California, Other States To Extend Obamacare Sign-Up Beyond Federal Limit


California and several other states will exempt themselves this year from a new Trump administration rule that cuts in half the amount of time consumers have to buy individual 2018-enrollment_1170health insurance under the Affordable Care Act.

In California, lawmakers are contemplating legislation that would circumvent the rule in future years, too.

The Trump administration’s rule gives people shopping for 2018 coverage on the federal exchange 45 days to sign up, from Nov. 1 through Dec. 15.

But in California and some of the other states that run their own exchanges — Colorado, Minnesota, Washington and Massachusetts, as well as the District of Columbia — consumers purchasing insurance for themselves this year will have extra time to make decisions.

In Colorado, for example, the sign-up period is from Nov. 1 to Jan. 12. In Minnesota, it will start Nov. 1 and run through Jan. 14. In Washington state, it is Nov. 1 through Jan. 15.

Consumers shopping for coverage in California’s exchange, Covered California, will still have the full three months they’ve had in recent years, starting on Nov. 1 and ending Jan. 31. Californians shopping for individual market plans outside the exchange will have those same three months to make up their minds.

“We want to make sure our consumers have the time they need to find the best plan that fits their needs,” said James Scullary, a spokesman for Covered California.

The rule that truncated the enrollment period for the federal exchange, published in April by the Centers for Medicare & Medicaid Services (CMS), gives state-based exchanges the ability to extend the amount of time allowed by tacking a “special” enrollment period onto the 45 days set by the federal government.

California and several other states will exempt themselves this year from a new Trump administration rule that cuts in half the amount of time consumers have to buy individual health insurance under the Affordable Care Act.

In California, lawmakers are contemplating legislation that would circumvent the rule in future years, too.

The Trump administration’s rule gives people shopping for 2018 coverage on the federal exchange 45 days to sign up, from Nov. 1 through Dec. 15.

But in California and some of the other states that run their own exchanges — Colorado, Minnesota, Washington and Massachusetts, as well as the District of Columbia — consumers purchasing insurance for themselves this year will have extra time to make decisions.

In Colorado, for example, the sign-up period is from Nov. 1 to Jan. 12. In Minnesota, it will start Nov. 1 and run through Jan. 14. In Washington state, it is Nov. 1 through Jan. 15.

Consumers shopping for coverage in California’s exchange, Covered California, will still have the full three months they’ve had in recent years, starting on Nov. 1 and ending Jan. 31. Californians shopping for individual market plans outside the exchange will have those same three months to make up their minds.

“We want to make sure our consumers have the time they need to find the best plan that fits their needs,” said James Scullary, a spokesman for Covered California.

The rule that truncated the enrollment period for the federal exchange, published in April by the Centers for Medicare & Medicaid Services (CMS), gives state-based exchanges the ability to extend the amount of time allowed by tacking a “special” enrollment period onto the 45 days set by the federal government.

Because that flexibility is limited to 2018 coverage, California legislators are taking an extra step to keep the three-month enrollment period for 2019 and beyond. Assemblyman Jim Wood (D-Healdsburg) introduced legislation last week that would ensure a three-month enrollment window for consumers seeking coverage in 2019 and subsequent years.

“When the Trump administration issued its new … rules cutting the ACA’s open enrollment period in half, we knew we had to act,” Wood said. “Californians have enjoyed a three-month enrollment period for years, and this change could catch people off guard and not allow them to sign up in time. That would be a travesty.”

Health policy experts say the federal rule is a political attempt to undermine the viability of the Obamacare insurance exchanges.

“It’s no big secret that the Trump administration isn’t a big fan of the Affordable Care Act or the individual market that it created,” said Dylan Roby, associate professor of Health Services Administration at the University of Maryland. “There’s just this general intent of the administration to reduce enrollment, reduce … subsidies and make it a little bit harder for people to enroll.”

The shortened enrollment window was part of a so-called market stabilization rule rolled out by the Trump administration that also offers insurance companies concessions, including the flexibility to sell some health plans that cover less of the enrollees’ cost of care than currently required by the ACA.

California’s insurance commissioner, Dave Jones, expressed concern about the impact of a shortened enrollment period in a letter to the federal government in March, before the rule was finalized.

Jones’ letter cited research that shows younger people tend to sign up for health insurance toward the end of open enrollment, and that putting up barriers to their enrollment could reduce the number of healthy people in the insurance pool.

That would “needlessly destabilize the market” and would “result in increased premiums for those who do enroll in coverage,” the insurance commissioner said.

