What Could Be More Important than October 1, Right?

Written by Ryan Singleton    October 1, 2013—the date’s been circled on our calendars for months. We’ve talked about it inpodcasts and spilled ink over it on our blog. October 1, 2013, is opening day for health insurance marketplaces, which are online destinations that will allow consumers to shop for and compare insurance under our reformed health care system.Sounds great, right? Of course, it does! It brings choices to consumers and theoretically gives more people access to affordable, quality health insurance. For years, the AIDS Foundation of Chicago (AFC) has been advocating for a more just health care system for people living with HIV/AIDS – and anyone in need of health care – and this is a gigantic step forward. Perhaps that’s why there’s so much frustration. October 1 is less than two weeks away, and most states—including Illinois—still haven’t launched their marketplaces or finished training in-person counselors, who are people designated to help individuals navigate insurance options online. To gain a nuanced perspective on the coming marketplaces, Inside Story sat down with John Bouman, president of the Sargent Shriver National Center on Poverty Law, a national organization that advances laws and policies that secure justice to improve the lives and opportunities of people living in poverty. Inside Story: A lot of people contact AFC about Illinois’ insurance marketplace, asking, “When will the site go live? Where can I find the web address?” The only answer we have is, “We don’t know,” which leaves people frustrated. Many know that marketplaces can’t sell insurance until October 1, but they still want to see the site in order to formulate questions for in-person counselors and to have reassurance that they’ll have health insurance in 2014. John Bouman: We have to keep the national picture in mind. People will want to use the frustrations and advocacy around the implementation to fuel the effort to de-fund and undo the whole ACA. We have to be careful that our legitimate advocacy around implementation issues is not used for that purpose. This means strong advocacy with the system but careful handling of the big public message—don't forget the thousands who do enroll and don't have problems. IS: What happens if October 1 comes and goes, and our marketplace system isn’t functioning smoothly or even worse, isn’t live yet? JB: October 1 is the opening date for enrollment. Coverage doesn't start until January 1, and people can enroll until March 31 and still be covered in 2014. So, the long-awaited October 1 live date for the website and enrollment is not paramount. January is. In the interest of paying attention to my previous point, we can have some patience with the start-up delays and inevitable glitches, mistakes, and other issues. Moreover, we have to contribute to an over-arching message that implementing something of this size inevitably has some start-up problems. This is normal stuff, and we're working on it. But it does not mean that the underlying policies are wrong or not worth their funding. Illinois authorities have also done their best to plan ahead, but more importantly they have been paying close attention to feedback from communities and acting quickly to correct mistakes or unanticipated issues. IS: Is there anything we, as general consumers, can do to make sure health care reform can make the greatest, positive impact? JB: Yes, for sure, we have to push hard to identify all the problems in this new system, so that we can pressure the state to fix them. If somebody discovers an issue, please contact Molly McAndrew, Program Manager for AFC's In-Person Counselor Program, at MMcAndrew@aidschicago.org. Courtesy of AIDS Foundation of Chicago. John Bouman, president of the Shriver Center, is widely recognized as one of the most effective and thoughtful public-benefit advocates in the country. He was a leader in the design and implementation of positive aspects of Illinois’ new welfare law in 1997, and he spearheaded the statewide efforts in Illinois to create both the FamilyCare program, which provides health care insurance for up to up to 400,000 working poor parents of minor children, and All Kids, the first state plan to extend health coverage to every child. Click here to read his full bio.

CBHC Reaction to U.S. Census Bureau 2012 Health Insurance Status Data

September 17, 2013

 

 

Statement by Jim Duffett, Executive Director, Campaign for Better Health Care, on U.S. Census Bureau 2012 Health Insurance Status Data

 

This morning, the U. S. Census Bureau announced findings from the official report on income, poverty and health insurance coverage for the nation.  The news, as expected, was not great.  There are still too many Americans who do not have the peace of mind that comes from knowing that they and their families will be able to obtain quality, affordable health care when they need it. 

The good news is that thanks to the Affordable Care Act, this is the last year in the history of our nation we will ever see such high numbers of uninsured Americans. Starting with next year's report, these numbers will shrink by tens of millions as more Americans are covered because of all the different consumer protections and eligibility expansions contained in Obamacare. 

