Tuesday, October 29, 2013

Notes from the Health Reform and Advocacy Workshop

On October 16, 2013 I spent the day with 20 community leaders, learning about health reform and advocacy. We had an extra special guest, Joe Scarborough from the DE HIV Consortium, who shared some of his inside tips on advocacy. Below I'll share some of my visuals and notes from our discussion on the Myths of Health Reform. You can see all the visuals here.

Health Reform Myths - Busted

People are so confused by what they hear from friends, family, politicians and even the news. They have no idea what is fact or fiction. This list will help bust some of the most popular myths about the Affordable Care Act/Obamacare.

Myth #1: Obamacare takes away freedoms.
Truth: Nobody is forced to buy insurance or do anything else. 
There is a requirement to have health insurance, but there are also several exemptions to this rule including financial hardship, religious objections, and not being required to file a federal tax return. If people choose not to sign up for insurance, they may face a penalty. You can learn more about the penalty here.

Myth # 2: It's a government takeover of health care.
Truth: Obamacare helps people afford private insurance purchased through online marketplaces from insurance companies.
 It is not "single payer" federal health insurance like our friends to the North in Canada have. And let's be frank, we already have "socialized medicine", we call it Medicare. 

Myth #3: Obamacare only helps "those people".
Truth: Everyone benefits from a more fair, affordable health care system. 
Most people will experience lower premiums (over time). Insurance companies will not be allowed to discriminate based on gender, age, or health status. No lifetime or annual coverage caps. Wealthy people (making over $200,000/year) will pay more in taxes.

Myth #4: Obamacare rations health care.
Truth: We already have rationed health care, the insurance companies do the rationing in terms of coverage limits, revoking coverage and preapproval policies.
The Affordable Care Act puts an end to discrimination, denials, and protects consumers by limiting out of pocket spending and deductibles. The law also requires all plans to have 10 essential health benefits which include hospitalization, prescription drugs, labs and tests, mental health  and substance abuse treatment, maternity care, and others.

Myth #5: Obamacare is bad for seniors.
Truth: Seniors have a number of protections, including limits on how much more than can be charged for insurance premiums. 
NO DEATH PANELS. The part of the law that some people referred to as "death panels" was actually a provision that would allow Medicare to pay for end of life counseling for seniors and their families. The counseling would have been provided by the patient's doctor, not some government panel. But due to all the controversy that provision was removed from the final law. 
There will be a reduction in the federal subsidy sent to insurance companies who provide the Medicare Advantage plans for seniors. This subsidy reduction may result in changes in benefits, but will not effect essential services. The federal government made this change to reduce spending in Medicare Advantage, which is more than the spending for traditional Medicare and Medicaid combined.

Myth #6: Obamacare means more taxes and higher premiums for everybody.
Truth: Most uninsured people will save money.
Some people, those who make over $200,000 will have to pay a bit more in taxes. Many people will see reductions in their premiums, thanks to getting a tax break to pay for insurance through the health insurance marketplaces. Women will no longer pay higher premiums than men, neither will sick people. Since most people get their insurance through their jobs (about half of Americans), they won't see much changes, except for the regular fluctuations in premiums from year to year. Here's some more info about the tax changes in the ACA.

Myth #7: Congress is exempt from Obamacare.
Truth: Congress has to buy insurance through the insurance marketplaces too. They don't get some secret fancy plans.

The morale of this story: check your facts. Good places to check are Factcheck.org and Politifact.com. And of course, this little old blog right here. 

And there's always our friends the Youtoons.

Friday, October 18, 2013

Q and A from the front lines: What case managers want to know about health reform

Sometimes I get to go out into the world and learn from our amazing HIV community. On September 24th I got a chance to talk with about 30 case managers, social workers and other front line workers from a variety of HIV providers, health centers, and community organizations. It was a lively discussion about how health reform will help people living with HIV (PLWHA). We also covered some basics in communication; how to talk about health reform so people will understand and feel empowered to enroll in new coverage. You can read some about the communication tips here. I'm just going to cover the big topics and provide some links to my go-to health reform resources. You can also read my past posts about health reform here for more background and HIV-specific information.

