ACA ‘Repeal and Replace’ Bill Unveiled

Repeal and Replace BilLate yesterday evening, a bill was introduced in Congress to repeal and replace the
Patient Protection and Affordable Care Act (ACA or Obamacare).  Prior to the actual introduction of this piece of legislation, there was a lot of speculation about what would be included, and although a version was just released, the House of Representatives is expected to begin considering the legislation in the relevant committees this week.  This is very fast moving compared with other legislation.

The bill is significantly shorter than the ACA and has been named “The American Health Care Act.”

If passed, the law would make several significant changes to our health care system.  For example, the bill would:

  • Eliminate the current requirement that most Americans have health insurance or pay a penalty.
  • Eliminate the current requirement for large employers (50+ employees) to pay a penalty if they do not provide adequate and affordable health insurance to their employees.
  • Require that people have “continuous coverage” or else they could be charged a 30% higher premium. Starting with open enrollment for 2019 insurance plans, anyone who has gone more than 63 days without coverage during the previous 12 months will be assessed a 30% late-enrollment surcharge on top of their base premium.
  • Eliminate the current system of financial assistance to purchase individual health insurance that is based on income and household size. Instead the law would provide tax credits based on age, rather than income. Those under 30 would receive $2,000 per year, up to those over 60, who would receive $4,000 per year. Only individuals earning up to $75,000 a year and married couples filing jointly earning up to $150,000 a year for would be eligible for the full credit. It is estimated that many people currently receiving financial assistance would see a 50% cut in the assistance that they receive under this new law.
  • Change the funding structure of the Medicaid system (i.e., to a per capita payment). This means that each state will receive a set amount of money each year. If states run out of money during the year, they will either have to limit enrollment, limit coverage, or both. This system might end up looking like the failed High Risk Pool structure we had prior to the ACA.
  • Increases the amount that insurance companies can charge older Americans for their health insurance from a 3:1 ratio to 5:1 ratio. Currently, insurance companies cannot charge a 64 year old more than 3 times what it charges a 21 year old. This bill would change that to 5 times what a 21 year old is charged, making health care that much more expensive for older Americans.
  • Eliminate several of the taxes (e.g., the medical device tax, the tanning tax, a tax on high earners, etc.) created by the ACA that were designed to help pay for the financial assistance provisions and expansion of coverage.

The bill does not repeal the protections for people with pre-existing conditions and allowing young adults to stay on their parent’s policy until they turn 26, but also doesn’t address some of the gaps in coverage. For example, the bill does not address the cost of prescription drugs or how much insurance companies can increase rates year to year.

So, while some protections from the ACA will survive, it is anticipated that if this bill passes, many of the 20 million Americans that gained coverage under the ACA will be negatively impacted. For the cancer community, passage of this bill could mean an increased likelihood of facing financial ruin due to a diagnosis.

Of course very few bills are ever passed exactly as they are introduced, so there will still likely be more changes.  Additionally, even if this bill is passed by the House of Representatives, it still has to pass the Senate, and be signed by the President.

Stay tuned for more updates.

What You Can Do

We will have to continue to wait and see what happens, but in the meantime, there is something that you can do.

  1. Share your experience and concerns: Call or email your elected officials and share your health insurance concerns. To find your elected officials or learn more about becoming an advocate, visit our Advocacy resources page. You can also find the Facebook and Twitter handles for the current members of Congress here.
  2. Tell your story: Share your story with Families USA or the National Coalition of Cancer Survivorship (NCCS), two health care advocacy organizations that are working to help our elected officials understand the dire consequences of repealing the ACA and how certain changes to our health care system can impact us all. But they need the stories of real people. If you feel comfortable doing so, you can share your story at http://familiesusa.org/share-your-storyor at org/blog/share-your-aca-story.

A Model for All Children’s Hospitals

Sadly, adults are not the only ones touched by cancer.  Kids get cancer, too.  While only triage-cancer-blog-school-reentry1% of all cancer in the United States is found in kids under the age of 15, in 2016 that means 10,380 children.  Childhood cancer has been on the rise for the past few decades.  However there is some good news out there.  Because of major treatment advances in recent decades, more than 80% of children with cancer now survive 5 years or more.

