U.S. Senate Proposes Health Care Changes

Another Step BackwardsYesterday, the U.S. Senate released the “Better Care Reconciliation Act (BCRA) of 2017,” containing their proposed changes to our health care system and the Patient Protection and Affordable Care Act (ACA). The language we have now is still being referred to as a ‘discussion draft,’ which means that it has not been officially introduced in the Senate. This bill would replace the text of the American Health Care Act (H.R. 1628), that was passed by the U.S. House of Representatives last month.  Additionally, this proposal has not been scored by the Congressional Budget Office (CBO), which is expected to release a score on Monday or Tuesday of next week.  That score will provide an estimated analysis of how much the bill will cost and how many people will lose coverage.

Senate Leadership are planning to hold a vote on this bill by the end of next week, leaving only a few days for the members of the Senate to review these proposed health care changes.  At this time, there is no plan to hold any committee hearings about this bill.

What’s Included

The bill is 142 pages long, so we are still working to digest its full ramifications, but we did want to highlight some things we know will have an impact on the cancer community.

              Consumer Protections

Certain consumer protections in the ACA remain unchanged by the BCRA, such as prohibiting health insurers from denying coverage or charging someone more for coverage based on a pre-existing condition, the ability for children under the age 26 to stay on their parent’s plan, and 90-day maximums for waiting periods for employer-sponsored plans.

However, other protections for people who have pre-existing conditions would be weakened. The BCRA sets up a system where states are incentivized with $2 billion to apply for a waiver. These waivers would give states the ability to redefine essential health benefits (EHB) and to change or reduce other coverage standards. This means that plans may no longer be required to cover services like prescription drugs, hospitalization, or mental health care.  Additionally, while current law prohibits insurance companies from placing annual or lifetime dollar limits on EHBs, they are allow to impose these limits on anything else.  So if, for example, a state chooses to not include prescription drugs as an EHB, plans could impose lifetime and annual limits on prescription drugs.

              Financial Assistance

Currently, there are two types of financial assistance options available to help people access plans sold through the ACA’s health insurance marketplaces: 1) premium tax credits, which lower monthly premiums based on income; 2) cost-sharing subsidies, sometimes referred to as cost-sharing reductions, which lower deductibles, co-payments, and co-insurance payments.

The way that cost-sharing subsides work is that the insurance company reduces what they charge individuals and in turn they are reimbursed by the federal government.  The BCRA would only keep the federal governments’ reimbursements back to the insurance companies for 2018 and 2019.  Eliminating these reimbursements for 2020 makes it more likely that insurance companies will pull out of state marketplaces, reducing choice for consumers and likely increasing costs for everyone.

The BCRA would also change the eligibility requirements for premium tax credits.  Currently, these credits are available to anyone purchasing a plan in the marketplaces who have a household income level between 138% and 400% of the federal poverty level (FPL).  In dollar amounts that is equal to an individual whose income is between $16,642 and $47,520. The BCRA is proposing cutting the tax credits so that they are only available to people with incomes up to 350% of the FPL ($42,210) starting in 2020.

In addition to having a low enough household income level, an individual must spend 9.5% of their income on health insurance premiums in order to get a tax credit. The BCRA is proposing that this amount be tiered based on age. For example, a 60-year-old with an income between 300 and 350% of the FPL would have to spend 16.2% of their household income on premiums before becoming eligible for a tax credit, while a 28-year-old would only have to pay 4.3%.

Current law also restricts insurance companies to only being able to charge older Americans up to three times more for their private health insurance. For example, a 64-year-old can only be charged a maximum of three times more than a 21-year-old in the same location. The BCRA is proposing to increase that age ratio to allow insurance companies to charge up to five times more for older Americans.

These changes would make it harder for everyone to purchase insurance in the marketplace, and would certainly impose a greater burden on older Americans.

              Individual and Employer Mandates

The BCRA would effectively eliminate the requirement for Americans to have health insurance by making the penalty $0.  It would also effectively eliminate the requirement for mid-sized and large employers to pay a penalty if they don’t provide health insurance to their employees, by making the penalty $0. The concern with these eliminations is that the money collected through the penalties help pay for some of the financial assistance people receive to purchase plans in the marketplaces.

