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What health reform means for the people of Illinois

A blog by IllinoisHealthMatters.org

Friday, October 25, 2013

Young Invincibles in Illinois

From Visualizing Health Reform,
Illinois Health Matters
Two months ago, Young Invincibles launched our Midwest Regional office here in Chicago. One of the main reasons why we chose to come to Illinois is that it has one of the highest numbers of uninsured young adults. In Cook County alone, over 158,000 19-35 year olds could be eligible for Medicaid and another 190,000 could be eligible for tax credits to make health insurance more affordable. Across the state, 286,000 19-35 year olds could receive Medicaid. Another 345,000 young adults in Illinois could receive tax credits.

Young Invincibles was founded around providing a voice for young adults in the Affordable Care Act (ACA) debate. Since then, we’ve worked hard to educate our generation about the benefits of the ACA, even as we expanded to work on other economic issues that affect young adults. As of October 1st, the launch of the health care marketplaces, we’ve been hard at work with Illinois Health Matters and many other organizations here in Illinois to spread information about the ACA to many uninsured young adults.

To help with that effort, we’re dispelling a few myths about young adults and health insurance that we’ve heard a lot.

Myth #1: Young adults choose not to get health care because they think they’re young and invincible.
This misconception is actually how Young Invincibles got its name! For the most part, our generation does not believe we are invincible, but instead have been shut out of buying insurance because it traditionally had been too expensive for many people. In fact, over 70% of young adults say that health insurance is very important to them. But, many young adults are just beginning their careers and may be working part-time jobs where they aren’t offered health coverage by their employer and can’t afford it on their own. With the ACA, that will change a lot. Now, a majority of uninsured young adults will be eligible for Medicaid or new tax credits to help reduce the cost of health insurance.

Myth #2: Young adults are young and healthy and won’t get sick or injured.
With more accessible health care, we will be able to take care of ourselves. While injuries can come at any time, like a broken finger playing softball or partially collapsed lung from falling on a speaker (both of which are true stories), it’s harder to predict when you’ll get hurt or sick. Coverage offers protections against those catastrophes. Moreover, many preventive services are now covered under the ACA, such as blood pressure tests, cholesterol screenings, HIV screenings, and many common immunizations. By taking advantage of these new, free benefits, you can prevent and treat diseases and conditions before they become a major issue, saving you money and improving your health.

Myth #3: Obamacare and the ACA are two different things. Obamacare is a type of insurance to be purchased.
Many people are still confused by the use of different names for the Affordable Care Act, such as Obamacare and the ACA. The Affordable Care Act, ACA, and Obamacare all refer to the same law.

There is also no government insurance takeover of private insurance. The only government insurance are programs like Medicare and Medicaid. If you buy a plan on the Health Insurance Marketplace, you will be purchasing private insurance, but with new protections and preventive care to ensure that you are buying a comprehensive plan that truly does cover your health care needs.

While these are just some of the common myths and misconceptions out there about the ACA, we still have a lot of work to do to get more information out to the people who need it. Check us out at health.younginvincibles.org to see what resources and information we have available. You can also vote in our video contest! Don’t forget to check us out on Twitter and Facebook, too!

Brian Burrell
Midwest Regional Manager
Young Invincibles

(Posted originally on the YI Blog)

Wednesday, October 23, 2013

Be Covered Illinois Care Fair a Huge Success

On Sunday, October 6th, Be Covered Illinois hosted a Care Fair with many of its partners on Chicago’s southwest side. It was a sight to see! The doors opened at 11:00am, but by 9:45, a line of people stretched outside the building waiting to get in. By the time the event ended at 5:00pm, 5,227 visitors had attended the event. Fifty-two registered In-Person Counselors representing 15 community organizations staffed the enrollment area, the largest gathering of certified navigators yet to be seen in the nation. A big ‘thank you’ and a shout-out to the following agencies for supporting the event with navigators:

• AIDS Foundation of Chicago
• Chicago Childcare Society
• Children’s Home and Aid
• Chinese American Service League
• El Hogar del Nino
• Health Leads USA
• Illinois African American Coalition for Prevention
• Instituto del Progreso Latino
• Lawndale Christian Development Corporation
• Metropolitan Family Services
• Pilsen Wellness Center
• Puerto Rican Cultural Center and Prime Care
• Sinai Community Institute
• The Resurrection Project
• United Way of Metropolitan Chicago

Despite the fact that the federal site – healthcare.gov – was still having difficulties, the resourceful navigators were able to engage attendees in conversations about the law and make hundreds of follow-up appointments with those seeking to enroll in health coverage on the Illinois Health Insurance Marketplace.

