CBO on ACA: Devil is in the Details

On Tuesday, while driving between meetings, my favorite talk radio host shared shocking details from a new report – Obamacare, or the Affordable Care Act, is going to result in a loss of 2 million jobs in the United States over the next 10 years. Well, I thought, it's going to be a long day.

Later I learned that this reporter was sharing details from the latest Budget and Economic Outlook Report from the Congressional Budget Office. The CBO is an independent agency tasked with providing fiscal analysis for Congress with the intent of informing the budget-making process. Periodically, they release these reports which provide a 10 year forecast demonstrating the economic impact of many policies. Since 2010, they have included analysis on the impact of the ACA.

Needless to say, I was anxious to dig into this nearly 200 page behemoth and figure out what was going on. What I read in this report turned out to be great news. The report does not say that the economy will lose 2 million jobs. It says that, by making it easier to access affordable, high quality health insurance, more than 2 million people can make the choice to leave their job and pursue their passions, spend time with their families, start businesses, or find better jobs.

For those of us that have been following and championing the ACA, this isn't actually new information. Last year, the Robert Wood Johnson Foundation released a report, entitled The Affordable Care Act: Improving Incentives for Entrepreneurship and Self-Employment, which estimated that we could see as many as 1.5 million entrepreneurial spirits leave their jobs to become their own boss in 2014 alone!

Both reports highlight the same important fact: Because of the promise made by the ACA, that we can all access good health care, people will have the freedom to do what they want without fear of medical emergency and financial ruin.

My father, sister, and brother-in-law are all self-employed. Even my grandmother owned a small craft shop for the better part of my 26 years. While they were all brave (and maybe a little stubborn) enough to pursue these passions before the ACA, it has not been without sacrifice. After my self-employed and uninsured father had emergency eye surgery in 1992, my family filed bankruptcy as a result of unpaid medical bills. If the ACA had been around then, things would have been much easier for us and my dad certainly would have avoided a lot of sleepless nights worrying about keeping his business or providing for my sister and I.

I was shocked when I heard that radio report, but – as always – the devil was in the details. Except the devil isn't really a devil at all. The bottom line is that the ACA presents a new opportunity: an opportunity for people like my dad, to become their own boss; for someone who has put in their years and saved their pennies to retire early; or for a new parent to work part time so they can spend more time watching their child learn and grow. The CBO report means that what happened in my family, and millions like us, doesn't have to happen anymore – and that is why I will continue to be a proud champion of the ACA.

– By Kathy Waligora

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Kathy Waligora is the Manager of Health Reform Initiatives at EverThrive Illinois (formerly the Illinois Maternal and Child Health Coalition).

See the 2013 ACA Self-Employment Infographic in PDF.

Does Your Cab Driver Have Health Insurance? Why Not Ask…

In his State of the Union address, President Obama called on us all to remember that citizenship “demands a sense of common purpose… an obligation to serve our communities.” He went on to challenge us on how we exercise the “spirit of citizenship.” Today I started my own personal journey towards a “spirit of citizenship” by actually engaging with people I encounter everyday on health insurance. On this cold day, I started with cab drivers.

In my brief experience I learned cab drivers are really confused about the ACA. One gentleman told me “Obamacare” wasn’t for him because he had a job, and that it was only for poor or sick people. Another driver said that he tried to get insurance last year, but that he had high blood pressure so no insurance company would take him. Yet another driver disclosed that when his wife broke her wrist in July he flew her all the way back to Turkey for surgery because he had no health insurance. A quick discussion (five minutes tops –including stop lights) with all three of these drivers cleared up their misperceptions. All three were surprised to learn they would be eligible for either a subsidy in the Marketplace or, in the case of the driver originally from Turkey, Medicaid expansion or County Care.

Fortunately, I was able to tell them about a new initiative of Enroll Chicago that is targeting cab drivers. Every Monday and Wednesday the city’s Department of Business Affairs and Consumer Protection has information booths with trained Get Covered Illinois navigators to help cab drivers enroll in health coverage.