              Medicaid

Under the ACA, states were given the opportunity to expand their Medicaid programs by adding a new category of eligibility for anyone with a household income under 138% of the FPL.  As part of this expansion the federal government would reimburse states for the costs of adding these newly eligible individuals to their Medicaid programs.  The BCRA would begin to reduce federal reimbursements at the end of 2020, over a three year period (from 2021 to 2023).  However, eight states have a ‘trigger clause,’ which means that if the federal funding falls below the rates promised in the ACA, the expansion in that state is eliminated immediately. The following states have a trigger clause: Arkansas, Illinois, Indiana, Michigan, Montana, New Hampshire, New Mexico, and Washington.

The BCRA is proposing significant cuts to the traditional Medicaid program, as well.  These cuts will unequivocally impact a substantial number of Americans:

  • Medicaid covers nearly 75 million people in the U.S., including children, people with disabilities, pregnant women, and seniors.
  • Approximately 25% of the U.S. population obtains health care coverage through Medicaid.
  • Medicaid covers 49% of all births in the U.S.
  • Medicaid covers 39% of all children and 76% of children in poverty.
  • The number of people on Medicaid in the U.S. is equivalent to the populations of these states combined: AK, HI, OR, NV, ID, UT, MT, WY, CO, NM, ND, SD, NE, KS, OK, MN, IA, AR, LA, MS, AL, KY, WV, SC, DE, CT, RI, NH, VT, and ME.

In addition to funding cuts, it would move the Medicaid program to a block grant system where states would receive a fixed amount of money per enrollee and if that money runs out during the year, states would have to decide whether to cut enrollment, cut coverage, raising taxes, or all three. This prior blog post provides some additional information about how block grants work.

The BCRA also proposes adding work requirements as a condition of receiving Medicaid. While work requirements may seem like a reasonable condition to gaining access to Medicaid, they may negatively impact certain populations. For example, individuals who are in cancer treatment and are unable to work, but don’t meet the very strict eligibility requirements for Social Security Disability benefits. The proposed language in the BCRA, does not provide a definition of disability, which further confuses the issue.

Next Steps

Shortly after release yesterday, four Republican U.S. Senators [Sens. Rand Paul (KY), Ted Cruz (TX), Ron Johnson (WI), and Mike Lee (UT)] announced their opposition to the bill, arguing that it should go further to repeal the ACA and further cut financial support for access to health insurance coverage.

In order for the bill to pass the Senate, the Republican Leadership need 51 votes in support.  There are 52 Republican Senators and 48 Democratic and Independent Senators. If there is a 50-50 tie, the tie can be broken by a vote from the Vice President of the United States, who is a Republican.

This suggests that in order to pass the bill, Senate leadership will need to make further changes.  However, making further cuts to our health care system may cause some moderate Republicans to pull their support for the bill. There are a number of Republican Senators who have expressed concerned over the cuts to Medicaid, such as Senator Shelley Moore Capito, who represents West Virginia, where 42% of all children in the state are covered by Medicaid.

Do You Need Health Insurance Now?

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 if you qualify for a special enrollment period.

  • 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 or want to understand more about health insurance, visit CancerFinances.org.

 What You Can Do

  • Contact your U.S. Senators and share your health care concerns, by calling (844) 257-6227. Even if you’ve called before, please call again. Even if you know how your Senators will vote, please call to share your thoughts.
  • To find your elected officials or learn more about becoming an advocate, visit our Advocacy resource page. You can also find the Facebook and Twitter handles for the current members of Congress here.

Stay tuned to our Blog and sign up for our newsletter, as we will continue to provide updates as more information becomes available, about this issue that affects all of us.

The Numbers Don’t Lie: The AHCA Will Cost Us

The Congressional Budget Office has released its “score” of the American Health Care The AHCA Will CostAct (AHCA) and the bottom line is that the AHCA will cost the cancer community greatly.

The Congressional Budget Office (CBO) is a non-partisan agency that is tasked with analyzing proposed legislation to determine its financial impact.  Most recently the CBO analyzed the House passed bill designed to make major changes to the Affordable Care Act (ACA). The CBO concluded that while the bill would reduce the overall federal deficit by $199 billion over a 10 year period, it would do so at the cost of Americans.

The biggest savings would come from cutting Medicaid, a programs that provides coverage to individuals with low incomes and disabilities.  The second largest cost savings would come from reducing the financial assistance that is currently available to many people who purchase individual health insurance through the ACA Marketplaces.

As a result of these changes, the report estimates that by 2026, 23 million Americans would be without health insurance. The CBO also notes that the AHCA could mean some Americans would buy policies that don’t cover “major medical risks.” The CBO doesn’t consider those individuals to be insured due to the policies’ inadequate coverage.

