Chicago Orgs Kick off Project to Educate Asian Americans About the ACA

There remains considerable misinformation and ignorance about the Affordable Care Act (ACA) among limited English-speaking Asian Americans and other immigrant groups regarding ACA and how it will impact them. Provisions of the health care reform law that are already in effect (children covered by parents’ insurance up to age 26, insurance companies prohibited from placing a lifetime limit on essential benefits) are unknown to most immigrant groups. 

Key provisions of the law that will have a major impact on uninsured immigrant populations, such as the affordable health insurance exchanges, will not have their desired effect unless the target population understands how these provisions apply to them and how to make the right choices for the health care coverage they need.

Through small employer tax credits and other provisions, the Affordable Care Act will also have a significant impact on small business owners which represent a major portion of the economy and life in ethnic neighborhoods such as Albany Park, Uptown, Rogers Park, and Chinatown. However, many of these ethnic business owners are linguistically isolated or inherently distrustful of government stemming from experiences in their countries of origin. They do not understand or are wary of government programs. Such linguistic and cultural barriers present an important challenge to the implementation of the ACA as 2014 draws near, and will impact the health of the vulnerable Asian immigrant and refugee population, in the Chicago metropolitan area.

In response to the lack of knowledge around the ACA, the Asian Health Coalition (AHC) and Health & Disability Advocates (HDA) have embarked on a project (with generous funding from the Lloyd A. Fry Foundation and The Chicago Community Trust): “Stay Informed!: Education on Health Reform” to provide culturally and linguistically tailored outreach and technical assistance on health reform to the Asian immigrant and refugee communities in the Chicago area. The target audiences for Stay Informed! are Asian community members and small business owners (SBOs).

The goal of Stay Informed! is to provide culturally competent education and outreach on the Affordable Care Act for linguistically isolated and disenfranchised Asian immigrant and refugee consumers and SBOs to enhance understanding of and participation in health care reform. Toward that end, we have created fact sheets and presentations in English, Chinese, Korean, Vietnamese and Khmer. Materials in additional languages will become available over the coming months

We have already conducted trainings at the Cambodian Association of Illinois and Chinese Mutual Aid Association and received many good questions from attendees about the Affordable Care Act. Please don't hesitate to use our fact sheets to educate your own communities and contact either of us with any questions.

Edwin Chandrasekar
Executive Director
Asian Health Coalition
edwin@asianhealth.org

Stephani Becker
Project Director
Health & Disability Advocates

sbecker@hdadvocates.org

What’s in the New Health Care Law for Women? Well-Woman Visits That Can Improve Your Health

As an emergency physician, I tend to work on the other side of preventive care services. I see what happens when women don’t know about safer sex and birth control, and end up with complications from sexually transmitted infections. I see what happens when women do not get routine screening for cervical cancer and struggle with life-threatening cancer. I see what happens with out-of-control hypertension and diabetes, and the heart attacks and strokes that are detected far too late.

These experiences have shown me that prevention is the best medicine. That’s one big reason why the Affordable Care Act provision requiring new insurance plans to cover women’s preventive care without any extra charges or co-pays is a real victory for women. These requirements, which go into effect Aug. 1, will be phased into existing insurance plans over time.

Because of this change, women will be able to obtain complete contraceptive care, screening for sexually transmitted infections, and screening and counseling for intimate partner violence. This builds upon earlier requirements that insurance companies cover – at no additional cost to women -- mammograms and screenings for cervical cancer. It’s clear to me that these mandates will significantly improve women’s health and lives and ultimately lead to a reduction in health care costs.

The Well-Woman Visit

One of the easiest ways to obtain preventive services is through a well-woman visit. These visits, which will soon be covered with no co-pay, give you the opportunity to ask key questions about birth control, sexually transmitted infections, and other reproductive issues, along with questions about diet and exercise and any health concerns you have. You can also discuss changes in your family’s medical history that are important for your health care provider to consider. For example, when my mother was diagnosed with breast cancer, my doctor recommended that I get earlier screenings.

Along these same lines, your health care provider may have questions or issues to discuss with you. Smoking, drinking and recreational drug use can create and contribute to health problems, and often need to be discussed and addressed multiple times before change happens. Well-women visits also give your health care provider a chance to screen for potential high blood pressure, diabetes, depression, domestic violence, and more.

