September 28, 2012

September 28 Washington Update

Greetings from Washington!  This week's update includes several items about implementation of the Affordable Care Act, including information about the new Summary of Benefits and Coverage and Uniform Glossary that will help consumers select a health insurance plan.  But first the legislative news ...

Congress has adjourned until November 13 (not coincidentally, after the election), and the new federal fiscal year (2013) begins on Monday, October 1. 

Appropriations.  As reported last week, before Members of Congress left town they had to pass a "continuing resolution" (CR) to fund government programs normally funded through appropriations bills (not programs automatically funded through "mandatory" spending, such as Social Security, Medicare, Medicaid and F2Fs).  The legislation has been signed by the President, and will keep the government running through March 27, 2013.  The CR provides for a slight increase in FY 2013 spending over the amount appropriated in FY 2012, which will result in a 0.612 percent across-the-board increase for most discretionary programs. The CR also includes a reauthorization of the TANF (Temporary Assistance for Needy Families) and SNAP (food stamp) programs.  

F2F funding bills (S. 2123 and H.R. 4083).  As reported earlier, the Senate F2F funding bill now has 12 cosponsors in addition to Senator Menendez.  The House bill also has 12 cosponsors in addition to Representative Pallone.  Cosponsors of both bills are listed at the end of this update.

The policy team - this week joined by Family Voices Executive Director Lynn Pedraza -- continues efforts to garner congressional support for the legislation by meeting with Hill staffers, particularly those of Senate Finance Committee members.  Thanks to those of you who have reached out to provide additional information to Hill staff.  This can make a big difference in their recommendations to their bosses about cosponsorship.

As we have said in the past, we are hoping that the F2F funding provision can be incorporated into a larger piece of legislation that is enacted during the lame duck session of Congress or early next year.  There is a distinct possibility that there will be a big budget deal in the coming months, which would provide the type of legislative "vehicle" we need. 

*** Thus, the coming weeks are a critical time to educate congressional staffers about the work of your F2F.  Please look out for additional communications from us about ways you can help to gain passage of legislation to extend F2F funding. ***

If your Members of Congress have not yet cosponsored the legislation, please contact them to ask that they do so.  See the guidance at the end of this update or click here now to send a pre-drafted letter to your Representative.  Please forward this information to your family, friends, health care providers, and other families of CYSHCN and ask them to contact their Members of Congress as well. 

And, if you haven't done so already, please thank your Senator(s) and Representative who have cosponsored the legislation. You can find their contact information by going to

NOTE:  Remember to undertake these activities in your personal capacity, not as an F2F, since federal resources may not be used for lobbying.

Health Care Reform Implementation 

Health Insurance Information for Consumers.  This week an important consumer tool required by the Affordable Care Act (ACA) became available for the first time.  This tool is the "Summary of Benefits and Coverage" (SBC), which is intended to provide standardized, easy-to-understand information about health plan benefits, out-of-pocket costs, and provider networks.  Insurance companies and employers are now required to provide SBCs to consumers/employees, along with a Uniform Glossary that defines insurance and medical terms in simple language.  

The SBCs will include "Coverage Examples," to help consumers compare coverage options by showing a standardized sample of what each health plan will cover for two common medical situations - having a baby and managing type 2 diabetes. 

SBCs are now available for consumers in the individual health insurance market.  For enrollees in group health plans enrolling during an open enrollment period, they will be available during the next open enrollment period that starts on or after Sept. 23, 2012. For enrollees who enroll outside of an open enrollment period, they will be available at the start of the next plan year that begins on or after Sept. 23, 2012.

The SBC and Glossary were developed in collaboration with the Department of Labor, Department of Treasury, consumer groups, the insurance industry, State Insurance Commissioners, and other stakeholders.

For more information, see

For a sample SBC, see (PDF - 530 KB)

For the SBC template, see (PDF - 475 KB)

For the Uniform Glossary, see (PDF - 139 KB)

Essential Health Benefits.  The ACA requires that all new, non-grandfathered plans in the individual and small group markets, both inside and outside the Exchange, offer a standard package of benefits known as "Essential Health Benefits" (EHB).  The ACA listed 10 categories of benefits that must be included in the EHB package -- such as "mental health and substance use disorder services, including behavioral health treatment," "rehabilitative and habilitative services and devices," and "pediatric services, including oral and vision care."  HHS left it up to the states to determine the scope of benefits that will be offered in each category based on one of several types of "benchmark" plans from which the states could choose.  States were asked to submit their benchmark plan choice to HHS by the end of this month.  In a blog entry today, a policy analyst from Community Catalyst emphasized that advocates must stay involved in the refinement of their states' EHB packages:  "Setting up the EHB feedback loop starts now... The role of consumer advocates moving forward is to not just be expert advisors but also be the keeper of stories. Stories that both illustrate the gaps in EHB coverage and the success of coverage will be highly relevant when additional opportunities for comment and feedback arise following the initial roll out in 2014." 

