Getting Ready for The Affordable Care Act

Understanding the ways in which the Affordable Care Act (ACA) will affect small organizations and change the shape of the health care market isn't easy, especially with the large amount of misinformation that has been spread about the law. To help make the picture clearer, Donors Forum’s Chicago Grantmakers for Effective Organizations hosted a session on Small Organizations in the Wake of the Affordable Care Act.

Stephanie Altman, Health and Disabilities Advocates, Kathy Chan, EverThrive Illinois, and Judith Haasis, Community Health, provided detailed information about what organizations can expect in the new environment and how the coming changes will affect them as individuals and employers.

Two key things nonprofit employers need to know about the ACA:

• Organizations with fewer than 50 full-time equivalent employees are not required by the law to provide insurance for their employees
• ACA provides an increased range of options for insuring employees.

The Small Business Health Options Program, or SHOP, can be accessed through healthcare.gov, and it can connect businesses with fewer than 50 employees to insurance options that might work for them.

Smaller nonprofits can also benefit from available tax credits. Organizations with fewer than 25 employees and annual average wages of less than $50,000 that pay more than 50 percent of the cost of health insurance premiums for their employees, may be eligible for a tax credit equal to 35 percent of their expenses. Organizations must obtain insurance through the SHOP marketplace to get the credit.

The many variables affecting an organization's health insurance decisions are best served by working with an expert. Navigators or assistors have been trained to work with small businesses and individuals to help them connect to benefits for which they might be eligible.

Businesses and individuals can also work with brokers, who can tailor recommendations to them in ways navigators cannot. Brokers are paid by insurance companies, so they will not add to an organization's expenses, and they can help businesses find plans that work for them.

It is important to note that navigators and brokers are prohibited from charging for their services.

The Individual Market

Along with providing possible subsidies for small businesses, the ACA makes significant changes to the insurance market for individuals. Changes from the ACA can be generally grouped into two areas:

• Changes that affect the quality of insurance policies
• Changes that provide more access to health insurance

Some of the provisions in the former category have already taken effect, like the provision stating dependents can remain on an insurance policy until they are 26 and the removal of lifetime limits on benefit amounts. Many major provisions, including the health insurance marketplace, are now starting up, with the marketplace accepting applications in anticipation of a launch in January 2014.

Other provisions will take effect at the beginning of 2014. They will describe a basic level of health insurance that all people should be able to access. There will be far fewer variables insurers can use to adjust premiums. Factors that were used in the past, such as gender or pre-existing health factors, cannot be taken into consideration. The only factors that will affect individual prices are age, geography, and tobacco use.

On the quantity side, the ACA expands Medicaid eligibility in states that opt in to the expansion, including Illinois, while also providing subsidized insurance options through the marketplace for individuals. This presents several possible challenges for organizations.

First, there is already a shortage of Medicaid specialty care providers, and having more individuals using Medicaid could make this shortage more pronounced. For primary care, Medicaid reimbursement rates are being raised to Medicare levels, which should help shortages in that area. Building specialty care capacity will be a challenge.

Another challenge is that as many as 1.5 million state residents will have insurance they didn't have before, and many of them are not familiar with the best ways to make use of access to preventative care. Helping people use their new resources to best improve their health will be important.

While ACA implementation is expected to significantly lower the numbers of uninsured in Illinois, undocumented immigrants are not covered by the ACA.Organizations committed to providing health care to uninsured, low-income individuals will still be needed. They must figure out how to adapt, including whether they should introduce new revenue streams by doing things such as taking in Medicaid patients.

The new environment presented by the ACA will be challenging, but it also presents opportunities for organizations and funders to enhance the health of people throughout the region as they work together.

Resources for individuals and organizations:

Illinois Health Marketplace (www.getcoveredillinois.gov)

How will the ACA impact nonprofit employers?

Employer Responsibility Under the ACA

~ Jason Hardy, Member Services Associate, Donors Forum

The ACA and Millennials: Time Will Tell

Recently, the media has delivered polarized opinions regarding how the Affordable Care Act (ACA) affects or will affect young adults. When reading news and op-ed headlines like “Why Obamacare is good for young people” (Klein, 2013) situated next to “Obamacare is really, really bad for you, especially when you are young” (Basu, 2013), it seems that young people should expect to feel lost when approaching such complex legislation. As these headlines demonstrate, the media has misrepresented the ACA as being either fantastic or detrimental for Millennials. Upon further investigation and review, it seems the reality is somewhere in-between “good” and yet to be seen “bad.”