Thankfully, now we need to talk about how children transition from treatment back to school.  There is a lot of discussion about adults returning to work after taking time off to deal with a cancer diagnosis.  We talk about the normalcy, the sense of the purpose, and the chance to socialize that work may bring.  Well, for these kids, returning to school can mean exactly the same thing.  And it also comes with its own degree of challenges.  Thanks to Stony Brook Children’s School Intervention and Re-Entry Program, there is now a model of how to help children transition from treatment to school.

The School Intervention and Re-Entry Team is made up of physicians, nurses, child life specialists, and educational liaisons who work with school personnel including teachers, school nurses, counselors, social workers, psychologists and other staff members in a joint effort to ease the child’s return to the classroom. This is a service that is free to all Stony Brook Children’s patients. Some of the services they provide include:

  • Presentations to the school faculty regarding a patient’s illness and treatment
  • Classroom presentations to the patient’s peers
  • Acting as a liaison between the hospital and the school
  • Arranging for home instruction
  • Advocating for appropriate educational service
  • Attending 504 and CSE/IEP meetings
  • Providing medical documentation to schools
  • Facilitating neuropsychological evaluations and/or other educational testing services
  • Holding ongoing phone consultation regarding school issues, placement, curriculum, accommodations, and other educational services

The program’s services don’t stop at high school either.  This year, they were able to offer a workshop specifically for students with cancer and blood disorders who are transitioning to college. The workshop was designed to educate these students as well as their siblings, parents and school personnel about their unique needs, and to empower this special population of students to realize their academic goals. There was also an expo with representatives from many regional colleges available to speak individually with students and families about their schools, programs, and services.

We recognize that all children are not being treated at Stony Brook Children’s.  But if you are a parent of a child with cancer, you are used to being an advocate for your child.  Let Stony Brooks Children’s School Intervention and Re-Entry Program be a model you advocate for at your child’s hospital.  After all, we all want our children to be healthy and successful in everything they do.

Being Aware of Our Environment: Asbestos and Mesothelioma

Most of us are aware of the toxins in our environment that could be detrimental to our health, like pollution, mold, and secondhand smoke. But many people don’t really think mesotheliomaabout another danger that could be hidden in their walls, the shingles on the roof, or the brake pads of their car: asbestos. Asbestos is a natural fiber that has been mined for decades because of its fire resistant properties. When disturbed, we can inhale these fibers and then they stick to the linings of our organs. Because they’re so durable, our bodies can’t break them down and get rid of the foreign toxin. Instead, anywhere from 10-50 years later, the symptoms of Mesothelioma might start to show.

Mesothelioma, a rare cancer, is known to be caused by exposure to asbestos. The cancer can develop in the lining of the abdomen, chest, or lungs. Pleural mesothelioma, or the type that develops in the lungs, is the most common resulting in 80% of cases. Regardless of the type, patients typically see nonspecific symptoms at first. The earlier symptoms of mesothelioma can include shortness of breath, chest pain, or lack of appetite. This leads to many believing they have the flu or another common, less serious ailment. Being aware of potential asbestos exposure is essential for an early diagnosis. It’s important to also remember secondhand exposure as a serious risk, if any loved ones have worked with asbestos. Though there are only 3,000 cases diagnosed each year, it’s estimated that 20 million people are at risk of developing this cancer and another 125 million people worldwide are exposed to asbestos in their workplaces each year.

Since this disease is so difficult to diagnose, it can sometimes take months for an official diagnosis to be made. In most cases, the disease has already progressed to a later, harder to treat stage. As such, the prognosis for mesothelioma patients is generally very poor. . Recently, there have been great strides made in developing better mesothelioma treatment methods and diagnostic techniques. Immunotherapy, for example, has shown promise for mesothelioma patients in a variety of clinical trials. Initiatives like the Cancer Moonshot 2020, a collaboration like no other to cure cancer, and Microsoft’s Project Hanover, which seeks to use artificial intelligence to solve cancer, also bring hope to patients for the future.