Shana Alex Charles, an assistant professor of health sciences at California State University-Fullerton, said the pushback by California lawmakers against federal attempts to shorten the enrollment period underscores the state’s commitment to having a marketplace that “actually makes sense.”

“If you want to maximize enrollment, you need to make sure people can get their paperwork together, and have the mindset and the time for people to complete the application,” she said.

Because that flexibility is limited to 2018 coverage, California legislators are taking an extra step to keep the three-month enrollment period for 2019 and beyond. Assemblyman Jim Wood (D-Healdsburg) introduced legislation last week that would ensure a three-month enrollment window for consumers seeking coverage in 2019 and subsequent years.

“When the Trump administration issued its new … rules cutting the ACA’s open enrollment period in half, we knew we had to act,” Wood said. “Californians have enjoyed a three-month enrollment period for years, and this change could catch people off guard and not allow them to sign up in time. That would be a travesty.”

Health policy experts say the federal rule is a political attempt to undermine the viability of the Obamacare insurance exchanges.

“It’s no big secret that the Trump administration isn’t a big fan of the Affordable Care Act or the individual market that it created,” said Dylan Roby, associate professor of Health Services Administration at the University of Maryland. “There’s just this general intent of the administration to reduce enrollment, reduce … subsidies and make it a little bit harder for people to enroll.”

The shortened enrollment window was part of a so-called market stabilization rule rolled out by the Trump administration that also offers insurance companies concessions, including the flexibility to sell some health plans that cover less of the enrollees’ cost of care than currently required by the ACA.

California’s insurance commissioner, Dave Jones, expressed concern about the impact of a shortened enrollment period in a letter to the federal government in March, before the rule was finalized.

Jones’ letter cited research that shows younger people tend to sign up for health insurance toward the end of open enrollment, and that putting up barriers to their enrollment could reduce the number of healthy people in the insurance pool.

That would “needlessly destabilize the market” and would “result in increased premiums for those who do enroll in coverage,” the insurance commissioner said.

Shana Alex Charles, an assistant professor of health sciences at California State University-Fullerton, said the pushback by California lawmakers against federal attempts to shorten the enrollment period underscores the state’s commitment to having a marketplace that “actually makes sense.”

“If you want to maximize enrollment, you need to make sure people can get their paperwork together, and have the mindset and the time for people to complete the application,” she said.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Tackling Health Care in September

Congress is back in session this week, which means they will likely be tackling health care issues. September will bring more proposed and actual changes to our health care system:

  • Last week, a group of eight governors released a market stabilization plan, which asks Congress to fund the cost-sharing reductions through 2018, improves risk pools, and makes other suggestions to increase competition among insurance companies selling plans in the marketplaces.
  • This week, the Senate Health, Education, Labor, & Pensions Committee (HELP) is scheduled to hold two hearings on how to stabilize the premiums of individual plans sold through the state health insurance marketplaces. These hearings will include state governors and state insurance commissioners.
  • A group of Republican Senators have proposed an amendment to the larger ACA repeal and replace proposals that were not previously passed by the Senate. Senators Graham, Cassidy, and Heller have proposed block granting to states the money allocated for the ACA financial assistance programs and Medicaid expansion, as well as place a per capita cap on the traditional Medicaid program. Click here to read the amendments.
  • The Trump Administration announced that they would cut the advertising budget by 90%, which promotes the availability of health insurance through the state health insurance marketplaces. They are also cutting the grants to local organizations that work in communities to help people enroll in health insurance coverage.
  • The Administration had already announced a six-week shorter open enrollment period, from November 1, to December 15, for coverage that begins on January 1, 2018.

If you or someone you know needs information about their health insurance options, visit www.CancerFinances.org.

Stay tuned for updates from Triage Cancer, as we learn more about these changes and how they might impact the cancer community.

A Snapshot of the Impact of Proposed Health Care Changes

Health care is a daily news topic. With Republican Members of Congress and the Health Care ChangesPresident working to repeal and replace the Affordable Care Act (ACA), many aspects of health care have been brought into question recently, for example, what constitutes as a pre-existing condition, increased coverage for veterans, and who is covered by Medicaid, among others. Today we will provide a snapshot of the impact of the proposed health care changes.

Pre-Existing Conditions

A pre-existing condition is considered a medical condition that started before a person’s health insurance coverage began. Before 2014, when the ACA’s pre-existing condition consumer protections went into effect, some insurance companies would not only deny coverage to people with pre-existing conditions, but even if you were able to get a policy, that policy might not cover your pre-existing condition for a specific period of time, or at all.