In addition to navigators, there were six groups serving as subject matter experts to help answer questions about the new health care law, and 36 organizations that provided information on the resources they provide for communities. The event was supported by almost 200 volunteers, as well as dedicated medical professionals that provided seven different medical screenings, including 527 flu and TDAP vaccines. As a thank you for attending the event, each family left with a bag of healthy groceries, 2,000 bags in all.

The day’s events were a testament to the fact that there is both interest in and the need to secure access to health insurance, and more importantly, health care services for the many people who until now had few healthcare options. With ACA, they will now have many more opportunities to secure access to coordinated, high quality healthcare when they need it.

The Be Covered Illinois Care Fair provided an important opportunity for community organizations to educate attendees about health reform and the health insurance marketplace and how the law can benefit them. People who came were genuinely hungry for knowledge. Knowledge is power, and that Sunday we empowered 5,227 people to have the information they need to gain new access to health care – care that they told us in no uncertain terms – was not only wanted, but desperately needed. As the day wound down, their personal stories and the smiles on their faces were all I needed to confirm that this Be Covered Illinois Care Fair was truly a success.

Words, however, cannot do justice to the positive spirit and collaboration that infused the Care Fair. To get a better sense of that, please take a look at the story that Sarah Schulte of ABC-7 News did on the news that evening.

If you wish to join us as a Be Covered partner organization, request resources or learn more about what we’re doing, please visit: www.becoveredillinois.org

Donna Gerber

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

Monday, October 21, 2013

How the Affordable Care Act Helps Immigrants

There are at least 40 million immigrants in the United States, accounting for about 13% of our country’s total population. The Affordable Care Act (ACA, also known as ObamaCare) helps immigrants by providing new and strengthening current health insurance coverage opportunities. Below are six important points about the ACA that all immigrants need to understand.

Lawfully present immigrants are eligible to purchase private health insurance plans in the health insurance marketplaces. Every state has made available to its residents access to a state or federal online marketplace where applicants will be provided a range of affordable private qualified health plans for them to enroll in. Essential health benefits, pre-existing conditions, and preventive care will all be covered under these qualified health plans. Open enrollment in these plans is from October 1, 2013, until March 31, 2014. Applicants must have enrolled in and purchased coverage by December 15, 2013, for coverage to start on its earliest date: January 1, 2014.

Lawfully present immigrants may qualify for federal financial help to lower the cost of their monthly premiums and cost-sharing (e.g., co-payments, deductible, co-insurance) to help them afford a private insurance plan through the Marketplaces. Lawfully present immigrants with household income between 100% and 400% of the federal poverty level (FPL) ($45,960 for an individual or $94,200 for a family of four) are eligible for premium tax credits and between 100% and 250% of the FPL ($28,725 for an individual and $58,875 for a family of four) are eligible for the cost-sharing reduction subsidies. The tax credit alone is estimated to provide $2,700 per family that purchases coverage on the Marketplace, reducing premium cost by an average of 32%. To qualify for this federal financial help, applicants cannot be offered affordable health insurance through their job or be eligible for Medicaid.

Most lawfully present immigrants who meet Medicaid program requirements, such as income and state residency, can enroll in Medicaid after they have been in the United States for 5 years or more. Some groups of lawfully present immigrants do not have to wait five years before they may enroll in Medicaid, including refugees, asylees, and pregnant women and children in some states. Immigrants will benefit greatly in states that choose to add the ACA’S new Medicaid eligibility category, which will expand that program to all adults under age 65 with household income of less than 138% of the FPL (about $15,800 for an individual and $32,500 for a family of four). In fact,more than half (52%) of uninsured Hispanics with incomes below this limit reside in states adding the new Medicaid eligibility category. Use of Medicaid does not affect one’s immigration status (public charge decision) unless the Medicaid use is for long-term care such as nursing home care.