Though a cure for mesothelioma  is still likely a ways off, there are steps we can take to help eliminate and prevent further mesothelioma cases. Asbestos is still not banned in the United States, even though 52 other countries have banned the toxin because of its health risks. Recent progress, however, gives hope for a future ban. Over the summer, the Frank R. Lautenberg Act was passed to amend the Toxic Substances Control Act, which allowed the U.S. Environmental Protection Agency (EPA) to evaluate existing chemicals for environmental and public health risks. On November 29th, their list of the first ten chemicals they will investigate included asbestos. Though this news doesn’t promise a ban on asbestos anytime soon, it’s a huge step in the right direction.

In the meantime, the best prevention is to continue raising awareness on the dangers of asbestos and educating loved ones. Together our voices can help make a difference in banning asbestos and saving millions of lives!

Changes to our Health Care System under President Trump

changes to our health care system under President TrumpTriage Cancer believes that access to affordable, quality health insurance coverage and medical care is critical to improving the health and well-being of the cancer community.  To that end, we will continue to provide you with updates on what is happening in Washington, D.C. and in states across the country, with respect to any changes to our health care system under President Trump, and how those changes may impact the cancer community.

Webinar on Wednesday

On Wednesday, January 25, Triage Cancer is partnering with the National Coalition of Cancer Survivorship on a webinar to bring you the latest news: Affordable Care Act Update: What Advocates and Cancer Survivors Need to Know.

What Happened in the Last Week

On Friday, President Trump took office and that afternoon, signed an executive order regarding The Patient Protection and Affordable Care Act (ACA).  This executive order does not repeal the ACA, but it does allow agencies to waive or defer provisions that “impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications.”

While there are few details in this executive order, it is broad enough to allow a number of potential significant changes. For example, under this order, the IRS could stop enforcing the requirement that people have health insurance coverage, referred to as the “individual mandate.”

Second, Republican Senators Susan Collins and Bill Cassidy introduced the Patient Freedom Act of 2017. The Senators claim that their bill will: return power to the states; increase access to quality, affordable health care for all Americans; improve patient choice; and begin to bring coverage to the nearly 30 million Americans who still do not have health insurance.  As we get additional details about this legislation we will share it with you.

Understanding the Possible “Replacements” & Other Changes

There is a great attention being paid to the repeal of the ACA, but there are other changes being discussed. Over the last few weeks, we have laid out how those changes may impact the cancer community in these blogs:

We also want to share some other resources that you may find helpful:

We hope that our elected officials will keep these issues in mind as they make their decisions over the next few days, weeks, and months on any changes to health care system.

What You Can Do

We will have to continue to wait and see what happens, but in the meantime, there is something that you can do.

Share your experience and concerns: Call or email your elected officials and share your health insurance concerns. To find your elected officials or learn more about becoming an advocate, visit our Advocacy resources. You can also find the Facebook and Twitter handles for the current members of Congress here.

Tell your story: Share your story with Families USA or the National Coalition of Cancer Survivorship (NCCS), two health care advocacy organizations that are working to help our elected officials understand the dire consequences of repealing the ACA and how certain changes to our health care system can impact us all. But they need the stories of real people. If you feel comfortable doing so, you can share your story at http://familiesusa.org/share-your-story at www.canceradvocacy.org/blog/share-your-aca-story.

Do You Need Health Insurance Now?

We also want to remind you that change is Washington is rarely swift and that we may not see changes for most of 2017.  That means that we have to continue to operate with the system we have for now and ensure that people have health insurance coverage for 2017.  If you do not have health insurance coverage, you can apply for Medicaid at any time or purchase a policy through the State Health Insurance Marketplaces until January 31, 2017.

For more information about how to choose a health insurance policy (including making choices between employer-sponsored options), watch our recorded webinar. If you aren’t sure what your health insurance options are, you can get personalized information on our recently released resource: www.CancerFinances.org.

Stay Tuned

Stay tuned to our Blog and sign up for our newsletter, as we will continue to provide updates as more information becomes available in the coming days, weeks, and months.

Post-Election Update: How health insurance may be changing

how health insurance may be changingAs we have reported since the election, changes to our health care system are likely to occur in 2017 and beyond.  While we wait for further action by Congress, we will continue to provide you with information about some of the the possible changes to our health care system and how we get health insurance.

