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.

The Affordable Care Act: An Overview of the Consumer Protections

The cancer community has benefited tremendously from the Patient Protection and Affordable Care Act (ACA).  As we have talked about in the past, the ACA is a complex law effecting multiple aspects of health care in this country.  One of the most important things the law has done is create new protections for all of us as consumers of health care.  We thought that it was important to review and highlight some of those consumer protections that apply now, regardless of where someone gets their health insurance: though the ACA Marketplaces, from an employer, or directly from a health insurance company.

  • Insurance companies can’t cancel your policy if you get sick or make a mistake on your application. In the past, insurance companies would cancel someone’s policy once they got sick under the claiming that they weren’t honest in their original applications, even if it was a simple mistake or omission.  Needless to say, a cancer diagnosis was a prime reason to rescind someone’s policy.  Now, insurance companies can only cancel your policy if they can show you committed fraud or intentionally lied about something important.
  • No annual or lifetime dollar limits on essential health benefits. For a cancer patient this means your insurance will be there for your entire cancer journey – from diagnosis to survivorship – even if that journey takes years or costs thousands of dollars.
  • Access to certain preventative services for free – meaning that these services are covered at 100%, even before you reach your deductible and without any co-payments.  Covered services include genetic testing, mammography screening and colon polyp removal.
  • All major medical insurance is guaranteed issue, meaning you can’t be denied coverage for any reason. Insurance companies used to take into consideration someone’s health status to determine if they would sell them coverage and how much they would charge for that coverage. Cancer was often a deal breaker.  It either meant extremely expensive coverage or no coverage all.  Since January 1, 2014, insurance companies can’t deny you coverage and you are free to change plans yearly.  This means cancer patients are able to take time off work for treatment and recovery or to change jobs, without the fear that they will never get insurance again.
  • You can’t be charged more based on health status or gender.  In the past, a cancer diagnosis often meant a significant increase in your premium.  And if you had a diagnosis like ovarian cancer, you would have been hit doubly hard because you were a woman with cancer.  Now, insurance companies are only allowed to consider four things when they are determining how much they are going to charge you: if you are buying an individual or a family plan, your geographic location, your age, if you use tobacco.
  • You have the right to get an easy-to-understand summary about a health plan’s benefits and coverage, called a summary of benefits and coverage (SBC).  This is critical for consumers to understand exactly what it is they are buying!
  • Health Insurance Marketplaces allow shoppers to compare health insurance plans that offer minimum essential coverage and include all new benefits, rights and protections of the law. Minimum essential coverage includes:
  1. Ambulatory patient services (outpatient care)
  2. Emergency Services (trips to the emergency room)
  3. Hospitalization (treatment in the hospital for inpatient care)
  4. Maternity and newborn care
  5. Mental health services and addiction treatment
  6. Prescription drugs
  7. Rehabilitative services and devices
  8. Laboratory services
  9. Preventive services, wellness services, and chronic disease treatment
  10. Pediatric services
  • Financial assistance is available to individuals, families and small businesses through the state Health Insurance Marketplaces.  There are two types of financial assistance: a premium tax credit and a cost sharing subsidy.  Eligibility for this assistance is based on family size and income level.  When entering the world of cancer treatment, the costs are overwhelming, and frankly almost impossible to handle without insurance.
  • The 80/20 rule and rate review provision help to keep insurers honest and keep rates down.  This rule means that most insurance providers must spend 80% of every dollar they take in on paying for claims and/or improvement in services and can only spend 20% on marketing and overhead costs.
  • You have the right to appeal any health insurance company decision. Under ACA and some state laws, you not only have the right to appeal a decision internally with your insurance plan, but you also have the right to ask for an external review.  This means that an external, independent, specialist will review your appeal and the insurance plan no longer has final say over whether to pay a claim.

None of these consumer protections existed prior to the ACA.  While we at Triage Cancer are the first to acknowledge that there are still many ways to improve our health care system, we are disheartened to think that we may be sent back to the days where a cancer diagnosis or having another serious medical condition may force you into bankruptcy, homelessness, or even not being able to get medical care.  The President-elect and congressional leaders have made numerous statements about their desires to “repeal and replace” the ACA.  While there isn’t a consensus as to what that looks like yet, you can read more about the possibilities being discussed here.

It is sometimes hard to remember how far we have come, but we only want to look forward, at how we can continue to improve the lives of those touched by cancer, and the rest of our country.

And you can help us do that.

