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Affordable Care Act, Health Insurance Exchange, Health Reform

Health Insurance Marketplace | Help!

Starting tomorrow many individuals who have never purchased health insurance before will be able to do so through the new Health Insurance Marketplaces established by the Affordable Care Act. If you will be using the Marketplace or assisting others there are many resources available. Below is a list of resources that I find most helpful:

1. Find Local Help from Healthcare.gov: https://localhelp.healthcare.gov/

  • Simply enter your zip code and you will be given a list of local organizations that can help individuals.
  • Results can be narrowed by organizations that administer Medicaid or CHIP or that have language access capability.

2. Helping Consumers Understand and Use Health Insurance in 2014 from the Institute of Medicine: http://iom.edu/~/media/Files/Perspectives-Files/2013/Discussion-Papers/BPH-Helping-Consumers-Understand.pdf

  • This 16 page report clearly explains the Health Insurance Marketplace and other changes occurring due to the Affordable Care Act.
  • Written in simple language and contains helpful graphs/charts/illustrations.
  • Very useful for anyone who anticipates helping individuals with the Marketplace.

3. Subsidy Calculator from Kaiser Family Foundation: http://kff.org/interactive/subsidy-calculator/

  • Interactive tool allows individuals to enter their income information to find out if they qualify for a tax subsidy or tax credit to purchase health insurance in the Marketplace.

4. How do I get an exemption from the fee for not having health coverage? from Healthcare.gov:  https://www.healthcare.gov/exemptions/

  • Provides easy-to-understand information about the exemptions that exist to the individual mandate provision of the Affordable Care Act.
  • Explains that an exemption exists for individuals in states that do not expand Medicaid eligibility. Individuals that would otherwise become eligible will not face a penalty for not having coverage beginning in 2014.
Affordable Care Act, Health Equity, Health Reform, Medicaid, Pennsylvania

Healthy Pennsylvania? Not exactly.

Tuesday afternoon the nation stood by waiting for Pennsylvania Governor, Tom Corbett, to announce that Pennsylvania would opt in to the Medicaid expansion provision of the Affordable Care Act.  The news viewers received instead was something very different.  Corbett made it clear that he was not “expanding Medicaid”, but providing a “common sense” plan to reform the state’s Medicaid program. The plan’s title, Healthy Pennsylvania, is quite the misnomer when one looks at the details.

The Healthy Pennsylvania objectives are threefold: reform Medicaid, increase access, and stabilize financing.  Reforming Medicaid is at the heart of the plan and includes many controversial proposals such as condensing the 14 existing Medicaid benefit plans into two alternative benefit packages; applying a $10 co-payment for “inappropriate” emergency room use; requiring applicants and beneficiaries to comply with work search requirements; and attaching a monthly premium for individuals who have incomes as little as 50% of the federal poverty level.

For the reasons below and others, I do not support Governor Corbett’s Healthy Pennsylvania plan.  It is unlikely that the federal government will approve it as well due to the many provisions presented in the plan that are contrary to the laws and regulations governing the Medicaid program. Instead of taking meaningful action to help improve access to care and health of Pennsylvanians, this proposal will act as a needless delay prohibiting hundreds of thousands of Pennsylvanians from getting comprehensive, affordable health coverage as set forth by the Affordable Care Act.

Consolidation

While it is true that the Medicaid program in Pennsylvania is complex, it serves a variety of different populations. For example, there is a plan for women who make slightly higher incomes to receive coverage for certain OBGYN services known as the Women’s Select Plan.  Another existing benefit in Pennsylvania is the Medical Assistance for Workers with Disabilities (MAWD).  This plan provides health coverage for workers with disabilities whose income would otherwise make them ineligible for the traditional Medicaid program in Pennsylvania.  The Governor’s proposal to consolidate the existing Medicaid programs leaves advocates questioning the fate of programs like these that serve specific groups.  Even more troubling is  that in addition to consolidation, the Governor would like the services covered by the plans to reflect that of employer-sponsored coverage.  The traditional Medicaid plan in Pennsylvania offers  coverage for a wide-range of coverage including comprehensive services for mental health and substance use challenges.  If this proposal were implemented it would significantly reduce the scope of services individuals would receive to keep them well.

Expansion

Within the Healthy Pennsylvania plan the Governor does agree to expand Medicaid eligibility for individuals up to 133% of the federal poverty level. He proposes to do this by enrolling those individuals into private health insurance plans on the Marketplace.  While this expansion of eligibility would increase access to some type of health coverage for individuals, it would do so in a way that is more costly and less efficient than enrolling individuals into traditional Medicaid.  The fact is that it is less costly to insure individuals through Medicaid than it does through the private health insurance market.

Cost Containment

In an effort, under the guise of cost savings and promoting personal responsibility, Corbett proposes to mandate several requirements under the Healthy Pennsylvania plan. Among the most controversial is the work search requirement. While the Governor stated that this requirement would only apply to “able bodied” individuals capable of working, his plan does not clearly define how this requirement would be applied and enforced.  Currently, no other states in the nation apply a work requirement to its Medicaid benefit.

Another controversial provision is the premium that individuals will need to pay for coverage. Individuals with incomes as low as 50% of the federal poverty level ($5,745/year) will be asked to pay a premium. The maximum premium an individual will pay will be $25 per month.  While $25 per month does not seem like much money to individuals who have steady incomes, for low-income individuals, it will act as a significant barrier to coverage and care.