Here are 4 ideas that we have heard from Republican leadership: President-elect Donald Trump, Speaker of the House of Representatives Paul Ryan, and Senate Majority Leader Mitch McConnell:

  1. Provide Medicaid block grants to states
  2. Allow insurance companies to sell policies across state lines
  3. Provide tax credits for purchasing health insurance coverage
  4. Regulate drug prices

Let’s break down what these ideas may actually mean.

  1. Provide Medicaid block grants to states

Currently, Medicaid is funded through a matching system, with the federal government paying for part of the expense of providing Medicaid coverage and states picking up the rest of the cost. There currently isn’t a limit on the amount of funds a state can receive to meet the health care needs of its population.

A block grant is a fixed dollar amount to provide coverage for a state’s health care needs. When the money runs out, that’s it.  This greatly increases the chances that people would go without care.  For example, imagine a year where winter storms are particularly harsh and the flu season is extreme. This would increase the number of people in a particular state that need medical care. What would happen if the state has already spent its Medicaid funds by the end of November? Would no one receive medical care in December?

While the argument in favor of Medicaid block grants is to give states more flexibility to improve their Medicaid programs, in reality, a Medicaid block grant system would likely cause states to have to make tough decisions: a) reduce the number of people eligible for Medicaid; b) reduce the coverage available through Medicaid; or c) both.

Click here to learn more about why block grants only sound like a good idea.

There would also be an impact on hospitals and health care providers. In states that have expanded access to Medicaid, there are fewer uninsured people in those states.  When people are uninsured and need medical care, the burden is often placed on hospitals and health care providers to cover the cost of that “uncompensated care.” If uninsured individuals can’t pay their medical bills, then providers are the ones who suffer. Over the last few decades, many hospitals have had to close, because they can’t afford to cover that uncompensated care. The ACA reduced the amount of uncompensated care by increasing the number of people with health insurance coverage. A Medicaid block grant program would likely increase the number of people without health insurance coverage, increase uncompensated care, and place the burden back on health care providers.

And just to wade a little further into the weeds . . .

If individuals with more expensive pre-existing conditions don’t have access to Medicaid in their state, then they are more likely to enter the individual health insurance market.  Those individuals are most expensive to ensure, and insurers pass on those costs to everyone, which increases the cost of insurance for everyone. This has proven to be the case now. In states that expanded access to their Medicaid programs, the cost of premiums for individual plans in their state health insurance marketplace were, on average, 7% lower than in states that did not expand access to Medicaid.

  1. Allow insurance companies to sell policies across state lines

While there are some federal laws, like the Affordable Care Act (ACA), which provides consumers protections in health care, there are also state laws that provide protections. Those state laws can offer protections such as coverage mandates. For example, a state may require an insurance company to cover oral chemotherapy at the same rate as IV chemotherapy, to reduce the out-of-pocket expenses for patients. Some states even give their insurance commissioner the power to reject excessive monthly premiums charged by insurance companies.

The problem with selling health insurance policies across state lines, is that it provides a loophole that allows insurance companies to not comply with certain state law requirements and offer less comprehensive coverage. Watch this great video which explains why selling insurance across state lines may sound like a good idea, but really poses some practical challenges.

  1. Provide tax credits to help people purchase health insurance coverage

Speaker Ryan’s “A Better Way” proposal suggests offering an “advanceable, refundable tax credit for individuals and families.” Making the purchase of health insurance tax deductible would be very helpful for many people in the United States.  However, for those with lower income levels, it does not sufficiently help those individuals get the money to buy adequate health insurance coverage in the first place. In addition, given the possible repeal of the ACA, whether there will be individual health insurance policies to buy is still unclear.

  1. Regulating drug prices

The cost of prescription drugs has been skyrocketing for decades, partly due to the significant scientific advances that have been made. It was proposed during the election to lower the cost of drugs through regulation. Watch this video to learn more about why regulating drug prices sounds like a good idea, but may not work the way we hope. The devil really is in the details.

We hope that our elected officials will keep these issues in mind as they make their decisions over the next few days, weeks, and months on any changes to health care system.

What You Can Do

We will have to continue to wait and see what happens, but in the meantime, there is something that you can do.

