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.

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.

Register now! Monday Conference Call with Senator Koehler!

Sen. Dave Koehler on SB1729 "Illinois' Competitive Health Care Marketplace: the Insurance Exchange"
Monday, April 25 12-1 PM

THE SCORE SO FAR

Round One - The passage of State Rep. Mautino's Exchange bill, HB1577, written by and for the insurance industry. No consumer participation, no consumer protections, no governance mechanism, eliminates IL's opportunity for $150-250 million in federal funding. Win for Big Insurance.

Round Two - HB1577, the insurance industry bill, has thus far been stopped in the Senate because of consumer involvement. A better, consumer-based alternative, SB1729, sponsored by Sen. Dave Koehler (D-Peoria) introduced as the first step in developing the Illinois exchange. Written by and for a variety of stakeholders, this competitive health care marketplace introduces a framework that includes a governance structure, some consumer protections, conflict of interest clauses, and begins to require insurance companies to meet strict standards for participation. SB1729 now numbers 17 co-sponsors and growing! WIN for Illinois consumers and small businesses!

Round Three - Consumers around the state are gearing up to win by making sure the insurance industry's bill is defeated and SB1729, the better consumer alternative, is passed in Springfield. We need to bring the same intensity to Springfield that we brought to the federal battle last year. JOIN US IN MAKING IT HAPPEN!

Register today to hear Sen. Dave Koehler explain SB1729 and how it impacts consumers and small businesses in Illinois. NOTE: Please update your calendar - this call is happening on Monday, April 25 at noon.

ABOUT SENATOR KOEHLER

Prior to making the jump to the Illinois Senate, Sen. Dave Koehler served as a minister for the United Church of Christ; was a staff member for the National Farm Worker Ministry and for Peoria Friendship House, served as Executive Director of the Peoria Area Labor Management Council (PALM), and the President for Labor Management Cooperative Health Programs, Inc. He served on the Peoria County Board from 1982 through 1988, and the Peoria City Council from 1989 to 1997. He is a current co-owner of the Peoria Bread Company. Sen. Dave Koehler (D-Peoria) serves as the Vice President of the Health Care Justice Act's Adequate Health Care Task Force.

UPCOMING CALLS

CBHC has conference calls every second and fourth Monday of every month. For more information on upcoming calls, speakers, and topics, visit our conference call webpage. Missed a call? Don't worry; you can listen to past calls on our audio archive!

HAVE AN IDEA FOR CALL TOPIC?

Let us know! These calls are meant to give you the information you want about health care reform in Illinois. Please let us know what topics you'd like to see us cover in future calls by emailing Kathleen Duffy with your ideas.

Jim Duffett
Campaign for Better Health Care

America’s Health Care Law: Providing Security and Opportunity for All

It's been a year since the historic vote that made the Affordable Care Act (ACA) a law, putting America on the path towards a system of quality, affordable health care for all. We have a lot to celebrate as we continue to implement and enforce our consumer protections here in Illinois.

Through the passage of health insurance reform, we have brought some of the most abusive practices of the insurance industry to an end, and instituted new rights and benefits for all. From birth to death, Americans now enjoy health care security and protection in new ways. Already in Illinois:

• 47,200 young adults in Illinois are now eligible to stay on their parents’ coverage through age 26
• Tens of thousands of small businesses receive tax credits that help them offer their employees coverage
• 7.5 million people in our state no longer need to worry about hitting a lifetime cap on benefits because of the ACA
• 612,000 Illinoisans will not have their insurance coverage rescinded when they get sick and need it most
• 1.8 million seniors are now eligible for free wellness care, and 109,421 of them received help in meeting the costs of their prescription drugs while in the Medicare Part D coverage gap

Despite all the benefits that the new law offers, the Affordable Care Act is not perfect, but it is a good start towards health care security for all Americans. It makes sense that the Illinois General Assembly builds upon the protections and rights of this law as we move ahead to work for a system of quality, affordable health care for all.