The numbers will get smaller as more young adults stay covered on their parents' insurance plans through age 26, protecting them through the  period of time between graduating college and finding work in a challenging job market.  More Americans will be insurable despite their pre-existing conditions.  And as more small businesses qualify for tax credits that allow them to offer health insurance coverage to their employees, yes - those numbers will keep going down.

Millions of Americans who will find coverage through the new Marketplace will know it is they that are in charge of their health care, not the insurance industry.  Millions of Americans will know peace of mind, the power of choice, personal responsibility, and fairness; all the values that we attach to health care will finally be realized.  Those are the numbers that we look forward to seeing increase over the next few years, thanks to Obamacare.

 

# # #

 

About Campaign for Better Health Care

We believe that accessible, affordable, quality health care is a basic human right for all people.  The Campaign for Better Health Care is the state's largest coalition representing over 300 diverse organizations, organizing to help create and advocate for an accessible, quality health care system for all.  For more information, visit  www.cbhconline.org.

The federal government pays what? Tax credits and cost-sharing subsidies under the ACA.

Approaching the new changes associated with the Affordable Care Act (ACA) as a consumer can be a daunting task. Understanding what you may qualify for is tough, and where to look for information that makes sense is not easy either. Two concepts designed to make health insurance affordable under the ACA, Advanced Premium Tax Credits (APTCs) and Cost Sharing Reductions (CSRs), will be explained below.

Both are only available to individuals enrolled in a Qualified Health Plan (QHP). Qualified Health Plans are private (not Medicaid or Medicare) health insurance policies purchased through the new health marketplace (where you can compare and purchase health insurance policies) that provide “essential” health benefits. APTCs and CSRs are not available to those who have or are eligible for employer based coverage that is affordable (annual premium is less than 9.5% of employees income).

      Advanced Premium Tax Credits

So what is an APTC?

To understand what an Advanced Premium Tax Credit is, it helps to be broken down into its parts. A tax credit is money that tax payers (that are purchasing Qualified Health Plans through the marketplace) can get back, much like a tax return. However, the credit is for your premium. Your premium is the money paid each month for a health insurance policy. 

The word “advanced” refers to when someone can get this tax credit. The federal government pays money directly to the insurance company (in advance) in order to reduce a person’s premium every month. As an alternative option, a person can pay the full premium and get the tax credit back at tax time. If a consumer is overpaid or underpaid for his/her APTC, it will be addressed when the consumer files taxes. This is known as reconciliation. If a consumer gets a pay raise, then s/he will be responsible for paying the federal government back for the initial overpayment of the APTC should they fail to report a change in income. When the consumer reports the income change, the APTC will be adjusted accordingly. This tax credit is intended to pay for premiums only.

In short, an APTC is money that a health insurance marketplace consumer (or the consumer’s insurance company) receives from the government to help pay the monthly cost (premiums) of having health insurance.

Who qualifies for an APTC?

People buying QHPs through the Illinois Health Insurance Marketplace who have income between 100-400% of the federal poverty level qualify for APTCs, as long as they plan to file a tax return and are not eligible to be claimed as a dependent ($45,960 is 400% of the federal poverty level for a single adult). So, if you are making less and purchase a QHP, you should qualify for an Advanced Premium Tax Credit. To find out how much and if you qualify, check out the Kaiser Family Foundation Subsidy Calculator.

     

      Cost Sharing Reductions

What is a Cost Sharing Reduction (CSR)?

A Cost Sharing Reduction is a subsidy (money paid by the government) to reduce cost sharing. Cost sharing can be understood as the costs a consumer pays out of pocket on services covered by health insurance. Money is paid by the federal government to the consumer’s insurance company to ensure deductibles, copayments, and coinsurance cost less. 

In summary, a CSR makes out of pocket costs lower because the government pays a portion of those costs by giving money to your insurance company.

Who qualifies for a Cost Sharing Reduction (CSR)?

Consumers must have an income below 250% of the federal poverty level, or $28,725. The consumer also must choose a Silver Plan (insurance company pays 70% of essential health benefits), and qualify for an APTC (see above). See here for information on Health Plan Categories & Essential Health Benefits.