The well-woman visit is important for another reason: it gives you and your health care provider a chance to get to know each other. Most people go to their provider or to a clinic only when there’s a problem, but the best time to get to know your provider isn’t when you’re in distress from a painful or troublesome condition. Studies have shown that health care providers make more accurate diagnoses when they know their patients and can put the symptoms in the context of your life. A well-woman visit is a precious opportunity to build this trusted relationship.

As an emergency physician, I am excited about the new provisions taking effect Aug. 1, which include annual well-women visits for those who want them. I would much rather women regularly visit their health care providers than come to the E.R. later suffering from preventable problems. So please take this opportunity and make an appointment with your provider. The importance of investing in your health is too crucial to ignore.

Leana S. Wen, MD
Dr. Wen is an emergency physician at Brigham & Women’s Hospital and Massachusetts General Hospital and a clinical fellow at Harvard Medical School. She is the author of a forthcoming book on patient advocacy, “When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests.” For more information, visit her blog When Doctors Don’t Listen or her website. You can also follow her on Twitter @DrLeanaWen.

(This post was originally posted here on Our Bodies, Ourselves as part of the Countdown to Coverage Campaign)

With A Little Help From My Friends

One of the joys of being an advocate for the Affordable Care Act is getting to help others figure out what help they have available to them and seeing them get the health care they need. As with any large implementation, the array of benefits under Obamacare can be daunting, and there is no shame in looking for help in figuring out what programs or benefits apply to you.

The drafters of Obamacare thought ahead and added a "Navigator"program to provide just that assistance.The Illinois Department of Insurance and the U.S. Department of Health & Human Services will be seeking organizations in the next year to employ people to be trained in all of these options and sent forth to aid wherever they can, especially in hard to reach communities. This is a great source of jobs and a great resource for a community's health care needs.

The way the law is written, the Navigators have to be neutral parties -- uncompensated by insurance companies and providing unbiased assistance -- through the entire process. Then, further down the line, if you have questions, you already have a familiar face to contact for answers.

In a world where we are all used to enraging battles regarding our health care coverage, Congress actually built an insightful program into the ACA. Be sure to send comments on the design of the program to Governor Quinn so that it can be as effective as possible, and be ready to spread the word to those that will need a helping hand.

Sometimes, we all need a little help from our friends.

David Zoltan
Guest Blogger, Illinois Health Matters

Ages 55-64 and Uninsured...Where Can We Go for Help?

The number of people without health insurance in the United States has increased steadily over the last several years, from 43 million in 2007 to 49 million in 2010. Individuals between the ages of 55 and 64 make up 11% of this uninsured population. This age group is particularly vulnerable when uninsured: people age 55-64 are more likely than younger people to be in fair or poor health, and people age 55-64 who are uninsured are twice as likely to be in fair or poor health than their counterparts with health insurance coverage.

Regardless of health status, individuals in this group do not qualify for coverage through Medicare or Medicaid unless they have a serious disability (i.e., one that meets Social Security’s definition of disability for purposes of awarding Social Security Disability Insurance). Therefore, most people age 55-64 who do not have employer coverage are forced to seek coverage in the individual insurance market, where they may currently be denied a plan or charged exorbitantly high premiums for having pre-existing conditions.

The implementation of the Affordable Care Act makes a big difference for this population. Right now, the ACA is providing incentives to small business owners to keep providing employer coverage for people between the ages of 55 and 64. In 2014, insurance companies will no longer be able to deny people coverage due to a pre-existing condition, and premiums and cost-sharing subsidies from the government will help to ensure that people can afford to pay for coverage.

But what can people in this age group do until 2014? With support from the Chicago Community Trust, AgeOptions has put together a toolkit, “No Insurance? Health Care Options for Individuals Age 55-64 Without Insurance”:

This toolkit contains information about health care resources for individuals without insurance coverage, including:

• “Safety net” organizations and programs that provide access to health care
• Affordable Care Act provisions that will assist these individuals in obtaining coverage
• Where to go for information and assistance in finding health care options

AgeOptions hopes that this toolkit will be a valuable resource for people who are 55-64 and who are uninsured or underinsured. For more information and materials created by the Make Medicare Work Coalition (MMW), visit the AgeOptions website here: http://www.ageoptions.org/whatwedo/MMW.cfm

Erin Weir
Manager of Health Care Access
AgeOptions

Affordable Care Act will greatly benefit women

The Supreme Court’s ruling upholding the Affordable Care Act marks a critical victory for women’s health, and the health of all Americans. Because of this landmark decision, millions of women and families will continue to have access to affordable, quality health care — many of whom previously had inadequate coverage or no coverage at all.

