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What health reform means for the people of Illinois

A blog by IllinoisHealthMatters.org

Tuesday, August 13, 2013

Clearing Up Confusion About Health Reform’s Out-of-Pocket Protections

Recent media coverage may have sown confusion about health reform’s requirement that health insurance plans cap how much consumers can pay out-of-pocket each year for medical care. The bottom line: for many plans, the protections will take effect as scheduled in 2014. Some plans will be able to wait an extra year to fully comply.

The health reform law requires that, starting next year, private insurance plans limit how much in cost-sharing charges — deductibles, copayments, and coinsurance — that people enrolled in a plan must pay each year for covered benefits provided by the plan’s network of health care providers. (This includes plans offered in the individual market or through employers. The requirement doesn’t apply to “grandfathered” plans.) In 2014, this “maximum out-of-pocket limit” will be $6,350 for an individual and $12,700 for a family.

Back in February, the Obama Administration provided an additional year to fully comply with this requirement but only for certain plans offered by employers.

Here are some clarifications about the February policy:

Health insurance plans in the individual market: In 2014, the maximum out-of-pocket limit will apply, as scheduled, to the individual (non-group) health insurance market. Millions of people are expected to gain coverage in this market in 2014, as health reform’s new improvements and federal subsidies significantly increase access to affordable coverage.

Employer-sponsored health insurance plans: The maximum out-of-pocket limit will also continue to generally apply to non-grandfathered plans offered by employers, including small group, large group, and self-insured plans. Employer plans that have a single insurer or administrator have to fully comply with the limit next year.

Employer plans that have “separately administered” benefits: The Administration provided the exception in February for these plans, in which an employer has one insurer or administrator for its primary package of health benefits and a different insurer or administrator for discrete benefits, such as prescription drugs. Because employers and insurers have claimed it will be difficult to coordinate an overall maximum out-of-pocket limit across separately administered benefits, they sought and received the ability to avoid full compliance for one year.

Even those employer plans with “separately administered” benefits that qualify for the delay still must apply some out-of-pocket limits in 2014. As the February guidance explained, these plans must ensure that their primary package of health benefits has an out-of-pocket limit of no more than $6,350 for individuals and $12,700 for families. A separately administered benefit, such as prescription drugs, that already has an existing limit on out-of-pocket costs must comply with the limits of $6,350 for individuals and $12,700 for families in 2014.

An employer plan wouldn’t have to add a cap to a separate benefit if the separate benefit currently lacks one. But this exception shouldn’t be misunderstood as broadly waiving the important out-of-pocket protection that health reform will bring in 2014.

Sarah Lueck

Sarah Lueck
Center on Budget and Policy Priorities

(This was originally posted here on the Off the Charts Blog)

Friday, August 9, 2013

Faith Leaders Leading the Way on ACA Outreach

CBHC's Faith Caucus is taking a lead role in our efforts to promote enrollment in Illinois' new Health Insurance Marketplace, and a crucial partner in spreading the positive word on health care reform. We are so pleased that the role of our faith leaders in outreach around the Affordable Care Act was important enough to have an AP story! 
Faith leaders emerge as key to health law outreach

— Religion and the nation's new health law haven't exactly been viewed as friendly partners in the public eye, with most of the attention focused on religious employers' objections to covering the cost of birth control.

But under the radar, leaders in some Illinois faith communities are spreading the word about the Affordable Care Act to make sure their uninsured members know about new benefits available starting in 2014 and about the approaching enrollment start date.

Read more here: http://www.bnd.com/2013/08/09/2736052/faith-leaders-emerge-as-key-to.html#storylink=cpy
For the full story, please visit http://www.bnd.com/2013/08/09/2736052/faith-leaders-emerge-as-key-to.html.

Thanks to Rev. Carole Hoke, Rev. Dr. Shirley Fleming, and Aida Giachello of the CBHC Faith Caucus, and to Carla Johnson (@CarlaKJohnson) of the AP for the story.

Monday, August 5, 2013

Primary Care Doctors Need Connections to ACA Information and to Navigators, Counselors

As the effort to promote the Health Insurance Marketplace and enroll consumers gears up, and clinics and community organizations hire, train and deploy the various “assisters” who will help patients and families get coverage, we shouldn’t ignore one of the most important touchpoints between the health care system and consumers – patient/physician interaction. Patients trust their doctors and may look to them for guidance about the Affordable Care Act (ACA). Unfortunately, many doctors haven’t been well educated about the ACA or what’s going to happen once the Marketplace is live.

The national American Academy of Pediatrics recently conducted a survey of its members and found that improvement is needed in pediatrician awareness of the Affordable Care Act (ACA). The survey, conducted in late 2012, showed that nearly half of pediatricians are vaguely or not at all familiar with key components of the ACA. Specifically, they lacked knowledge of some components that could directly benefit their practices – such as the temporary increase in payment from Medicaid to Medicare levels, and coverage of Bright Futures services with no cost-sharing for children enrolled in new insurance plans.