So, what is the big difference between APTC and CSR?

Besides the differences in eligibility for these two forms of financial help on the Marketplace, there is one other main difference: a consumer will not have to pay back a CSR even if his/her income increases. An APTC, however, will be decreased if a consumer’s income goes up. So, if a consumer does not report the income change to the Marketplace, then s/he will be required to pay back the amount that was overpaid (as part of an APTC) during tax time.

Emily Gelber, MSW, LSW

Health & Disability Advocates

For more information:

State Health ReformAssistance Network Charting the Road to Coverage

Kaiser FamilyFoundation Subsidy Calculator

Healthcare.gov Glossaryof Terms

Empowering Illinoisans: What’s "in it for them” in Health Care Reform

With the planned opening of the Illinois Health Insurance Marketplace now less than a month away, more people across Illinois are starting to sit up and take notice. While there’s been plenty of discussion about health care reform leading up to this; too many people remain unaware of this new law and the benefits it may offer to them and their families.

The Affordable Care Act or as some simply say “Obamacare” – means that millions more Americans will now have greater access to affordable health insurance coverage Expanding access to care and improving health care quality are undoubtedly good things. But, let’s face it; health insurance can be confusing!

The first step is to help people understand what the new law has to offer in simple and understandable ways. And the second step is to encourage them to take action by enrolling in a health insurance plan that meets their needs.

Successfully accomplishing these two steps will take a concerted and coordinated effort among the State of Illinois and the many other groups who share the goal of successfully implementing the Affordable Care Act in Illinois. Many organizations, including the many involved in Illinois Health Matters, have been committed to outreach and education for several years. And the State of Illinois is now in the process of launching its widespread community outreach and education campaign.

We at Blue Cross and Blue Shield of Illinois also wanted to contribute to Illinois’ public education effort about the new health care reform law. That’s why we launched the Be Covered Illinois outreach and education campaign back in April. Be Covered Illinois is an unbranded grass roots campaign that works with and through a diverse coalition of partners. Today we have 42 community partners across the State and the list is growing daily. Be Covered Illinois community partners know their neighborhoods, the people, the issues important to them and are the most trusted and credible messengers able to communicate most effectively.

What Be Covered Illinois does is support its partners by providing easy to understand information about the Affordable Care Act through multiple distribution channels, including: 

• Personal outreach where trained Be Covered Illinois speakers can explain the changes under health reform to groups;
• Representatives at community parades and festivals passing out information that people can take home and look over. 
• Examples of currently available “consumer-friendly” Be Covered Illinois printed materials in both English and Spanish include fact sheets, brochures, key dates and a glossary of insurance terms that many folks may be unfamiliar with. And as we learn the questions that people have, we continue to produce new materials to answer them. 

To be clear, Be Covered Illinois materials are not Blue Cross branded product marketing, but rather an unbranded campaign to educate people about ACA and encourage them to enroll in the Health Insurance Marketplace.

Be Covered Illinois information can also be accessed through a bi-lingual informational website (www.BeCoveredIllinois.Org), a mobile texting campaign (JoinIL to 33633) where folks can sign up to receive information and updates via their cell phones, or on Facebook and Twitter. Be Covered Illinois even has a toll free helpline number (1-888-809-2796) that people can call to speak with trained health reform experts to answer any and all questions.

In our shared commitment to partner with the State, Illinois Health Matters and the other Illinois education and outreach to broaden awareness during this time of historic health care reform, we invite you to review and access the Be Covered Illinois materials that we currently offer our community partners by visiting www.BeCoveredIllinois.Org. Or better yet, we invite you and your organization to sign up to become a Be Covered partner. As a partner, we will keep you abreast of the latest available materials, provide you with quantities of print copies of materials and work with you to plan an effective education campaign tailored to your organization’s needs to ensure your constituents take action before the end of open enrollment!

I also want to let you know that Be Covered Illinois will be hosting a community Care Fair with our partner organizations on Sunday, October 6th, so mark your calendars now. The event will be held at Chicago Indoor Sports, at 3900 S. Ashland Ave., from 11:00am to 5:00pm and offer fun family activities, a kids’ zone, free health screenings and flu shots, offer help in understanding the new health care law, as well as direct folks to Illinois Navigators and In-Person counselors who can assist them, some of which we expect to be in attendance. Attendees can even leave with a free bag of healthy groceries! Be sure to join us for a fun and informative Sunday afternoon and let your community members know about it.