At Planned Parenthood of Illinois, we understand how this law will have an unprecedented effect on women’s health. The law guarantees women direct access to OB/GYN providers without referrals, and ends discriminatory practices against women, such as charging women higher premiums and denying coverage for “pre-existing conditions.” And in just six weeks, women will gain access to birth control without a co-pay — which will have a tremendous economic impact on already stretched family budgets.

Since August 2010, more than 45 million women have already received full coverage for preventive health screenings, including mammograms and Pap tests. Now with this ruling, 17 million more women will have access to health insurance for the first time. And millions more young adults will be able to stay on their parent’s health insurance plans, just like the 3.1 million young adults who have done so since September 2010.

In Illinois alone, 469,469 women of reproductive age will now gain coverage under the Affordable Care Act by 2014.

The increased access to preventive health care and family planning under the Affordable Care Act provides immeasurable economic value to women, families and society. Not only does every dollar invested in federal family planning save taxpayers and families nearly $4, but unintended pregnancies are already costing U.S. taxpayers $11 billion a year.

Women realize that health and wellness are key to prosperity and independence. In times of economic uncertainty, it is more important than ever to stay healthy. For women, birth control isn’t a political or social issue — it’s basic health care and an economic concern. The money — up to $600 on average — that women will save on birth control each year is equal to five weeks of groceries for a family of four, nine tanks of gas in a minivan, or one semester of college textbooks.

Planned Parenthood of Illinois health centers already provide basic health care to nearly 75,000 patients every year, and to 3,321 patients in Springfield alone. Because this landmark law has been upheld, we know we’ll be able to do even more for the communities we serve in the months and years ahead.

Carole Brite

President and CEO

Planned Parenthood of Illinois

(Originally posted on July 10 in the State Journal-Register)

Expanding Medicaid: The Choice is Clear

The Supreme Court on June 28^th ruled that while the federal Affordable Care Act’s (ACA) Medicaid expansion is constitutional, in the event that a state does not implement the expansion, it would be unconstitutional to withdraw all Medicaid funding from that state. The ruling appears to leave intact both the mandatory nature of the expansion and the other remedies that the federal Medicaid authorities might use to enforce it. The states, however, might view the removal of the most aggressive remedy (full Medicaid defunding) as opening up some additional degree of choice about whether to forego the expansion and risk whatever lesser penalties federal authorities may impose (such as a partial withholding of funds). In Illinois, as in any other state, it is clear that expanding the Medicaid program on schedule in 2014 is by far the smart and right thing to do, regardless of the potential federal penalties for not expanding.

1.  The ACA’s expansion is aimed at covering some of the most vulnerable low-income adults who are otherwise unable to afford private insurance. Not all low-income Illinoisans are currently eligible for Medicaid. Instead, right now, to qualify for Medicaid, a low-income person must fit into a “category,” such as being 65 or over, or totally and permanently disabled, or pregnant, or a child under age 19, or a parent or caretaker relative of a child under age 19. But if you are a single, childless, non-disabled adult without a penny to your name, you do not qualify for Medicaid. This expansion adds another category—having household income less than 138% of the Federal Poverty Level (FPL), which would apply to an estimated 500,000 individuals in Illinois. People in a wide range of circumstances will belong to the “newly eligible” group. Many will be low-wage, part-time workers. Some will be unemployed, either recent or long term. Some will have health conditions that, if addressed by consistent medical care, could and would allow them to get jobs. Some are really destitute, even homeless. Some are young adults, perhaps having aged off Medicaid, which they received as children, but are not fortunate enough to have parents with insurance that would cover them until they turn 26. Others are middle-aged or close to 65. Some are people who had insurance coverage, but lost it through changes in circumstances such as job loss or divorce. 

Of the newly eligible population in Illinois, an estimated 431,000 Illinoisans with household incomes less than 100% FPL will be left in the cold without the Medicaid expansion. The ACA envisioned that these folks would qualify for Medicaid. That’s why the federal subsidy to help pay for private insurance premiums starts at 100% FPL and goes to 400% FPL. So, without the Medicaid expansion, these folks will likely be priced out of affordable health insurance through the Exchange because they won’t qualify for the federal financial help (unless they are lawfully residing residents ineligible for Medicaid). They will have to continue to access safety-net providers and emergency rooms for care, driving up costs for these providers and showing up sicker. And, these folks are still held responsible under the individual mandate to prove insurance coverage or why they are exempt.