Lawfully present immigrants with household incomes of less than 100% of the federal poverty level are also eligible for the private Marketplace coverage and can get help paying premiums and cost sharing if they are ineligible for Medicaid (either because they are not LPRs or because they are LPRs with less than five years of residency).

Undocumented immigrants may not buy health insurance through the Marketplaces, even at full cost. However, until this is remedied, undocumented immigrants need to know that
community health centers, strengthened by ACA funding, will still accept patients regardless of immigration status, emergency rooms will continue to treat undocumented immigrants for free or at very low cost, many hospitals have charity care obligations that essentially provide free care to low-income patients, regardless of immigration status, undocumented immigrants may purchase health coverage through an employer or a spouse’s employer, undocumented immigrants may purchase private health insurance off of the Marketplace, and some state-funded Medicaid programs are open to them regardless of immigration status.

Undocumented immigrants also need to understand that, if they have family members who are U.S. citizens or lawfully present, these family members are required to have health insurance under the law starting in 2014, or face a penalty at tax time, unless they qualify for some exemption. This means that undocumented parents who have lawfully present or U.S. citizen children must ensure that their children have health insurance (through a child-only private Marketplace plan or through Medicaid, for instance). It’s important to remember that only those individuals in a family who are applying for health insurance are required to provide citizenship and immigration status. So undocumented parents applying through the Marketplace for private or Medicaid coverage for their eligible family members will not be asked for a Social Security Number for themselves (only for the applicants).

There is no charge to individuals who receive in-person help in enrolling in Medicaid or Marketplace coverage. The ACA provides federal funding to train and certify in-person consumer assisters to walk individuals through all of their health insurance coverage options. You can find an in-person assister by going to your Marketplace’s website. These assisters cannot and will not charge individuals for this enrollment assistance, including answering questions post-enrollment. Lastly, enrollment information is not shared with immigration agencies for the purpose of enforcement.

Andrea Kovach
Sargent Shriver National Center on Poverty Law

(Reblog from the Shriver Brief)

Tuesday, October 15, 2013

Getting Ready for The Affordable Care Act

Small Organizations in the Wake of the Affordable Care Act 144Understanding the ways in which the Affordable Care Act (ACA) will affect small organizations and change the shape of the health care market isn't easy, especially with the large amount of misinformation that has been spread about the law. To help make the picture clearer, Donors Forum’s Chicago Grantmakers for Effective Organizations hosted a session on Small Organizations in the Wake of the Affordable Care Act.
Stephanie Altman, Health and Disabilities Advocates, Kathy Chan, EverThrive Illinois, and Judith Haasis, Community Health, provided detailed information about what organizations can expect in the new environment and how the coming changes will affect them as individuals and employers.
Two key things nonprofit employers need to know about the ACA:
  • Organizations with fewer than 50 full-time equivalent employees are not required by the law to provide insurance for their employees
  • ACA provides an increased range of options for insuring employees.
The Small Business Health Options Program, or SHOP, can be accessed through healthcare.govand it can connect businesses with fewer than 50 employees to insurance options that might work for them.
Smaller nonprofits can also benefit from available tax credits. Organizations with fewer than 25 employees and annual average wages of less than $50,000 that pay more than 50 percent of the cost of health insurance premiums for their employees, may be eligible for a tax credit equal to 35 percent of their expenses. Organizations must obtain insurance through the SHOP marketplace to get the credit.
The many variables affecting an organization's health insurance decisions are best served by working with an expert. Navigators or assistors have been trained to work with small businesses and individuals to help them connect to benefits for which they might be eligible.
Businesses and individuals can also work with brokers, who can tailor recommendations to them in ways navigators cannot. Brokers are paid by insurance companies, so they will not add to an organization's expenses, and they can help businesses find plans that work for them.
It is important to note that navigators and brokers are prohibited from charging for their services.
The Individual Market
Along with providing possible subsidies for small businesses, the ACA makes significant changes to the insurance market for individuals. Changes from the ACA can be generally grouped into two areas:
  • Changes that affect the quality of insurance policies
  • Changes that provide more access to health insurance
Some of the provisions in the former category have already taken effect, like the provision stating dependents can remain on an insurance policy until they are 26 and the removal of lifetime limits on benefit amounts. Many major provisions, including the health insurance marketplace, are now starting up, with the marketplace accepting applications in anticipation of a launch in January 2014.
Other provisions will take effect at the beginning of 2014. They will describe a basic level of health insurance that all people should be able to access. There will be far fewer variables insurers can use to adjust premiums. Factors that were used in the past, such as gender or pre-existing health factors, cannot be taken into consideration. The only factors that will affect individual prices are age, geography, and tobacco use.
GetcoveredlogoOn the quantity side, the ACA expands Medicaid eligibility in states that opt in to the expansion, including Illinois, while also providing subsidized insurance options through the marketplace for individuals. This presents several possible challenges for organizations.
First, there is already a shortage of Medicaid specialty care providers, and having more individuals using Medicaid could make this shortage more pronounced. For primary care, Medicaid reimbursement rates are being raised to Medicare levels, which should help shortages in that area. Building specialty care capacity will be a challenge.
Another challenge is that as many as 1.5 million state residents will have insurance they didn't have before, and many of them are not familiar with the best ways to make use of access to preventative care. Helping people use their new resources to best improve their health will be important.
While ACA implementation is expected to significantly lower the numbers of uninsured in Illinois, undocumented immigrants are not covered by the ACA.Organizations committed to providing health care to uninsured, low-income individuals will still be needed. They must figure out how to adapt, including whether they should introduce new revenue streams by doing things such as taking in Medicaid patients.
The new environment presented by the ACA will be challenging, but it also presents opportunities for organizations and funders to enhance the health of people throughout the region as they work together.
Resources for individuals and organizations:

