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. 

Resources

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.

What to say when you talk about health reform

Everything I am about to say comes from the great work of Enroll America. Those folks have done the research and pulled it all together so we can use it to make sure all Americans have the affordable quality care they need. So check out all of their resources for everything you need to plan your outreach and enrollment work.

The health reform law is so confusing and complicated. It doesn't surprise me that so many people feel like its just too much to understand, let alone do anything. So I'm going to try to break it down into some simple messages for you to share with people you want to encourage to sign up through the Marketplaces. (If you don't know what a Marketplace is, then start with this fun and simple video.

Some things to keep in mind when talking to people about health insurance:

1. Share personal stories about the uninsured and how health reform helps them be healthy and more secure.
2. Keep it simple and concrete.
3. Make sure the message is targeting the individual. Single people don't identify with messages about families and vice versa.
4. Share your values, like "security", "family", "fairness". Financial and health security are the biggest motivators for the uninsured to seek more information about the Marketplace.
5. There is deep confusion and skepticism among consumers, due to lack of experience with insurance or bad experiences. Be prepared for it.
6. Most people (91%) think that health insurance is necessary or very important.
7. Cost and affordability are the top barriers to coverage for most people.
8. Use examples and dollar amounts whenever possible, rather than percentage or other abstract concepts.

Four messages about health reform that will reach most uninsured people:

1. All insurance plans will have to cover doctor visits, hospitalizations, maternity care, emergency room care, and prescriptions.

This refers to the 10 Essential Health Benefits. You can learn more about them here.

2. You might be able to get financial help to pay for a health insurance plan.

People with income between 100% FPL and 400% FPL (Federal Poverty Line) will be eligible for tax breaks to pay for premiums. There is also help for some people to cover co-pays. You can learn more about ways to make health coverage affordable here.

3. If you have a pre-existing condition, insurance plans cannot deny coverage.

Health insurance companies cannot discriminate against anyone based on health status or pre-existing conditions, including HIV, cancer, diabetes, or any other chronic condition or infectious disease. More on these protections here.

 
4. All insurance plans will have to show the costs, and what is covered in simple language with no small print.

The health care law requires all coverage information to be simple, clear and comparable. So you can compare plans for the different services, doctors, and limits. No small print allowed.

Healthcare.gov is the place to go to learn about the Insurance Marketplaces and how to access insurance. Here's a great place to start to figure out what kinds of information you need to enroll and how to compare your options.

TEDMED 2013 Comes to OHP

Do you want to learn and be inspired by some of the world's greatest thinkers and innovators in health care and public health? 

It's your lucky day! 

Thanks to the sponsors of TEDMED 2013, the Office of HIV Planning is holding a 2 day TEDMED LIVE event April 17-18th. You are welcome to come over with your lunch and watch sessions from Washington DC live in real time.  

What? You don't know what this TEDMED thing is?! Ok, just check it out for yourself.

The people we will hear from include artists, scientists, doctors, and athletes. We will watch 3 sessions of 5-7 presenters over the two days. We are talking major players: (former) Google execs, the Director of the National Institutes of Health, stars from So You Think You Can Dance?, and so many more entrepreneurs, innovators and leaders.

 

April 17th 11:30am-1:00pm: Translating the Untranslatable

Featuring: ZDoggMD, Mick Cornett, Jill Sobule, David Agus, Jay Walker, Sally Okun,  Richard Simmons (yes, THAT Richard Simmons!)

April 18th 11:00am - 12:45pm: Going Farther While Staying Closer

Featuring: Washington Conservatory of Music, Susan Desmond-Hellman, Roni Zeiger, Elizabeth Marincola, Christopher J.L. Murray, Larry Brilliant

April 18th 1:00 - 3:00pm: What Happens When We Mix Up the Models? 

Featuring: Francis S. Collins, Manzari Brothers, Gary Slutkin, David Odde and Black Label Movement, Zubin Damania

Registration Encouraged.

All you have to do is let us know you are coming by filling out this quick registration form. If you are unable to come in person, please contact Nicole for alternative arrangements.

As a special thank you, all those who attend will receive online access (on demand and streaming) to all the TEDMED 2013 sessions through April 21st. 

Everybody is welcome to join us, no matter your profession. You are bound to be inspired and challenged by the awesome presenters at TEDMED. 

Inspiration is free, you just have to show up.