2.  Minimal state investment will reap overwhelming benefit. The ACA increased the Federal Medical Assistance Percentage (FMAP) rates for the newly eligible individuals under the expansion to 100 percent for calendar years 2014 through 2016, and then gradually declining to 90 percent in 2020 where it remains indefinitely. By 2020, when Illinois will pay just 10 percent of the cost of care for this new population, the annual state cost is estimated at $157 million. (This is 10% of the current cost per adult beneficiary in Illinois, $3,157, times 500,000 new beneficiaries). But even as this cost will rise due to inflation, it will also be offset by benefits such as larger state tax revenues from increased employment and provider income and an increased insured population. It will also be offset by increased efficiencies due to the new system to simplify and coordinate eligibility and enrollment for Medicaid and the Exchange, which is nearly entirely paid for by the federal government. It may also be offset by the stabilization of the health of almost half of the newly eligible population in the event that the federal government gives permission for Cook County to expand Medicaid early, this year or next. If Cook County is allowed to expand Medicaid early, an estimated 250,000 folks will have medical homes and coordinated care, which would likely stabilize chronic conditions, prevent disabilities, and therefore reduce future Medicaid costs. Finally, state costs can be further minimized by increasing efficiency through care coordination initiatives, especially for persons with chronic conditions and for dual eligibles (persons eligible for both Medicaid and Medicare). The Lewin Group estimates that the ACA will increase Illinois’s Medicaid spending by just 2.8% between 2014 and 2019. The Congressional Budget Office has estimated that the ACA would impose less than a 1% increase in state Medicaid costs.  Moreover, these high federal matching rates are highly likely to stay. In Medicaid’s close to 50-year history, Congress has never decreased FMAP levels in Medicaid other than to allow the expiration of temporary FMAP increases enacted as parts of stimulus packages in recessions. The more states that adopt the “newly eligibles” expansion, the more members of Congress who will resist any reduction below 90% down the line. In fact, with sufficient support, Congress could amend the matching rate, keeping it at 100% indefinitely.

3. Expanding Medicaid creates jobs. We know from our recent past that an increased federal matching rate in the Medicaid program has an enormously significant economic impact—called amultiplier effect—throughout the economy and positively impacts jobs. When Congress included an increase in the federal Medicaid matching rate in the American Recovery and Reinvestment Act from 50% to 61.88% from October 2008 through December 2010, $1.2 billion per year for that period flowed into Illinois. For FY 2009, one estimate places the value of the wages generated from the Medicaid program that included the enhanced match as high as $15.8 billion, supporting as many as 385,742 jobs. The job growth and wages generated are likely to be much more substantial under the ACA’s Medicaid expansion, since the federal matching rate under the ACA is 100% from 2014 through 2016 and an additional roughly 500,000 newly eligible Medicaid patientsare expected to enroll. State and local revenue increases when Illinois residents pay income, sales, and other taxes generated by the federal funding for the Medicaid expansion; this revenue would offset much, perhaps all, of the additional costs.

4. Participating in the Medicaid expansion will help stabilize the state budget. The budget is critically dependent on federal Medicaid funding. The Illinois Medicaid program is by far the largest source of federal revenues to the state. Federal funds also support the Department of Human Services, Department on Aging, Department of Children and Family Services, local public health departments, Cook County Health and Hospitals Systems, Illinois’s state universities, and local school districts’ special education programs, among others. The Medicaid expansion will provide crucial federal funds across the state and local governments to support programs now being delivered to the expansion population with no federal funds, or being withheld from that population due to lack of funds.

5. We pay for the health care for the uninsured in any event, so let’s use federal dollars to pay for their current uncompensated care. A Kaiser and Urban Institute report on state spending under the expansion found that under the expansion, by 2019, Illinois would have reduced its number of uninsured adults in this newly eligible population by over 42% with the federal government paying for over 94% of the cost. This could translate into a decrease in Illinois’s uncompensated care spending of as much as $1.5 billion. And any cost to the state will be there, whether or not Illinois takes the money provided for the expansion. Working Illinoisans in low-wage jobs without insurance still get sick, still get injured. But without the federal dollars from the Medicaid expansion, other Illinoisans with insurance will still have to pick up the cost of their care, to the tune of $1,000 per year in increased annual premiums. And local property taxes are strained to support the township medical assistance programs and safety net health systems that provide care for low-income uninsured people now. In fact, currently over $400 million in services for uncompensated care is being provided annually by just one hospital: Cook County’s Stroger Hospital. 