Each day, more than 300 drivers come into the BACP office at 2350 W. Ogden Avenue to renew their licenses. They typically have to wait up to two hours to complete the license paperwork. Learning about health coverage options and enrolling in health insurance must be an excellent way to kill time – because in the first two days since program started, more than a hundred cab drivers talked to the navigators about health coverage. Think about how we could amplify that number if each of us were to talk to our cab drivers about health coverage!

Kudos to Enroll Chicago and the BACP for recognizing how they can exercise the “spirit of citizenship,”  making it easy for cab drivers to become informed and take action. I’m doing my part by sharing information about what Enroll Chicago and BACP are doing at 2350 W. Odgen.

How are you harnessing your “spirit of citizenship” when it comes to myth busting around the ACA? Let us know at info@illinoishealthmatters.org.

– By Barbara Otto, CEO, Health & Disability Advocates

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If you have a media inquiry about this campaign, please contact Brian Richardson at the Chicago Department of Public health, Enroll Chicago 312-747-9805, brian.richardson@cityofchicago.org.

Photo credit: yooperann via photopin, cc license.

Consumer Information for January 1, 2014

As the start of coverage for Qualified Health Plans in the Marketplace approaches, the Centers for Medicare and Medicaid Services (CMS) anticipates that some of the newly insured individuals will have questions about how to access healthcare services. CMS has posted information on Marketplace.cms.gov to address questions that consumers may have with the January 1 start of coverage through their selected health plan.

Individuals who have insurance for the first time or have new plans beginning on January 1 are likely to have many questions related to coverage, premiums payments, co-payments, and other issues and may need to reach their individual insurance plan. Below is information for consumers on how to access their health plans as well as education factsheets explaining how health insurance works.

• What to know about seeing your doctor
  http://marketplace.cms.gov/getofficialresources/publications-and-articles/seeing-your-doctor.pdf
• What to know about getting your prescription medications
  http://marketplace.cms.gov/getofficialresources/publications-and-articles/getting-your-prescription-medications.pdf
• Appealing your insurers' decision not to pay
  http://marketplace.cms.gov/getofficialresources/publications-and-articles/appealing-your-insurers-decision-not-to-pay.PDF
• I signed up, but don't have health coverage. What should I do?
  http://marketplace.cms.gov/getofficialresources/publications-and-articles/signed-up-but-no-coverage.pdf
• Getting emergency care
  http://marketplace.cms.gov/getofficialresources/publications-and-articles/getting-emergency-care.pdf
• What you should know about early renewal of health coverage
  http://marketplace.cms.gov/getofficialresources/publications-and-articles/early-renewal-of-coverage.pdf
• What you should know about provider networks
  http://marketplace.cms.gov/getofficialresources/publications-and-articles/what-you-should-know-provider-networks.pdf
• Contacting your Health Plan’s Customer Service Phone Number (includes a link to a database containing the customer service phone numbers for all of the Qualified Health Plans) https://data.healthcare.gov/dataset/QHP-Customer-Service-Phone-Numbers/vryg-tdzf?)
  http://marketplace.cms.gov/getofficialresources/publications-and-articles/contact-health-plan.pdf

Payments of Premiums
The deadline to sign up for coverage to start January 1st was December 23rd.

We want to remind you that consumers need to pay their premium directly to the insurance company in order to have coverage by January 1, 2014. Consumers can pay when invoiced by the plan, call the issuer to make payment, or pay online if the plan accepts online payment. All consumers have until at least December 31 to pay for coverage effective January 1, although some insurance companies have extended this deadline. Consumers should check with their insurance company to find out when their first premium is due in order for coverage to be effective January 1. Consumers should also confirm with the issuer that their first month’s premium has been received and that enrollment is complete.