  • Even though the election is over, as citizens, we still have a say in how our government is run. It is time to organize, mobilize, and advocate for the cancer community. Call or email your elected officials and tell them what the ACA means to you. Tell your story! To find your elected officials or learn more about becoming an advocate, visit our Advocacy resources page.
  • Communicate with your elected officials about your health insurance concerns. You can find the Facebook and Twitter handles for the current members of Congress here.
  • Share your story with Families USA or the National Coalition of Cancer Survivorship (NCCS), two health care advocacy organizations. Both organizations have pledged to work 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 who will be impacted by the ACA’s repeal. If you feel comfortable doing so, you can share your story at http://familiesusa.org/share-your-story or at http://www.canceradvocacy.org/blog/share-your-aca-story/.

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

A Post-Election Update: Health Insurance in the U.S.

triage-cancer-blog-election-2016There is no doubt about it, the results of the 2016 presidential election will bring significant changes to our country.  Some of the most significant changes will likely be to our health care system and the way that many of us access health insurance coverage.

We have heard from many of you with your questions about these potential changes and your concerns that you will lose access to your health insurance coverage.  So, we wanted to reach out to you today to share with you the information that we have at this point, and assure you that we will continue to keep you informed and advocate for access to quality, affordable health insurance coverage for the cancer community and others.

The Republican Party is now in control of the Presidency, U.S. House of Representatives, and the U.S. Senate, which means that there are less impediments to passing Republican legislation out of Congress and having it signed by the President. This could improve the productivity of Congress in passing legislation on behalf of the people of the United States, but we also know that both political parties have different ideas about our health care system and access to health insurance coverage. While we would definitely love to have a crystal ball about the potential changes to our health care system that might be coming, at this early stage, we do not know exactly what will happen when President-elect Trump takes office on January 20, 2017.

Here is what we do know:

  • The Speaker of the House Paul Ryan, Senate Majority Leader Mitch McConnell, and President-elect Trump have confirmed that the first item on their agenda, in January, is repealing the Patient Protection and Affordable Care Act (otherwise known as the ACA or Obamacare).
  • Those same individuals have different ideas about what to replace the ACA with and other changes that they want to make to our health care system. You can read more about some of their ideas here:

Now, some of Congressman Ryan’s ideas are actually already law, included in the ACA. One of President-elect Trump’s ideas, making health insurance premiums tax-deductible for individuals, could be helpful for the cancer community. So, we remain optimistic that our elected officials will continue to propose, legislate, and implement laws that will have a positive impact on all of us.

  • Our health care system isn’t only controlled by our elected officials in Washington, D.C. Our state governors and legislators also have an impact, and we may see some changes to our health care options and system in each state, as a result of the election.
  • The details of our health care system are often influenced and implemented by leaders of our federal and state agencies, such as the U.S. Department of Health and Human Services. When a new President is elected, those agency leaders often change, too. Click here to learn more about potential members of President-elect Trump’s cabinet.
  • If the ACA is repealed it means that health insurance companies can go back to: denying people with pre-existing conditions or charging them more for health insurance; canceling our policies when we try to use our coverage; and imposing annual and lifetime limits on policies.
  • If the ACA is repealed it means that we will no longer have access to free preventive care, and seniors and people with disabilities on Medicare will pay more for their prescription drugs.
  • If the ACA is repealed, it means that the Medicaid expansion would end, the Marketplaces would be closed, young adults under age 26 would not be able to access their parents’ health insurance coverage, and an estimated 20-25 million people would lose their health insurance coverage.

While we at Triage Cancer are the first to acknowledge that there are still many ways to improve our health care system, we are disheartened to think that we may be sent back to the days where a cancer diagnosis or having another serious medical condition may force you into bankruptcy, homelessness, or even not being able to get medical care. It is sometimes hard to remember how far we have come, but we only want to look forward, at how we can continue to improve the lives of those touched by cancer, and the rest of our country.

And you can help us do that.

  • Even though the election is over, as citizens, we still have a say in how our government is run. It is time to organize, mobilize, and advocate for the cancer community. Call or email your elected officials and tell them what the ACA means to you. Tell your story! To find your elected officials or learn more about becoming an advocate, visit our Advocacy resources page.
  • Communicate with your elected officials about your health insurance concerns. You can find the Facebook and Twitter handles for the current members of Congress here.
  • Share your story with Families USA, a health care advocacy organization. Families USA has pledged to work furiously 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 who will be impacted by the ACA’s repeal. If you feel comfortable doing so, you can share your story at http://familiesusa.org/share-your-story.

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.

President-elect Trump pledged “to every citizen of our land that [he] will be President for all Americans.” Help us to make sure that he understands what is important to the cancer community and how we can continue to improve our health care system without taking a step backwards.

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

The Danger of Fixed Indemnity Plans: But Not in the Eyes of the Court

A recent court ruling declared that consumers must have the option of buying certain types of health insurance that do not meet the standards of the Patient Protection & Affordable Care Act (ACA).

