Welcome to the Illinois Health Matters Blog

What health reform means for the people of Illinois

A blog by IllinoisHealthMatters.org

Thursday, September 26, 2013

If You Have Medicare, No Need to Go to Insurance Marketplaces


By Susan Jaffe, Kaiser Health News. This story produced in collaboration with USA Today

This post is courtesy of AARP's blog. 

While the Obama administration is stepping up efforts encouraging uninsured Americans to enroll in health coverage from the new online insurance marketplaces, officials are planning a campaign to convince millions of seniors to please stay away – don’t call and don’t sign up.
“We want to reassure Medicare beneficiaries that they are already covered, their benefits are not changing and the marketplace doesn’t require them to do anything,” said Michele Patrick, Medicare’s deputy director for communications.
medicare-pillTo reinforce the message, she said the 2014 “Medicare & You” handbook – the 100-plus-page guide that will be sent to 52 million Medicare beneficiaries next month — contains a prominent notice: “The Health Insurance Marketplace, a key part of the Affordable Care Act, will take effect in 2014. It’s a new way for individuals, families, and employees of small businesses to get health insurance. Medicare isn’t part of the Marketplace.”
Still, it can be easy to get the wrong impression.
“You hear programs on the radio about the health care law and they never talk about seniors and what we are supposed to do,” said Barbara Bonner, 72, of Reston, Va. “Do we have to go sign up like they’re saying everyone else has to? Does the new law apply to us seniors at all and if so, how?”
Enrollment in health plans offered on the marketplaces, also called exchanges, begins Oct. 1 and runs for six months. Meanwhile, the two-month sign-up period for private health plans for millions of Medicare beneficiaries begins Oct. 15. In that time, seniors can shop for a private health plan known as Medicare Advantage, pick a drug insurance policy or buy a supplemental Medigap plan. And in nearly two dozen states, some Medicare beneficiaries who also qualify for Medicaid may be choosing private managed care plans. None of these four kinds of coverage will be offered in the health law’s marketplaces.
Since many of the same insurance companies offering coverage for seniors will also sell and advertise policies in the marketplaces, seniors may have a hard time figuring out which options are for them.
“Over the next six months seniors will be bombarded with information and a lot of it will be conflicting and confusing,” said Nick Quealy-Gainer, Medicare task force coordinator for Champaign County Health Care Consumers, an Illinois advocacy group.
“Every time there is publicity about the marketplaces, our calls spike,” said Leta Blank, director for the Montgomery County, Md., State Health Insurance Assistance Program.
While Medicare officials steer seniors away from the marketplaces, there is nothing in the health law that prevents beneficiaries from signing up for markertplace plans, said Juliette Cubanski, of the Kaiser Family Foundation. If they do, they will not qualify for premium tax credits for the marketplace plans. (Kaiser Health News is an editorially independent program of the foundation.)
These plans may appeal to wealthy seniors – about 5 percent of Medicare beneficiaries — who pay higherpremiums for Medicare based on their income and assets, said Cubanski. But for the vast majority of seniors, she said, Medicare’s benefit package is better and more affordable compared to marketplace coverage.
healthcare-symbolConfusion about different government health programs could also create opportunities for scams.
In Denver, AARP officials received complaints from seniors who were told they would lose their Medicare coverage [pdf] if they did not divulge their Social Security numbers and other confidential information needed for their new “national health insurance card” under the Affordable Care Act. The Federal Trade Commission issued an alert about such scams in March.
“One of the things we are paying special attention to is fraud prevention messages,” said Medicare’s Patrick. Seniors can be particularly vulnerable to scams “but with all of the changes in the health care landscape, we may need to be even more careful this year.”
Some Questions From Seniors About Medicare And The Health Marketplaces: 
  • Will I lose Medicare coverage? No.
  • Do I need a new Medicare card? No.
  • Do I have to re-enroll in my Medicare Advantage or supplement plan through the marketplace? No, these policies are not sold in the marketplaces.
  • Will seniors in Medicare have to buy supplemental insurance? No.
  • Will they be fined if they don’t buy coverage in the health marketplaces? No, as long as seniors have Medicare Part A, which is free and covers hospitals, nursing homes and hospice. [They] already have insurance, so they are not subject to the penalty that most uninsured adults under 65 will have to pay.