Please note that once a consumer selects a plan through the Marketplace, it may take the health plan 48-72 hours to receive and process the enrollment, so please encourage consumers to continue to periodically check back with their selected health plan. The insurance company will also send plan information and an insurance card to consumers who have completed enrollment including payment of the premium.

https://www.healthcare.gov/how-to-have-the-best-experience-with-healthcare-gov/#part=5

https://www.healthcare.gov/how-to-have-the-best-experience-with-healthcare-gov/#part=6 

(Reposted from the Champions for Coverage December 27, 2014 email)

As Federal Website Improves, GCI Promotes a “Culture of Coverage” Across Illinois

As the federal website continues to improve, Get Covered Illinois today kicked off its first statewide TV advertising campaign, designed to raise awareness of the new state of healthcare that becomes a reality in 2014, with the opportunity to purchase a health care plan through the Illinois Health Insurance Marketplace.

“Now that the federal website has improved, we are shifting from educating consumers to the next phase of encouraging enrollment. We are urging thousands of uninsured residents in Illinois to get covered in this new state of healthcare that we are entering in 2014,” Jennifer Koehler, Executive Director of Get Covered Illinois said. “If you visited GetCoveredIllinois.gov before but didn’t select a plan, come back and try again. With the upgrades to the federal website that were recently put in place, the enrollment system is working much more smoothly. Now is the time to select a plan and get covered.”

In addition to the TV ad launch, Get Covered Illinois is ramping up its outreach efforts for an enrollment push leading up to Dec. 23, the first of a series of key enrollment dates under the federal Affordable Care Act (ACA). Consumers must enroll in a health plan by Dec. 23, and have paid a premium by Dec. 31, in order to have coverage on Jan. 1 through the plans offered on the Illinois Health Insurance Marketplace, which is accessed through healthcare.gov. The full open enrollment period for the Marketplace runs through March 31, 2014.

The Get Covered Illinois advertising campaign is designed to educate those who need insurance on the essential benefits and financial assistance available through the Marketplace, and to drive enrollment for coverage starting as soon as Jan.1. The advertising includes TV, radio, digital and social media, with an emotional connection to reach broader, multicultural populations of Illinoisans to encourage them to take action.

The nearly $1-million TV ad buy includes the eight major-media markets in Illinois, and is targeted to reach Illinois’ uninsured population. The campaign features one 30-second ad that highlights the all-inclusive nature of the new state of healthcare across Illinois; and two 15-second spots: one that highlights the fact that insurers can no longer deny coverage because of pre-existing conditions, and one that features a mom-to-be.

The TV advertising builds on the radio and digital banner advertising that began on Nov. 18 and is similarly targeted at Illinois’ uninsured population.

In addition to the statewide ad push, Get Covered Illinois and its more than 250 community partners are planning about 300 events to drive coverage around the state before Dec. 23. For planned enrollment events in your area, including those on Dec. 14, visit GetCoveredIllinois.gov and click on the events tab.

“We are encouraged that after two months of education and engagement by our more than 1,500 trained and certified Navigators assisting people to enroll across the state, there is steady feedback that residents are successfully buying Marketplace plans,” said Brian Gorman, Director of Outreach and Consumer Education for Get Covered Illinois. “We want to encourage people to sign up starting at our website, or work directly with a Navigator in your area, or call the help desk. All services are free.”

Get Covered Illinois is also further strengthening its Social Media presence to reach the uninsured through Facebook (www.facebook.com/coveredillinois) and Twitter (@CoveredIllinois). GCI recently launched a series of info graphics on social media that feature “30 Days, 30 Benefits.” The 30 pieces describe how the 10 Essential Health Benefits included in all Marketplace plans link directly to the real-life health needs people confront in their daily lives. GCI will also share testimonials of Illinois residents who have successfully enrolled in the Health Marketplace across social channels. These videos highlight what having health coverage will now mean for their lives.

The following is an operations, engagement and enrollment update from Get Covered Illinois >>

The U.S. Department of Health and Human Services (HHS) has released numbers for the first two months of enrollment under the ACA that indicate 67,936 applications on behalf of 124,252 individual people have been completed from Illinois and that 7,043 people have selected a private health care plan through the healthcare.gov website since Oct. 1.

Traffic on the Getcoveredillinois.gov website has remained steady, with 529,650 website visits since Oct. 1 and more than 245,800 users of the screening tool that leads users either to the federal website or the state’s new Medicaid eligibility site, ABE.illinois.gov (Application for Benefits Eligibility). The ABE site has received more than82,000 applications.