Now at the one-year mark, the Campaign for Better Health Care and our statewide coalition encourage our elected officials in Springfield to move forward with the implementation of the required components of this new law. Any delay will have a profound negative impact on quality of life for millions of Illinois' working families, children, seniors, individuals and small businesses.

Our State Representatives and State Senators in Springfield need to stand up for the middle class and small businesses, not the insurance industry. Did you know that the top Illinois insurance companies amassed surpluses in excess of $28.3 billion in 2010? Surplus is a company's total assets minus liabilities. In other words, it’s what's left after ALL other possible costs of doing business (including all possible future claims by policyholders, paying dividends to shareholders, etc) are accounted for. Their surpluses increased by an additional $2.5 billion from 2009, even in the current economic conditions we face.

We need to implement and strengthen the health care law at the state level in a few ways. First, let’s institute fair rate review laws as outlined in Representative Greg Harris’s proposal. Rate review means that insurance companies will have to justify their requests for rate increases to the state Department of Insurance and cannot raise your rates unless their request passes this review. Laws similar to this exist in 30 states, but Illinois currently has no oversight mechanism in place.

Rate review increases transparency in the process - insurance companies will have to prove the need to charge their customers more. With more information about the rationale for rate hikes, consumers will be better prepared to make an informed decision about whether or not to purchase insurance from a specific company. This will stimulate positive competition in the health insurance marketplace, and benefit consumers by lowering costs.

Second, the Illinois General Assembly needs to begin developing a competitive health insurance marketplace, commonly known as an insurance health exchange. St. Senator Dave Koehler’s proposal begins setting up the competitive health marketplace for Illinois.

The marketplace is voluntary – if you like the insurance you have, you can keep it and not use the marketplace. However, the marketplace is always available in case you want or need it. This approach will give consumers greater control, more choice, improve quality, increase transparency, and create much needed competition in the insurance marketplace.

On this milestone anniversary of new freedom and protection for American health insurance consumers, let's work together to make Illinois' health care laws work for us, not for the obscene and greedy surpluses of insurance companies.

Jim Duffett
Executive Director, Campaign for Better Health Care

Out-of-Pocket Spending Caps Protect Families in Illinois

March 23, 2011 marks the one year anniversary of the Affordable Care Act (ACA), landmark legislation in the fight to ensure quality affordable health care for all Americans. To celebrate this milestone, the Campaign for Better Health Care and the Health Care Justice Campaign have announced that March is Health Care Justice Month in Illinois.

"We want to look back at the new benefits that are already helping Illinois' working families and look ahead to the benefits that are yet to come," said Jim Duffett, Executive Director of the Campaign for Better Health Care (CBHC). "It is amazing that so many Illinoisans are already experiencing a positive impact from this law, and inspiring to realize how many more will in the near future."

To kick off Health Care Justice Month, CBHC co-released a report by Families USA examining how the health care spending caps in the ACA will positively affect Illinois families. The health care cost cap provision does not kick in until 2014, but until it does, the resulting analysis for Illinois spotlights the tremendous need for spending caps to protect family budgets:

• In 2011, 590,500 Illinoisans under the age of 65 are in families that will spend more than the out-of-pocket caps for services that will be covered in the Affordable Care Acts essential benefits package.
• The Affordable Care Act spending caps, when adjusted to 2011, would be $5,950 for individuals and $11,900 for families. Out-of-pocket health care spending by these Illinois families will exceed the caps by more than $1.0 billion in one year alone.

Health Care Justice Month will feature online activities like a poll on the benefits of the Affordable Care Act and events across the state, including a postcard campaign, a series of Minority Health Care Roundtable discussions, and the Campaign for Better Health Care Faith Caucus' annual Sound the Alarm Sabbath weekend. During Sound the Alarm, congregations of all faith traditions reflect upon the moral imperative of health care reform, and sound a traditional musical instrument 18 times to mark Illinois' 1.8 million uninsured.

The Families USA report, Worry Less, Spend Less: Out-of-Pocket Spending Caps Protect Families in Illinois, found that more than nearly three-quarters (71.7%) of the Illinoisans who will spend more than the out-of-pocket caps an estimated 423,700 people are in working families.

