September 30 Washington DC Update
Washington DC Update 9/30/13
[Don’t forget to check out the Family Voices/NCFPP ACA webpage!]
1 DAY UNTIL OPEN ENROLLMENT BEGINS…. even if there is a government shut-down. On Saturday night, the House passed a new version of the “Continuing Resolution” (CR) that would make appropriations to keep the government running temporarily once the new fiscal year begins on October 1. See http://thehill.com/homenews/house/325331-house-sends-stopgap-back-before-senate-48-hours-to-shutdown. This bill would delay, through December 31, 2014, the implementation of any provisions of the Affordable Care Act (the ACA or “ObamaCare”) that were not already in effect as of September 30, 2013, including the individual mandate, the elimination of pre-existing condition exclusions for adults, and the elimination of annual caps. (A timeline showing the ACA provisions that take effect on October 1 can be found at http://kff.org/interactive/implementation-timeline/.) More discussion about a delay is below under ACA News.
At this point, the House-passed bill goes back the Senate, which will take it up on Monday afternoon and is certain to reject it. An earlier version of the CR adopted by the House would have de-funded the Affordable Care Act. That version was rejected by the Senate late last week.
Since neither chamber seems ready to “blink,” it looks like a government shut-down will occur. The administration has said that this will NOT affect the ACA open-enrollment period beginning on October 1, since federal funds needed to implement it do not depend on the appropriations that would be made by the CR. See http://www.reuters.com/article/2013/09/27/us-usa-healthcare-shutdown-idUSBRE98Q1A620130927.
UPCOMING WEBINARS AND CALLS
Answering Questions about ObamaCare. On Tuesday, October 1, every hour from 9AM – 9PM ET, Doctors for America will host a webinar titled, “Coverage is Good Medicine:
How to Answer Patient Questions about New Insurance Marketplaces.” While it is geared toward physicians, the webinar is open to everyone. There will be 15 minutes to cover basics about Exchanges and 30 minutes for Q & A. Participants will receive a flier, voicemail script and script for answering questions. Click on your choice of time to register.
Plan Selection and Enrollment. On Wednesday, October 2nd at 2 pm ET, the Center on Budget and Policy Priorities (CBPP) will conduct a webinar focused on the plan selection and enrollment process for consumers. The CBPP webinars are usually very good, and space is limited. You can register at https://www4.gotomeeting.com/register/519222767.
This webinar will provide an in-depth look at the factors consumers should consider when selecting a plan in the new health insurance marketplaces, as well as the details of completing enrollment. It will feature real-life scenarios to illustrate what factors might be important to consumers as they decide what plan to enroll in. There will be time for questions. Topics covered:
* How common cost-sharing features of health plans work;
* How the availability of premium and cost-sharing subsidies might impact people's plan choice;
* Why various plan elements (provider network, formulary, and more) may be important;
* The deadlines for enrollment in a plan, how timing affects when coverage starts, and the importance of paying the first month's premium.
Best Practices in Outreach and Education. Until Midnight on October 3, 2013, a recording of this September 19 CMS teleconference is available by calling 1-855-859-2056. The conference id number is 63901001. The teleconference highlighted best practices from Arkansas, Connecticut, Kentucky, and Minnesota in reaching consumers about the Health Insurance Marketplace. Officials from those states described effective strategies they have taken to help consumers learn about the new ways to get health insurance coverage. (Reusable grocery/tote bags were a very effective way to attract people to information booths in Kentucky!)
Using Health Information Technology to Support Child Health Quality. On Tuesday, October 15, 2:00-3:30 PM ET, the Center for Medicaid and CHIP Services at CMS will conduct the last in a series of five webinars designed to share findings and lessons learned from the CHIPRA Quality Demonstration Grants. During this webinar, participants will learn how grantees from Florida and Illinois have developed health information technology applications to improve the quality of care delivered through medical homes and for prenatal care. The webinar will also feature presentations from the Agency for Healthcare Research and Quality (AHRQ) and grantees from North Carolina and Pennsylvania about the development and testing of the CMS-AHRQ children’s electronic health record format. Register here.
TIME-SENSITIVE – COMMENTS DUE Monday, September 30.
Discrimination in health care delivery. If you or your child has ever experienced discrimination in the delivery of health care, HHS would like to hear about it. In advance of issuing proposed regulations on an ACA provision prohibiting discrimination in certain health programs and activities on the basis of race, color, national origin, sex, age, or disability, HHS has asked for information about personal experiences with discrimination, among other things. Family Voices is working with other child-health and disability organizations to develop comments, but we encourage individuals to submit their own comments as well. For more information and to submit comments (at top right of page), see http://www.regulations.gov/#!documentDetail;D=HHS-OCR-2013-0007-0001.
