New Study Builds Case for Expanding Medicaid

A new study in the New England Journal of Medicine confirms what consumer health advocates have known for decades: Medicaid is essential for keeping low-income households on stable financial footing. This should come as no surprise, since protecting families from unexpected and devastating medical costs is exactly what health insurance is meant to do. The study also proves that Medicaid coverage significantly improves beneficiaries’ mental health.

But opponents of Medicaid have distorted the study’s results; they claim it supports their agenda to block millions of low-income, uninsured families from accessing this vital coverage program. Their arguments are misinformed at best. The new study only strengthens the case for expanding Medicaid.

What the study tells us: Medicaid Works!

The researchers looked at the health and finances of low-income, uninsured Oregon residents who were given the opportunity to enroll in Medicaid through a one-time lottery, and compared it to their peers who remained uninsured.

The study shows that Medicaid virtually eliminated all catastrophic medical expenditures (medical expenses exceeding 30 percent of household income) for its beneficiaries. It also indicates that people with Medicaid coverage are significantly less likely to face any medical debt, borrow money to pay bills, or skip payments.

These results are extremely promising, especially in light of the fact that medical bills currently prompt more than 60 percent of U.S. bankruptcies. If we want to reduce the drag bankruptcies create on our economy and the ruin they leave behind in our communities, providing low-income families with Medicaid coverage is a good place to start.

The study also found that Medicaid is a powerful tool in combating mental illness. Medicaid beneficiaries in the study were 30 percent less likely to suffer from depression than those who remained uninsured. Given that suicide takes more lives in the US than any other form of injury and that depression accounts for more than $83 billion in the US between lost productivity and medical expenses, the impact of Medicaid on depression deserves attention and celebration.

File Under: Non sequitur

Instead of celebrating, opponents of Medicaid are arguing this study makes the case for withholding Medicaid coverage from millions of low-income, uninsured families. They base this on the study’s failure to detect statistically significant improvements in a handful chronic disease measures — blood pressure, cholesterol, or hemoglobin levels — in those with Medicaid compared to those without coverage.

That’s like saying because your blood pressure didn’t go down, we are going to prevent you from getting coverage for cancer treatment or a pap smear.

It’s certainly true that the U.S. health care system needs to be better at managing chronic conditions. We routinely lag behind other industrialized nations on measures of chronic care management, such as following medical guidelines for treating hypertension and diabetes. Plus, this study only looks at the impact of two years of coverage; significant improvements in these persistent chronic illnesses may take much longer to materialize.

This is hardly a reason to block millions of low-income families from gaining health coverage they need and deserve. We have no evidence that people with private insurance or Medicare fare any better than Medicaid beneficiaries on these measures, yet no one is suggesting we should all drop our health insurance.

Getting people covered is the first step in creating an effective health care system that works for everyone, but it is not the only step. The ACA contains numerous initiatives to improve the quality of health care.

File under: extremely relevant

Meanwhile, dozens of states are still trying to decide whether or not to take up the option to extend Medicaid coverage to millions of low-income, uninsured adults. This study confirms Medicaid can give beneficiaries peace of mind that they won’t go bankrupt when they experience that unexpected illness, and make staggering improvements in their mental health. It adds to the growing list of reasons why this decision should be a no-brainer for all 50 states.

Katherine Howitt, Senior Policy Analyst
Community Catalyst

(This blog was first published on the Community Catalyst Blog)

Young People Get Covered in Big Numbers

Today, the Commonwealth Fund released the findings of its Biennial Health Insurance Survey, showing that a skyrocketing number of young people have gained insurance since the health care reform passed.

While it is clear that 2014 coverage options will be crucial – there are still high numbers of the population who were either uninsured, underinsured, or unprotected from high out-of-pocket costs – young people have already begun to see new reform benefits due to the earlier implementation of the dependent coverage provision.  Specifically, the report stated that:

• Approximately 3.4 million young adults have gained coverage since the dependent coverage provision took effect.
• About 79 percent of 19 to 25 year-olds were insured at the time of the survey, up from 69 percent in 2010.
• The number of people saying they had trouble with medical bills or debt climbed in the past decade, yet stayed statistically the same from 2010 to 2012.  According to Commonwealth, this is likely due to the increased coverage of young adults, since other age cohorts saw either no improvement or deterioration in coverage.

In other words, the ACA’s dependent coverage provision has increased coverage and saved young people from medical bills and medical debt.

The better news? The best is yet to come.  Over half of the potential new Medicaid enrollees are under the age of 35, and millions more will have access to subsidies on new health care marketplaces.  This survey makes clear: when offered good options, young people enroll in insurance.  And the ACA has some really great options coming down the pike.

Jen Mishory
Young Invincibles

(This post was first published on the Young Invincibles Blog here)
http://younginvincibles.org/2013/04/young-people-get-covered-in-big-numbers/

Funding Opportunity Announced for Illinois In-Person Counselors

Beginning October 1, 2013, the Illinois Health Insurance Marketplace will open for enrollment. Pursuant to the Affordable Care Act, the Marketplace will be a website where those seeking insurance coverage can shop for health care and determine if they are eligible for financial assistance with premiums and health costs. In Illinois, we are estimating that more than half of our Health Insurance Marketplace customers will want help enrolling in the program.

