New Fact Sheet: How the Health Reform Law Helps People with HIV

Still wondering how the Affordable Care Act helps people living with HIV/AIDS? Well, there’s no need to wonder anymore!

The HSS Office of Health Reform has developed a new fact sheet about how the Affordable Care Act (ACA) is particularly important for people living with HIV/AIDS, as well as other people living with serious medical conditions. The law has made significant progress in addressing the concerns and advancing the rights of people with HIV consistent with the goals of the President’s National HIV/AIDS Strategy.

Among the ways the new health law is helping people with HIV are the following:

• Ensuring that AIDS Drug Assistance Program (ADAP) benefits are now considered as contributions toward a Medicare beneficiary’s true Out of Pocket Spending Limit for drug coverage.
• Improving access to coverage and protecting people with HIV/AIDS now by making available a Pre-Existing Condition Insurance Plan in every state and making important insurance reforms to protect people from insurance company abuses;
• Offering quality coverage and care to every person with HIV/AIDS in 2014 and beyond via Medicaid expansion, additional insurance reforms, and closing the “Donut Hole”, and
• Increasing opportunities for health, well-being, and cultural competency.

So, whether you are just learning about the Affordable Care Act or looking for updated information, this fact sheet gives you the tools you need to make informed choices about your health. Read more details in the fact sheet (PDF) about what the health care law does to help people with HIV/AIDS.

This post originally appeared on the HIVHealthReform.org Blog.

The Affordable Care Act: A New Tool in the Fight Against Breast Cancer

Did you know that the Affordable Care Act is upping the ante on breast cancer awareness and prevention efforts?

According to breastcancer.org, about one in eight U.S. women (just under 12%) will develop invasive breast cancer over the course of their lifetimes. In 2011 alone, it was estimated that nearly 230,000 women were diagnosed with some form of the disease, and tens of thousands of women lost their lives to it. Breast cancer is the second most common type of cancer in women and one of the most deadly cancers among our mothers, sisters, and grandmothers. But it doesn’t have to be. Raising awareness about breast cancer, educating women about effective preventive health practices and increasing access to doctors and routine mammograms can reduce the cost, hardship, and lives lost to this all-too-common form of cancer. And this is precisely what theAffordable Care Act is doing for women all across the country.

The Affordable Care Act (ACA) authorizes the Centers for Disease Control and Prevention (CDC) toaward grants to fund breast cancer education and awareness campaigns across the country. The Act also directs the Secretary of Health and Human Services, along with the CDC, to establish an advisory committee on breast cancer and to launch a breast cancer awareness and education campaign, targeting young women with information about prevention and early detection. The law also authorizes the CDC to conduct research to better understand the disease, as well as the most effective prevention and awareness-raising efforts.

The CDC states that mammograms can detect breast cancer up to three years before it can be felt. And according to Health and Human Services, 3,700 lives would be saved every year if 90 percent of women 40 years old and up received routine breast cancer screenings. It is no secret that educating women about the importance and effectiveness of early detection is crucial to reducing the prevalence and mortality rates of breast cancer. 

However, this isn’t just an awareness issue. Especially in today’s economy, the financial cost of a routine mammogram—let alone making a visit to the doctor—is high enough to deter women from getting their necessary check-ups. The Affordable Care Act works to solve this problem for many American women. The health reform law is making women’s preventive health care affordable by requiring health insurance companies to cover certain preventive health services, like routine mammograms, free of co-pay for individuals with new or “non-grandfathered” plans. This means that any woman with a health insurance plan that is new or has changed significantly since March 23, 2010, can receive necessary routine mammograms without having to pay any money out of pocket for the procedure. Yearly well-woman check-ups will soon be free, too, giving women a chance to speak to their doctors about their health without worrying about their bank accounts.