Jason Hardy, Member Services Associate, Donors Forum

Thursday, October 10, 2013

The ACA and Millennials: Time Will Tell

Recently, the media has delivered polarized opinions regarding how the Affordable Care Act (ACA) affects or will affect young adults. When reading news and op-ed headlines like “Why Obamacare is good for young people” (Klein, 2013) situated next to “Obamacare is really, really bad for you, especially when you are young” (Basu, 2013), it seems that young people should expect to feel lost when approaching such complex legislation. As these headlines demonstrate, the media has misrepresented the ACA as being either fantastic or detrimental for Millennials. Upon further investigation and review, it seems the reality is somewhere in-between “good” and yet to be seen “bad.”

The Good: This is easier to explain, because much of it is based on factors that can be measured or already enacted provisions within the ACA.
  • “The percentage of young adults without health insurance has fallen by more than 4 percentage points since 2009, declining from 31.4 percent to 27.2 percent in 2012, or more than 1 million individuals” (Commonwealth Fund, 2013). Additionally, “The law has helped 6.6 million young adults who have been able to stay on their parents’ plans until the age of 26, including 3.1 million young people who are [now] newly insured” (Office of the Press Secretary, 2012). This provision prevents young adults from aging out of insurance coverage as they graduate from high school or college and has reduced the percent of young adults without insurance.
  • There is always the option to opt out of ACA coverage and pay a penalty. This allows individuals to exercise their freedom and not buy coverage if it proves financially challenging or if their circumstances change. However, it allows people to risk not planning for accidents or unforeseen health needs that may require them to use healthcare services that are unaffordable without insurance. 
  • There is more transparency. Under the ACA, insurers have to provide understandable information to consumers. “All consumers, for the first time, will really be able to clearly comprehend the sometimes confusing language insurance plans often use in marketing,” said HHS Secretary Kathleen Sebelius. “This will give [consumers] a new edge in deciding which plan will best suit their needs and those of their families or employees” (Department of Health and Human Services, 2012).
  • All FDA approved birth control options are covered without copays, coinsurance, or deductibles (Centers for Medicare and Medicaid Services). This already existing provision immediately removes the barrier of up-front costs allowing for greater consumer choice and access--particularly for health services like birth control that young women are more likely to utilize.
  • “Nearly 13 million Americans will receive a rebate this summer because their insurance company spent too much of their premium dollars on administrative costs or CEO bonuses” (Office of the Press Secretary, 2012). This benefit seems fairly obvious as it will allow a large portion of insured Americans to reinvest or reallocate those savings into goods and services they otherwise may not have been able to afford without the rebate (e.g., childcare, energy saving home appliances, or healthy foods/activities).
The Bad: The negative views regarding the ACA are often related to one of two ideas: the “what-ifs” and the “myths.” In this discussion, only the “what-ifs” causing apprehension among readers will be covered. Much of what is presented as “bad” about the ACA is speculative, and has yet to be seen. Prior to condemning or celebrating the law, time should be allowed to observe its enactment.
  • 22 states are not expanding Medicaid at this time (Kaiser Family Foundation, 2013). Young adults that cannot get coverage under their parents’ plans might slip through the cracks. If they have to purchase insurance from the marketplace, budgeting premiums into an already stretched budget is not easy, even if premiums are kept under $100 per month. Honestly: affordability is largely subjective and may vary despite attempts like cost-sharing subsidies and tax credits attempting to control costs.