In order to meet their needs, Governor Pat Quinn and the Illinois Health Insurance Marketplace established the In-Person Counselor program (IPC). IPCs 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. IPCs will be instrumental in the Marketplace’s plan to create a statewide “Culture of Coverage” by engaging, educating, and enrolling the uninsured in Illinois in qualified health plans.

Today, the Illinois Health Insurance Marketplace is very excited to announce the release of the grant application for the In-Person Counselor program.

The Illinois Health Insurance Marketplace, in coordination with the Illinois Department of Public Health, will be accepting applications through the end of May 2013 from community groups and other qualified organizations who want to participate in the IPC program. The state has designated approximately $28 million in federal funds for grants to participating groups. Organizations that are selected through the online application process will participate in a training and certification process this summer.

For more information about the application process for the Illinois IPC Grant Program, go to: http://www2.illinois.gov/gov/healthcarereform/Pages/IPC.aspx.

Additionally, the Illinois Health Insurance Marketplace will also conduct an informational webinar on Thursday, May 9 at 10:00 AM. Interested groups can register for the webinar by going to https://www305.livemeeting.com/lrs/8002054163/Registration.aspx?PageName=hfhrvf978qb8w95p.

Thank you,

Brian Gorman

Director of Outreach and Consumer Education
Illinois Health Insurance Marketplace

A Simpler Way to Apply for Health Care

By Kathleen Sebelius, Secretary of Health and Human Services
Posted April 30, 2013

Today, we take one more step toward meeting the promise of helping millions of Americans access quality, affordable health coverage.

We have finalized the application you can complete later this year to learn what health insurance programs you are eligible for and the discounts to help pay for it. Starting in October, it will be the one application you can use to apply for the new Health Insurance Marketplace, Medicaid, the Children’s Health Insurance Program, and tax credits that will help pay for premiums.

I’m also pleased to say the application has been simplified and significantly shortened. The application for individuals is three pages, and the application for families is reduced by two-thirds, to seven pages. This is much shorter than industry standards for health insurance applications today.

Whether you choose to use this application to apply for coverage online, by phone, or on paper, the Health Insurance Marketplace will give you better options than they have today – with one destination to apply and many resources to get help. In-person counselors and a toll free phone line will be available to help you through every step of the process.

The online application that will go live on Healthcare.gov when the Health Insurance Marketplace opens for enrollment on October 1, can be found here: http://cciio.cms.gov/resources/other/index.html#hie

You can sign up to learn more and get ready to enroll at signup.healthcare.gov.

(This post was originally on the healthcare.gov blog here).

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.

The “Rate Shock” Myth

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)

The “Culture of Coverage:” How Illinois is making the Health Insurance Marketplace Work

On March 29th, Illinois submitted an outreach and enrollment plan to the federal government, a requirement for all states participating in a state-federal partnership health insurance exchange. In the proposal, the marketplace team explains that they plan to treat outreach and enrollment like a political campaign, working not to elect a candidate but instead to introduce a new “health culture” to Illinoisans who have traditionally been excluded from coverage. The campaign will launch full-force in July in order to address skepticism and the general lack of awareness around the Affordable Care Act before enrollment begins on October 1st of this year.

Campaign values:
Illinois faces a variety of challenges, including limited English proficiency and low literacy rates, which make the task of reaching and enrolling certain populations of residents difficult. 78% of uninsured adults and 83% of the Medicaid population are unaware of insurance options under the ACA. To insure that Illinois is successful in promoting awareness of the Affordable Care Act, the marketplace team’s work will be guided by the following principles:

1. Promotion of a State-wide Culture of Coverage; 
2. Empowerment of Community-Based Organizations and Stakeholders; 
3. Metric-Focused Encouragement of Enrollment; 
4. Promote Health Care as a Value; and 
5. Build a Strong and Trusted Reputation Among All Residents. 

Campaign strategy:
Based on the assumption that many Illinoisans aren’t aware of their options, the marketplace team will hire a professional marketing firm by the end of May. This firm will work to create a cohesive brand that speaks to target populations while establishing the Illinois marketplace as a trusted entity and something that residents will want to participate in. This media campaign will consist of television, print, outdoor, direct mail, online, and social media advertising.

The field program:
While the exchange branding is no doubt important, the marketplace team recognizes that empowering community partners to assist in the outreach and enrollment process may be the most effective way to achieve a “culture of coverage,” as these community partners are already known and trusted entities. This collaboration, titled the “field program,” will focus on the “4 E’s:” Engage, Empower, Educate, Enroll.

Staffing structure:  
Illinois will be divided into 8 “Outreach Regions,” which will be constructed geographically and by information around where the uninsured in Illinois reside. Each region will be headed by an Outreach Coordinator, who will report to the Director of Outreach & Consumer Education.

In order to assist with enrollment, three categories of assisters will be established. Similar training must be undergone in order to qualify for each category. The assister categories are as follows: 

1. Navigators: part of a federally-run assistance program 
2. In-Person Counselors: a state program that will coordinate with Regional Outreach Coordinators. Selected entities are expected to spend one year as assisters. 
3. Certified Application Counselors: Additional national funding for individuals who aren’t funded through grant money.

It’s coming…
The marketplace team is already working hard to make sure the health insurance marketplace works in Illinois. In the meantime, click here to check out the full Illinois Health Insurance Marketplace Outreach & Education Plan!

Kathryn Bailey
Health & Disability Advocates