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

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.

Affordable Care Act, Health Insurance Exchange, Health Policy, Health Reform, Pennsylvania

Pennsylvania State-Operated Health Insurance Exchange- Not Happening

PA Will Miss Health Insurance Exchange Deadline

On Wednesday, October 17, Pennsylvania Health Insurance Commissioner, Michael Consedine stated that the Commonwealth will not be meeting its November 16th deadline to submit an Exchange Blueprint to the Health and Human Services (HHS) Department. Because of this, the State will not be able to establish its own state-based exchange but must instead either default to a Federally Facilitated Exchange (FFE) or partner with the federal government to establish a Partnership FFE.

Affordable Care Act, Essential Health Benefits, Health Reform, Pennsylvania

Pennsylvania’s Essential Health Benefits Package Progress (or lack thereof)

Previously, I provided information about the progress of Pennsylvania’s Health Insurance Exchange (HIX) implementation.  Today I received an email from Pennsylvania Insurance Department (PID) Commissioner, Michael Consedine, providing an update on the Commonwealth’s developments with the Essential Health Benefits (EHB) package and other health reform issues.

In his email, sent out through PAHealthOptions.com, the Insurance Commissioner provided links to three documents that should inform the reader of the “most recent activities of the department.”  The links included: 1. A report conducted by Deloitte on the EHB in Pennsylvania; 2. A letter to the HHS Secretary regarding the EHB; and 3. A letter to the HHS Secretary requesting more information about HIX implementation.  Following the links Commissioner Consedine assured the reader that, “We continue to be committed to pursuing health care reform solutions that work best for Pennsylvanians – but we are similarly committed to making sound, informed decisions – not just fast ones.”

The Deloitte study analyzed the Commonwealth’s choices of existing plans within the state to operate as the EHB as provided by HHS.  These include: 1. The largest plan by enrollment in any of the three largest small group insurance products in the State’s small group market; 2. One of the three largest State employee health benefit plans by enrollment; 3. One of the three largest federal employee insurer options; or 4. The largest HMO plan offered in the State’s commercial market.

Deloitte found that there was only a one percent difference between the total value or cost between the highest and lowest options; however coverage differences did exist among the plans, most notably for dental and specialized services including behavioral health. The study also found that all ten of the existing plans analyzed would need to be supplemented in order to meet requirements under the Affordable Care Act (ACA).

So, the question is: Which health plan will Pennsylvania choose as its Essential Health Benefits package? Like the letter to HHS about the Health Insurance Exchange, Commissioner Consedine, provides a similar answer. The Commissioner states, “Given what we believe to be the clear statutory obligation on HHS to define EHBs and the lack of any rulemaking that would allow Pennsylvania to make an informed and consequential decision by September 30th, we are simply providing the study conducted by the Commonwealth at this time.”  Commissioner Consedine also stated in his letter that he will be “directing interested parties to submit their comments and recommendations to you [HHS] for your consideration. . . ..”

In an ironic attempt to subvert a “one-sized fits all” Washington D.C. policy on the State of Pennsylvania, the Insurance Department has chosen to defer to Washington D.C. to craft the EHB package and will most likely default to a Federally-Facilitated Exchange (FFE) or a Partnership FFE.