John Bouman, President of the Sargent Shriver National Center on Poverty Law said, "As demonstrated by Families USA's excellent report, the caps on families' out of pocket health care spending that will go into place under the ACA in 2014 will be extremely important to the financial well-being of working families and small businesses."

In particular, employees of Illinois small businesses, those with fewer than 100 employees, face the threat of high out-of pocket health care spending:

• An estimated 239,500 Illinoisans in families where the head of the household is employed by a small business will spend more than the out-of-pocket caps.
• More than two in five Illinoisans (40.6%) who will spend more than the out-of-pocket caps are in families where the head of the household works for a small business.
• Of those Illinoisans in families of small business workers, more than four-fifths (82.0%) have a head of household who works for a business with fewer than 25 employees.
• Families of Illinois small business employees will spend nearly $414.0 million more than the out-of-pocket caps in 2011 alone.

Janine Lewis, Executive Director of the Illinois Maternal and Child Health Coalition, added, "We applaud these caps which will help women and children afford access to critical health services to keep themselves and their families healthy."

"Two decades of rising health care costs have squeezed families into coverage with higher premiums, higher copayments, and higher deductibles, and sometimes these costs have forced families out of health coverage altogether," Ron Pollack, Executive Director of Families USA, said. "These families are terribly vulnerable to financial devastation caused by unexpected illness or injury, and they generally face only bad alternatives, including massive credit card debt, bankruptcy, even foreclosure."

"The report from Families USA clearly shows that 590,500 Illinoisans, and nearly 15 million people across the nation, will deal with this kind of health and financial crisis this year alone. The caps on out-of-pocket spending that will be put in place by the Affordable Care Act will have a profound, beneficial impact on the fortunes, finances, and futures of families in Illinois."

Pollack noted that between 2000 and 2010, the average premium for job-based family coverage grew from $6,438 to $13,770, an increase of 114 percent. These increases have been a special burden for small businesses, which, because of lower buying power and proportionately greater administrative costs, pay, on average, 18 percent more than large businesses for a comparable health insurance plan.

"These caps will be of special value to small businesses and the employees of small businesses," Pollack said.

The spending cap provision of the Affordable Care Act includes a sliding scale that will ensure those with lower and middle incomes will pay less out of pocket than those with higher incomes. "Access to affordable health coverage is the key to economic security and opportunity for the working families and small businesses of Illinois," said Jim Duffett. "This provision of the Affordable Care Act ensures that they will now be able to get a fair deal."

-- Kathleen Duffy, Campaign for Better Health Care

Florida Judge Rules Against Affordable Care Act

The Social Security Act, the Voting Rights Act, the Civil Rights Act and the Minimum Wage Act were all landmark laws that changed our country for the better. They secured essential freedoms for all Americans and improved our quality of life. All were initially struck down by lower court judges unwilling politically or unable intellectually to embrace the fact that our Constitution permits that kind of progress. An activist conservative lower court federal judge in Pensacola, Florida, has now made his contribution to this history.  

U.S. District Judge Roger Vinson ruled this week that the Affordable Care Act’s (ACA’s) provision requiring most Americans to obtain private health insurance, or else face a modest tax penalty, was unconstitutional. He is the only judge who has adjudicated challenges to the law to be so aggressively activist as to strike down the whole law. Unlike the other judges who have ruled the “individual mandate” to be unconstitutional, Judge Vinson went further and held that the individual mandate was so intertwined with the rest of the law that it could not be “severed” from it, and so he invalidated the whole law.

The Justice Department immediately announced that it plans to appeal the decision to the U.S. Court of Appeals for the 11th Circuit. The score in the cases now stands as follows: 13 challenges have been filed in federal courts since March 23, 2010; ten suits have upheld the law, and three rulings have found all or part of the ACA unconstitutional. So far, judges appointed by Republican presidents have ruled consistently against the ACA, while Democratic judicial appointees have ruled for it. And in the most recent case, all but one of the state officials who filed suit are Republican.

