Monday, January 20, 2014

Following Dr. King’s Lead: Helping People Get Health Care

Today our state and nation will celebrate the memory and legacy of Dr. Martin Luther King, Jr. Here in Maine there will be events statewide to honor him and his passion for equality.
https://bangordailynews.com/2014/01/17/news/state/martin-luther-king-jr-events-planned-statewide/  


“Of all the forms of inequality,
injustice in health care is the most shocking and inhumane.”

 Dr. Martin Luther King, Jr.,
Second Convention of the Medical Committee for Human Rights,
Chicago, March 25, 1966


The enactment of the Affordable Care Act was the most sweeping reform of our health care system since President Lyndon B. Johnson signed Medicaid and Medicare into law on July 30, 1965. Yet, the journey for health care justice continues. Before the Affordable Care Act, many could not afford health insurance because people with different incomes had to pay the same fixed amount – often much too high. People with lower and moderate incomes had to go without coverage. There were no subsidies (called advanced premium tax credits) to help lower the cost of monthly payments. Today, President Barack Obama has provided us with needed tools to help our neighbors obtain affordable health insurance coverage. However, Dr. King’s quote above is still applicable because so many remain unaware that subsidies to lower their payments are available. So, let’s change that!

As of today, January 20th, only 71 days will remain to help enroll uninsured Mainers into an affordable health insurance plan. The deadline is March 31, 2014. Here are some simple actions you can take to help a neighbor or loved one get the health insurance coverage they need:


Your action, like those of Dr. King, to help someone – maybe someone you don’t even know – to understand how to enroll could save their life. Take action! Honor Dr. King!

By Joe Ditré, Executive Director, Consumers for Affordable Health Care

Friday, November 22, 2013

Feds Move Health Insurance Enrollment Deadline to December 23rd for Applicants Seeking January 1st Coverage

Good News! If you have been trying to enroll in a health plan on Healthcare.gov so that your coverage will begin on January 1, 2014, there is some good news today from the federal government. You now have until December 23rd – not December 15th – to enroll and your coverage will be effective on January 1, 2014.
Many people have had difficulty with Healthcare.gov, the Web site that allows comparison shopping and enrollment. This week, we began hearing reports that many of the initial problems have been resolved and people in Maine have been able to apply online without long delays.
To ease some of the pressure to have coverage that is effective on January 1, 2014, the federal Department of Health and Human Services sent out a notice today that HHS intends to extend the deadline for enrollment for those wishing to have coverage that begins on January 1, 2014 from December 15, 2013 to December 23, 2013.
Here is what HHS said in a memo today:
Today, we intend to extend the date by which consumers need to enroll in a plan in order to get coverage on January 1 from December 15 to December 23.
This extension will allow consumers more time to review plan options, talk with their families, providers or enrollment assistors, and enroll in a plan. We know that in Massachusetts, people visited the site three to six times before enrolling in a plan and we want to give people time to make their decision. We understand the technical challenges have made comparing plans more difficult and we want to give consumers as much time as possible. 
The reference to what happened in Massachusetts relates to that state’s experience after its universal health coverage law took effect. The federal Affordable Care Act is based on Massachusetts’ successful law. 

Many who are shopping on Healthcare.gov for coverage likely will visit the site numerous times before making a final decision. Today’s announcement gives them more time to decide.  That’s good news.
-Joe Ditre, CAHC Executive Director

Saturday, November 16, 2013

Let's take a moment to remember how we got here and where we're going

I'm tempted to start off by saying what a crazy week it's been - but that's not news to anyone who has turned on the TV, surfed the internet or opened a newspaper.  It's also not new since for the past six weeks those of us involved in helping to implement the Affordable Care Act (ACA) and those just trying to follow its progress have felt like they've been on a bucking bronco ride that never ends.  Regardless of whether they were real or imagined by the media, since October 1 when the Marketplace opened we've been in "crisis a day" mode.

Six weeks in let's take a few minutes to look back and look forward and, if I can be so presumptuous, try and dispel a little of the "fog of war" that has built up around the implementation of the ACA. This past week we've heard about cancelled plans, enrollment numbers and uncancelled plans.  I'm not sure what is the general public is supposed to think when even those of us deeply involved in the process have a tough time keeping up.

So as we all take a deep cleansing breath  let's start by looking at some specifics regarding the plan cancellations.    

The ACA was designed to reform the existing system - contrary to what the law's opponents would have you believe it was not a government takeover of the country's health care system (If it had been the whole process would have been much easier!)  Instead it works within the existing system to try and make it possible for more people to access quality affordable health care. 
That was the goal, but even working within the existing system, a certain amount of change and disruption was inevitable - and more than that - a certain amount was required in order to make the system work better. 