The Good: This is easier to explain, because much of it is based on factors that can be measured or already enacted provisions within the ACA.

• “The percentage of young adults without health insurance has fallen by more than 4 percentage points since 2009, declining from 31.4 percent to 27.2 percent in 2012, or more than 1 million individuals” (Commonwealth Fund, 2013). Additionally, “The law has helped 6.6 million young adults who have been able to stay on their parents’ plans until the age of 26, including 3.1 million young people who are [now] newly insured” (Office of the Press Secretary, 2012). This provision prevents young adults from aging out of insurance coverage as they graduate from high school or college and has reduced the percent of young adults without insurance.
• There is always the option to opt out of ACA coverage and pay a penalty. This allows individuals to exercise their freedom and not buy coverage if it proves financially challenging or if their circumstances change. However, it allows people to risk not planning for accidents or unforeseen health needs that may require them to use healthcare services that are unaffordable without insurance. 
• There is more transparency. Under the ACA, insurers have to provide understandable information to consumers. “All consumers, for the first time, will really be able to clearly comprehend the sometimes confusing language insurance plans often use in marketing,” said HHS Secretary Kathleen Sebelius. “This will give [consumers] a new edge in deciding which plan will best suit their needs and those of their families or employees” (Department of Health and Human Services, 2012).
• All FDA approved birth control options are covered without copays, coinsurance, or deductibles (Centers for Medicare and Medicaid Services). This already existing provision immediately removes the barrier of up-front costs allowing for greater consumer choice and access--particularly for health services like birth control that young women are more likely to utilize.
• “Nearly 13 million Americans will receive a rebate this summer because their insurance company spent too much of their premium dollars on administrative costs or CEO bonuses” (Office of the Press Secretary, 2012). This benefit seems fairly obvious as it will allow a large portion of insured Americans to reinvest or reallocate those savings into goods and services they otherwise may not have been able to afford without the rebate (e.g., childcare, energy saving home appliances, or healthy foods/activities).

The Bad: The negative views regarding the ACA are often related to one of two ideas: the “what-ifs” and the “myths.” In this discussion, only the “what-ifs” causing apprehension among readers will be covered. Much of what is presented as “bad” about the ACA is speculative, and has yet to be seen. Prior to condemning or celebrating the law, time should be allowed to observe its enactment.

• 22 states are not expanding Medicaid at this time (Kaiser Family Foundation, 2013). Young adults that cannot get coverage under their parents’ plans might slip through the cracks. If they have to purchase insurance from the marketplace, budgeting premiums into an already stretched budget is not easy, even if premiums are kept under $100 per month. Honestly: affordability is largely subjective and may vary despite attempts like cost-sharing subsidies and tax credits attempting to control costs.
• Young adults may end up paying more for health insurance coverage than the health services that they consume and need. Some media sources have stipulated this is a bad thing because young adults could be subsidizing services they may not have the fortune of utilizing. Much like what is speculated about Social Security benefits, it is also difficult to know that there will be enough money in future generations to assist with cost-sharing for the millennial generations’ health benefits as they age. As former US President Bill Clinton recently said, “This only works. . . if the young people show up" (Taranto, 2013).
• With the unemployment rate being almost twice as high for young adults as for the general population—13% for young adults aged 20 to 24, and 7.3% as stated by the US Bureau of Labor Statistics--and living in a rapidly changing economy, the ability to pay premiums for marketplace insurance policies may vary from month to month, potentially creating financial insecurity for young adults. 

Overall, the Affordable Care Act is not a two-sided coin for Millennials. As with all large policy implementations, there will undoubtedly be challenges and hurdles to address over time. Since the ACA was enacted in 2010, we've already seen some successes. In proceeding to evaluate the Affordable Care Act implementation, it is important consider how both the positive and negative consequences will unfold for individuals.

Let's allow time to see if the “what-ifs” become "what is" before jumping to a conclusive or alarmist opinion.