One of the many ways in which the ACA tried to protect consumers, was by not allowing Cautioninsurance companies to sell “fixed indemnity” health insurance plans as a stand-alone product. A fixed indemnity plan is a type of health insurance that pays consumers a fixed amount for each service, regardless of the actual cost of the medical care received. For someone received treatment for a cancer diagnosis, these plans can prove to be very dangerous, leaving patients with huge out-of-pocket costs. However, these plans do give people the freedom to visit their preferred doctor or hospital, without having to stay within a defined “network” of providers.

In 2014, the Obama Administration enforced rules that such insurance could only be sold to those with more extensive coverage; where the fixed indemnity plan was meant as a supplemental policy, not as a “substitute for major medical coverage.” The Administration was concerned that allowing consumers to buy fixed indemnity insurance plans as a stand-alone product gives people “the mistaken belief that it provides comprehensive coverage.”

And we have certainly seen that to be true. Marketing of these plans can be deceptive, and many people do not realize that the policy they have bought will not cover much of their medical expenses, leaving them with enormous medical bills, and only bankruptcy ahead of them. In some circumstances, people have not been able to get the medical care they need because they cannot afford it. In addition, because these are limited policies, hey do not meet the requirement that most people in the United States have health insurance coverage, leaving people with an additional penalty to pay come tax time.

Despite these issues, the Court disagreed, ruling that the Obama administration could not restrict the sale of these plans. The Court agreed with the plaintiffs in the case, who felt that because fixed indemnity plans are a branch under catastrophic health insurance (policies that are intended to protect you from unexpected health costs), these plans could be a valuable option for those who have incomes that fall in the coverage gap: they make too much for Medicaid, but too little for financial assistance in the Health Insurance Marketplace.

Although the court ruling may provide more health insurance options for consumers, it poses hidden risks. Consumers with fixed indemnity insurance generally have fewer protections, meaning that they can still have pre-existing condition exclusions, caps on benefits, no access to free preventive services, and the policy does not have to cover a certain percentage of medical costs. In addition, because the stand-alone insurance has a fixed amount for each service, it may leave consumers with a large bill to cover the difference, depending on their health needs. And, despite the lower monthly costs, there is usually a higher annual deductible. Thus, it’s imperative that consumers are not only aware of the costs, but also the protections each respective plan provides for them.

Triage Cancer is hosting a webinar on October 18, 2016, on “Choosing Wisely: How to Pick Health Insurance Plans.”  Register Here. In the meantime, there are other webinars available for watching at any time here.

Don’t Miss these Changes to the 2017 Health Insurance Marketplaces!

In March 2016, the U.S. Department of Health and Human Services released new rules for Triage Cancer Blog Health Insurance Marketplace Changesthe health insurance marketplaces. These marketplaces are available to people who want to purchase their own health insurance in any of the 38 states that use the online federal marketplace (www.HealthCare.gov) or to any of the 13 states and District of Columbia that host their own health insurance marketplaces.

In a recent article published by Kaiser Health News, they provide a summary of three specific changes that may affect consumers using the 2017 federal marketplace (www.HealthCare.gov):

  1. Increased consumer access to information about the size of an insurers’ network of doctors and hospital.

New rules require insurers to give consumers 30-days’ notice if a provider is being removed from the health insurance plan’s network. Insurers must also provide continued coverage for up to 90 days for patients in active treatments (e.g., chemotherapy, or for women in later stages of pregnancy) – unless the provider is being dropped for cause.

  1. Increased warning for “surprise” medical bills from out-of-network providers.

A patient’s ancillary care, such as radiology or anesthesiology, will count towards an insurance plan’s annual out-of-pocket maximum, if the insurer does not notify the patient (within 48 hours) that they may receive care and bills from out-of-network providers.

  1. More standardized out-of-pocket costs for consumers.

This new rule was designed to make comparison shopping between plan choices easier for consumers. Federal regulators have created six standard plans that they are asking insurance companies to voluntarily offer in 2017.  These plans include specific costs for copayments, prescription drugs, primary care, mental health, and substance abuse treatments. This standardized plan design has been implemented in several states, including California, Oregon, and DC; and allows consumers to plan for possible expenses.  But these plans have been opposed by insurance companies. Because of this opposition, consumers will likely see both standardized plans and the current varied policies available in the marketplaces. In addition to these plans, HHS has decided that the maximum amount that consumers can be charged for annual out-of-pocket costs is $7,150 for an individual and $14,300 for family coverage.

For more information about the Affordable Care Act and health insurance options, read our Quick Guide on the ACA and Health Insurance.  Or read past blogs on health insurance topics, here.

Resources:

Kaiser Health News

Kaiser Family Foundation