Before the law was passed, some people purchased insurance plans that did not provide true protection.  It's worth taking a minute to review one telling statistic.  In a study of personal bankruptcies across the country, the data showed that over 60 percent of bankruptcies had a medical cost component, and of those about three quarters had health insurance  (Source: MedicalBankruptcy in the United States, 2007)
 
So there was a real problem with people buying insurance that wasn't true protection or real coverage.  To address that issue the ACA introduced national standards that every plan had to comply with.  This was a crucial part of the reforms and not something that should be taken back.  But it did mean that not all existing plans would continue - but this is so important I'm going to repeat myself:  these were not true protection so it makes sense they should be eliminated.

In order to ease the transition, the law allowed for plans to be grandfathered - that meant that if you had a plan on the day the law was passed, you could keep that plan.  That happened - but confusion resulted when plans changed after that date, thus losing their grandfathered status, or people bought new plans after that date not realizing those plans were not grandfathered.  Some of these plans would need to be drastically changed as of January 1, 2014 in order to comply with the law.

What the recent uproar over plans being cancelled doesn't seem to take into account that this was done for real and valid reasons.  However, because of the uproar the President this week said that the administration would change enforcement temporarily so that these plans could continue for another year in order to smooth the transition (although note that it's a state option and as of my writing this we have not yet heard if Maine will take the President up on his offer).

Before we leave this topic, let's note that the process would have been a lot smoother if the website was fully functional and the people who received these cancellation notices could have easily shopped for new coverage and seen the help they would be eligible for to pay for the new coverage.  At the end of the day we need to remember that this issue is an implementation problem, not a policy failure - these plans should be discontinued, just because it's a bit disruptive does not mean we should give up on these very needed reforms.

This bring me to another part of this week's frenzy, the release of enrollment numbers for October.  I won't spend much time on this because the simple fact is that that the only thing surprising about the numbers released was how high they were.  We've been reading about and experiencing the problems with the website since day one, given that why would anyone be surprised that the enrollment numbers were small? 

Now let's look forward. 

Keep in mind that it doesn't matter if you enrolled on October 1 or plan on enrolling on December 15, your coverage still wouldn't begin until January 1.  And given the administration's recent clarification, you actually have until March 31 to enroll in a plan and still not face a penalty.  So there is still plenty of time left, the question is will it be enough?

Indications started to come in last week that the answer is a guardedly optimistic yes.  We always knew that improvement to healthcare.gov would be incremental.  It was never going to happen that we went to sleep one night with the website not working at all and woke up the next day to a fully functioning site.  Instead, changes and fixes are being made on a daily basis, recently it's seemed like those fixes have started to add up. 

My own experience talking to people is that the website IS getting better.  As I go around the state talking about the law I've heard more and more website success stories.   But it's not just me.  The Portland Press Herald reported that: Healthcare website may be starting to work, Maine sources say.  Let me be clear, people are still having problems with the website.  But more and more people are getting through the process successfully.

We're not out of the woods yet.  The uproar in DC continues, opponents of the law will continue to try and paint technical implementation issues as substantive policy failing.  But that said I can't help but think of Winston Churchill's words in November of 1942 - still a long way from the end of the war but after a significant military victory he said:   "Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning."


 -Mitchell Stein, CAHC Policy Director

Tuesday, October 22, 2013

Keep Calm and Don’t Believe the Headlines

I spent yesterday participating in the legislature’s Exchange Advisory Committee – a group whose goal is to monitor the implementation of the Affordable Care Act and contribute what we can to the process.  I also spent a lot of time talking to the press.  But with all that attention I’m concerned that a very incomplete message is getting out to the public, compelling me to try and set the record straight.

The headlines highlighted the immediate negative without putting things in perspective. 

Let’s be clear – people are frustrated with the problems we've seen on healthcare.gov.  In fact in some ways, those of us involved in the process on a daily basis are probably more frustrated than the general public who may have tried the website once or twice.  Recent surveys bear out that impression with a new Washington Post poll out this morning showing a slight uptick in recent support for the law, from 42 percent in September to 46 percent in October, in spite of the problems.

For those who joined us at our September conference - Successfully Implementing the Affordable Care Act in Maine - you’ll remember the phrase, “this is a marathon, not a sprint”.  What was true then is still true now.  Three weeks into a six-month open enrollment period is too soon to be passing judgment.

The president yesterday acknowledged the problems.  He told us that getting the website fully functional is the top priority and announced a “tech surge” to help accomplish that goal.  (On a side note, does anyone else besides me picture planeloads of geeks with glasses and pocket protectors parachuting onto the Mall in DC when they hear that phrase?)  Anyway, while we can complain about the fact that the focus on the website’s functionality is coming now instead of six months ago, our primary focus has to be on looking forward and getting Mainers covered, not on looking back and second guessing past decisions.

It’s ironic that the people most opposed to the law – who in fact refused to provide sufficient funding for the building of the Marketplace - are now the ones so quick to point out that it isn't working perfectly.