The Affordable Care Act, referred to in the media by “Obamacare”, is also making strides for women who currently battling breast cancer and those who are survivors. Thanks to “Obamacare’s” many new consumer protections, insurance companies are no longer able to place lifetime limitson insurance policies, and in 2014, they will no longer be able to place annual limits on coverage, meaning people everywhere can rest easy knowing that the health insurance they pay for will be there for them when they need it most. Also in 2014, insurance companies will no longer be able to discriminate against anybody for having a pre-existing condition, like breast cancer, which means that women will no longer be denied coverage or charged a higher rate because they’ve fallen victim to cancer.

Breast cancer affects women and men of all races and ethnicities, but did you know that African American women are at a greater risk than any other race of dying from breast cancer in America? Find information on how the Affordable Care Act is working to reduce health disparities like this one across the country online.

For information on what you can do to stay ahead of breast cancer and on top of your health, visit the American Cancer Society online. For more in-depth information about breast cancer, like risks, treatments, and support, visit the National Breast Cancer Foundation website.

Coauthored by Rachel Gielau and Caitlin Padula

This post was originally posted at The Shriver Brief, as a part of their weekly "Did You Know?" blog series that highlights important, but not well known, features of the health reform law about prevention, wellness, and personal responsibility for our health.

Ensuring Young Adults’ Coverage Now Saves Us All Money Down the Line

Because of the Affordable Care Act, millions of Americans now have access to affordable health care and millions more will soon have coverage, as well. One group of Americans that is especially benefiting from our new law is young adults.

According to the Obama administration, 2.5 million previously uninsured young adults ages 19 through 25 are now covered. The majority of those who have recently gained coverage took advantage of a provision in the Affordable Care Act that allows young adults to stay on their parents’ plan until age 26.

Historically, young adults have been the age group most likely to go without health insurance. Almost 28 percent of 18- to 25-year-olds were uninsured in 2010 compared to only 9.8 percent of children under 18 years of age and 20.5 percent of 26- to 64-year-olds. For young adults, the recession hit particularly hard.

In fact, many recent college graduates had a hard time finding a job with health insurance, or finding a job at all. As a result, even more young adults went without health coverage.

Thanks to the health reform law, young adults no longer have to take this gamble. And, millions of parents have peace of mind, knowing that their young adult children will get good, affordable health care when they need it. For millions of parents around the country, this provides a huge sigh of relief:

They don’t have to worry about going bankrupt if disaster strikes and their child winds up in the emergency room with piles and piles of costly medical bills.

Insuring young adults is not only good for parents and kids; it’s good for us all. Because young adults are typically healthier and are less likely to need expensive medical services, their presence in the insurance pool means that costs for everyone are lower.

Without health reform, millions of young adults would be uninsured once they left college or even high school and the costs of their health care would ultimately be paid for by the insured when they eventually do seek medical attention.

Ensuring young adults are covered now saves us all money down the line and gives parents and their kids the peace of mind that they’ll have coverage they can count on when they need it the most.

By Ron Pollack
Originally posted here on the Health Insurance Resource Center
Ron Pollack is the Founding Executive Director of Families USA, the national organization working to achieve high-quality, affordable health coverage for everyone in the U.S. The Hill, a weekly newspaper covering Congress, named Mr. Pollack one of the nine top nonprofit lobbyists. Modern Healthcare named him one of the 100 Most Powerful People in Health Care.

States Taking the Lead in Strengthening Consumer Protection

Recently, five more States strengthened their laws protecting consumers in disputes with their health insurance plans. The District of Columbia, Massachusetts, New Hampshire, Ohio and Wisconsin have bolstered their laws surrounding the part of the appeals process known as “external review.”  These five States join 33 others that provide these State-based external review protections that ensure consumers have a voice. The remaining States’ consumers are protected by a Federal process.

The strengthened appeals rights are one of several common-sense consumer protections and insurance market reforms established by the Affordable Care Act. Having a meaningful appeals process ensures that you actually receive the benefits that your insurer has promised.

So, what exactly is an external review? 

