November 19, 2013

November 19 Washington DC Update

Washington DC Update 11/19/13

{Don’t forget to check out the Family Voices/NCFPP ACA webpage!}

Greetings from Washington!  The big news last week was the administration’s announcement to address the problem of health insurance cancellations.  Now health plans that don’t meet the ACA benefit and cost-sharing standards can be sold by insurers, if they choose to do so and if state regulators permit it.  Read more below under “ACA News.”


Beyond the Basics of Health Reform: Determining Eligibility for Premium Tax Credits.

On Wednesday, November 20th at 2:00 – 3:00 pm ET, the Center for Budget and Policy Priorities will present the next in a series of webinars about details of ACA implementation.  This webinar will explain how marketplaces determine eligibility for advance payments of premium tax credits and how the IRS makes the final determination of eligibility, including a review of rules relating to household income and size, income verification, and how the IRS will verify income and reconciles advance payments to the final determination it makes of the premium tax credit.  The webinar will feature real-life scenarios, and there will be time for questions.   Space is limited. Register at  

Webinar: Helping Consumers Understand Premium Tax Credits, Avoid Re-payment Obligations, and Select PlansOn November 22, 2013, at 3:00 pm ET, Manatt Health Solutions, with support from the State Health Reform Assistance Network (State Network), will present a series of slide presentations to help states and their "assisters" address some of the issues most confusing to consumers.  Click here to register.  Click here for more information on the webinar series.  


ACA scrutiny.   See below under “ACA News.”

F2F Funding.  Federal funding for Family-to-Family Health Information Centers (F2Fs) was authorized only through FY 2013, so F2Fs will cease receiving grant funds at the end of May 2014 (the end of the FY 2013 grant cycle) unless legislation is enacted to extend funding.  Senator Robert Menendez (D-NJ) and Representative Frank Pallone (D-NJ) have introduced bills (S. 423 and H.R. 564) that would extend F2F funding at the current level of $5 million per year through FY 2016. 

The Family Voices policy team has been working with key Members of Congress to try to get an F2F funding extension included in must-pass legislation.  Over 20 national organizations have agreed to sign a letter endorsing the F2F bills, but the likelihood of the legislation’s enactment will be greatly enhanced if more Members of Congress support these bills, particularly if there is bipartisan support. 

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) and a new cosponsor, Rep. Tony Cardenas (D-CA) from the Los Angeles area.

U.N. Convention on the Rights of Persons with Disabilities.  Sen. Robert Menendez (D-NJ), Chairman of the Senate Committee on Foreign Relations, and proponent of the U.N. Convention on the Rights of Persons with Disabilities (CRPD), has scheduled a second hearing on the treaty for Thursday, November 21, at 9:30 AM ET.  Secretary of State John Kerry is scheduled to testify.  A webcast of the hearing will be available on the committee’s website

An earlier hearing on the treaty was held on Tuesday, November 5.  A video and testimony from that hearing are available on the committee website. This article from The Hill, describes the pro- and con-ratification arguments presented by the witnesses. 

As with other treaties, the Senate must ratify the CRPD for the U.S. to have full participation in implementation decisions.  In December, ratification failed in a close vote, but now the outlook may be different.  For more information, see, or the website of the US International Council on Disabilities, which has gathered over 750 endorsements of the treaty from national and state organizations, including Family Voices.


[Please see above for information about webinars and teleconferences related to the ACA.]

Administration addresses cancellation of health insurance policies.  Due to the Affordable Care Act (ACA), many exiting individual and small-group insurance plans may no longer be sold or renewed after January 1, 2014, because they would not comply with the law’s standards for benefits and various consumer protections.  As a consequence, individuals and small businesses covered by such plans recently began to receive notices that their existing insurance plans would be cancelled. 

Under political and public pressure, the administration decided last week to address this problem with a “transitional policy” that would permit the sale of insurance plans that do not meet the standards established by the ACA.  This transition policy applies to individual and small-group insurance policies that were in effect on October 1, 2013, and for which renewal would take effect between January 1, 2014, and October 1, 2014. 