In notes yesterday from Health and Human Services and from the White House, several strategies were recommended for how to deal with the issues.  Many of them are points we've already been making here in Maine but they are worth repeating:
  • Remember there are no early bird specials. You have until December 15 to enroll in coverage that begins on the earliest date possible – January 1
  • You no longer need to create an account to view your marketplace options. You can check them out at this link. https://www.healthcare.gov/find-premium-estimates/https://www.healthcare.gov/find-premium-estimates/
  • Make use of the Kaiser subsidy calculator to help assess your situation: http://kff.org/interactive/subsidy-calculator/http://kff.org/interactive/subsidy-calculator/
  • Consider completing a paper application.  You can download the application online, or call the Consumer s for Affordable Health Care HelpLine at 1- 800-965-7476 to ask for a copy
  • Consider using the Marketplace call center to start the process at 1-800-318-2596. The number of staff at the call center has been increased by 50% since Oct 1!
  • Seek local assistance – use enroll207.com to find local help with the process or call our HelpLine at 1- 800-965-7476.  Organizations across Maine at over 66 locations are standing by to offer assistance. 
  • The open enrollment period runs until March 31
In conclusion, while these past few weeks have been bumpier than we had hoped or expected, the battle is far from over.  Many of us have waited all our lives for meaningful health care reform in this country.   So keep calm and remember: the Affordable Care Act is more than just a website! There is still plenty of time to make sure that, in the words of Ezra Klein, these past few weeks become a story CMS employees tell around the campfire to scare children.

-Mitchell Stein, CAHC Policy Director


Thursday, October 3, 2013

It was the best of times; it was the worst of times.

"It was the best of times; it was the worst of times."

People usually stop there, but let’s go ahead and review the whole quote:
“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way.”  Charles Dickens, A Tale of Two Cities (1859).
Was Dickens writing about this week?  I think so!
Tuesday, October 1, 2013, was a historic day for two reasons.  Those reasons exemplify the duality highlighted in the full quote. 
On the one hand, after years of effort (or decades depending on when you think the battle for access to health care began) we had the most visible sign that the Affordable Care Act (ACA) implementation is underway.  While the law has already benefited millions of people, the Marketplaces (Exchanges) opened for business.  Here in Maine, while there were some glitches in the technology, we know that several people successfully enrolled in their new coverage (which will begin on January 1, 2014).  For those of us who have been working on expanding access to health care, it truly was the beginning of the “season of light”.
On the other hand, we also had a shut-down of the federal government for the first time in 17 years.  A few (20-30 by some counts) reactionary members (of one faction of one party) in one house of Congress succeeded in holding the government hostage.   Because they were not given what they wanted, they refused to fund the federal government.  The irony of the situation is that they were trying to stop the full implementation of the ACA.  Instead they stopped the government while ACA implementation rolled on.

Those opposed to the law realize that once people who had previously been unable to afford health coverage started to see the benefits of the law and enroll it would be too late to stop.  On Tuesday we saw interest in the Marketplace that was orders of magnitude greater than even the most optimistic estimates.  Another way to put it is that it was the success of the law that opponents were really concerned with, not the failure of the law that they were predicting publicly.
And so we move forward, the federal government still shut down and people successfully enrolling in quality, affordable coverage every day, truly putting the "affordable" in "Affordable Care Act". 

I’ll leave you today with one more duality – here in Maine while tens of thousands of our fellow Mainers will benefit from the ACA in the coming weeks, tens of thousands of others who could benefit are currently left out due to the Governor’s veto of the bill to change MaineCare eligibility.  While we celebrate the new opportunities for many, we continue to work to bring those opportunities to all. 
-Mitchell Stein, CAHC Policy Director
P.S.  If you want to support the effort to cover tens of thousands of Mainers by accepting federal funds, please visit www.covermainenow.org.

Friday, September 6, 2013

ACA in Maine: Q&A with Mitchell Stein, CAHC Policy Director

Every day we get one step closer to enrolling thousands of Mainers in the ACA Marketplace, an exciting and historic moment for Maine.  Our greatest challenge is in helping consumers understand the law, what it means for them, and how to get information when they need it.  This brief Q&A with Mitchell provides the answers to some of these questions.

What is the Affordable Care Act?
The Affordable Care Act is the law of the land.  One of its major goals is to provide access to affordable health coverage.  In the first year millions of additional people will gain affordable health care coverage, and thus access to health care. 

The ACA also aims to improve the quality of our health care, bringing down the cost of care for everyone; it provides basic insurance regulation at the federal level (setting a floor for minimum requirements across the country) and train more health care workers to meet the growing demand for health care services.  The importance of these items can’t be overstated.  While in the short-term, providing access to health care will be the most visible part of the law, over the long-term improving quality and lowering cost are just as important.     