It means having an independent third party review your insurer’s decision, no matter where you live, thanks to the Affordable Care Act. Often, you can resolve disputes with your health plan by asking your insurer to reconsider its decision, in a process known as an “internal appeal.” But if, for example, your insurer still denies payment after the internal appeals process, you now can ask for an external review by an independent review organization to decide the matter.  Insurance companies must accept the outcome of this external review.  This means that your insurance company no longer gets the final say, and that patients and doctors get a greater measure of control over health care decisions.

These protections are important because when an insurer refuses to pay for a covered health care service, consumers could be faced with a large unplanned bill, and may not be able to afford the care their doctors say they need.

The Affordable Care Act sets these new important appeals standards for consumer protections and encourages States to take the lead in ensuring their own residents benefit from them.  Where States have not yet passed laws implementing these consumer protections, HHS has set up a process to ensure that consumers in these States also benefit from the same protections and standards.  If a State changes its external review process in the future, the State may request a new determination at any time. 

Having DC, Massachusetts, New Hampshire, Ohio and Wisconsin step up to the plate to ensure consumers’ external review rights is a perfect example of how the Affordable Care Act empowers States to protect consumers.

This post was originally published on The HealthCare Blog on November 22, 2011
By Eliza Bangit, Acting Director of the Consumer Support Group

Care Transitions & Health Reform: What's the Big Deal?

You may have heard the buzz about care transitions as an aging professional, or health care professional, or even if you are simply keeping up on current events. Transitions in care are a form of care coordination during a transitional event. Care transitions are broadly defined. Here are a few examples: transitioning within a hospital from the emergency room to an in-patient floor; transitioning from a nursing home back home; transitioning from private payer health insurance to Medicare. Right now the focus is on the transition from the hospital—and there’s good reason for this. Here’s a few key numbers to explain why:

19.6% According to a study published in the New England Journal of Medicine in April 2009, 19.6% of Medicare beneficiaries discharged from a hospital stay were readmitted to a hospital within 30 days. That means almost 1 out of every 5 Medicare beneficiaries to leave the hospital returns in 30 days or less! If you open the window of time after discharge to 90 days, this number jumps to 34%–this is more than 1 out of 3 Medicare beneficiaries. In Illinois, the study showed our 30-day readmissions to be slightly higher than the national average at 21.7%.

$17.4 Billion According to the same article referenced above, the cost of the readmissions for Medicare beneficiaries totaled $17.4 Billion for one year! This is almost 17% of the $102.6 billion that Medicare reimbursed hospitals for the year of the study. With health care costs in the United States continuing to increase, care transitions are understandably an identified area for health care systems improvement.

$500 Million In accordance with section 3026 of the Affordable Care Act, CMS made $500 Million available for the new Community Care Transitions Program (CCTP). CCTP is a unique funding opportunity for community-based organizations (CBOs) to lower readmissions to the hospital. CBOs are able to apply for reimbursement of care transition service provision through a Medicare fee-for-service mechanism. CCTP requires CBO partnership along the continuum of care including: hospitals, skilled nursing facilities, home health agencies and more.

2014 The Illinois Hospital Association is partnered with Blue Cross Blue Shield of Illinois to address high hospital readmission rates through the “PREP” Program. PREP stands for Preventing Readmissions through Effective Partnerships, and 201 hospitals in Illinois have pledged to lower hospital readmissions in the state by 2014. One of the five initiatives of the PREP Program is improving transitions of care.

3025 Section 3025 of the Affordable Care Act introduces penalties to hospitals for preventable readmissions. Starting in 2013, Section 3025 allows CMS to withhold up to 1% of Medicare payment reimbursement to hospitals. By 2015, up to 3% of Medicare reimbursement to hospitals may be withheld due to preventable readmissions. This means that hospitals that do not improve their readmission rates will receive an overall reduced Medicare reimbursement from CMS. For medium to large hospitals, a 1% reduction in reimbursement is estimated to cost from $500,000 to $1,000,000 in lost revenue. If hospitals don’t figure out how to lower readmissions, it is going to cost them a lot of money.