6. Illinois hospitals need the Medicaid payments to offset reductions in federal funds in other areas. Targeted hospital subsidies, known as disproportionate share hospital (DSH) payments, will decline under the Affordable Care Act. The reduction was justified on the theory that the Medicaid expansion will eliminate the need for DSH subsidies by greatly reducing the burden of uncompensated care. If hospitals lose those payments, and the loss is not made up by the expansion of Medicaid, it will devastate not only hospitals, but entire communities. Many Illinois hospitals, especially in rural areas, simply are not viable if their DSH subsidies decline without being replaced by expanded Medicaid. Hospitals are among the largest employers in their communities. When a hospital closes, the community not only loses a major employer, but providers leave too, and then the community has great difficulty recruiting new industry. Additionally, expanding Medicaid will ensure that Illinois’s medical providers will have the financial support coming from the Medicaid expansion to offset the ACA’s Medicare payment reductions. Doctors and hospitals are counting on the Medicaid expansion (which will bring in revenue for services to the newly eligible and reduce the need for uncompensated care) to be in place as the Medicare payment changes are phased in.

7. Expanded coverage is the linchpin for the big picture reforms that will deliver both better health outcomes and lower costs. Coverage requires an investment (which the federal government virtually entirely funds under the ACA). But the investment will yield returns. Coverage makes possible arelationship with a regular medical provider. That, in turn, facilitates prevention, wellness advice, early detection of conditions, maintenance care (avoiding acute care), a platform for the full use of health information technology that avoids duplication and mistakes and spreads best practices, and care coordination. Coverage thus addresses the cost of health care by improving health outcomes across the system. This overall downward bending of the cost curve helps all of us, not just the newly insured. 

8. Federal Medicaid dollars will finally be paying for behavioral and mental health services for Medicaid enrollees. Under the ACA, the newly eligible population will have a benefit package that includes mental health and behavioral health services. These are costs now being borne by state and local funds, or else the services are simply not being provided—with impact on emergency rooms, state institutions and the criminal justice system. These state and local costs will be replaced with federally funded Medicaid.

9. Illinois’s veterans deserve health insurance. Not all veterans are able to get care at a Veterans Affairs hospital. And, in fact, roughly 43,000 Illinois veterans are uninsured (along with 25,000 of their family members). Illinois needs to take care of veterans, and the ACA’s Medicaid expansion will do just that. At implementation in 2014, nearly half of uninsured veterans will likely qualify forexpanded Medicaid coverage. Illinois should serve these veterans, just like they served its citizens.

10. Does Illinois really want to subsidize health care in other states? As Justice Scalia stated in his dissent, “Those States that decline the Medicaid Expansion must subsidize, by the federal tax dollars taken from their citizens, vast grants to the States that accept the Medicaid Expansion.” So if Illinois does not take advantage of the federal 100%/90% funding for the Medicaid expansion, other states that chose to expand will get the benefit of Illinoisans’ federal tax dollars.

11. Expanding Medicaid coverage helps the financial viability of community clinics.Clinics are our best—really only—strategy for providing health care to the uninsured outside of emergency rooms. There will still be plenty of uninsured after the ACA is implemented, plus many of the newly insured Medicaid beneficiaries will get their care from clinics. The only way that clinics can serve the uninsured is by serving a critical percentage of patients who have coverage. The Medicaid reimbursement for covered patients allows the clinic to also serve the uninsured. With a high percentage of patients covered, the clinics will be able to expand capacity to serve the uninsured as well as those newly coverage by Medicaid.   

12. The Medicaid expansion is simply the right thing to do. We have a chance, through the incredible leveraging of federal funds, to provide health coverage—and the chance for better health and upward mobility—to hundreds of thousands of our state’s most vulnerable, needy residents. We can create a system that expands its circle of moral concern to include the uninsured, recognizing as Justice Ruth Bader Ginsburg wrote in N.F.I.B. v. Sebelius, that “[v]irtually everyone … consumes health care at some point in his or her life.”