Wednesday, September 25, 2013

Do we Have to Cancel Obamacare to Keep the Government Running? No.

Last Friday, the House voted — yet again — to defund the Affordable Care Act, aka Obamacare. In a creative twist, Republicans tacked the anti-ACA language onto the Continuing Resolution that provides funding to keep the government running.

What does this mean?
Continuing Resolutions are the stopgap funding mechanisms that Congress has been relying on since the sequester started, to keep programs running in the absence of traditional appropriations measures. The resolution must pass both houses of Congress, in some form that is acceptable to both.

So what will happen next is that the Senate will snip out the offending defunding language and send a "clean" version of the measure back to the House. Speaker Boehner could then bring it to a vote — thereby annoying the party's right wing — or majority leaders may try a slightly modified tack, perhaps finding some other aspect of the ACA law to challenge in the version they send back. It could bounce back and forth several times this way.

The deadline for the current Continuing Resolution is October 1st; if it is not passed by then, parts of the government will start to shut down. In particular, these will be the parts that are heavily dependent on year-to-year appropriations, such as the National Institutes of Health and the FDA. Cancer research could be jeopardized, drug approvals slowed, Social Security checks delayed due to staff being furloughed.

Won't shutting down the government bring Obamacare to a halt as well?
Not really, because the vast majority of the funding for implementation falls outside the annual appropriations process. In fact, on July 24, the Congressional Research Service responded to an inquiry from Oklahoma Rep. Tom Coburn on this very question, saying that by and large ACA implementation would be unaffected. Here are some of the highlights:
  • Medicare claims are paid from the Medicare Trust Fund, not annual appropriations
  • Changes to Medicare and Medicaid law are already in place
  • Many of the implementation grants to states have already been made
  • The IRS would continue to collect taxes and user fees
  • The individual mandate and health consumer protections are already in place (as matters of law, not funding)
  • Even in a "shutdown" there are provisions for essential services to continue
The full report is available here.

Last Friday's action was the 42nd time that congressional Republicans have voted to defund the ACA, and it is not the first time a government shutdown has been threatened. In 2011, a shutdown was narrowly averted, leading to the current "sequester." And the 1995-96 federal budget debates actually resulted in 28 days without non-essential services. Government funding is, in fact, only half the story; there is also the debt ceiling. In October, the nation's debt ceiling must be increased so that national bills can be paid. Failing to pay the already-accrued bills of the United States would have worldwide economic consequences. But the president has made it clear that he will not negotiate on the debt ceiling.

And what is our role, here on the ground?
Since there is no chance that the Senate will approve ACA defunding, the new approach, said Illinois Congresswoman Jan Schakowsky, will be to sow confusion. For example, there is already a major campaign to try to get young people not to enroll.

And that is why it is so important to get the word out. "We need to reach everyone," she said. "We have a week until launch day. But we have six months to get people enrolled." Rep. Schakowsky keeps an Obamacare Toolkit updated on her website. Rep. Schakowsky was a featured speaker at Monday's Statewide Conference Call Series organized by the Campaign for Better Health Care; the call focused on issues surrounding the threatened shutdown.

"One reason the Republicans do not want the ACA to go into effect is that they are assuming it will work," said Jennifer Beeson, Director of Government Relations at Families USA, another featured speaker. "Success is what will stop them."

But "we must remember how confused the American public is about this law, " said Beeson. "Many aren't even sure it's law." But "the law is real. It is in every state." The Families USA site features a Health Reform Central and state-by-state information.

The best time to reach people, Beeson noted, is when they are ready to take action — which is why the days ahead are so important. Starting next Tuesday, when people can go out and find out what is available to them, HHS will be doing targeted messaging to eligible groups; health districts and hospitals will have people available to counsel individuals; organizations and libraries will hold informational sessions. And we need to be ready on the ground with detailed information to provide outreach.

"Despite the obstructiveness and the rancor," said Rep. Schakowsky, "we are at the threshold of a very great moment."

Nina Sandlin
Guest Blogger for Health & Disability Advocates

Monday, September 23, 2013

What Could Be More Important than October 1, Right?