Emily Gelber MSW, LSW
Illinois Health Matters Analyst
Health & Disability Advocates

No, Health Reform Doesn’t Give Congress Special Treatment

Some health reform opponents claim the Obama administration is giving members of Congress and their staffs special treatment under the Affordable Care Act. The claim, which a number of media stories have repeated uncritically, is simply false: Although they will be required to enroll in health plans offered within the new health-insurance exchanges established under the law, members of Congress and their staffs will not receive extra financial help to pay for their medical care.

Critics are angry because the administration has confirmed that members of Congress and their staffs can continue to receive employer contributions to cover part of their premium costs. But that’s not special treatment. Today, most large employers do the same — the federal government, which provides coverage for members of Congress, their staffs and other federal employees, is no different.

In reality, it’s the critics — as part of their ongoing assault on the health care law — who are seeking special treatment for Congress, by proposing to make members and their staffs the only workers in the United States whose employer is barred by law from helping to cover their premiums. There’s no reason to discriminate against members and their staffs in this way, especially when doing so would make it more difficult to recruit and retain high-caliber congressional staff.

Here’s the issue: Under a provision authored by Sen. Chuck Grassley (R-Iowa) and added to the legislation during the Senate Finance Committee’s health care deliberations in 2009, members of Congress and their staffs won’t be allowed to continue buying coverage through the Federal Employees Health Benefits Program, which offers a variety of health insurance plans to federal employees. Instead, congressional staffers and members will only be able to enroll in plans offered in the ACA’s new exchanges, with the government continuing to make an employer contribution. (Grassley himself has confirmed that he intended for the federal government to continue making employer contributions under the provision.)

Critics claim this is special, gold-plated treatment because other people can’t get an employer contribution and use it to help buy coverage in the health exchange system. That’s incorrect. The ACA explicitly allows small businesses with fewer than 50 employees (up to 100, at state option) to offer their employees health plans through the exchanges and to help cover the premiums. This is essentially the same treatment that members of Congress and their staffs will receive.

Nor is the setup for Congress double dipping, as some mistakenly charge. Members of Congress and their staffs, just like the small-business employees, will be ineligible for federal tax credits to help cover the cost of their exchange health plans — unlike people with low and moderate incomes without employer coverage who buy health plans in the exchanges on their own.

There is one way in which health reform’s treatment of members of Congress and their staffs is unique — but it doesn’t involve preferential treatment. They are the only people in the country working for a large employer that is allowed to offer health plans exclusively through the exchanges. Unlike all other federal employees, they will not be able to enroll in plans offered through FEHBP. That’s because of the Grassley amendment.

Some members of Congress who oppose the ACA propose to prohibit the federal government from contributing toward the insurance premium costs of members and their staffs. Now that would be special treatment — the health care law does not prohibit the employer of any other workers in the country from making such a contribution.

If critics truly wanted to make sure there is nothing unique here, they would propose dropping the Grassley amendment and treat members of Congress and their staffs the same as other federal (and private-sector) employees, by allowing them to continue to enroll in plans offered through FEHBP, with the federal government continuing to make a contribution to help cover the costs. That’s how health reform treats other employers: It allows them to maintain current insurance arrangements and contribute on their employees’ behalf.

Why aren’t opponents of the health care law trying to do that? Presumably because there’s no political advantage in doing so. It’s time to get beyond political firefights and get on with responsible governing, including making health insurance coverage under the ACA work as effectively as possible for the American people.

Robert Greenstein is president of the Center on Budget and Policy Priorities

This post was posted first on Politico and reposted with permission from the Center on Budget and Policy Priorities.

ACA: More Than Just Healthcare for People With Disabilities

For people with disabilities finding a job has always been a one-two punch. It's not just the salary and financial independence they're looking for; they also are in greater need of health benefits than say, a nondisabled 30-year old.

October 1 marks the first day that people with disabilities can finally get both needs met. Under the provisions of the Affordable Care Act, many of the barriers to private health care for persons with disabilities will disappear. Americans can now shop for benefits in the new health insurance marketplace, for coverage beginning January 1, 2014.

For the first time ever, people with disabilities cannot be denied coverage due to a pre-existing condition, denied particular services or charged more for coverage based on their health status. Many health plans have to cover certain preventive services like routine vaccinations. And the ACA limits the ability of insurers to cap annual services on patients.

The ACA undeniably changes the paradigm for working-age people with disabilities, who now do not need to choose between healthcare and a job. If an employer doesn't offer insurance, the Marketplace will, with plans starting at less than $100 a month. No longer does a person with a disability need to rely on Medicaid, the free state healthcare program for low-income people where the income requirement is so stringent that not even a full-time McJob would be allowed.