12 Let’s take a look at what’s happening in Illinois with care transitions from the hospital. The Illinois Transitional Care Consortium (ITCC) was formed to more effectively address needs of older adults transitioning from the hospital to the community by linking hospital based services with the aging network through intensive care coordination. ITCC consists of 12 partners: community-based organizations, hospitals, a university research facility, and a policy and advocacy research organization. ITCC developed the Bridge Model: a unique social work led model of transitional care that builds upon the Care Coordination Unit (CCU) system and Aging Network in Illinois. ITCC is currently developing a proposal for funding through the Community Care Transitions Program (CCTP), described above.

For more information on care transitions, please feel free to contact me, Kristen Pavle, Associate Director of the Center for Long-Term Care Reform at Health & Medicine Policy Research Group.

This post was originally posted on the Chicago Bridge's blog site. For more information on older adults, visit the Chicago Bridge website.

Neighborhood Stories: The Importance of Community-Based Health Organizations

Today, Illinois Health Matters launched the third release in their ongoing multimedia series, Neighborhood Stories. This installment reveals through video and investigative journalism the importance of community based organizations, such as neighborhood health centers and grassroots health coalitions. Such organizations provide a variety of comprehensive services to people in underserved communities, such as the South and West Sides of Chicago, who often do not have health insurance or access to quality, affordable care.
 

In “Community-Based Organizations Play a Critical Role in Reform,” author Jeffrey Steele finds community organizations act as a vital link between the federal level ACA, the state-level policies that result from the act, and the people who will benefit from the health care reform. Steele describes various ways that community organizations in Chicago are helping to implement the ACA. For example, there is an individual in every community-based organization that Celine Woznica, program director for the Asian Health Coalition in Chicago, calls a “mother hen.” They are usually trusted and respected members of community that people come to and ask questions. Inquiries may range from where to go for a flu shot to how to get heating assistance to when to go for citizenship classes. “These staff are the very people who have to be well versed on the Affordable Care Act, and how to help people take advantage of it -- from preventive care to the health exchange,” Woznica says.

Community organizations are integral to distributing accurate information about the health reform process. At Erie Neighborhood House, a west side social service organization and community service agency, they are focusing on more “in person” workshops while other groups may utilize ethnic media and webinars. As Jim Duffett, Executive Director of Campaign for Better Health Care, sums up, “The more people who take ownership at the local level, the stronger we’ll all be in winning comprehensive reform.”

The video, “Wellness on the West Side,” profiles the story of Eliazar Mejia, a woman diagnosed and treated for diabetes at Lawndale Christian Health Center (LCHC). LCHC is a shining example of “coordinated care” – where they provide a multitude of different types of care and programs all in one place. Many people who do not have insurance, such as the 38% of LCHC’s patients, end up letting a health problem develop and worsen until it sends them to the emergency room. LCHC fills the gap between no care and the emergency room for its 60,000 patients. Bruce Miller, the CEO of LCHC, sums up the organization’s overall commitment to its patients: “Our goal as a community-based organization is to provide care for everybody who needs care. Whether they have insurance, whether they don’t have insurance, we’ve never cared. So, as we think about the future, what the impact could be of health care reform, it’s our hope certainly, that many of our uninsured patients will have…better access to care, and will use that care more frequently.”

“Wellness on the West Side” is just one in the Neighborhood Stories series, presented by Illinois Heath Matters. Previous videos profile individuals and families, small businesses, and the importance of a consumer-focused health policy in Illinois. All videos and articles are featured in the “Neighborhood Stories" section of the Illinois Health Matters website, along with articles that share how community organizations, including Health & Disability Advocates, local Chambers of Commerce and others are educating and informing underserved groups about their health care coverage options under the new law. The multimedia series is part of the Local Reporting Initiative, supported in part by The Chicago Community Trust.

Neighborhood Stories: The Impact of the Affordable Care Act on the South and West Sides of Chicago

“We don’t talk about health care much,” Henry Edwards admits.

