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.

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.

Health Reform To-Do List

This presentation was designed specifically for people living with HIV/AIDS (PLWHA) who are uninsured or in need of affordable insurance options. Most of the information is general to PLWHA in the US, but some Pennsylvania information is included because the state is not expanding Medicaid coverage to low income adults (not at this time anyway). These slides are adapted from content developed by the Target Center. I highly recommend providers and consumers of Ryan White services check out the Target Center for great resources about Health Reform and so much more.

I created this interactive presentation in an effort to help more people understand how the Affordable Care Act, or "Obama Care" may affect them. It's intended to be used as a starting-off point to explore resources to help you make the best decisions for yourself and your family. Anything that is underlined is a link to something to help you understand your options or help plan for your new coverage in 2014. Please take time and explore the links.

If you have questions or comments, please be sure to leave comment here or email me. I will do my best to answer your question or lead you to a good resource.

Summer 2013 Update: Priorities and Funding

I shared this Prezi with the Positive Committee at their July 8, 2013 meeting, to give them an update on the Planning Council's activities over the last couple of months. A couple things for you to know/consider before viewing the Prezi:

• You can read more about the priority setting process, including the factors and scoring process here. The Comprehensive Planning Committee is responsible for facilitating the priority setting process at lest once every three years, or whenever there is a need to update the list due to policy or other changes to the care system. Priority setting just means putting the Ryan White care services in order of importance/need according to certain factors, based on information about community need and impact on the continuum of care. 

• The Philadelphia EMA received less of a decrease in the Part A funding than we were told to expect. The grant award was a little more than 6% less than the 2012 award. The Planning Council already developed a plan for a decrease, and this plan is represented by the 2013 pie chart in the Prezi. the 2012 pie chart is how the money was budgeted for last year. You will notice that the most significant differences are in Early Intervention Services and Care Outreach, which were ended as of the first quarter of this grant year (June 30, 2013), due to the funding decreases. Other services will receive less money too, because Early Intervention and Care Outreach Services couldn't absorb all of the cut.

• The Regional Allocations meetings where the community decides how to budget our Ryan White Part A funds will be at the Office of HIV Planning. Everyone is welcome to attend and participate. The Office of HIV Planning plans to provide meeting materials to participants before the meeting. If you would like to attend a meeting, please call 215-574-6760.
• PA Counties (Chester, Bucks, Delaware and Montgomery)- 
• Tuesday, July 23rd from 1-4pm
• NJ Counties (Camden, Burlington, Salem and Glouchester) - 
• Thursday, July 25th from 1-4pm
• Philadelphia - 
• Tuesday, July 30th from 1 - 4pm

Health Reform and HIV Providers: Part 2

The presentation below was given by Ann Ricksecker (Planning Council member and PA/MidAtlantic AETC staff) and myself at the PA HIV Provider Capacity Building Training on June 18, 2013. The purpose of the presentation is to provide some basic background on the ACA and  practical steps for organizations to prepare for the future of the Ryan White Program. Thanks to the  TARGET Center for providing some great materials to work from, especially the 6 steps.

If this is your first visit to our blog, you may want to check out my previous posts on some of the important issues covered in this presentation like: payer of last resort, providers' roles in health reform, and health reform resources. You need to have a background in health reform in order to get the most from this slides.  I will be creating a web-based presentation with audio for these steps as well, so stay tuned.





During this presentation a few questions came up that I needed to do some more research before I could answer. I decided to share those questions and my answers here. If you have questions, let me know in the comments and I'll post a follow up ASAP.

Question 1: Contracting with an insurance company is sometimes difficult and time consuming. What steps can an organization take to make it easier/more efficient?

Here's a good example from Kevin Moore of the AIDS Care Group about the difficulties some will face in dealing with health insurance companies. Here are some ways you may get some help if you run into a dead end:

1. Call your state insurance department and see what assistance they can provide. (PA, NJ)

2. Call your state's insurance marketplace to get some help facilitating the relationship with the insurer. At this time I couldn't find any contacts for either NJ or PA's marketplaces.  (Both PA and NJ will have federally-facilitated Marketplaces.)

3. Call a provider who is on the insurance plan and ask for a contact person in that agency's contract office. Then ask for a contact with the insurer who will actually help. 

I'm sure there are other options. Anybody have another option that worked?

Question 2:  Will case managers be expected to help consumers pick a health plan? Do case managers have a role in the state insurance marketplaces?

Short answer: Yes! 