GCI encourages uninsured residents to:

• Visit the website where you can find out if you qualify for a subsidy and compare health plans side-by-side (there is also a Spanish-language version of the website).
• Sit with a specially trained Navigator at one of the hundreds of partner sites across the state; find a Navigator nearby through the website by entering a zip code. Bi-lingual Navigators are available.
• Call the help desk at 866-311-1119. Operators are available to help you each day from 8 a.m. to 8 p.m. Spanish-language assistance is available on the phone.

(Published on Friday, December 13 at Get Covered Illinois)

ACA Success Story in Southern Illinois

Laura Olmsted, a Certified Application Counselor (CAC), from Shawnee Health Services, had the great pleasure of helping Bill*, a 53 year old from Marion, Illinois, understand what the Affordable Care Act is all about.

Bill is a hardworking self-employed contractor -- making $23,000/year -- who works independent construction jobs, and has not been able to afford health insurance. However, health insurance is something that Bill desperately requires. In the past year and a half, he has suffered not one, but three heart attacks and a broken femur. Mounting medical bills are causing him incredible financial burden, and preventing him from accessing care that he needs.

Luckily, Bill recently met Laura, who helped him to complete an application on Healthcare.gov once he went through the Get Covered Illinois screener. Bill received great news: not only was he eligible for insurance, but he had options, ranging from the low end of paying nothing for a Bronze level or lower end Silver plan, to only $180 per month for a high-end Silver plan after the premium tax credit was factored in.

Laura’s client considered his choices and selected a Silver Multi-State plan through Blue Cross Blue Shield of Illinois where he pays only pocket change - $4.53 per month - for his premium. The plan has a $250 deductible and an out of pocket max of only $2,000 per year. Bill plans to pay for the premiums up front since the price was so affordable.

Should Bill have looked into buying health insurance prior to the enactment of Obamacare (the Affordable Care Act), he would have encountered a very different situation:

• No certified enrollment specialist would have helped him find and understand his health insurance options;
• Unless he was connected with an insurance broker, Bill would have had to shop for plans on his own, rather than being able to compare them all in one place;
• No tax credits or subsidies would be available to help him afford his premium;
• Bill may have been denied coverage based upon pre-existing conditions; and
• If Bill did find coverage, prior to Oct. 1 of this year, he likely would have found a plan with higher premiums and without the requisite 10 essential health benefits like the qualified health plan that he recently purchased.

Because of his new options through the Illinois Health Insurance Marketplace, Bill will now be able to receive the health care necessary to get well, and continue living a healthy, productive life in Illinois.
 
(*Bill is a fictional name to protect the client's anonymity)

DOI Moves to Allow Consumers to Continue Current Coverage into 2014

The Illinois Department of Insurance (DOI) announced on November 22 that it will follow President Obama’s November 14 recommendation and allow insurance companies to renew a number of health plans in the individual and small group markets that do not meet certain Affordable Care Act (ACA) requirements without being penalized. Illinois joins Florida, North Carolina, Ohio, Kentucky, Kansas, Oregon, South Carolina, Colorado, Hawaii and Texas in giving insurance companies the choice to renew existing health insurance policies with current policyholders.

“DOI came to this decision based on the concerns raised by Illinois consumers and the guidance from the U.S. Department of Health and Human Services,” Andrew Boron, Director of the Illinois Department of Insurance said. “Allowing companies to renew current plans gives consumers more time to evaluate their options and will provide a smoother transition into the health care coverage system envisioned by the ACA.”

DOI will immediately work with insurance companies who choose to extend the terminated or cancelled coverage to quickly renew such policies. In step with President Obama’s announcement, policies in effect on Oct. 1, 2013, in the individual or small group market, can be renewed for a policy year starting between Jan. 1, 2014, and Oct. 1, 2014.

According to notifications received by DOI, approximately 185,340 people in Illinois have been advised by insurers so far in 2013 that their coverage has been cancelled or terminated. DOI’s most recent data indicate that more than 476,000 Illinois residents were insured by private individual policies in 2012.