The new law also takes some of the burden off employers, too. Employers hiring people with disabilities can be assured that rates will not rise. All health insurance plans will be required to offer a standard set of benefits like hospital care and doctors' visits, as well as cover services like medication, therapy and rehabilitation services, which people with disabilities need throughout their lifetime. There will be limits on rate increases and co-pays. Small employers with fewer than 50 full-time workers can also purchase coverage through the Marketplace.

What's more, 25 states and the District of Columbia have kicked in with their own programs to provide extra coverage to workers if the benefits a company offers are too "basic" for a person's unique disability needs. These special plans wrap around private employer-based coverage.

And an optional program known as Medicaid Buy-In allows workers with a disability in 42 states and the District of Columbia to retain Medicaid coverage and pay health premiums on a sliding fee scale based on their income. Medicaid buy-in programs are geared toward higher-paid workers, for whom a salary truly trumps federal assistance.

As always, our mission at Think Beyond the Label is to increase the percentage of working-age Americas with disabilities in the workforce. The ACA will help us to be more successful at connecting qualified workers to the employers that want to hire them. No longer will a job seeker need to ask: Does my employer offer insurance? Is the plan comprehensive enough to take care of my disability? Will my health needs be better met through federal and state programs that discourage work?

The ACA makes business and economic sense, too. Less reliance on federal disability insurance programs that limit work (and cost billions of dollars a year to run). Less concerns from employers -- especially small employers -- about how to pay for coverage for a person with a disability. More opportunity for all Americans to achieve financial independence and make a significant economic contribution -- to pay for important life goals like starting a family, buying a house and sending kids to college.

Though the law may have passed under President Obama, it was Ronald Reagan who asked, "How can we love our country and not...reach out a hand when they fall, heal them when they're sick, and provide opportunity to make them self-sufficient so they will be equal in fact and not just in theory?" The ACA does just this, providing an innovative approach that will give millions of people with disabilities a chance to live the American dream, without sacrificing their critical healthcare needs.

Barbara Otto

Principal, Think Beyond the Label

 Follow Barbara Otto on Twitter: www.twitter.com/@beyondthelabel 

This post was published first on the Huffington Post blog

Strong Interest in Illinois: State is Meeting Demand

 

Chicago – A stronger than expected showing for the Get Covered Illinois website, GetCoveredIllinois.gov, dominated the State’s storyline on the opening day of the Illinois Health Insurance Marketplace.  The following is an operational update:

WEBSITE:

The Get Covered Illinois website opened on time at 12:00 a.m. Monday, October 1.  As of 3:30 p.m. CST, more than 69,840 visitors had come to the online marketplace. 65,043 of them were unique visitors; and the page views totaled more than 412,580, with visitors viewing an average of six page views per visit.

“With a project of this magnitude, there was no accurate way to predict what our web traffic would be,” offered Jennifer Koehler, Executive Director of Get Covered Illinois. “But with that said, today’s numbers certainly validate the strong interest in healthcare in Illinois, and we’re glad to be able to service it. It also validates our strategy of education, since all this has come with basically no advertising. So we are overall very, very pleased.” 

Only a handful of early and minor glitches were reported, impacting a very limited number of consumers. All minor glitches were reported and fixed by early afternoon. “The site has performed incredibly well, the way we designed it to,” added Koehler. 

Additionally, the State received more than 1,100 online applications submitted on the ABE (Application Benefits Exchange) portion of the Get Covered Illinois site. 

HELP DESK:

The Help Desk received more than 350 calls as of 3:30 p.m.  Calls were answered in an average speed of six seconds, and callers were on line with Help Desk specialist an average of six minutes.

FIELD OPERATIONS:

There is steady interest, as judged by customers at our grantee community organizations today.  Most consumers are reportedly doing exactly as State officials hoped – coming in to be introduced to the process, the website, the Navigators and making appointments over the next few weeks as they become educated themselves on the site, and come back with prepared questions, and more ready to enroll.