Case managers already help people get enrolled in health insurance. Enrolling in a Marketplace plan is just another option. HRSA has been very clear that Ryan White providers are expected and encouraged to help consumers with eligibility and enrollment, including consumer education about health insurance and health reform. In the end, consumers are responsible for picking the appropriate health plan for their individual needs, but case managers and other providers will need to be available to help with those decisions. If the Ryan White provider is not staffed or resourced to provide this assistance, then a referral should be made to a local resource that can provide the required level of support and guidance.

The 4 E's are the latest buzzwords: education (about health reform), eligibility (for public and private insurance options), enrollment (in public and private insurance) and engagement (in care). Consumers will be looking to their case managers and medical providers for answers about insurance and eligibility. To learn more about consumer outreach and enrollment check out the resources at Enroll, America.

Question 3: What opportunities are there for community-based organizations in the era of coordinated care and health homes? 

There are opportunities for CBOs in this new world. CBOs have skills and services that support and promote whole-person care like cultural competency and care coordination (case management).  You can become a Federally Qualified Health Center (FQHC) or form a cooperative agreement with a FQHC. Either option would allow for the possibility of either becoming a Primary Care Medical Home or a Medicaid Health Home (which are essentially the same thing. Primary Care Medical Home (PCMH) is the general term and the Medicaid Health Home is a type of PCMH.).  

Here is a great step-by-step guide for CBOs to integrate with health homes.

You can download the slides from the hivhealthreform.org webinar for much more detail on how (and why) to integrate with a clinical provider: Pathways to Collaboration. 

Integrating with a clinical site is just one option for sustainability. We will explore other options in future posts.

#socialnetworkingproblems: How to get started, be strategic, and avoid the pitfalls of social media

On Wednesday morning, I had the pleasure of presenting at the 14th Annual Prevention and Outreach Summit presented by Philadelphia FIGHT.  It was an expanded version of a much briefer presentation on social media strategy for HIV programs that I had done for the SMART4Life provider forum a couple of weeks ago.  I'm passionate about using social media to spread information, change social norms, and generally do good things, so I was excited to share what I know with some local programs and organizations.

Here's my full slide deck, complete with links:



That first slide is something that we refer to around the office as simply, "The Slide."  It drives a lot of what we do here.  See, if things don't change, half of today's young Black men who have sex with men (MSM) will be HIV-positive by the time they hit the age of 35.  Half.

Half.

This is completely appalling and totally unacceptable.  What we've been doing hasn't been working.  I know there are a lot of barriers to social media for public health organizations (like outdated policies and not being allowed to bill for the time spent online), but we can't afford to keep doing the same tired things when they're clearly not having the effect we need them to. 

So, social media.  I gave participants in my session this handout to help get them started.  My presentation was really geared toward spending as little money on social media as possible.  It's difficult enough to get a good grasp on social media for a small business, but for small nonprofits and public health organizations, it can feel almost impossible.  Luckily I both love to learn and to share, so I'll be writing more posts on this subject in the future.  In the meantime, here are some of my favorite resources.
 

• CDC's National Prevention Information Network (NPIN) ran a series of webinars on social media for public health.  The first series is over, but you can get the recordings and slide sets here.
• Social media for public health (#SM4PH) Twitter chats.  These are on a variety of topics, and they can be a great opportunity to network with others in your field.  Follow @sm4ph on Twitter for updates.
• Net Tuesday Meetups.  Held the first Tuesday of every month in Center City Philly, with the theme "social web for social change."  A friendly group of people that know how to make things happen with little to no funding.
• If you like books as much as I do, I'd recommend the new Social Change Anytime Everywhere from Allyson Kapin and Amy Sample Ward.
• And my favorite social media blogs/websites:
• Dialogue Consulting.   They're Australian, so keep this in mind when looking at webinar times.
• John Haydon.  Discussing social media for nonprofits.
• Nonprofit Tech 2.0.  A social media guide for nonprofits.
• Seth Godin.  Neither nonprofit nor social media-specific, but generally good, helpful advice.  Short, sweet, and published daily.
• The Face of the Matter.  Health communications blog from Philadelphia-based Jim Garrow.
• Buffer.  A more general interest blog about productivity, social media, and more.
• Mashable's Social Media section.  All the most up-to-date news on social media.  Easy to get information overload here - take what you need, and ignore the rest.
• Public Health Memes.  Great for a field-specific laugh.

There's the roundup.  If you're already on social media, what are some of your favorite resources?  If you're not, what's stopping you?