Written by Ryan Singleton   
October 1, 2013—the date’s been circled on our calendars for months. We’ve talked about it inpodcasts and spilled ink over it on our blog. October 1, 2013, is opening day for health insurance marketplaces, which are online destinations that will allow consumers to shop for and compare insurance under our reformed health care system.Sounds great, right? Of course, it does! It brings choices to consumers and theoretically gives more people access to affordable, quality health insurance. For years, the AIDS Foundation of Chicago (AFC) has been advocating for a more just health care system for people living with HIV/AIDS – and anyone in need of health care – and this is a gigantic step forward.
Perhaps that’s why there’s so much frustration.

October 1 is less than two weeks away, and most states—including Illinois—still haven’t launched their marketplaces or finished training in-person counselors, who are people designated to help individuals navigate insurance options online.

To gain a nuanced perspective on the coming marketplaces, Inside Story sat down with John Bouman, president of the Sargent Shriver National Center on Poverty Law, a national organization that advances laws and policies that secure justice to improve the lives and opportunities of people living in poverty.

Inside Story: A lot of people contact AFC about Illinois’ insurance marketplace, asking, “When will the site go live? Where can I find the web address?” The only answer we have is, “We don’t know,” which leaves people frustrated. Many know that marketplaces can’t sell insurance until October 1, but they still want to see the site in order to formulate questions for in-person counselors and to have reassurance that they’ll have health insurance in 2014.

John Bouman: We have to keep the national picture in mind. People will want to use the frustrations and advocacy around the implementation to fuel the effort to de-fund and undo the whole ACA. We have to be careful that our legitimate advocacy around implementation issues is not used for that purpose. This means strong advocacy with the system but careful handling of the big public message—don't forget the thousands who do enroll and don't have problems.

IS: What happens if October 1 comes and goes, and our marketplace system isn’t functioning smoothly or even worse, isn’t live yet?

JB: October 1 is the opening date for enrollment. Coverage doesn't start until January 1, and people can enroll until March 31 and still be covered in 2014. So, the long-awaited October 1 live date for the website and enrollment is not paramount. January is. In the interest of paying attention to my previous point, we can have some patience with the start-up delays and inevitable glitches, mistakes, and other issues.

Moreover, we have to contribute to an over-arching message that implementing something of this size inevitably has some start-up problems. This is normal stuff, and we're working on it. But it does not mean that the underlying policies are wrong or not worth their funding. Illinois authorities have also done their best to plan ahead, but more importantly they have been paying close attention to feedback from communities and acting quickly to correct mistakes or unanticipated issues.

IS: Is there anything we, as general consumers, can do to make sure health care reform can make the greatest, positive impact?

JB: Yes, for sure, we have to push hard to identify all the problems in this new system, so that we can pressure the state to fix them. If somebody discovers an issue, please contact Molly McAndrew, Program Manager for AFC's In-Person Counselor Program, at MMcAndrew@aidschicago.org.
Courtesy of AIDS Foundation of Chicago.
John Bouman, president of the Shriver Center, is widely recognized as one of the most effective and thoughtful public-benefit advocates in the country. He was a leader in the design and implementation of positive aspects of Illinois’ new welfare law in 1997, and he spearheaded the statewide efforts in Illinois to create both the FamilyCare program, which provides health care insurance for up to up to 400,000 working poor parents of minor children, and All Kids, the first state plan to extend health coverage to every child. Click here to read his full bio.

Wednesday, September 18, 2013

CBHC Reaction to U.S. Census Bureau 2012 Health Insurance Status Data

September 17, 2013
Statement by Jim Duffett, Executive Director, Campaign for Better Health Care, on U.S. Census Bureau 2012 Health Insurance Status Data
This morning, the U. S. Census Bureau announced findings from the official report on income, poverty and health insurance coverage for the nation.  The news, as expected, was not great.  There are still too many Americans who do not have the peace of mind that comes from knowing that they and their families will be able to obtain quality, affordable health care when they need it. 

The good news is that thanks to the Affordable Care Act, this is the last year in the history of our nation we will ever see such high numbers of uninsured Americans. Starting with next year's report, these numbers will shrink by tens of millions as more Americans are covered because of all the different consumer protections and eligibility expansions contained in Obamacare. 