According to the CBO, under the AHCA “it would become more difficult for less healthy people (including people with preexisting medical conditions) in [some] states to purchase insurance because their premiums would continue to increase rapidly.”  Additionally, the AHCA would result in higher premiums for older, less healthy Americans.

Although none of this information is unexpected, the CBO report confirms our beliefs that the AHCA would undoubtedly harm the cancer community.  But remember the AHCA is not law yet! The Senate has to pass a bill, the two versions have to be reconciled, and then the President has to sign it into law.  So there is still time to act!

Contact your Senators, go to town halls being hosted by your elected officials, and educate yourself on how this law could really impact you.

Stay tuned to this blog as we will provide updates as more information becomes available.  Also, please join us on June 21, 2017 for a free webinar – An Update to Our Health Care System.  It is open to all and we are providing free CEUs for health care professionals. Register today!

Today Congress Voted to Take a Step Backwards

Today, the U.S. House of Representatives voted, by a two-vote margin, to pass the A Step BackwardsAmerican Health Care Act.  As we have talked about in prior posts, if signed, this law is a step backwards and would hurt millions of Americans.

It has the potential to effect people with pre-existing conditions like cancer, individuals who get their health insurance through an employer, people with disabilities or low incomes who receive care through Medicaid, and seniors receiving Medicare.

This bill was hastily thrown together and was passed without a score from the Congressional Budget Office, which means that Members of Congress don’t even know how much it is going to cost us.

For now, nothing has changed. The ACA Marketplaces are still open for business, Medicaid expansion still exists in the states that have expanded, and we still have the consumer rights afforded to us by the ACA.

Although this bill may appear to give people more choice when it comes to purchasing health insurance, it is important to remember that more choice doesn’t always mean better choice or more affordable choice. Lower cost plans that don’t provide adequate coverage for things like cancer treatment and mental health, will end up costing consumers more in the end.

It will likely be weeks before the Senate will consider the bill so now is the time to act. Contact your Senators, go to town halls being hosted by your elected officials, and educate yourself on how this law could really impact you.

Stay tuned to this blog as we will provide updates as more information becomes available.  Also, please join us on June 21, 2017 for a free webinar – An Update to Our Health Care System.  It is open to all and we are providing free CEUs for health care professionals.  Register today!

Latest Update on Changes to Our Health Care System – Our Worst Fears Realized

Our Worst Fears RealizedOnce again we find ourselves in the position of having to share some frightening news when it comes to health care system.  Last week, an amendment (referred to as the MacArthur Amendment) was proposed to the American Health Care Act (AHCA), the legislation designed to ‘repeal and replace’ the Patient Protection and Affordable Care Act (ACA). In the last few days there have been additional negotiations to try to secure enough votes in the House of Representatives to pass this legislation.  According to new reports a vote is expected on this new version any day now. To state it plainly, the MacArthur Amendment is our worst fears realized.

The MacArthur Amendment makes a bad bill worse, and would:

  • Result in more than 24 million people losing their health insurance coverage;
  • Eliminate the Medicaid expansion program and cut more than $800 billion from Medicaid over the next decade;
  • Decrease the solvency of the Medicare Trust Fund by four years;
  • Eliminate the critical premium tax credits which lower the monthly premiums of plans being sold in the Marketplace for people;
  • Eliminate public health funding by repealing the Prevention and Public Health Fund established by the ACA;
  • And possibly most significantly, the new proposal would allow states to opt out of consumer protections, which would allow insurance companies to:
  • Not cover Essential Health Benefits – this means that insurance companies could decide to no longer cover chemotherapy, prescription drugs, prevention services, or hospitalization.
  • Increase costs for older adults – currently older adults can only be charged up to 3 times more for their coverage. This bill wants to increase that ratio to allow insurance companies to charge up to 5 times more for their coverage. Read this fact sheet for more information about how this bill would hurt older adults.
  • Charge people with pre-existing conditions higher premiums – while those states would then have to create a high risk pool, coverage in high risk pools could cost more, be delayed, or even have enrollment limits. 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 has a video describing why high risk pools may sound like a good idea, but have some challenges in reality.

The Kaiser Family Foundation has an excellent side-by-side comparison of the ACA and the AHCA and the potential changes to our health care system.

It is important to note that the current bill specifically exempts these changes from impacting Members of Congress, so that their coverage is not reduced or their costs are not increased by this legislation.