Improving mental health care services. In a letter dated August 1, the leadership of the Senate Finance Committee -- Committee Chair Max Baucus (D-MT) and Ranking Member Orrin Hatch (R-UT) – asked the mental health community to offer comments on ways to improve the nation’s mental health care system through changes in Medicare and Medicaid policies. They seek responses to the following questions: What administrative and legislative barriers prevent Medicare and Medicaid recipients from obtaining the mental and behavioral health care they need? What are the key policies that have led to improved outcomes for beneficiaries in programs that have tried integrated care models? How can Medicare and Medicaid be cost-effectively reformed to improve access to and quality of care for people with mental and behavioral health needs? Family Voices will be submitting comments, and we hope that readers of the update who are involved in the mental health care system will consider doing so as well. Comments should be submitted to MentalHealth@finance.senate.gov.
F2F Funding. ACTION ITEM. The Family Voices policy team is working with key Members of Congress to secure an extension of F2F funding for at least another year via incorporation of the F2F-funding legislation into a larger bill that is certain to be enacted. It is possible that such a legislative “vehicle” will be arising soon, so it would be very helpful to get more cosponsors of these bills NOW, particularly Senate Republicans. If you would like to contact your Representative and/or Senators to urge them to cosponsor one of these bills, you can find their contact information at http://www.congressmerge.com/onlinedb/index.htm.
Background. Senator Robert Menendez (D-NJ) and Representative Frank Pallone (D-NJ) have introduced bills (S. 423 and H.R. 564) to extend funding for Family-to-Family Health Information Centers (F2Fs) at the current level of $5 million per year through FY 2016. The Senate bill currently is cosponsored by Senators Sheldon Whitehouse (D-RI), Al Franken (D-MN), Amy Klobuchar (D-MN), Elizabeth Warren (D-MA), and Christopher Coons (D-DE). The House bill is cosponsored by Representative David Cicilline (D-RI).
Short-term CR, debt-limit, sequestration. As noted last week, there are several big issues to be negotiated among the two chambers of Congress and the President in the coming weeks – the short-term CR (discussed above), the debt-limit extension, and the spending levels for the remainder of FY 2014, which will be determined by any changes made to the sequester law. While the news of the day is the potential (likely) government shut-down, the debt-limit issue is of greater importance. It is estimated that the “debt limit” will be reached in mid-October, at which point the Treasury Department essentially runs out of funds to pay the nation’s bills in the absence of Congressional or (extraordinary executive) action. Such a “default” has never happened before. The President has said that he will not negotiate on the debt limit. In a statement made on Friday, he said: “Failure to [extend the debt limit] would be far more dangerous than a government shutdown. It would effectively be an economic shutdown, with impacts not just here, but around the world. We don’t fully understand what might happen, the dangers involved, because no Congress has ever actually threatened default. But we know it would have a profound destabilizing effect on the entire economy -- on the world economy, because America is the bedrock of world investment.”
[Please see above for a discussion of congressional efforts to delay ACA implementation, and webinars and calls related to the ACA.]
More on ACA delay. The Republican majority in the House and conservative think-tanks argue that the ACA will result in the loss of employer-sponsored insurance, increased premiums, and a reduction in jobs and work hours. See http://www.speaker.gov/video/fairnessforall-one-year-delay-protects-all-americans-obamacare; http://obamacare.heritage.org/. These arguments are refuted in a piece by the Center for Budget and Policy Priorities found at http://www.cbpp.org/cms/index.cfm?fa=view&id=4025. ACA opponents have argued for a delay in, at least, the individual mandate to purchase insurance. The individual mandate, though, is necessary to make the whole system work: a sufficient number of healthy people are needed in the insurance pool to keep premiums at a reasonable level, and these people might not be inclined to purchase insurance without a mandate. This point is explained briefly in a post from the blog of the Georgetown Center on Children and Families, and in more detail in a 6-page brief authored by analysts from the Urban Institute, found at http://www.urban.org/UploadedPDF/412902-Delaying-the-Individual-Mandate-Would-Disrupt-Overall-Implementation-of-the-Affordable-Care-Act.pdf.
ACA implementation glitches. There have been several technical glitches related to the ACA roll-out. See http://www.reuters.com/article/2013/09/26/usa-healthcare-business-idUSL2N0HM1B720130926. Some of the problems are limited to the federal Marketplace website to be used by consumers in states not running their own Exchanges, while some have arisen with Exchange websites run by the states, including the inability to make on-line determinations of federal subsidies and/or Medicaid eligibility. See http://www.chicagotribune.com/health/sns-rt-us-usa-healthcare-technology-20130928,0,7910465.story.
These problems relate to:
- Medicaid eligibility determinations. According to the Wall Street Journal, the federal Marketplace website will not be able to electronically transfer Medicaid applications to states until November 1. See http://www.ihealthbeat.org/articles/2013/9/25/federal-insurance-exchanges-face-medicaid-applications-glitch. Consumers can apply directly to their state’s Medicaid agency, however.
- Spanish-language website. The administration has announced that there will be a delay of several weeks before the Spanish-language version of the federal www.healthcare.gov website will be available, although there will still be Spanish speakers available by phone on Oct. 1 to begin the enrollment process. The delay should not have a great practical effect, since consumers have until December 15 to enroll for coverage that will begin on January 1. The White House has estimated that 70 percent of the Latino population will enroll through English-language portals.