Andrea Kovach
Sargent Shriver National Center on Poverty Law

(Original post can be found here at The Shriver Brief)

Let’s Make Sure the Affordable Care Act Lives Up to Its Name

Low-income workers received a potentially devastating blow when the US Supreme Court decided to strike down the provision in the Affordable Care Act (ACA) penalizing states that do not expand access to Medicaid to families earning up to 133% of the poverty line. Unless states voluntarily expand Medicaid, many low-income workers will be left to shoulder the cost of mandated insurance on their own because few are likely to be covered through their employer.

According to the administrative rules for the ACA, employers (with 50 or more employees) have to pay a “shared responsibility fee” only when they neglect to cover full-time employees. Under this new law, full-time employees are defined as those who average 30 or more hours per week, and employers are granted ample leeway in defining the time period on which eligibility is based. Research I’ve conducted in several industries indicates that work hours in today’s hourly jobs are often scarce, with many workers expressing a preference for additional hours of work for additional pay. Because employers condition access to benefits on job status and hours worked, hourly workers, especially part-time workers, are often excluded from company-sponsored health insurance. The ACA is unlikely to do much to extend employer-sponsored coverage to hourly workers and may even heighten their risk of poverty given the incentive to employers to keep work hours below 30 a week.

Let’s make sure the Affordable Care Act lives up to its name by encouraging Governor Quinn and our legislators to voluntarily expand Medicaid. Because the federal government will pick up over 90% of the tab for the expansion, it makes good fiscal sense for both Illinois taxpayers and Illinois families.

Susan Lambert
Associate Professor
School of Social Service Administration
University of Chicago

(Portions of this letter were published in the Chicago Tribune, July 6 Voice of the People here)

Five Reasons Why States Should Act Quickly to Set Up Health Insurance Exchanges

Now that the Supreme Court has upheld the Affordable Care Act, we know that insurers will no longer be able to deny people coverage or charge them more based on their health status or gender, subsidies will be available to help people with low and moderate incomes afford coverage, and a state or federal exchange will be operating in every state in 2014.

A number of states are well on their way to establishing their own exchanges. But many other states instead have dragged their feet, citing uncertainty prior to the high court’s ruling (see map). With last Thursday’s decision, however, states can no longer use that excuse as grounds to avoid implementing the law. States that have said they prefer to operate their own insurance exchanges (rather than have the federal government run the exchanges for them) must act quickly.



Five reasons why states should start or resume planning activities immediately:

1. Deadlines are approaching – quickly. States must officially notify the Department of Health and Human Services (HHS) by November 16, 2012 – that is, in less than five months – of their intention to operate a state-based exchange and submit an application for federal approval of the exchange’s design and operations.

2. Applications alone won’t be enough. States seeking approval of their exchange proposal have to demonstrate sufficient progress to HHS by January 1, 2013 in order to prove that their state does not need a federally run exchange.

3. Operations will start before 2014. Exchanges – whether state- or federally run – will have to start enrolling individuals, families, and small businesses by October 1, 2013. States operating an exchange will also need to ensure they can determine eligibility for federal premium and cost-sharing subsidies available to individuals with low and moderate incomes who will buy coverage through the exchange. They also must be able to coordinate with their state Medicaid and CHIP programs. This means that new and improved information technology systems must be developed and tested.

4. Key policy decisions will take time. States must decide how they’ll approach and implement a wide variety of policies, such as financing operations of the exchange after 2014, selecting health plans to be sold in the exchange, conducting outreach and education to consumers, and developing services to attract small businesses.

5. Federal grant funds are available to fully fund states’ exchange set-up costs. States can apply for and receive federal funds that will finance all costs related to the design and launch of their exchanges. The funds can be used to conduct research on their insurance market, develop or upgrade their IT systems, hire and train staff, as well as support all operating costs for the exchange’s first year. The grants will be provided through 2014, as long as funds are available. But the sooner states access the funds, the sooner they can put them to work – and increase their chances of meeting all of the important implementation deadlines.

Despite these factors, leaders in several states responded to the Supreme Court decision by continuing to delay their own decisions on whether to move forward and create a state-based exchange. Because of the time crunch, this foot-dragging could effectively be a decision in itself – to forgo any chance of operating an exchange themselves and instead default to an exchange set up by the federal government.

Dave Chandra
Center on Budget and Policy Priorities

(Original post can be found here on the Off the Charts Blog)

Scariest thing in the world

Wes Craven has certainly tried hard over the years to give us scary. Joss Whedon sprinkled it with humor. Edgar Allen Poe taught us all some lessons in horror.