  1. Share your experience and concerns: Call or email your elected officials and share your health insurance concerns. To find your elected officials or learn more about becoming an advocate, visit our Advocacy resources page. You can also find the Facebook and Twitter handles for the current members of Congress here.

 

  1. Tell your story: Share your story with Families USA or the National Coalition of Cancer Survivorship (NCCS), two health care advocacy organizations that are working to help our elected officials understand the dire consequences of repealing the ACA and how certain changes to our health care system can impact us all. But they need the stories of real people. If you feel comfortable doing so, you can share your story at http://familiesusa.org/share-your-storyor at canceradvocacy.org/blog/share-your-aca-story.

Do You Need Health Insurance Now?

We also want to remind you that change is Washington is rarely swift and that we may not see changes for most of 2017.  That means that we have to continue to operate with the system we have for now and ensure that people have health insurance coverage for 2017.  If you do not have health insurance coverage, you can apply for Medicaid at any time or purchase a policy through the State Health Insurance Marketplaces until January 31, 2017.

For more information about how to choose a health insurance policy (including making choices between employer-sponsored options), watch our recorded webinar. If you aren’t sure what your health insurance options are, you can get personalized information on our recently released resource: www.CancerFinances.org.

Stay Tuned

Stay tuned to our Blog and sign up for our newsletter, as we will continue to provide updates as more information becomes available in the coming days, weeks, and months.

Post-Election Update: Are HSAs a health care solution?

As we anxiously await further action by Congress, we want to continue to share with HSA Health Care Solutionyou some of the possible changes to our health care system.  Today we are talking about if high deductible health plans and Health Savings Accounts (HSA) are a health care solution.

High Deductible Health Plans

A high deductible health plan is a health insurance plan that has a very high deductible. A deductible is a fixed dollar amount that you have to pay before your health insurance coverage begins. You could have a $0 deductible or a $10,000 deductible, depending on the plan that you choose.  This applies to plans that you might get through your employer or a plan that you would get from an insurance company. Now, when we say “high” deductible that is going to mean something different to each of us. But generally, in 2017, a high deductible health plan can have a deductible of $1,330 or more. But some plans have deductibles as high as $7,000. This means that you have to pay your $7,000 deductible out-of-pocket first, before your health insurance coverage kicks in.

The ACA did guarantee access to some preventive care and immunizations without having to pay a deductible, but if the ACA is repealed that protection might also go away.

Having to pay $7,000 or more before your health insurance coverage starts is something that most people would find difficult. And that is what contributed to the problem of medical bankruptcy. Prior to the ACA, 62% of all bankruptcies in the US were based on medical debt. And 78% of those individuals that had to file bankruptcy because of their medical bills actually had health insurance. Their higher out-of-pocket costs forced them into filing bankruptcy. Higher out-of-pocket costs also cause people to go without medical care.

On the other hand, the benefit to a high deductible health plan is that the monthly premium is usually lower. This might be a useful plan option if you are healthy and don’t need ongoing medical care. But, if you have a serious medical condition like cancer, you will likely pay more out-of-pocket with this type of coverage.

Health Savings Accounts or HSA’s

One way to deal with the costs of this type of coverage is by also choosing a Health Savings Account or HSA. A health savings account is a personal savings account where you can save money to pay for your medical expenses, including your deductible. There are significant tax benefits of having this account, because you don’t pay taxes on the money that you put in your HSA (up to a certain amount each year). The downside is that you actually have to have money to put in the HSA to use to pay your deductible and other medical expenses. And the concern is that most people don’t have the ability to save that kind of money to pay for their medical expenses.

Click here for a detailed overview of how high deductible health plans work with health savings accounts, and whether or not this is a realistic solution for individuals and families with lower incomes.

We hope that our elected officials will keep these issues in mind as they make their decisions over the next few days, weeks, and months on any changes to health care system.

What You Can Do

We will have to continue to wait and see what happens, but in the meantime, there is something that you can do.