Exchange grants to states.  This week, HHS awarded a new round of grants to help states develop their health insurance "Exchanges" (marketplaces) under the Affordable Care Act (ACA). These new Affordable Insurance Exchange Establishment Grants went to Arkansas, Colorado, Kentucky, Massachusetts, Minnesota, and the District of Columbia.  For more information, click here.

Medicaid State Plan Amendments Needed to Implement the ACA.  The Center for Health Care Strategies has published a table to help states keep track of the various Medicaid State Plan Amendments they must make to conform to the requirements of the ACA.  The table catalogues mandatory and optional provisions that may require amendments, including links to the applicable ACA text, deadlines for approval, and available guidance.   While this tool is intended to help states, it will also be useful to advocates who want to ensure they have input as the state develops its new policies.  The table can be found at

Brochures & Educational Materials.   For brochures and materials related to the implementation of the Affordable Care Act, see links below and

Ø  ACA Educational PowerPoints

Ø  The Health Care Law & You (PDF - 8.99 MB)

The Top Five Things You Need to Know

 Ø  Families with Children (PDF - English 7.27 MBSpanish 1.23 MB)

Ø  Health Care Providers (PDF - English 2.71 MBSpanish  517 KB)

Ø  People with Disabilities (PDF - English 2.56 MBSpanish  930 KB)

Ø  Seniors (PDF - English 11.3 MBSpanish  1.54 MB)

Ø  Small Business Owners (PDF - English 4.22 MBSpanish 646 KB)

Ø  Young Adults (PDF - English 6.56 MBSpanish  919 KB)


As always, please feel free to contact us with any questions. 

Brooke Lehmann, MSW, Esq.


Janis Guerney, Esq.

NOTE:  Past issues of the Washington update can be found on the Family Voices home page by scrolling down in the "News Feed" section.


Cosponsors of House F2F funding bill, H.R. 4083, sponsored by Rep. Frank Pallone (D-NJ): Rep Carson, Andre [IN-7] - 4/26/2012
Rep Cicilline, David N. [RI-1] - 2/17/2012
Rep Engel, Eliot L. [NY-17] - 2/17/2012
Rep Green, Gene [TX-29] - 3/5/2012
Rep Hanabusa, Colleen W. [HI-1] - 7/18/2012
Rep Langevin, James R. [RI-2] - 2/17/2012
Rep Michaud, Michael H. [ME-2] - 2/17/2012
Rep Norton, Eleanor Holmes [DC] - 2/17/2012
Rep Pingree, Chellie [ME-1] - 2/17/2012
Rep Rangel, Charles B. [NY-15] - 3/8/2012
Rep Roybal-Allard, Lucille [CA-34] - 3/20/2012
Rep Waxman, Henry A. [CA-30] - 7/9/2012

Cosponsors of Senate F2F funding bill, S. 2123, sponsored by Senator Robert Menendez:
Sen Akaka, Daniel K. [HI] - 6/4/2012
Sen Bingaman, Jeff [NM] - 2/17/2012
Sen Conrad, Kent [ND] - 2/17/2012
Sen Franken, Al [MN] - 6/5/2012
Sen Inouye, Daniel K. [HI] - 8/2/2012
Sen Kerry, John F. [MA] - 3/13/2012
Sen Klobuchar, Amy [MN] - 5/8/2012
Sen Lautenberg, Frank R. [NJ] - 2/17/2012
Sen Snowe, Olympia J. [ME] - 2/17/2012
Sen Whitehouse, Sheldon [RI] - 2/17/2012
Sen Wyden, Ron [OR] - 9/19/2012
[Senator Schumer has agreed to cosponsor but has not yet been officially added.]

Contacting your Members of Congress about F2F funding bills

All of you who are concerned about the future of F2Fs should contact your Members of Congress to urge that they cosponsor the Menendez or Pallone bill. You can call them through the Capitol switchboard at 202-224-3121.  (To find the names of your Members of Congress, go to  When you speak to the receptionist, state that you are a constituent and ask to speak to the staff person who handles health issues.  If that person is not available to talk, you can leave a BRIEF message identifying yourself as a constituent who has a child with special health care needs (if applicable) and asking that the Representative/Senator cosponsor a bill that would extend funding for Family-to-Family Health Information Centers.  Refer to the appropriate bill number and sponsor - in the Senate, S. 2123, sponsored by Senator Menendez; in the House, H.R. 4083, sponsored by Rep. Pallone.  Leave your home phone number and email address.

You can also write to your Representative (even if you call) via the "Advocacy" section of the Family Voices website, where you will find a pre-written letter that you fill in with your personal information.  (You do not need to know the name of your Representative.)  Please ask families you have worked with, friends, and relatives to write their Representatives through the Family Voices website also.  The URL is   At this time, the website is not configured to automatically send the letter to Senators, but simple instructions about how to contact your Senators, and text to copy and paste, can also be found on that page.  (You do not need to know the names of your Senators.)

Remember:  Federal resources may not be used for lobbying activities.

Please feel free to call Brooke or Janis (contact information above) if you have any questions.