Pediatricians also cited low confidence in their ability to respond to parents’ questions regarding the new law. Only 5% of pediatricians reported that they are very confident in their ability, while 33% reported that they are not at all confident, with the rest somewhat or moderately confident. Clinicians such as pediatricians are not yet being asked many questions by their patients and parents, so they have not been motivated to learn their own key points or prepare their office staff to provide information. In the AAP survey, 86% of pediatricians reported that they are seldom or never asked questions concerning the ACA. Most of their knowledge to date comes from what they see in the media, so they are very much aware of aspects such as the ban on pre-existing condition exclusions, the requirements to have health insurance by 2014 or pay a fine, and the provision allowing young adults to stay on parents’ health insurance up to age 26. But once the Marketplace is up and running, and public relations campaigns about enrollment are in full swing, and assisters are everywhere, what will they need to know so they can effectively advise their patients?

Locally, two major primary care provider associations did an assessment of members which confirmed an interest in more support and information. In May 2013, the Illinois Chapter of the American Academy of Pediatrics (ICAAP) and the Illinois Academy of Family Physicians (IAFP) conducted an informal survey asking pediatricians and family physicians to estimate need for Marketplace information among patients, patient’s parents and family members, and clinic staff. Responses were received from nearly 40 unique medical practice sites employing over 500 physicians. Only 3 responded that they would not be interested in any education or services related to the Marketplace. Nearly all (85%) want information on the Marketplace to post or handout to patients, and almost as many (75%) want a counselor or assister to speak to their practice staff.

While the number of medical practices that are independent, small business is dwindling, and most staff have insurance coverage via a hospital or health system, staff may still need information for friends and family members or to make new choices if products through the Marketplace are better for their families. Only about a quarter of physicians responding expected their health system to provide information on the Marketplace for patients and staff, and most (65%) said their health system was definitely not planning to employ navigators or counselors, which may be more available in the safety net clinics than in private systems. But the need for information – even in private practices – is there! Many physicians attested to seeing their patients lose insurance due to the economy, and pediatricians regularly note that while their patients are insured via All Kids or private insurance, many of their parents or primary caregivers are not. Children also age out of All Kids or their parents’ insurance and so many young adults will seek help in securing coverage.

For the ACA roll out to work, consumers need to get quality, consistent messages about the need to enroll and how to use the health care system, no matter where they are. Targeting efforts in low income communities and in clinics that currently serve the uninsured makes sense, but the ACA effects everyone, and all primary care offices should be able to connect a patient or family who needs coverage to someone who can help them.

Scott G. Allen, MS, Executive Director
Illinois Chapter, American Academy of Pediatrics

Thursday, August 1, 2013

Special Report: Impact of ACA on Uninsured Asians in Illinois

The Affordable Care Act (ACA) will greatly improve the health of Americans by offering newly available coverage to the uninsured without pre-existing health condition exclusions, improving physical and mental health, and reducing the financial burden associated with healthcare. The Asian Health Coalition (AHC) and Health & Disability Advocates (HDA) jointly present this Special Issue Brief predicting that 75,000 currently uninsured Asians in Illinois will be eligible for coverage in 2014 through the Medicaid expansion signed into law last week (SB 26) and the health insurance marketplace (formerly known as the “Exchange”).

Working with datasets from the U.S. Census Bureau’s American Community Survey and Public Use Microdata Area (PUMA), key findings show:
  • Of the nearly 600,000 Asian Americans in Illinois, more than 80% live in just 4 counties comprising Cook, DuPage, Kane and Lake.
  • There is more than a 40% rate of limited English-proficiency in many Asian subgroups (Chinese, Korean, Laotian, Pakistani).
  • More than 92,000 Asian Americans in Illinois are presently without health insurance.
  • 75,000 individuals (or more than 80% of the uninsured Asians) are expected to be eligible for coverage in 2014 with one-third of those obtaining coverage through the Medicaid expansion and the remaining two-thirds through the new health insurance marketplace.

Insurance Coverage by Asian Subgroup
“Health insurance makes a big difference in access to necessary medical care, financial security, and ultimately health outcomes for vulnerable populations,” said Stephanie Altman, Programs & Policy Director at HDA. "The uninsured receive less preventive care and recommended screenings than those with health insurance, and therefore may forego needed care or prescriptions due to cost,” she added.

“Open enrollment is just 60 days away and outreach and enrollment efforts targeted to communities of color are more important than ever if we are to maximize enrollment into new health coverage options”, said Edwin Chandrasekar, AHC’s Executive Director. “The Illinois Department of Public Health has awarded $27 million to community-based organizations through the In-Person Counselor Grant Program and this is a positive step in the right direction to tailoring outreach and education strategies to meet the diverse racial and ethnic Asian American subgroup needs.”

For more information about this brief, please contact the Asian Health Coalition at (312) 372-7070 or info@asianhealth.org.

Edwin Chandrasekar
Asian Health Coalition