  1. Share your experience and concerns: Call or email your elected officials and share your health insurance concerns. To find your elected officials or learn more about becoming an advocate, visit our Advocacy resources page. You can also find the Facebook and Twitter handles for the current members of Congress here.
  1. Tell your story: Share your story with Families USA or the National Coalition of Cancer Survivorship (NCCS), two health care advocacy organizations that are working to help our elected officials understand the dire consequences of repealing the ACA and how certain changes to our health care system can impact us all. But they need the stories of real people. If you feel comfortable doing so, you can share your story at http://familiesusa.org/share-your-storyor at canceradvocacy.org/blog/share-your-aca-story.

Do You Need Health Insurance Now?

We also want to remind you that change is Washington is rarely swift and that we may not see changes for most of 2017.  That means that we have to continue to operate with the system we have for now and ensure that people have health insurance coverage for 2017.  If you do not have health insurance coverage, you can apply for Medicaid at any time or purchase a policy through the State Health Insurance Marketplaces until January 31, 2017.

For more information about how to choose a health insurance policy (including making choices between employer-sponsored options), watch our recorded webinar. If you aren’t sure what your health insurance options are, you can get personalized information on our recently released resource: www.CancerFinances.org.

Stay Tuned

Stay tuned to our Blog and sign up for our newsletter, as we will continue to provide updates as more information becomes available in the coming days, weeks, and months.

Post Election Update: Changes to Medicare

Established in 1965, Medicare now covers nearly 48 million seniors and an additional 9 Changes to Medicaremillion people with disabilities. For information about Medicare, read our previous blogs or our Quick Guide to Medicare. Congressional leaders have indicated that there are changes to Medicare on the way.

Medicare’s benefits can be accessed in two ways. Through traditional Medicare, services are covered as fee for service.  Meaning that you can get medical care from any provider that accepts Medicare coverage.  Alternatively, Medicare Advantage is a way to get Medicare coverage through a managed care plan (HMO or PPO). These managed care plans are offered by private health insurance companies and have specific networks of providers that are covered by the plan.

Throughout the contentious election season, President-elect Donald Trump, promised to preserve Medicare as is.  However since the election, key Republican leaders have proposed changes to Medicare.

For example, U.S. Congressman Tom Price, a noted conservative who was recently nominated to be the next U.S. Secretary of Health and Human Services (HHS), has proposed, among other changes, moving Medicare to a voucher system. This would mean giving each individual a voucher worth a certain amount of money to go and buy private health insurance coverage.  There are a number of potential challenges with this approach for consumers:

  1. If the ACA is repealed, many of the consumer protections will no longer be available
  2. It is unclear if the amount of the voucher will be enough to actually buy coverage. If it isn’t then individuals will have to pay more for their health insurance than they were paying under Medicare
  3. It is unclear what the individual health insurance market will look like and what plan options will be available
  4. It is unclear if those options will provide equal coverage to Medicare
  5. As seniors and people with disabilities often have higher medical expenses, they may be charged more for their coverage and plans may be too expensive for people to buy

Congressman Price’s nomination to lead HHS, which has control over Medicare, has caused many to question the validity of President-elect Trump’s campaign promise to protect Medicare.

Speaker of the House Paul Ryan has also championed a voucher system, which he calls “premium support.”  In his 2016 proposal entitled “A Better Way,” Ryan makes several recommendations. Under his plan, the Medicare eligibility age would be raised from 65 to 67 by 2020.  Then in 2024, “Medicare beneficiaries would be given a choice of private plans competing alongside the traditional Medicare program on a newly created Medicare Exchange.” Increasing subsidies for Medicare Advantage and allowing private insurers to offer a variety of coverage levels is suggested as well.  Unfortunately, consumers who choose plans with more comprehensive coverage and flexibility may be required to pay the difference.

Some economists say that a privatized Medicare Advantage would be more efficient and enhance benefits to consumers while decreasing the cost to taxpayers.  Other experts say that Medicare would not automatically be more efficient if privatized. They argue that Medicare already efficient and the projected savings privatized Medicare Advantage was supposed to provide have not materialized.

Additionally, both Price’s and Ryan’s proposals leave out important details.  For instance, how much money would be given to individuals to purchase insurance? Would benefits be guaranteed?  How would the quality of coverage be monitored and ensured?  Would subsidies increase in proportion to the rising cost of healthcare?