Then there is real scary. The kind you don't find in books or movies. The slow fear that doesn't have a release in a moment involving some guy in a mask.

For two years, I was a diabetic without health insurance. Doesn't sound like the kind of thing John Carpenter would toss out there for 90 minutes, does it? But it is, without a doubt, the scariest thing on Earth.

I was laid off in 2008, one week precisely before Lehman Brothers crumbled and the global economy with it. While I was offered COBRA and searched desperately for some way to keep my insurance, there was nothing I could qualify for as a diabetic for less than $700 a month. Unemployment insurance only added up to about $1400 a month, so to pay for insurance, I'd have to skip rent or utilities or food.

Medicaid was no help either. Illinois is a great state, but our Medicaid system here is currently set up to help only the lowest of the low. I "made too much money" on unemployment, even as a diabetic, to qualify for the program.

Yet without insurance, insulin, the very thing I need to take multiple times a day just to live, would cost me insane amounts of money. I take two types of insulin. Each bottle of insulin lasts me about two to three weeks. Each bottle without insurance costs over $110-120. It would cost me over $450 a month just for my insulin. That doesn't begin to take into account the syringes, the other pills I take to help control aspects of my health as a diabetic, or any of the other conditions that I have related to my diabetes or not.

Taking care of my health looked impossible. I was lucky though. I had some amazing doctors and nurses that did everything they could to get me insulin, that helped me navigate the systems to eventually get set up for charity care where we could, and even cajoled a few pharmacy reps I think into making sure I survived. I would not be here but for their incredible hard work and help.

Despite all that hard work, it was still not always enough. I had to pay out of pocket once, early on when I still had a small emergency reserve of money, and visit the emergency room three times to get insulin when we couldn't get it fast enough from our various alternate sources. That's three ER visits that the state had to pay for, and therefore, in the end, you footed the bill through your tax dollars in the most inefficient way possible.

The Affordable Care Act changed all of that. I was one of the first to sign up for the "high-risk pool", IPXP here in Illinois, that was set up to help get those of us with pre-existing conditions in the individual market into plans that could help us until the health insurance exchanges start in 2014. I stood side-by-side with Governor Quinn as he announced the program to the public, and I defend it to this day as an important stop-gap measure.

Thanks to the subsidies made available through Obamacare, IPXP only costs me about $150 a month instead of the $700 I was quoted before. It'll be more now that I've celebrated my 35th birthday, going up to $200 a month, but that's still far better than not having insurance at all.

I got a job after three years of looking, one year after I got into the IPXP plan, but it was a contractor position that didn't offer benefits. I kept the IPXP plan through that year of employment, and I didn't have to worry about trying to wait until a job came along that offered health benefits. Now that I'm once again in the job market, I seamlessly have nothing to worry about from IPXP as it stays with me. This is what everyone can look forward to with the exchanges starting in January 2014.

One of the last fears I had left was washed away when the Supreme Court declared the ACA constitutional and upheld the law. (See my reaction to the ruling here) It's not the last hurdle, but it is one of the most important ones. There is no doubt now that Obamacare is the rightful law of the land and can help 32 million previously uninsured Americans just like me to ensure that health care is a right, not a privilege.

There are still challenges, and I hope you'll stand with me to ensure that I, and so many more just like me, never face that fear again. We will talk about many of those challenges in the days ahead, no doubt. Thank you for being interested in my story and for doing your part to ensure health care for all.

David Zoltan,
Guest Blogger for Illinois Health Matters

Since When is 2% Considered Massive?

I don't know about you but I've been enjoying watching all of the reactions to yesterday's decision. In addition to the chuckle I got when a few major news outlets got it wrong, I've been smirking about opponents' claims that the law places a "massive tax" on all Americans.

Let's just put things in perspective here: Only a tiny fraction of people will be impacted by the individual responsibility provisions - those who can afford coverage but choose not to buy it.

What is that "tiny fraction" you ask? Researchers at the Urban Institute told us earlier this year that only TWO out of one hundred would be impacted (more here on this from the Center on Budget and Policy Priorities). And again: These are people who can afford coverage but choose not to buy it.

What IS massive? The millions of Americans who now have peace of mind that they will have access to secure health coverage even when they get sick, change jobs, ore face challenging health conditions. They can rest assured that getting the health treatment they need won't bankrupt their families.

Elisabeth Burak
Senior Program Director
Georgetown University Center for Children & Families

(originally posted here on the Say Ahhh! Children's Health Policy Blog)