Basic protections of the law

We started off reviewing the basic protections of the Affordable Care Act (a.k.a. Obamacare or Health Reform) and how they help PLWHA.
1. Insurance companies can't discriminate based on health status. Nobody can be denied coverage or lose coverage because of a new or pre-existing condition or diagnosis. This means no longer can PLWHA be denied coverage because of their HIV status or any other health conditions. This is big!

2. Insurance companies cannot charge women more for insurance. No more discrimination based on biological sex, everybody pays the same.

3. Essential Health Benefits (EHB) include many services either previously not guaranteed under private insurance or not offered by the Ryan White program. These will help fill in gaps of coverage for many PLWHA. You can find out more about EHB here.

4. No more lifetime caps on spending. Whether you cost the insurance company $100 or $10 million, they can't deny you coverage. Pretty awesome for people with complex and chronic health conditions.

Ryan White and health reform

Many people are wondering what health reform means for the Ryan White program. I can't see the future, but what we do know is this: The Ryan White program will continue as is for now. The long term changes and adjustments remain to be seen, and will depend on how PLWHA in different states fair in gaining health coverage, as well as what gaps and barriers remain that prevent PLWHA from access all the care they need to stay healthy. 

This brief is a good resource explaining how the Ryan White Program will interact and be influenced by health reform. I also wrote a blog post about the future of Ryan White earlier this year, so check that out for some more about Reauthorization.

Medicaid and ACA

Half of the PLWHA who receive Ryan White services (in the Philadelphia region) are covered by Medicaid. So for the most part, health reform doesn't really change anything for those individuals. They continue to be covered by Medicaid for many services, and Ryan White services can offer "coverage completion" to fill in any gaps to care. Just like always. 

Now this is where it gets tricky, the health reform law also allows states to expand Medicaid coverage to include low income adults below 133% of the Federal Poverty Line (about $15,000 for a single person). But states can choose not to expand coverage to those adults. Only half the states have decided to open up their Medicaid programs to low income adults. New Jersey has, and you can read more about it here. As of this writing, Pennsylvania has not. PA's Governor Corbett has offered a proposal for some serious Medicaid reforms (which we will dive into in another post), which he calls Healthy Pennsylvania. You can read the concept paper here. He has included expanding Medicaid eligibility to low income adults. We have at least several months to see what happens with Medicaid in PA. 

ADAP and health reform

NASTAD estimates that about 60% of PA's ADAP (AIDS Drug Assistance Program) clients will transition to a Marketplace plan for health care and prescription coverage. Many ADAP clients will transition from uninsured or under-insured to a Marketplace plan with the help of federal tax breaks to pay for insurance premiums. You can learn more about premiums and tax credits here. Those ADAP clients who do not qualify for enrollment in a Marketplace plan will stay on ADAP and continue to access Ryan White services, as appropriate.  People will not be covered by SPBP (ADAP in Pennsylvania) and a Marketplace plan, one or the other.

Helping clients understand options and enroll

Many case managers and social workers are concerned about their ability to assist clients in the health reform enrollment process. The process seems complicated and there is a lot to know. No doubt we will have some bumps on the road to coverage for all, but we can do it by working together. There are a few ways to offer assistance to individuals and families.

One easy option is to partner with a Navigator agency in PA or NJ. More information about those organizations here.

Your organization can apply to become a Certified Application Counselor (CAC) organization and offer help with the enrollment process to your clients. CMS offers an online training course for CACs, however there is no funding attached to these CACs.

Your organization can also become a Champion of Coverage to help share the news about coverage options. This one is easy, provide brochures and posters in your office, post some links on your website, or tell your clients about enrollment support in your community.

All Ryan White service providers are expected to help with outreach and enrollment for the Marketplaces. This is the top priority of the entire Department of Health and Human Services. 


Here are some of the best sources on health reform I have found. 