The numbers will get smaller as more young adults stay covered on their parents' insurance plans through age 26, protecting them through the  period of time between graduating college and finding work in a challenging job market.  More Americans will be insurable despite their pre-existing conditions.  And as more small businesses qualify for tax credits that allow them to offer health insurance coverage to their employees, yes - those numbers will keep going down.

Millions of Americans who will find coverage through the new Marketplace will know it is they that are in charge of their health care, not the insurance industry.  Millions of Americans will know peace of mind, the power of choice, personal responsibility, and fairness; all the values that we attach to health care will finally be realized.  Those are the numbers that we look forward to seeing increase over the next few years, thanks to Obamacare.

# # #
About Campaign for Better Health Care
We believe that accessible, affordable, quality health care is a basic human right for all people.  The Campaign for Better Health Care is the state's largest coalition representing over 300 diverse organizations, organizing to help create and advocate for an accessible, quality health care system for all.  For more information, visit  www.cbhconline.org.

Friday, September 13, 2013

The federal government pays what? Tax credits and cost-sharing subsidies under the ACA.

Approaching the new changes associated with the Affordable Care Act (ACA) as a consumer can be a daunting task. Understanding what you may qualify for is tough, and where to look for information that makes sense is not easy either. Two concepts designed to make health insurance affordable under the ACA, Advanced Premium Tax Credits (APTCs) and Cost Sharing Reductions (CSRs), will be explained below.

Both are only available to individuals enrolled in a Qualified Health Plan (QHP). Qualified Health Plans are private (not Medicaid or Medicare) health insurance policies purchased through the new health marketplace (where you can compare and purchase health insurance policies) that provide “essential” health benefits. APTCs and CSRs are not available to those who have or are eligible for employer based coverage that is affordable (annual premium is less than 9.5% of employees income).

      Advanced Premium Tax Credits

So what is an APTC?
To understand what an Advanced Premium Tax Credit is, it helps to be broken down into its parts. A tax credit is money that tax payers (that are purchasing Qualified Health Plans through the marketplace) can get back, much like a tax return. However, the credit is for your premium. Your premium is the money paid each month for a health insurance policy. 

The word “advanced” refers to when someone can get this tax credit. The federal government pays money directly to the insurance company (in advance) in order to reduce a person’s premium every month. As an alternative option, a person can pay the full premium and get the tax credit back at tax time. If a consumer is overpaid or underpaid for his/her APTC, it will be addressed when the consumer files taxes. This is known as reconciliation. If a consumer gets a pay raise, then s/he will be responsible for paying the federal government back for the initial overpayment of the APTC should they fail to report a change in income. When the consumer reports the income change, the APTC will be adjusted accordingly. This tax credit is intended to pay for premiums only.

In short, an APTC is money that a health insurance marketplace consumer (or the consumer’s insurance company) receives from the government to help pay the monthly cost (premiums) of having health insurance.

Who qualifies for an APTC?
People buying QHPs through the Illinois Health Insurance Marketplace who have income between 100-400% of the federal poverty level qualify for APTCs, as long as they plan to file a tax return and are not eligible to be claimed as a dependent ($45,960 is 400% of the federal poverty level for a single adult). So, if you are making less and purchase a QHP, you should qualify for an Advanced Premium Tax Credit. To find out how much and if you qualify, check out the Kaiser Family Foundation Subsidy Calculator.

      Cost Sharing Reductions

What is a Cost Sharing Reduction (CSR)?
A Cost Sharing Reduction is a subsidy (money paid by the government) to reduce cost sharing. Cost sharing can be understood as the costs a consumer pays out of pocket on services covered by health insurance. Money is paid by the federal government to the consumer’s insurance company to ensure deductibles, copayments, and coinsurance cost less. 

In summary, a CSR makes out of pocket costs lower because the government pays a portion of those costs by giving money to your insurance company.

Who qualifies for a Cost Sharing Reduction (CSR)?
Consumers must have an income below 250% of the federal poverty level, or $28,725. The consumer also must choose a Silver Plan (insurance company pays 70% of essential health benefits), and qualify for an APTC (see above). See here for information on Health Plan Categories & Essential Health Benefits.

So, what is the big difference between APTC and CSR?

Besides the differences in eligibility for these two forms of financial help on the Marketplace, there is one other main difference: a consumer will not have to pay back a CSR even if his/her income increases. An APTC, however, will be decreased if a consumer’s income goes up. So, if a consumer does not report the income change to the Marketplace, then s/he will be required to pay back the amount that was overpaid (as part of an APTC) during tax time.