Exactly what, if any, changes will be implemented is still unclear.  Not every member of Congress who is committed to repealing the Affordable Care Act, also thinks that making changes to Medicare should be their top priority.  Those who do want to make changes to Medicare have different opinions on how to do so.

One thing is certain: these proposed changes have caused considerable anxiety for Medicare recipients and their advocates. Triage Cancer will continue to follow this issue and share information as we receive it. Stay tuned to our blog and newsletter for the latest information.

Post-Election Update: What does the Budget have to do with the ACA?

budget repeal provisions ACAThere have been many stories in the news over the last few weeks about potential changes to our health care system and last night the Senate voted on a budget resolution that started the ball rolling on to repeal provisions of the  Affordable Care Act (ACA).

President-elect Donald Trump, Speaker of the House of Representatives Paul Ryan, and Senate Majority Leader Mitch McConnell have continued to state that they are eager to make changes to our health care system. In December, on 60 Minutes, Speaker Ryan stated that the repeal of the Patient Protection and Affordable Care Act (ACA) was a priority in the House of Representatives.  Senator McConnell has repeatedly confirmed that the ACA repeal will be the first item the Senate votes after the inauguration of President-elect Trump.

Yesterday, President Trump stated that he would offer his own plan to repeal and replace the ACA simultaneously, as soon as his nominee for Secretary of Health and Human Services, Tom Price, is confirmed by the Senate.

But repealing an entire law, as if it never existed, is a complicated thing.  Especially a law that has been in effect for six years and touches so many people and involves so many federal and state agencies.  And the steps that they are taking to repeal the law are also complicated.

Road to Repeal

Normally, when a bill is proposed in the Senate or House of Representatives, it is reviewed by one or more committees and then if suggested by a committee, all of the members have the opportunity to vote on the bill. Most bills require a majority vote.  In the Senate that means 51 votes are required to pass.  However, if some members don’t want there to be a vote on a bill, they can filibuster it. A filibuster is procedure where debate over a bill is extended to delay or prevent a final vote. Sixty votes are required to break a filibuster. To avoid the filibuster, Senator McConnell has lead an effort to pass changes to the ACA through the budget reconciliation process, which cannot be filibustered and only requires 51 votes, which the Republicans have.

Senate Action Yesterday

Yesterday, the Senate took the first steps to repeal the ACA. Members of the Senate voted 51-48 to pass a budget blueprint, which directs the House and the Senate to come up with repeal legislation by January 27. The House of Representatives could vote on the budget blueprint by Friday.

What Does a “Replacement” Look Like?

Even though Congress is moving forward with plans to repeal the ACA, exactly what they would replace the ACA with is still unclear, and when changes will go into effect is also unknown.

Repealing the ACA will have a significant impact on the cancer community.  In previous blogs we have explained some of the consumer protections in the ACA, as well as the danger in only keeping protections for people with pre-existing conditions, without also keeping those consumer protections.

In this blog, we wanted to start to share with you one of the proposals that these leaders have advocated for, as they might be part of a “replacement.”

President-elect Trump has suggested that he would replace the ACA, with High Risk Pools. A high risk pool is a health insurance coverage option available for people with pre-existing conditions that is subsidized by the government.

History of High Risk Pools

High risk pools are not a new idea. In fact, more than 35 states had high risk pools to try to help people with pre-existing conditions access health insurance coverage, before the ACA became law.  While those high risk pools offered a lifeline for many people to get access to coverage when they couldn’t get it another way, they were not a solution to the problem. For example, in California, the state’s high risk pool only offered coverage up to $75,000 a year.  Cancer care is often much more expensive than that, which left people to pay for their care out-of-pocket. Many of those state high risk pools had 6-month waiting periods for coverage if you had a pre-existing condition, wait lists due to state budget constraints, and very high deductibles and out-of-pocket costs.

Kaiser Health News released a video in October, describing why high risk pools may sound like a good idea, but have some challenges in reality.

For a more detailed explanation of high risk pools and our past experience with using high risk pools to try to meet the needs of people with pre-existing conditions, visit: http://kff.org/health-reform/issue-brief/high-risk-pools-for-uninsurable-individuals.