Information is power, and we want to work with you to empower as many Illinoisans as we can!

Donna Gerber

Chair, Be Covered Illinois Campaign
Vice President, Community Investments
Blue Cross and Blue Shield of Illinois

Clearing Up Confusion About Health Reform’s Out-of-Pocket Protections

Recent media coverage may have sown confusion about health reform’s requirement that health insurance plans cap how much consumers can pay out-of-pocket each year for medical care. The bottom line: for many plans, the protections will take effect as scheduled in 2014. Some plans will be able to wait an extra year to fully comply.

The health reform law requires that, starting next year, private insurance plans limit how much in cost-sharing charges — deductibles, copayments, and coinsurance — that people enrolled in a plan must pay each year for covered benefits provided by the plan’s network of health care providers. (This includes plans offered in the individual market or through employers. The requirement doesn’t apply to “grandfathered” plans.) In 2014, this “maximum out-of-pocket limit” will be $6,350 for an individual and $12,700 for a family.

Back in February, the Obama Administration provided an additional year to fully comply with this requirement but only for certain plans offered by employers.

Here are some clarifications about the February policy:

Health insurance plans in the individual market: In 2014, the maximum out-of-pocket limit will apply, as scheduled, to the individual (non-group) health insurance market. Millions of people are expected to gain coverage in this market in 2014, as health reform’s new improvements and federal subsidies significantly increase access to affordable coverage.

Employer-sponsored health insurance plans: The maximum out-of-pocket limit will also continue to generally apply to non-grandfathered plans offered by employers, including small group, large group, and self-insured plans. Employer plans that have a single insurer or administrator have to fully comply with the limit next year.

Employer plans that have “separately administered” benefits: The Administration provided the exception in February for these plans, in which an employer has one insurer or administrator for its primary package of health benefits and a different insurer or administrator for discrete benefits, such as prescription drugs. Because employers and insurers have claimed it will be difficult to coordinate an overall maximum out-of-pocket limit across separately administered benefits, they sought and received the ability to avoid full compliance for one year.

Even those employer plans with “separately administered” benefits that qualify for the delay still must apply some out-of-pocket limits in 2014. As the February guidance explained, these plans must ensure that their primary package of health benefits has an out-of-pocket limit of no more than $6,350 for individuals and $12,700 for families. A separately administered benefit, such as prescription drugs, that already has an existing limit on out-of-pocket costs must comply with the limits of $6,350 for individuals and $12,700 for families in 2014.

An employer plan wouldn’t have to add a cap to a separate benefit if the separate benefit currently lacks one. But this exception shouldn’t be misunderstood as broadly waiving the important out-of-pocket protection that health reform will bring in 2014.

Sarah Lueck
Center on Budget and Policy Priorities

(This was originally posted here on the Off the Charts Blog)

Faith Leaders Leading the Way on ACA Outreach

CBHC's Faith Caucus is taking a lead role in our efforts to promote enrollment in Illinois' new Health Insurance Marketplace, and a crucial partner in spreading the positive word on health care reform. We are so pleased that the role of our faith leaders in outreach around the Affordable Care Act was important enough to have an AP story! 

Faith leaders emerge as key to health law outreach

CHICAGO — Religion and the nation's new health law haven't exactly been viewed as friendly partners in the public eye, with most of the attention focused on religious employers' objections to covering the cost of birth control.

But under the radar, leaders in some Illinois faith communities are spreading the word about the Affordable Care Act to make sure their uninsured members know about new benefits available starting in 2014 and about the approaching enrollment start date.

Read more here: http://www.bnd.com/2013/08/09/2736052/faith-leaders-emerge-as-key-to.html#storylink=cpy

For the full story, please visit http://www.bnd.com/2013/08/09/2736052/faith-leaders-emerge-as-key-to.html.

Thanks to Rev. Carole Hoke, Rev. Dr. Shirley Fleming, and Aida Giachello of the CBHC Faith Caucus, and to Carla Johnson (@CarlaKJohnson) of the AP for the story.

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