Emily Gelber, MSW, LSW
Health & Disability Advocates

For more information:

Thursday, September 12, 2013

Empowering Illinoisans: What’s "in it for them” in Health Care Reform

With the planned opening of the Illinois Health Insurance Marketplace now less than a month away, more people across Illinois are starting to sit up and take notice. While there’s been plenty of discussion about health care reform leading up to this; too many people remain unaware of this new law and the benefits it may offer to them and their families.

The Affordable Care Act or as some simply say “Obamacare” – means that millions more Americans will now have greater access to affordable health insurance coverage Expanding access to care and improving health care quality are undoubtedly good things. But, let’s face it; health insurance can be confusing!

The first step is to help people understand what the new law has to offer in simple and understandable ways. And the second step is to encourage them to take action by enrolling in a health insurance plan that meets their needs.

Successfully accomplishing these two steps will take a concerted and coordinated effort among the State of Illinois and the many other groups who share the goal of successfully implementing the Affordable Care Act in Illinois. Many organizations, including the many involved in Illinois Health Matters, have been committed to outreach and education for several years. And the State of Illinois is now in the process of launching its widespread community outreach and education campaign.

We at Blue Cross and Blue Shield of Illinois also wanted to contribute to Illinois’ public education effort about the new health care reform law. That’s why we launched the Be Covered Illinois outreach and education campaign back in April. Be Covered Illinois is an unbranded grass roots campaign that works with and through a diverse coalition of partners. Today we have 42 community partners across the State and the list is growing daily. Be Covered Illinois community partners know their neighborhoods, the people, the issues important to them and are the most trusted and credible messengers able to communicate most effectively.

What Be Covered Illinois does is support its partners by providing easy to understand information about the Affordable Care Act through multiple distribution channels, including: 
  • Personal outreach where trained Be Covered Illinois speakers can explain the changes under health reform to groups;
  • Representatives at community parades and festivals passing out information that people can take home and look over. 
  • Examples of currently available “consumer-friendly” Be Covered Illinois printed materials in both English and Spanish include fact sheets, brochures, key dates and a glossary of insurance terms that many folks may be unfamiliar with. And as we learn the questions that people have, we continue to produce new materials to answer them. 
To be clear, Be Covered Illinois materials are not Blue Cross branded product marketing, but rather an unbranded campaign to educate people about ACA and encourage them to enroll in the Health Insurance Marketplace.

Be Covered Illinois information can also be accessed through a bi-lingual informational website (www.BeCoveredIllinois.Org), a mobile texting campaign (JoinIL to 33633) where folks can sign up to receive information and updates via their cell phones, or on Facebook and Twitter. Be Covered Illinois even has a toll free helpline number (1-888-809-2796) that people can call to speak with trained health reform experts to answer any and all questions.

In our shared commitment to partner with the State, Illinois Health Matters and the other Illinois education and outreach to broaden awareness during this time of historic health care reform, we invite you to review and access the Be Covered Illinois materials that we currently offer our community partners by visiting www.BeCoveredIllinois.Org. Or better yet, we invite you and your organization to sign up to become a Be Covered partner. As a partner, we will keep you abreast of the latest available materials, provide you with quantities of print copies of materials and work with you to plan an effective education campaign tailored to your organization’s needs to ensure your constituents take action before the end of open enrollment!

I also want to let you know that Be Covered Illinois will be hosting a community Care Fair with our partner organizations on Sunday, October 6th, so mark your calendars now. The event will be held at Chicago Indoor Sports, at 3900 S. Ashland Ave., from 11:00am to 5:00pm and offer fun family activities, a kids’ zone, free health screenings and flu shots, offer help in understanding the new health care law, as well as direct folks to Illinois Navigators and In-Person counselors who can assist them, some of which we expect to be in attendance. Attendees can even leave with a free bag of healthy groceries! Be sure to join us for a fun and informative Sunday afternoon and let your community members know about it.

Information is power, and we want to work with you to empower as many Illinoisans as we can!

Donna Gerber

Chair, Be Covered Illinois Campaign
Vice President, Community Investments
Blue Cross and Blue Shield of Illinois