One of the more alarming provisions set forth in the plan without any clarification or description is a $10 co-payment for “inappropriate” emergency room usage.  The plan fails to define or describe situations when using the emergency room would be inappropriate as opposed to appropriate.  The plan also fails to explain how this co-payment would be collected or who would be responsible for determining when the co-payment should be imposed on an individual.  Individuals and families who might be experiencing serious medical conditions could delay seeking emergency treatment due to this co-payment.  The Emergency Medical Treatment and Labor Act (EMTALA) was enacted to ensure all individuals had access to necessary health services in times of crises regardless of ability to pay.  Enacting a policy such as this can confuse individuals about their right to receive care in these settings.  If implemented this provision will unjustifiably penalize the poor.

The Governor’s plan can be accessed here: http://www.dpw.state.pa.us/healthypa/index.htm.

Comments on the plan can be submitted via email to: RA-PWHealthyPA@pa.gov or by mail to:

Department of Public Welfare,
Office of the Secretary,
Health & Welfare Building,
625 Forster Street,
Harrisburg, PA 17120

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Can Legal Care Improve Infant Mortality? Incorporating Medical-Legal Partnership in Healthy Start Programs

Can Legal Care Improve Infant Mortality? Incorporating Medical-Legal Partnership in Healthy Start Programs

An article attorney Dan Atkins and I wrote for the National Center for Medical-Legal Partnership on the impact of medical-legal partnerships in Healthy Start programs. 

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Thoughts on Governor Corbett’s coming announcement re: Medicaid expansion in Pennsylvania

Public health advocates in Pennsylvania have been working tirelessly to influence Governor Corbett to “opt in” to Medicaid expansion since the U.S. Supreme Court made its surprising decision on June 28, 2012 regarding the Affordable Care Act (ACA).  The Governor’s office has leaked to the press that tomorrow we will get the news we have been waiting for during a big announcement the Governor is set to deliver.  One would think that advocates should welcome this news; however instead of celebrating, many of us are gearing up for our next challenge: explaining to the public and the legislature why we will not support Governor Corbett’s Medicaid expansion proposal.

For months Governor Corbett adamantly opposed expanding Medicaid eligibility citing misleading financial analyses, over reliance on the Medicaid program, and unsubstantiated fears that the federal government will “break its promise” regarding the 100% federal matching rate for the program for years 2014, 2015, and 2016.  More recently, as the Governor’s political popularity continues to dwindle, he has moved from adamantly opposing expansion to considering options within expansion.  Based on recent statements by the Governor, the Pennsylvania Department of Welfare Secretary, Beverly Mackereth, and the Insurance Commissioner, Michael Consedine, it is very likely that the Governor’s proposal will be similar to those of Arkansas and Iowa.  Governor Corbett favors privatization and it is likely he will propose expanding Medicaid eligibility for individuals, but instead of enrolling them into the traditional Medicaid program, the newly eligible individuals will be enrolled into the private health insurance plans on the Marketplace. In addition to this, the Governor will likely request a waiver from moving children in households with incomes up to 138% of the federal poverty level from CHIP into the Medicaid program; a provision of the ACA to which the Governor has expressed great opposition.  Other items the Governor might propose as part of the Medicaid expansion in Pennsylvania could include work requirements and increased co-payments for services. With the maintenance of effort requirement of the ACA expiring at the end of the year, advocates also fear Governor Corbett’s expansion plan will unfortunately come with a reduction in the current Medicaid benefit, negatively impacting our most vulnerable residents.

Governor Corbett is making the issue of Medicaid expansion in Pennsylvania needlessly complex in order to satisfy both a Republican base and to improve his popularity overall.  In doing so, the Governor will continue to delay the opportunity for approximately 600,000 residents to get comprehensive health coverage.  Some of the messages we need to get across are clear: (1) The current Medicaid program in Pennsylvania is efficient and works to provide comprehensive coverage to those who need it most; and (2) Pennsylvania residents will pay for Medicaid expansion through income tax regardless of whether we expand or not.  The government should expand in a way that provides the best services to individuals, not the highest profits for corporations.

 

Affordable Care Act, Health Policy, Health Reform, Inequality, Medicaid, Pennsylvania

Medicaid Expansion in Pennsylvania: Is it still possible?

budget letter photoToday, Pennsylvania Governor, Tom Corbett, announced his 2013-2014 proposed budget. During his budget address he announced that without further flexibility and reform from the federal government, expanding Medicaid in Pennsylvania would be, “financially unsustainable for Pennsylvania taxpayers”.  Governor Corbett’s announcement came a day after Republican Ohio Governor, John Kasich, announced that he would be expanding Medicaid in his state. Governor Kasich is the fifth Republican governor to do so.

While today’s announcement is certainly not good news for public health advocates, Corbett’s announcement did not entirely eliminate the possibility of expansion. In addition to his statement on the matter, Corbett sent a letter to HHS Secretary Sebelius identifying his concerns.

Corbett’s 2013-2014 proposed budget materials can be found here.

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Corbett’s Health Insurance Exchange Decision

Corbett’s Health Insurance Exchange Decision

Pennsylvania Governor, Tom Corbett, announced on December 12th that the Commonwealth will not be establishing its own Health Insurance Exchange. To most of us, this came as no surprise. Here’s the link to the Governor’s statement along with his letter to Secretary Sebelius. Within his letter, the Governor states his financial concerns of expanding Medicaid eligibility within the state. He cites to a $4 billion cost to the state over an eight year period. At this time the Governor has not decided whether Pennsylvania will expand Medicaid eligibility or not.