Henry is a 24-year-old father, husband and life-long resident of Garfield Park and suffers from asthma. Henry works 30 hours a week – just under full-time – so employer-based insurance isn’t available to him. His wife, Renee, is hoping to be promoted to a full-time position soon so they can apply for insurance coverage through her job.

Henry and Renee have a six-month-old son, making them eligible for health insurance from FamilyCare, an Illinois Medicaid program. But the cost of living and caring for a family while trying to afford Henry’s more than $200-a-month asthma medication is a constant concern for the Edwardses.

Henry’s struggle is profiled in a new Local Reporting Initiative called Neighborhood Stories, released today by Illinois Health Matters and supported in part by The Chicago Community Trust. The Neighborhood Stories series will showcase articles and videos of people living and working in the underserved neighborhoods of Chicago’s South and West sides and how the Affordable Care Act affects them.

Neighborhood Stories also profiles small businesses, such as Ruby's in Garfield Park, formerly Edna’s, a soul food landmark. At one time, Ruby’s employees bought health benefits through AFLAC; today, Ruby’s owner Henry Henderson says he can’t afford to help out, even though he wants to.

To see and share the videos profiling Henry Edwards and Ruby’s restaurant, go here and here. Under the new health care law, people who have a pre-existing condition can no longer be disqualified from affordable private insurance. Health care reform will also provide a range of options for health coverage through a health insurance exchange to those who do not have such coverage through their employers. In addition, small business tax credits are now available for those who want to provide coverage.

Still, experts say that many individuals and small businesses on the South & West sides of Chicago either don't know much about the new health care law or are wary of how its provisions might affect them. To that end, Neighborhood Stories will also publish a series of articles that discuss how to better disseminate information about the Affordable Care Act. The first of these articles focuses on what small business leaders think about the new law, and how to help educate business owners.

For more information about the impact of the Affordable Care Act, check out our Individuals & Families and Small Business pages. And be sure to bookmark our Neighborhood Stories page – next month we’ll highlight what local policymakers are doing to implement the new health care law in Illinois.

Stop Right There: “Medicaid Glitch” Not a State Budget Problem

Earlier this week, the Associated Press reported an alleged “glitch” in the new health care law, proclaiming it would allow some early retirees with Social Security benefits and other income to qualify for Medicaid in 2014. While we may agree or disagree with expanding Medicaid for a small population of 62-65 year olds with Social Security benefits we need to agree on one thing: this glitch is not a state budget problem.

What’s alarming about this reported glitch is that it will be used as ammunition – yet another example of a federal burden put on states that must be lifted through a radical restructuring of Medicaid itself. The call to action will be to convert Medicaid to a block grant and eliminate current requirements that states not restrict Medicaid eligibility through 2014, known as “maintenance of effort.”  

You can see it starting to surface: in the AP article, the former governor of Utah characterizes this as adding “fuel to the fire” and references Washington rules that don’t make sense. The article also mentions governors “clamoring” for change.  One can easily be left with the impression that Medicaid expansion in 2014 will lead to collapsing state budgets everywhere.  Yet the pending expansion will have no impact on states’ bottom line at first, and very little thereafter.  

So, let’s put this “state budget” issue to rest right now with actual facts:

Under current Medicaid, federal government and states share the costs of the program.  Today, states pay anywhere from just over 25% to 50% of the cost.  In 2014, funding for the Medicaid expansion will work very differently than the current funding formula: the expansion will be entirely paid for by the federal government for the first few years; states will pay a small percentage of the costs thereafter. 

State Share of Cost for Newly Eligible Medicaid

Year	State Share
2014	0%
2015	0%
2016	0%
2017	5%
2018	6%
2019	7%
2020 and beyond	10%

It is disingenuous to pretend the 2014 Medicaid expansion will be an additional burden to states, or that the size or scope of state obligations will be at all similar.  Addressing this “glitch” simply cannot be addressed by abandoning states’ obligation to Americans who rely on Medicaid as a health care safety net until health care reform through the Affordable Care Act is complete.

John V. Coburn
Health & Disability Advocates