Today’s announcement was made on the same day that federal authorities pushed back the deadline for enrolling in a plan that begins on Jan. 1, from Dec. 15 to Dec. 23. The change gives people eight additional days in which to consider their options.

For Illinois consumers, the ability to renew plans will depend on their insurance company’s decision of whether or not to exercise this option. Consumers should contact their local insurance agent to discuss what options are available to them.

In addition, according to the federal government, any insurance company choosing to renew a non-compliant plan in 2014 should notify consumers that they can purchase coverage through the Health Insurance Marketplace where they may qualify for federal financial assistance, which may include premium tax credits for small employers and other subsidies for individual consumers. This notice should also advise consumers about the protections under the ACA they are foregoing by renewing their current plans including certain Essential Health Benefits that may not be offered through existing plans. Such protections will be required in plans being sold in the Health Insurance Marketplace.

Insurance companies will not be permitted to sell any new plans after December 31, 2013 that do not meet ACA standards. Consumers seeking healthcare coverage should continue to visit http://getcoveredillinois.gov to learn about new health insurance options available through the Marketplace. Those who may consider keeping their current policy should compare it with new plans offered through the Marketplace which cover more benefits, sometimes at a lower cost. DOI is also recommending consumers that have questions regarding differences between a continuation of their current coverage and benefits afforded to them through a plan on the Health Insurance Marketplace to call DOI’s Office of Consumer Health Information at (877) 527-9431.

The following insurers have received approval to offer coverage through the Illinois Health Insurance Marketplace:

Aetna Life Insurance Company
Coventry Health and Life Insurance Company
Coventry Health Care of Illinois, Inc.
Health Alliance Medical Plans, Inc.
Health Care Service Corporation, a Mutual Legal Reserve Company (Blue Cross)
Humana Health Plan, Inc.
Humana Insurance Company
Land of Lincoln Mutual Health Insurance Company

“Making certain that Illinois residents have access to quality affordable health care remains one of our top priorities,” continued Boron. “Today’s actions reinforce our commitment to a culture of coverage.”

Republished from Get Covered Illinois News

An Illinois Navigator's Experience Finding Lower Premiums in the Marketplace

I decided I might as well enroll myself with a Qualified Health Plan on the Marketplace before I sat down as an In Person Counselor (with a client) so I tried for a few days right after Oct. 1.

Since the site was so slow, I decided to wait until some of the excitement wore off and tried again in mid-October. I sat down after dinner and put in an hour on the computer. I quickly verified my identity, similar to the online process for requesting your free credit report. I answered simple questions about what streets I have lived on, former cities I lived in, etc. They were all multiple choice questions, and I got them all right!

Then I was able to compare the plans for my county and sort them based on certain features: metal, HSA eligible, out-of-pocket costs, etc. At that point there are fewer plans to choose from and I checked off the "compare box" on three that I thought seemed to be a good fit. After looking at the plans, side by side I was able to click on a link with each that took me to the website for each plan so I could do a provider search. I entered my current doctor and to see if my doctor was in-network. This made it pretty easy for me to decide. The pages did load slowly so I folded laundry while they loaded.

Once I enrolled in health coverage, I had to decide to elect or not to elect to access dental. I went through the same process with the dental coverage, but did find that the links did not work for all the dental plans. I eventually decided on a plan and enrolled. Then I put the laundry away while it loaded and waited.

At the end, I got the page where it said my application was complete. I printed out the page along with my application ID# and am excited to let people know that my premiums are going down!

I self-pay for insurance now and will still do so in 2014. I currently pay just over $340 a month for health and dental. Starting in January, I will only pay $185.10 for health and dental. I make too much money for any tax subsidy, so even without assistance I am seeing a huge benefit. I still get to see the same doctor and dentist that I have had since I was a kid and really cannot complain too much. Buying insurance before privately took more time as I would have to research and deal with the insurance brokers and then the underwriters questioning of any of my possible health issues.

I look forward to helping my clients find affordable options on the Marketplace, too.

Joann Boblick
Certified In Person Counselor
La Grange, IL