The issuers of these non-compliant policies are required to provide certain information to the policy holders, including the fact that they can buy plans that do meet ACA standards, both inside and outside Marketplaces (Exchanges), and the fact that they may be eligible for subsidies to buy such plans.  The policy holders also must be told which ACA standards these existing plans do not meet -- the bar against discrimination in premium pricing based on health status; guaranteed issue and renewal; the ban on pre-existing condition exclusions and other health status discrimination provisions (except in the case of group coverage where such a bar already is in effect); non-discrimination in health care; coverage of essential health benefits; and coverage for people participating in approved clinical trials. 

Several ACA provisions are NOT suspended under the administration’s transition policy:  coverage of preventive benefits, dollar limits on annual and lifetime coverage, and coverage of the under-26 population through their parents’ policies.

For more information, see this article from George Washington University’s “Health Reform GPS.”

It is important to note that the administration’s action merely permits the sale of such plans if the insurers want to sell them and if state regulators permit them to do so.  The reaction of state insurance regulators has been mixed, and the health insurance industry group, America’s Health Insurance Plans, issued a negative statement, expressing concern about how the administration’s transition policy would affect premiums.  Insurers and some health policy analysts are concerned that relatively healthy people will keep the sub-standard plans, skewing the pool of those who seek insurance in the Marketplace, thus increasing insurers’ costs and ultimately increasing premiums.  Although the administration has said that it will use its risk-adjustment authority to offset increased costs to insurers, it did not guarantee to make them whole.

Meanwhile, the House of Representatives took matters into its own hands, passing the "Keep Your Health Plan Act" by a 261-157 vote, with 39 Democrats joining all but five Republicans in supporting the measure.  The bill would go further than the administration’s policy by allowing insurers not only to renew existing plans that do not comply with the ACA, but to sell such plans to new customers as well.  The Senate is not expected to take up the bill and the President has threatened to veto it.

In the Senate, Democrats Mary Landrieu (D-LA) and Mark Udall (D-CO) have offered other bills that would address the cancellation problem, and have been supported by several Democratic colleagues, most of whom are facing tough reelection battles in 2016.

Administration announces enrollment figures.  On Wednesday, the Department of Health ad and Human Services (HHS) issued a 28-page report detailing data about people seeking insurance through ACA marketplaces.  An HHS press release summarizes the data.  From Oct. 1-Nov. 2, 106,185 individuals selected plans from the Marketplace, and another 975,407 made it through the process by applying and receiving an eligibility determination, but had not yet selected a plan. An additional 396,261 were determined or assessed as eligible for Medicaid or the Children’s Health Insurance Program (CHIP).  For a discussion of the report, see this article from the Commonwealth Fund.  For an optimistic outlook on the low enrollment numbers to date, see this post from the Health Affairs blog.  Meanwhile, the administration continues its work to fix the website so that more people can choose health insurance plans and find out whether they are eligible for subsidies.  Unfortunately, an article in the Washington Post reports that it does not look like the website will be operating optimally by the end of November, the goal that had been set by the administration.  Yet, HHS was sufficiently confident of improvements to the website that it contacted about 270,000 people who had problems with the site to invite them to try again.


States may extend high-risk pools. According to this article from the Commonwealth Fund, some states are considering extending their high-risk pools since they are not confident that those currently covered by these programs will be able to get insurance on the Exchanges.  Once the ACA’s ban on pre-existing condition exclusions takes effect for everyone on January 1, 2014, these plans should not be needed, if the Exchanges are working properly.  In some states, such an extension would require legislative action.  The federal Pre-existing Condition Insurance Plan (PCIP) created by the ACA, which covers about 100,000 people, could not be extended without additional authority and funding from Congress.