“We know this is not nearly the same as buying a gallon of milk, a new pair of shoes, or anything in daily life,” said Director of Outreach Brian Gorman.  “Shopping for health insurance is brand new for more than a million Illinois residents, and it will take education and time to get comfortable with this new process.  But we are thrilled to see, today that process of understanding the right plan for them and their families started in earnest in locations all across Illinois. Consumers responded to our ask – which was to meet their community partners, understand the resources available and get an appointment when they are ready to get covered.” 

SOCIAL MEDIA:

Follow us on >>

Facebook: www.facebook.com/coveredillinois

Twitter: @CoveredIllinois

Hashtag: #GetCoveredIllinois

Posted with permission from GetCoveredIllinois.gov

If You Have Medicare, No Need to Go to Insurance Marketplaces

BULLETIN TODAY | PERSONAL HEALTH

By Susan Jaffe, Kaiser Health News. This story produced in collaboration with USA Today. 

This post is courtesy of AARP's blog. 

While the Obama administration is stepping up efforts encouraging uninsured Americans to enroll in health coverage from the new online insurance marketplaces, officials are planning a campaign to convince millions of seniors to please stay away – don’t call and don’t sign up.

“We want to reassure Medicare beneficiaries that they are already covered, their benefits are not changing and the marketplace doesn’t require them to do anything,” said Michele Patrick, Medicare’s deputy director for communications.

Learn how the new health law works for you and your family

To reinforce the message, she said the 2014 “Medicare & You” handbook – the 100-plus-page guide that will be sent to 52 million Medicare beneficiaries next month — contains a prominent notice: “The Health Insurance Marketplace, a key part of the Affordable Care Act, will take effect in 2014. It’s a new way for individuals, families, and employees of small businesses to get health insurance. Medicare isn’t part of the Marketplace.”

Still, it can be easy to get the wrong impression.

“You hear programs on the radio about the health care law and they never talk about seniors and what we are supposed to do,” said Barbara Bonner, 72, of Reston, Va. “Do we have to go sign up like they’re saying everyone else has to? Does the new law apply to us seniors at all and if so, how?”

Enrollment in health plans offered on the marketplaces, also called exchanges, begins Oct. 1 and runs for six months. Meanwhile, the two-month sign-up period for private health plans for millions of Medicare beneficiaries begins Oct. 15. In that time, seniors can shop for a private health plan known as Medicare Advantage, pick a drug insurance policy or buy a supplemental Medigap plan. And in nearly two dozen states, some Medicare beneficiaries who also qualify for Medicaid may be choosing private managed care plans. None of these four kinds of coverage will be offered in the health law’s marketplaces.

Since many of the same insurance companies offering coverage for seniors will also sell and advertise policies in the marketplaces, seniors may have a hard time figuring out which options are for them.

“Over the next six months seniors will be bombarded with information and a lot of it will be conflicting and confusing,” said Nick Quealy-Gainer, Medicare task force coordinator for Champaign County Health Care Consumers, an Illinois advocacy group.

“Every time there is publicity about the marketplaces, our calls spike,” said Leta Blank, director for the Montgomery County, Md., State Health Insurance Assistance Program.

While Medicare officials steer seniors away from the marketplaces, there is nothing in the health law that prevents beneficiaries from signing up for markertplace plans, said Juliette Cubanski, of the Kaiser Family Foundation. If they do, they will not qualify for premium tax credits for the marketplace plans. (Kaiser Health News is an editorially independent program of the foundation.)

These plans may appeal to wealthy seniors – about 5 percent of Medicare beneficiaries — who pay higherpremiums for Medicare based on their income and assets, said Cubanski. But for the vast majority of seniors, she said, Medicare’s benefit package is better and more affordable compared to marketplace coverage.

Confusion about different government health programs could also create opportunities for scams.

In Denver, AARP officials received complaints from seniors who were told they would lose their Medicare coverage [pdf] if they did not divulge their Social Security numbers and other confidential information needed for their new “national health insurance card” under the Affordable Care Act. The Federal Trade Commission issued an alert about such scams in March.

“One of the things we are paying special attention to is fraud prevention messages,” said Medicare’s Patrick. Seniors can be particularly vulnerable to scams “but with all of the changes in the health care landscape, we may need to be even more careful this year.”