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 reach your U.S. Representative, you can call the US Capitol Switchboard at (202)-224-3121, and an operator will help to connect you. 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.

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 who need coverage actually get it 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 if you qualify for a special enrollment period.

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 or want to understand more about health insurance, visit CancerFinances.org.

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

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.

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: 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.

Why Pre-Existing Condition Protections Are Not Enough

Over the last week, we have continued to hear about proposed changes to our health triage cancer blog pre-existing conditioncare system from the President-elect and members of Congress.  Some of those changes would have a significant impact on the cancer community. Next week, we will start to break down how those changes might impact the cancer community. However, this week, we wanted to talk about pre-existing conditions.

What is a Pre-Existing Condition?

“Pre-existing condition” used to be a term that only health insurance companies and health law attorneys used. The Patient Protection and Affordable Care Act (ACA) made that term more common, because the ACA prohibited health insurance companies from denying coverage to anyone with a pre-existing condition. A pre-existing condition is any medical condition that exists before the health insurance policy begins; the condition “pre-exists” the policy. A pre-existing condition is often thought of as a serious medical condition, such as a cancer diagnosis.  But prior to the ACA, insurance companies would routinely deny coverage to anyone with conditions such as arthritis, allergies, asthma, or even acne. Really, any medical condition was a reason for denial. And this had a huge impact on the cancer community. Over the close to two decades that we have worked in the cancer community before the passage of the ACA, we  would often have to to tell people that they didn’t have any option to access health insurance coverage because of their pre-existing condition.  The ACA changed that.

This change to our health care system was so significant that most people don’t want to see that portion of the ACA repealed. The President-elect and the Speaker of the House have both said that they would want to continue to provide protections for people with pre-existing conditions.  However, they have not provided details on whether they would do that by keeping the ACA rule, or create some other option.

Last week, we highlighted a few of the consumer protections in the ACA, some of which apply to plans offered by employers, plans offered through the State Health Insurance Marketplaces, and individual and family plans that you can buy directly from an insurance company.  Those consumer protections would be lost if the ACA were to be repealed.

Assuming that they keep the rule that ensures people with pre-existing conditions can purchase insurance, that rule by itself, isn’t enough to protect consumers, and here’s why:

  1. Coverage: the ACA ensures that plans have a minimum level of essential health benefits.
    1. Without this protection, people with pre-existing conditions might still be able to buy a plan, but the coverage might be minimal (like not covering mental health care or prescription drugs).
  2. Caps on benefits: the ACA does not allow insurance companies to place annual or lifetime caps on essential health benefits.
    1. Without this protection, people with pre-existing conditions might still be able to buy a plan, but the plan might cap benefits at $100,000 for the year, or $1 million for a lifetime, or even lower, leaving people to pay for medical expenses out of pocket.
  3. Rescissions: the ACA forbids health insurance companies from canceling your policy, unless your commit fraud on your application or leave off important information.
    1. Without this protection, people with pre-existing medical conditions might find their policies cancelled after submitting an expensive claim that the health insurance company doesn’t want to pay.
  4. Prevention: the ACA requires most health plans to provide free preventive care.
    1. Without this protection, we will go back to having to pay co-pays, co-insurance amounts, and deductibles when receiving preventive services, and many people will be forced to forgo that care.
  5. Out-of-pocket maximums: for plans sold in the Marketplaces, the ACA placed a cap on how high the out-of-pocket maximums could be, which greatly reduced out-of-pocket costs for people with pre-existing conditions.
    1. Without this protection, people will likely see even higher out-of-pocket medical costs.

And finally . . .

  1. Price: the ACA requires US Citizens, and those lawfully present in the US, to have health insurance coverage (with some exceptions).
    1. Without this requirement, many who are not currently in need of medical care, will not buy health insurance coverage, leaving only people with pre-existing conditions buying coverage. If we do not have a balanced risk pool, which includes people who are healthy as well as people with more serious medical conditions, then health plans will likely increase monthly premiums for everyone. In addition, if those people who are healthy wait until they get sick to buy coverage, that will further skew the risk pool and increase premiums even more. If the plans are too expensive to buy, then it won’t matter that people with pre-existing conditions are “allowed” to buy health insurance coverage.

We hope that our elected officials will keep these issues in mind as they make their decisions over the next few 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-story or 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. If you want your policy to begin on January 1, 2017, you need to have picked a plan by December 15, 2016.

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.