  • Young adults may end up paying more for health insurance coverage than the health services that they consume and need. Some media sources have stipulated this is a bad thing because young adults could be subsidizing services they may not have the fortune of utilizing. Much like what is speculated about Social Security benefits, it is also difficult to know that there will be enough money in future generations to assist with cost-sharing for the millennial generations’ health benefits as they age. As former US President Bill Clinton recently said, “This only works. . . if the young people show up" (Taranto, 2013).
  • With the unemployment rate being almost twice as high for young adults as for the general population—13% for young adults aged 20 to 24, and 7.3% as stated by the US Bureau of Labor Statistics--and living in a rapidly changing economy, the ability to pay premiums for marketplace insurance policies may vary from month to month, potentially creating financial insecurity for young adults. 
Overall, the Affordable Care Act is not a two-sided coin for Millennials. As with all large policy implementations, there will undoubtedly be challenges and hurdles to address over time. Since the ACA was enacted in 2010, we've already seen some successes. In proceeding to evaluate the Affordable Care Act implementation, it is important consider how both the positive and negative consequences will unfold for individuals.

Let's allow time to see if the “what-ifs” become "what is" before jumping to a conclusive or alarmist opinion.

Emily Gelber MSW, LSW
Illinois Health Matters Analyst
Health & Disability Advocates




Thursday, October 3, 2013

No, Health Reform Doesn’t Give Congress Special Treatment

Some health reform opponents claim the Obama administration is giving members of Congress and their staffs special treatment under the Affordable Care Act. The claim, which a number of media stories have repeated uncritically, is simply false: Although they will be required to enroll in health plans offered within the new health-insurance exchanges established under the law, members of Congress and their staffs will not receive extra financial help to pay for their medical care.

Critics are angry because the administration has confirmed that members of Congress and their staffs can continue to receive employer contributions to cover part of their premium costs. But that’s not special treatment. Today, most large employers do the same — the federal government, which provides coverage for members of Congress, their staffs and other federal employees, is no different.

In reality, it’s the critics — as part of their ongoing assault on the health care law — who are seeking special treatment for Congress, by proposing to make members and their staffs the only workers in the United States whose employer is barred by law from helping to cover their premiums. There’s no reason to discriminate against members and their staffs in this way, especially when doing so would make it more difficult to recruit and retain high-caliber congressional staff.

Here’s the issue: Under a provision authored by Sen. Chuck Grassley (R-Iowa) and added to the legislation during the Senate Finance Committee’s health care deliberations in 2009, members of Congress and their staffs won’t be allowed to continue buying coverage through the Federal Employees Health Benefits Program, which offers a variety of health insurance plans to federal employees. Instead, congressional staffers and members will only be able to enroll in plans offered in the ACA’s new exchanges, with the government continuing to make an employer contribution. (Grassley himself has confirmed that he intended for the federal government to continue making employer contributions under the provision.)

Critics claim this is special, gold-plated treatment because other people can’t get an employer contribution and use it to help buy coverage in the health exchange system. That’s incorrect. The ACA explicitly allows small businesses with fewer than 50 employees (up to 100, at state option) to offer their employees health plans through the exchanges and to help cover the premiums. This is essentially the same treatment that members of Congress and their staffs will receive.