- SHOP. There will be a one-month delay in the ability of small businesses to purchase health insurance plans online through the Small Business Health Options Program (SHOP), although relevant information will still be available and applicants can still enroll by phone, mail or fax beginning Oct. 1. Small businesses can purchase insurance at any time; there is no limited open-enrollment period. The administration is also undertaking a SHOP awareness campaign. See http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2013-Press-Releases-Items/2013-09-26.html.
Choices and premiums in Exchange plans. On September 25, the Department of Health and Human Services released a report showing that the majority of consumers will have a choice of at least two different health insurance companies in their state, usually more. The report also indicates that premiums nationwide will be around 16 percent lower than originally expected. Individuals in the 36 states where HHS will fully or partly run the Marketplace will have an average of 53 qualified health plan choices. The report also gives an overview of pricing and the number of coverage options across the nation, finding that the average premium nationally for the second lowest cost “silver” plan will be $328 before tax credits. The report provides premium and plan options broken down by state where information is available. A press release about the report can be found at http://www.hhs.gov/news/press/2013pres/09/20130925a.html. The report can be found at http://aspe.hhs.gov/health/reports/2013/MarketplacePremiums/ib_marketplace_premiums.cfm, and state-specific data be found at http://aspe.hhs.gov/health/reports/2013/MarketplacePremiums/datasheet_home.cfm.
But, do lower prices reflect narrow provider networks?....
Concerns about network adequacy in Exchange health plans. Long-time New York Times health reporter Robert Pear wrote an article last Sunday (Sept. 22) about network adequacy in health plans offered on insurance Exchanges. A narrow provider network can make plans less expensive, and hold down their costs by discouraging those with high health care needs from enrolling in those plans. As noted in the article, “Even though insurers will be forbidden to discriminate against people with pre-existing conditions, they could subtly discourage the enrollment of sicker patients by limiting the size of their provider networks.” In response to this article, two health experts from the Georgetown University Center on Health Insurance Reforms, posted this blog, which notes, “…if certain secondary or tertiary providers are excluded from the network to discourage those with chronic diseases from enrolling in a plan, the plan … may not only be in violation of network adequacy standards, but also of the Affordable Care Act’s prohibition against discriminatory benefit design. State insurance regulators are responsible for assuring that these violations don’t occur and they should be vigilant about it.” Thus, consumer and patient advocates have another potential problem to be aware of – weak provider networks -- but also a potential weapon to fight it in the ACA’s anti-discrimination provisions.
FEATURED ACA RESOURCES
[Some of these were listed in last week’s Update but are worth repeating.]
Family Voices/NCFPP Webpage on the ACA. Family Voices and the National Center for Family/Professional Partnerships (NCFPP) have a frequently updated and searchable ACA resource page which can be found at http://www.fv-ncfpp.org/tools-and-resources/aca/. This page offers a place for families, family leaders, and others to go for information they need to understand the ACA's impact on children with special health care needs and their families, and to help others to understand it as well. We welcome suggestions for resources to post on the webpage. Please send your ideas to mailto:firstname.lastname@example.org.
Timeline of effective dates of ACA provisions. http://kff.org/interactive/implementation-timeline/.
Health Exchange and ACA basics. On www.healthcare.gov, one can find the explanation of a marketplace at https://www.healthcare.gov/what-is-the-health-insurance-marketplace. A list of 15 key pieces of information about ACA Exchanges and health insurance can be found at
For those seeking a more in-depth but clear description of how the entire ACA works, see the 111-page “Understanding ObamaCare: Politico’s Guide to the Affordable Care Act, at http://files.www.cmhnetwork.org/news/POLITICO_Understanding_Obamacare_Guide.pdf.
“Beyond the Basics…” The Center on Budget and Policy Priorities (CBPP) recently completed an excellent webinar series, “Beyond the Basics…” which covered in detail the ACA’s premium tax credits; cost-sharing reductions; employer responsibility; and how household size and income will be determined for Medicaid and premium tax credits. It illustrated these concepts with examples of various types of households. Slides and other materials for all the webinars are posted at www.healthreformbeyondthebasics.org.
Calculation of premium subsidies; Kaiser Family Foundation calculator. Unfortunately, the calculation of premium tax credits and cost-sharing subsidies is rather complex. The federal www.healthcare.gov website will enable people to make calculations after October 1. Until then, HHS is referring people to the Kaiser Family Foundation subsidy calculator at http://kff.org/interactive/subsidy-calculator/. The Foundation encourages other organizations to feature the calculator on their websites using the embed instructions.
State-specific brochures on the premium tax credit. Consumers Union and the Robert Wood Johnson Foundation have produced printer-ready brochures, tested on consumers, to explain the premium tax credits available under the ACA. The brochures are available for every state and DC, in both Spanish and English. These and worksheets for consumer assistors and tax preparers are available at https://sites.google.com/a/consumer.org/tax-credit-brochure/.
If you have any suggestions about how to make the Update more useful to you please let us know! And, as always, please feel free to contact us with any questions.
THE FAMILY VOICES POLICY TEAM
Janis Guerney, Esq.
Brooke Lehmann, MSW, Esq.
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