PREEMIE Act and National Pediatric Research Act.  Last week the Senate approved a House-passed bill to reauthorize the Centers for Disease Control and Prevention’s (CDC) research and programs on preterm birth, including improvements in national data tracking on preterm birth. The Prematurity Research Expansion and Education for Mothers who deliver Infants Early (PREEMIE) Act also reauthorizes programs at the Health Resources and Services Administration aimed at improving the treatment and outcomes for infants born prematurely.  The bill was approved along with another bill to create a National Pediatric Research Network to encourage more support of pediatric research.  That legislation authorizes the National Institutes of Health (NIH) to establish pediatric research consortia throughout the nation.  Both bills will now be going to the President for his signature.



Spanish-language ACA consumer resource center.   Last week, the Kaiser Family Foundation launched a new Spanish-language consumer resource center to help Spanish-speaking individuals understand the ACA.  The center features a new Spanish-language subsidy calculator, which allows consumers to estimate health insurance premiums and tax credits within the ACA marketplaces according to their zip code, income, family size, age and tobacco use. Organizations and individuals may embed the calculator on their websites for free.

Also featured on the new consumer resources center are Spanish versions of the Foundation's "Obamacare and You" fact sheets: "Obamacare y Usted," which provide short overviews of what the health law means for different segments of the population, including those who are uninsured, have a pre-existing condition, buy insurance on their own, obtain coverage through an employer, qualify for Medicaid, have Medicare, or are women. The Spanish-language consumer resources page also features the Foundation's newest animated video, "Los YouToons Se Preparan Para Obamacare," which can be embedded or downloaded for free.

The Spanish-language resource center can be found at All of the Foundation's Spanish-language materials can also be found on the Foundation's website in English.

Enrollment tracker and state marketplace information.  Last week the Kaiser Family Foundation also launched an expanded marketplace resource to track enrollment reports for all 50 states and the District of Columbia. The new data table provides key data each state's total number of completed marketplace applications, the number of people in those applications determined eligible to enroll in a marketplace plan or in the state's Medicaid or Children's Health Insurance Program, and the number who selected a marketplace plan.

The data reflect activity through Nov. 2 for the 36 states relying on the federal marketplace, and more recent data from some of the 14 states plus the District of Columbia, which are running their own marketplaces.  The information will be updated regularly.

The Foundation also has developed state-by-state estimates of the number of people eligible to receive tax credits, profiles describing each state's marketplace, and other state indicators related to health reform.

Worth repeating:

NEW BLOG from Family Voices!  The first installment of the Family Voices ACA monthly blog, written by  Lauren Agoratus --  the mother of a child with multiple disabilities and the NJ Coordinator for Family Voices and the southern coordinator in her state's Family-to-Family Health Information Center -- is about How People with Disabilities can Access the Marketplace under Healthcare Reform.   This blog posting discusses lifetime caps, essential health benefits, tiered plans, accessibility standards, health plan options for special needs, and more. 

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  This page offers information for both families and family leaders to help them understand the ACA's impact on CYSHCN 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

Indiana Family Voices ACA guide. Indiana’s Family Voices has created this resource guide to answer basic questions about purchasing insurance under the ACA and to help families choose the most suitable insurance plan for them and their children with special health care needs.

Indian Health Services ACA Webpage.  The new IHS ACA webpage ( is now online.  It provides ACA-related information specific to American Indians and Alaska Natives (AI/AN) and answers many questions being asked by these communities. 

Doctors for America.  Doctors for America has a number of ACA resources, including a speakers bureau, Power Point presentation and state-by-state information, slides, brochures and points of contact.

Get Covered Calculator.”  Get Covered America, has released a “Get Covered Calculator,” which provides estimates of how much a family will have to spend to get insurance coverage based on the number of people in the household, the family income, and location.

Follow HHS.  ACA information is available from HHS via Facebook, Google + and Twitter.


National Family Caregivers Month 2013November is National Family Caregivers Month.   This year's theme is "Family Caregivers - Now More Than Ever!"  A media toolkit is available for download.  The toolkit includes:


If you have any suggestions about how to make the Update more useful to you, please let us know!  Does it provide the right amount of information?  What parts are helpful and not so helpful?  And, as always, please feel free to contact us with any questions. 

Yours truly,


Janis Guerney, Esq.


Brooke Lehmann, MSW, Esq.


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