Many parts of the law are already in effect, but the most significant ones begin soon.  October 1, 2013 is the beginning of the first open enrollment period for the Maine Health Insurance Marketplace (also known as the Exchange).  Through the Marketplace, subsidies will be available to low and middle income individuals and families to help them purchase health coverage.  Beginning on January 1, 2014, all individuals must have coverage, either through an employer, public programs like Medicaid and Medicare, or by purchasing a plan on their own. 

While the road to full implementation of the ACA may have some bumps, it will provide health coverage to tens of thousands of our fellow Mainers and to millions of people across the country.
 
Why do we need it?
Our country spends more on health care than any other – often almost twice as much (when measured as a percent of GDP).  But even though we spend all that money by all measures of quality we don’t do very well.   People in other countries live longer and are healthier.  Also, for all that money, about 15% of our population is uninsured, that means almost 50 million people don’t have coverage.  As a result, they may delay or forgo needed care altogether, until they can no longer wait and then seek care in the Emergency Department, where treatment is much more expensive.
 
What aspects of the law are creating the most confusion?
Many people are not aware of the basics of the law so are worrying unnecessarily.  If you are covered at work, things won’t change much and there is no action you need to take.  Also, if you are covered by Medicare, other than some improvements like the closing of the “donut hole” in your prescription drug coverage things won’t change at all – you don’t need to go to the Marketplace or do anything different than you’ve done in the past.


There are also benefits available to small businesses that aren’t well known  – tax credits for those with less than 25 employees and the chance to shop on the Marketplace for those with less than 50 employees.

How will Maine's rollout of the ACA differ from other states? What's unique here?
When the Supreme Court found the law constitutional, they said that the proposed changes to Medicaid (MaineCare) enrollment are optional for each state.  The legislature passed a bill to make the changes but it was vetoed by the Governor.  This will leave about 80,000 people in our state that will be uninsured and will not be able to benefit from the law.  It also means we are leaving $250 million in federal funds that have already been set aside, that could help to boost our economy by creating jobs.

Also, here in Maine our Marketplace (or exchange) will be run by the federal government.  This will not have a big impact on people who go to the Marketplace, but there are some states that are running their own marketplaces. 
 
One tip you'd give consumers who are trying to make sense of all this?
Relax and take a deep breath.  The sky is not falling, and your doctor is not now working for the IRS.  Oct 1 is the start of open enrollment for the Marketplace, but it will go on for six months – there is time to figure this out.  If you’re one of the vast majority of people already covered by your employer’s plan (or as a dependent), Medicare or other program such as the VA, you don’t need to take any action.  If you are currently uninsured or purchase individual coverage, go to http://www.healthcare.gov for more information – remember, help with your premiums is available for people with low to moderate income, including those in families of four with incomes up to 94k (400 percent of the federal poverty level), so many people will qualify for help. 

If you have 3 minutes you can check out our new youtube video about the Marketplace!

Tuesday, August 13, 2013

Health Policy by anecdote - never a good idea!

“All the trees are dying!”

               “How do you know?”

“Because this leaf just fell on my head so that means all the leaves are falling off all the trees.”

Generalizing from an isolated incident or two is never a good idea – especially when you then want to use those generalizations to make policy.
Recently there’s been a lot of talk about the ACA’s employer mandate resulting in employers cutting hours to avoid the requirement to provide health coverage to their employees. (Specifically, employers with 50 or more full-time equivalents must provide insurance to full-time employees defined as those working 30 or more hours a week, even though that requirement does not kick in until 2015).
While no one would argue that this might be happening in some cases (hence the anecdotes), the evidence shows that there has been no recent increase in the number of part-time workers. 
But don’t just take my word for it; that would be no different than believing those who say it is happening.  Instead, let’s take a look at two data heavy articles recently published on the issue:

First from Politico, Obamacare isn't destroying jobs:
"Part-time workers represent 19.0 percent of total employment — below the post-recession peak of 20.0 percent and exactly the same as a year ago.” 

If employers were cutting hours in preparation for the requirement that they provide coverage to those working more than 30 hours, we would see an increase in the relative number of part-time workers in the economy.
There have been reports published trying to argue that in fact there is data to support the position that employers are cutting hours.  Our second set of data comes from Is Obamacare Forcing You to Work Part-Time? (Bloomberg) where we can see in detail that those arguments fall short of being convincing since among other facts there has been no noticeable drop in worker hours, contradicting the argument that more people are being shifted into part-time roles.
And finally, the White House shares this set of data in animated form - focusing on the restaurant industry, supposedly the place where all these hours are being cut.
To sum up, yes you can find an employer or two who has cut hours, and others may follow, but when looking at the economy as a whole we can see that these cases are the outliers – the data just does not support any other conclusion.
-Mitchell Stein, CAHC Policy Director