Healthcare.gov - the official place to get all your health reform information, find out about your state's Marketplace, enroll in coverage, print brochures, get live online help, and so much more.

HIVhealthreform - webinars, tools, blog posts, issue briefs - you'll find almost everything you need to know about health reform and HIV at this wonderful website. You should definitely sign up for their newsletter.

Kaiser Family Foundation - newly-updated subsidy calculator, interactive health reform timeline, state Marketplace profiles, and lots more.

Monday, October 7, 2013

Notes from the 2013 Pennsylvania Health Access Network Conference

I am grateful to the folks at PHAN for pulling together an informative conference for PA advocates, providers, and public health wonks like me. We mostly talked about health reform and the Affordable Care Act, with enrollment starting on October 1. Here are some of my notes and impressions. I would love to hear from others who attended.

The conference theme of Cover the Commonwealth informed the whole day's programming. We talked and talked about health reform in PA, including Gov. Corbett's proposal to reform (and expand) Medicaid, Healthy Pennsylvania. We also discussed how to talk to people about health reform and new coverage options. I wrote a separate post about communication tips. You can see all the tweets from the conference at #PHAN13

Navigators and Certified Application Counselors

Every type of community organization and health care provider is encouraged to have Certified Application Counselors on staff to help individuals and families enroll in the Marketplace. You can find out how to become a Certified Application Counselor organization here. Keep in mind that there will be a delay between application and approval from CMS, I have heard 30-60 days. 

Three of the federally-funded Navigator organizations were on hand to talk about their plans to help enroll every eligible Pennsylvanian. They have some big goals and are going to need help to reach them. These organizations want to work with your CBO or community group, so contact them to set up a time for their navigators to come and help enroll your clients/members.

Resources for Human Development is focusing on the 10 PA counties with the most uninsured people. Philadelphia County has the most uninsured of any county (and the most people). 

Pennsylvania Association of Community Health Centers (PACHC) will support all the Navigators and Certified Application Counselors in the state. 

Mental Health Association of Pennsylvania will also have Navigators in the community throughout the state ready to help enroll people in the Marketplace. 


In mid-September, Governor announced his Medicaid reform plan, Healthy Pennsylvania. All we know about the reforms are contained in the concept paper, about 10 pages. So the details are unknown. Included in these reforms would be coverage for low income adults, regardless of health or disability status, essentially it is Medicaid expansion by another name. I can share with you my initial impressions and some of what I learned at the conference. Please remember that this is just a proposed plan, not a reality. The Governor must submit a Medicaid waiver application to the federal government for approval, which will take at least several months. At this point in time, Medicaid is going to work as it has, nothing new for the short term.

Proposed Medicaid reforms include requiring working-age, non-disabled recipients to actively looking for employment and/or enroll in a job training program. This kind of requirement is not allowed under current Medicaid law and is a big task to oversee and administer. Some people are thinking this could be a roadblock to federal approval.

Gov. Corbett would like to remove all co-pays associated with Medicaid coverage and start requiring a monthly premium (bill) based on income, no more than $25/month for an individual or $35 for a household. Many people would pay no premium or very little. 

With these reforms, Gov Corbett argues the state would be able to include more people in Medicaid, including low income adults. These newly-eligible recipients would be enrolled in the insurance Marketplace and given state/federal subsidies to pay for insurance just like other Pennsylvanians buying insurance through the state marketplace. These individuals/families would also be required to pay a monthly premium based on income. The will also have a choice to select a Marketplace plan or the Health Choices plans. 

Other items in the concept paper include a penalty of $10 for "inappropriate use" of the Emergency Room, reduction in the number of benefit packages offered to different categories of Medicaid enrollees from 14 to 2, and no changes to children's benefits under Medicaid/CHIP.

I encourage you to sign up for the PHAN newsletter to keep up to date on all the training and events they offer. They will be a great resource for health reform in PA. A member of PHAN will come to your organization to educate your clients or staff. You can also participate in webinars and conference calls.