Some Questions From Seniors About Medicare And The Health Marketplaces: 

• Will I lose Medicare coverage? No.
• Do I need a new Medicare card? No.
• Do I have to re-enroll in my Medicare Advantage or supplement plan through the marketplace? No, these policies are not sold in the marketplaces.
• Will seniors in Medicare have to buy supplemental insurance? No.
• Will they be fined if they don’t buy coverage in the health marketplaces? No, as long as seniors have Medicare Part A, which is free and covers hospitals, nursing homes and hospice. [They] already have insurance, so they are not subject to the penalty that most uninsured adults under 65 will have to pay.

Do we Have to Cancel Obamacare to Keep the Government Running? No.

Last Friday, the House voted — yet again — to defund the Affordable Care Act, aka Obamacare. In a creative twist, Republicans tacked the anti-ACA language onto the Continuing Resolution that provides funding to keep the government running.

What does this mean?
Continuing Resolutions are the stopgap funding mechanisms that Congress has been relying on since the sequester started, to keep programs running in the absence of traditional appropriations measures. The resolution must pass both houses of Congress, in some form that is acceptable to both.

So what will happen next is that the Senate will snip out the offending defunding language and send a "clean" version of the measure back to the House. Speaker Boehner could then bring it to a vote — thereby annoying the party's right wing — or majority leaders may try a slightly modified tack, perhaps finding some other aspect of the ACA law to challenge in the version they send back. It could bounce back and forth several times this way.

The deadline for the current Continuing Resolution is October 1st; if it is not passed by then, parts of the government will start to shut down. In particular, these will be the parts that are heavily dependent on year-to-year appropriations, such as the National Institutes of Health and the FDA. Cancer research could be jeopardized, drug approvals slowed, Social Security checks delayed due to staff being furloughed.

Won't shutting down the government bring Obamacare to a halt as well?
Not really, because the vast majority of the funding for implementation falls outside the annual appropriations process. In fact, on July 24, the Congressional Research Service responded to an inquiry from Oklahoma Rep. Tom Coburn on this very question, saying that by and large ACA implementation would be unaffected. Here are some of the highlights:

• Medicare claims are paid from the Medicare Trust Fund, not annual appropriations
• Changes to Medicare and Medicaid law are already in place
• Many of the implementation grants to states have already been made
• The IRS would continue to collect taxes and user fees
• The individual mandate and health consumer protections are already in place (as matters of law, not funding)
• Even in a "shutdown" there are provisions for essential services to continue

The full report is available here.

Last Friday's action was the 42nd time that congressional Republicans have voted to defund the ACA, and it is not the first time a government shutdown has been threatened. In 2011, a shutdown was narrowly averted, leading to the current "sequester." And the 1995-96 federal budget debates actually resulted in 28 days without non-essential services. Government funding is, in fact, only half the story; there is also the debt ceiling. In October, the nation's debt ceiling must be increased so that national bills can be paid. Failing to pay the already-accrued bills of the United States would have worldwide economic consequences. But the president has made it clear that he will not negotiate on the debt ceiling.

And what is our role, here on the ground?
Since there is no chance that the Senate will approve ACA defunding, the new approach, said Illinois Congresswoman Jan Schakowsky, will be to sow confusion. For example, there is already a major campaign to try to get young people not to enroll.

And that is why it is so important to get the word out. "We need to reach everyone," she said. "We have a week until launch day. But we have six months to get people enrolled." Rep. Schakowsky keeps an Obamacare Toolkit updated on her website. Rep. Schakowsky was a featured speaker at Monday's Statewide Conference Call Series organized by the Campaign for Better Health Care; the call focused on issues surrounding the threatened shutdown.

"One reason the Republicans do not want the ACA to go into effect is that they are assuming it will work," said Jennifer Beeson, Director of Government Relations at Families USA, another featured speaker. "Success is what will stop them."

But "we must remember how confused the American public is about this law, " said Beeson. "Many aren't even sure it's law." But "the law is real. It is in every state." The Families USA site features a Health Reform Central and state-by-state information.

The best time to reach people, Beeson noted, is when they are ready to take action — which is why the days ahead are so important. Starting next Tuesday, when people can go out and find out what is available to them, HHS will be doing targeted messaging to eligible groups; health districts and hospitals will have people available to counsel individuals; organizations and libraries will hold informational sessions. And we need to be ready on the ground with detailed information to provide outreach.

"Despite the obstructiveness and the rancor," said Rep. Schakowsky, "we are at the threshold of a very great moment."

Nina Sandlin
Guest Blogger for Health & Disability Advocates