Nor is the setup for Congress double dipping, as some mistakenly charge. Members of Congress and their staffs, just like the small-business employees, will be ineligible for federal tax credits to help cover the cost of their exchange health plans — unlike people with low and moderate incomes without employer coverage who buy health plans in the exchanges on their own.

There is one way in which health reform’s treatment of members of Congress and their staffs is unique — but it doesn’t involve preferential treatment. They are the only people in the country working for a large employer that is allowed to offer health plans exclusively through the exchanges. Unlike all other federal employees, they will not be able to enroll in plans offered through FEHBP. That’s because of the Grassley amendment.

Some members of Congress who oppose the ACA propose to prohibit the federal government from contributing toward the insurance premium costs of members and their staffs. Now that would be special treatment — the health care law does not prohibit the employer of any other workers in the country from making such a contribution.

If critics truly wanted to make sure there is nothing unique here, they would propose dropping the Grassley amendment and treat members of Congress and their staffs the same as other federal (and private-sector) employees, by allowing them to continue to enroll in plans offered through FEHBP, with the federal government continuing to make a contribution to help cover the costs. That’s how health reform treats other employers: It allows them to maintain current insurance arrangements and contribute on their employees’ behalf.

Why aren’t opponents of the health care law trying to do that? Presumably because there’s no political advantage in doing so. It’s time to get beyond political firefights and get on with responsible governing, including making health insurance coverage under the ACA work as effectively as possible for the American people.

Robert Greenstein is president of the Center on Budget and Policy Priorities
CBPP

This post was posted first on Politico and reposted with permission from the Center on Budget and Policy Priorities.

Tuesday, October 1, 2013

Strong Interest in Illinois: State is Meeting Demand



 
Chicago – A stronger than expected showing for the Get Covered Illinois website, GetCoveredIllinois.gov, dominated the State’s storyline on the opening day of the Illinois Health Insurance Marketplace.  The following is an operational update:

WEBSITE:

The Get Covered Illinois website opened on time at 12:00 a.m. Monday, October 1.  As of 3:30 p.m. CST, more than 69,840 visitors had come to the online marketplace. 65,043 of them were unique visitors; and the page views totaled more than 412,580, with visitors viewing an average of six page views per visit.

“With a project of this magnitude, there was no accurate way to predict what our web traffic would be,” offered Jennifer Koehler, Executive Director of Get Covered Illinois. “But with that said, today’s numbers certainly validate the strong interest in healthcare in Illinois, and we’re glad to be able to service it. It also validates our strategy of education, since all this has come with basically no advertising. So we are overall very, very pleased.” 

Only a handful of early and minor glitches were reported, impacting a very limited number of consumers. All minor glitches were reported and fixed by early afternoon. “The site has performed incredibly well, the way we designed it to,” added Koehler. 

Additionally, the State received more than 1,100 online applications submitted on the ABE (Application Benefits Exchange) portion of the Get Covered Illinois site. 

HELP DESK:

The Help Desk received more than 350 calls as of 3:30 p.m.  Calls were answered in an average speed of six seconds, and callers were on line with Help Desk specialist an average of six minutes.

FIELD OPERATIONS:

There is steady interest, as judged by customers at our grantee community organizations today.  Most consumers are reportedly doing exactly as State officials hoped – coming in to be introduced to the process, the website, the Navigators and making appointments over the next few weeks as they become educated themselves on the site, and come back with prepared questions, and more ready to enroll.

“We know this is not nearly the same as buying a gallon of milk, a new pair of shoes, or anything in daily life,” said Director of Outreach Brian Gorman.  “Shopping for health insurance is brand new for more than a million Illinois residents, and it will take education and time to get comfortable with this new process.  But we are thrilled to see, today that process of understanding the right plan for them and their families started in earnest in locations all across Illinois. Consumers responded to our ask – which was to meet their community partners, understand the resources available and get an appointment when they are ready to get covered.” 

SOCIAL MEDIA:

Follow us on >>

Twitter: @CoveredIllinois
Hashtag: #GetCoveredIllinois

Posted with permission from GetCoveredIllinois.gov