At the heart of these lawsuits is the individual responsibility provision. This part of the ACA says that most individuals who can afford it will be required to obtain basic health insurance coverage or else pay a fee to help offset the cost of providing medical care to uninsured individuals. If affordable coverage is not available to an individual, he or she will be eligible for an exemption. The individual responsibility provision is an extremely important tool to help ensure that healthy people have health insurance policies, too; otherwise, only the sick or old may choose to have coverage, which would drive up costs for consumers and insurers alike. Every insured family pays an average of $1,000 more a year in premiums to cover the care of those who have no insurance, and the cost of uncompensated care was an estimated $43 billion in 2008.

Like the Virginia judge, Judge Vinson did not issue an injunction against the ACA’s implementation. Indeed, Judge Vinson rejected a constitutional challenge to the part of the ACA that will expand Medicaid in 2014 to individuals with household incomes under 133 percent of the poverty level. The plaintiff state officials had argued that this expansion unlawfully imposes on their sovereignty; however the Judge Vincent held that there is no infringement because a state can choose whether to participate in the Medicaid program.

Nevertheless, Judge Vinson’s ruling invalidating the whole law (as “un-severable” from the individual mandate provision) means that the 26 state officials who are plaintiffs in the case are in an ambiguous position as to whether they will continue implementation activities in their states. They might gamble on the ruling of this fringe judge holding up on appeal. Wisconsin’s governor, a highly partisan Republican, has said he will stop implementing the law. That is unfortunate for the people who live in Wisconsin and in any other state where a governor decides to exalt his or her ideology over the needs of the citizens that are being addressed by the ACA.

Americans—including lots of them who live in Wisconsin—cannot afford to lose the benefits already flowing from provisions of the Affordable Care Act that have nothing to do with the individual mandate, including discounts for seniors struggling with the cost of lifesaving prescriptions, tax credits for small businesses struggling to provide coverage for employees, protections for children who have pre-existing conditions, and coverage for young adults up to age 26.

In the midst of our nation’s jobs crisis, Americans are counting on the Affordable Care Act to put them back in control of their own healthcare, stop insurance company abuses, and lower escalating healthcare costs. Judge Vinson and at least some of the state officials in the case have other priorities.

John Bouman
Sargent Shriver National Center on Poverty Law 
(Originally posted in the Shriver Brief  on Feb. 2, 2011)

Health Reform Will Help Small Businesses in Illinois

Did you know that almost 8 out of 10 small businesses in Illinois with 25 or fewer workers will receive financial relief because of the Affordable Care Act? If you want to see if your small business qualifies, check out the Small Business Majority's tax credit calculator at http://smallbusinessmajority.org/tax-credit-calculator/

Tax credits for purchasing health care coverage are just one of many important provisions in the Affordable Care Act that will help make high-quality health coverage more affordable and accessible for Illinois' small businesses. Here are some other provisions-

Health Insurance Exchanges for Purchasing Coverage: Starting in 2014, the Illinois health benefit insurance exchange will be up and running, creating a new marketplace where employers will be able to purchase high-quality, affordable health plans for their workers. In the exchanges, small employers will be able to view comparable and clear information on benefits and costs for each insurance plan so that they can find the policy that best meets the needs of their workers. This simplified system of shopping for and enrolling in health coverage will ease administrative burdens on small employers who may have limited staff and time for searching for health coverage.

A Prohibition on Charging Higher Premiums Based on Pre-Existing Conditions: Starting in 2014, when small businesses purchase coverage for their workers, insurers will be prohibited from charging them higher rates if their workers have pre-existing health conditions. This will make coverage more affordable for both the owners and the employees of small businesses.

The Campaign for Better Health Care is here to help link Illinois consumers and small businesses to affordable, quality healthcare. Visit our website at www.cbhconline.org or call our Health Care Helpline toll-free at 1-888-544-8271 to share your story. We use the poignant stories of ordinary Illinoisans to bring the human impact of the health care crisis home to legislators, news media and community leaders.

Jim Duffett
Executive Director
Campaign for Better Health Care