spread the word about the Affordable Care Act and about the high-risk pools for pre-existing conditions, helping people with diabetes or cancer or any of dozens of other conditions. Perhaps you've been the beneficiary of legal counselling through the Chicago Medical-Legal Partnership for Children or had a Illinois Warrior to Warrior Volunteer Veteran reach out to you in support. They've touched our lives in so many ways, and I'd like to invite you to come and honor their first 20 years of helping our communities.

Escape Fire, on the other hand, is brand new, and you have a chance to be the first to see this critical look at the American healthcare system. Healthcare policy wonk and recently retired head of Medicare and Medicaid under President Obama, Dr. Don Berwick, famously compared saving our healthcare system to a counterintuitive way to fight a fire, inspiring the name for the movie. Join us as we jump into the fire and see stories that highlight where the problems are and where Health & Disability Advocates are fighting every day to ensure problems like these don't persist.



Get your tickets for next week's event now, and I look forward to seeing you there!

David Zoltan,
Guest Blogger, Illinois Health Matters

More info on the event can be found here.

Community Health Workers in Illinois - What Should Certification Include?

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

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

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

Janna Stansell, MPH*

Health & Medicine Policy Research Group

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

Summaries of Benefits and Coverage: Simplifying Shopping for Health Insurance

As of September 23, the “wild west” of shopping for health insurance coverage has been at least partially tamed, thanks to the Affordable Care Act (ACA). Consumers can now get standardized, simplified summaries of benefits and coverage (SBC) that will help them understand what’s covered by an insurance policy and allow them to make apples-to-apples comparisons among plan options. These summaries are modeled on the labels we use to compare ingredients in our food, and are designed to be easy to read, with medical and insurance terms that are defined in a standard, easy-to-understand way. According to public opinion tracking polls by the Kaiser Family Foundation, this provision is one of the most popular provisions in the ACA.

For me, these forms are the culmination of hundreds of hours of effort as part of a statutory working group tasked with developing the templates for these forms. Put together by the National Association of Insurance Commissioners (NAIC), the working group represented state insurance regulators, consumers, insurance companies, health care providers and insurance brokers. We spent over a year working through the content and format of the form, and the Obama Administration adopted our recommendations with very few changes.

The U.S. Department of Health and Human Services (HHS) notes the following important details about the SBC:

• The provision applies to ALL health plans, whether you get coverage through your employer or purchase it directly, starting September 23, 2012.
• Insurers need to provide the SBC to consumers at the time they apply for coverage, and to enrollees upon renewal.
• The form includes coverage scenarios for two common situations: normal delivery of a baby and treating type 2 diabetes. These scenarios can give interested consumers an approximate picture of their future out of pocket costs under the policy.
• Non-English speakers can request the SBC in their native language – insurers are required to translate the form into common languages such as Spanish and, in some states, Chinese, Tagalog and Navajo.

Consumers’ Union has provided a very helpful “explainer” on the SBC, you can check it out here. Going forward, it will be interesting to see how accessible the forms truly are for consumers, and whether and how consumers use them to shop for insurance. I’m hopeful these forms can help empower consumers with better information so they can make better decisions about what coverage is best for themselves and their families.

For information on developments like this—and much more—be sure to check in with CHIRblog‘s series on “Implementing the ACA.” 

Sabrina Corlette
Georgetown University Center on Health Insurance Reforms

(This blog was originally posted on the Center on Health Insurance Reforms blog site here )

HIV/AIDS Coverage and Care: Before, During, and After ACA Implementation

The Affordable Care Act, passed in 2010, is expected to expand insurance coverage and care for millions of people in the U.S., including people living with HIV. The provisions of the ACA will dramatically impact access to care, specifically antiretroviral therapy (ART), which is critical for the health of people with HIV.

Traditionally, there have been numerous sources of insurance coverage for people living with HIV. Most notably are public programs, such as Medicaid and Medicare, and the Ryan White HIV/AIDS program. Currently, Medicaid is estimated to cover the largest share of people with HIV and a significant portion of people with HIV rely primarily on Ryan White, operating as the “payer of last resort” for people with HIV who are uninsured or underinsured.

Prior to the implementation of the ACA, people living with HIV were more often than not, shut out of the individual market due to the fact that insurers consider HIV an uninsurable, pre-existing, condition. Medicaid, Medicare and public programs were therefore, important pathways for people living with HIV to receive coverage. However, prior to the ACA, federal law excluded non-disabled adults without dependent children from Medicaid, presenting a catch-22 for many low-income people with HIV who could not qualify UNTILL they were disabled even though Medicaid covers medications that delay and hinder the development of HIV-related disability. Ryan White has often supplemented these other forms of coverage, providing additional services where needed.

The ACA is currently in a transition period until its full effect date of 2014. Until then, the ACA has established a temporary program in which every state allows people with pre-existing medical conditions, such as HIV, to purchase coverage through a Pre-Existing Condition Insurance Plan (PCIP). The transitional ACA plan also prohibits individual and group plans from placing lifetime limits on coverage, preventing people will expensive illnesses, like HIV, from exhausting their coverage. 

Additionally, a new state Medicaid option was developed to cover childless adults with incomes up to 138% of the federal poverty level (FPL), however, limits to coverage or continued ineligibility result in the continued use of the Ryan White program. 

The full extent of ACA’s coverage expansions will go into effect in 2014. With this full implementation, insurers will no longer be able to deny coverage to people with pre-existing conditions, and with this, the temporary Pre-Existing Condition Insurance Plan will no longer be needed. Annual limits on coverage will also be prohibited and health insurers will be required to guarantee issue and renew health insurance regardless of health status. Individuals will be able to purchase coverage through state-based “health insurance exchanges”, and people without access to employer-sponsored coverage will be eligible for subsidies to purchase coverage within the exchange.

Finally, the ACA also establishes a new Medicaid eligibility category for people with incomes up to 138% FPL, thus removing categorical eligibility requirement that have often limited people with HIV in the past.

The ACA has increased and improved access to care for people living with HIV and following its full implementation in 2014, it is expected to further expand and enhance access.


*To read Kaiser Family Foundation’s full take on the issue, please see the article
How the ACA Changes Pathways to Insurance Coverage for People with HIV

*To get access to more articles, fact sheets and blog posts on the issue, check out http://www.hivhealthreform.org/

The University of Chicago Medicine is Implementing Health Care Reform

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

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

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

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

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

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

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

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

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

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

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