We hope that our elected officials will keep these issues in mind as they make their decisions over the next few days, weeks, and months on any changes to health care system.

What You Can Do

We will have to continue to wait and see what happens, but in the meantime, there is something that you can do.

  1. Share your experience and concerns: Call or email your elected officials and share your health insurance concerns. To find your elected officials or learn more about becoming an advocate, visit our Advocacy resources page. You can also find the Facebook and Twitter handles for the current members of Congress here.
  1. Tell your story: Share your story with Families USA or the National Coalition of Cancer Survivorship (NCCS), two health care advocacy organizations that are working to help our elected officials understand the dire consequences of repealing the ACA and how certain changes to our health care system can impact us all. But they need the stories of real people. If you feel comfortable doing so, you can share your story at http://familiesusa.org/share-your-storyor at canceradvocacy.org/blog/share-your-aca-story.

Do You Need Health Insurance Now?

We also want to remind you that change is Washington is rarely swift and that we may not see changes for most of 2017.  That means that we have to continue to operate with the system we have for now and ensure that people have health insurance coverage for 2017.  If you do not have health insurance coverage, you can apply for Medicaid at any time or purchase a policy through the State Health Insurance Marketplaces until January 31, 2017.

For more information about how to choose a health insurance policy (including making choices between employer-sponsored options), watch our recorded webinar. If you aren’t sure what your health insurance options are, our recently released toolkit, Finances 101, may be useful.

Stay Tuned

Stay tuned to our Blog and sign up for our newsletter, as we will continue to provide updates as more information becomes available in the coming weeks and months.

Medical Marijuana: A Post-Election Update

medical marijuanaOn Election Day, voters across the country showed they were in favor of legalizing medical marijuana, and in some states, recreational marijuana as well. California, Maine, Massachusetts, and Nevada voted to legalize the recreational use marijuana, while Arkansas, Florida, and North Dakota passed ballot initiatives legalizing medical marijuana.

Marijuana, whether used recreationally or for medical reasons is still illegal under federal law. However, over the last few years, the federal government has opted to let states pass laws in this area and not to prosecute people who are following those state laws.

We have posted previously about the laws related to medical marijuana, which you can read more about here.

President-elect Donald Trump has nominated Senator Jefferson Sessions for Attorney General of the United States. If confirmed, it is likely that Senator Sessions will take a different approach towards state laws on medical and recreational marijuana.

To learn more about Senator Sessions’ views on marijuana, read this informative article: http://www.politico.com/magazine/story/2016/12/jeff-sessions-coming-war-on-legal-marijuana-214501.

Important News Regarding Changes to Medicare

medicaredotgovThe new year will bring changes to Medicare.  Click here to see what Medicare will cost in 2017.

Also, if you recently became eligible for Medicare, but thought it would be less expensive to keep your Marketplace coverage because you get financial assistance to pay for your Marketplace coverage, then the rest of this message is for you. 

When you became eligible for Medicare Part A (the hospital portion of Medicare that is usually premium-free), you also became ineligible for Marketplace financial assistance. So that means you will be on the hook for the full price of the Marketplace plan. This also means that you probably missed the open enrollment period for Medicare Part B (the other part of Medicare coverage that has a premium). And, it means that if you do try to get Medicare Part B now, you will pay a late enrollment penalty for the rest of your life.  But . . .

For a limited time, you can apply for “equitable relief” that will give you a Special Enrollment Period to enroll in Part B. It also means that they won’t apply a late enrollment penalty, but you must apply by MARCH 31, 2017!

Some of you in this situation may have been notified of this program by mail. But it you weren’t notified, or lost the notice, or even feel you received misinformation about qualifying for financial assistance, you should contact the Social Security Administration (800-772-1213) to apply for the “equitable relief.”

Your application should include:

  • Any information or documentation you have on how you learned that the financial assistance would not apply and/or why you thought you could continue financial assistance.
  • Any letters (including the notice mentioned above), emails, notes from conversations
  • Or any other relevant information

And more good news – you don’t need to show that your confusion was caused by any particular source to qualify for this relief. You can just be confused.  We know health insurance is confusing!

To learn more about Making Sense of the Medicare Mazewatch our recorded webinar.