The various Republican plans to repeal and replace the Affordable Care Act (ACA) have not done enough to retain protections for people with pre-existing conditions, which could increase health care costs and potentially limit coverage for an estimated 130 million Americans. And this is a very low estimate, when you consider that an insurance company can designate anything from acne, to allergies, to high blood pressure, to obesity, as a pre-existing medical condition.  If you think that broadly, most people in the U.S. have some sort of pre-existing condition.

Coverage for Veterans

Under the Affordable Care Act, coverage for veterans has improved greatly. According to the Urban Institute, the expansion of Medicaid to adults with incomes up to 138% of the federal poverty level (FPL) in more than half the states and the establishment of health insurance marketplaces with income-based financial assistance subsidies, expanded the health insurance options available to veterans.” In just the first two years after these ACA coverage options become available, the uninsured rate of nonelderly veterans dropped about 40%.

If these veterans lose these ACA options for coverage, Time.com writes, “This would likely leave the thousands who do not qualify for VA care without coverage at all, as insurance becomes unaffordable without the ACA’s subsidies. Hundreds of thousands of spouses and children could also lose coverage.”

Who is Covered By Medicaid

The latest Congressional proposal to reform our health care system (BCRA) would make severe cuts to the Medicaid program, potentially leaving millions without health insurance coverage. Who gets Medicaid now? Many groups in our society who need the greatest protection, including seniors, individuals with very low income levels, people with disabilities, and children. Many states have very high numbers of children covered by Medicaid.  For example, in North Carolina, nearly 96% of children have health insurance.  A little under half of those children have Medicaid.

Stay tuned to our blog for the latest information about changes to our health care system and other cancer survivorship issues.

ACA “Skinny Bill” Repeal Failed

Last night the Senate voted against the so called ACA “Skinny-Bill” Repeal, 49-51.  This Skinny Bill Failsbill would have eliminated the medical device tax as well as the individual and employer mandates.

Practically speaking, this means that the protections and health insurance options created by the ACA remain, for now.

Thank you to all of you who contacted your elected officials and used your voice to advocate for the cancer community.

However, our work is not done.

Many Senators have expressed their concerns with how the ACA repeal efforts were handled in secret and without open committee hearings to discuss proposals to improve our healthcare system. We hope that can be seen as a signal for Congress to start working together to make changes where the ACA can be improved upon.

Unfortunately, after the vote the President has declared via Twitter: “let ObamaCare implode.”

Unfortunately, we just don’t know what that means.  It could mean that all federal agencies simply stop enforcing the consumer protections created in the law. It may also mean that the Department of Health and Human Services will stop paying for Americans to receive financial assistance to purchase health insurance.

Senate leadership has indicated that they plan to move on to other legislative priorities. So the possibilities now for health care reform include: bipartisan committee work (e.g., hearings, debate, new proposals, etc.), stabilizing the marketplaces, and administrative action by federal agencies to change the health care law.  However, these actions may end up being contrary to each other, as many threatened agency actions have actually helped to destabilize the marketplace and increase premiums.

One thing does seem certain, the efforts to provide accessible, affordable health care for all Americans must continue. If this is an issue that concerns you, you can keep talking to your elected officials about how important access to quality, affordable health insurance coverage is to the cancer community.

We will continue to provide updates on this issue and others impacting the cancer community.

Health Care Update: Senate This Week

Here is a quick update on what has happened in the Senate this week to make changes to our health care system.

  1. The Senate attempted to vote on an amendment that included the last version of the Better Care Reconciliation Act (BCRA), and $100 billion for Medicaid, which moderate Republicans wanted and a proposal from conservative Republican Senator Ted Cruz (TX), to allow bare-bones health insurance plans to be sold again. Result: Did not pass with a 43-57 vote
  1. The Senate then voted on an amendment to repeal the Affordable Care Act, without any replacement, but the repeal would not go into effect for two years. Result: Did not pass with a 45-55 vote

Next steps:

The Senate is now considering other amendments to see if they can get 50 Senators to agree on something, so that the Senate can send the bill back to the House to finalize legislation for the President to sign.

These amendments are being referred to as a “skinny repeal,” which means that they are looking at specific provisions in the ACA that they can repeal.  Provisions that they are discussion include removing all taxes created by the ACA, and eliminating the employer and individual mandates.

The Congressional Budget Office has said that the skinny repeal would cause premiums to increase by 20% and 16 million more people would be uninsured, almost immediately. Experts say that the skinny repeal would destabilize the individual insurance market.

There will continue to be votes throughout the week, so stay tuned and continue to contact your elected officials.

Senate This Week

Senate’s Efforts to ‘Repeal & Replace’ Stall…For Now

This week the Senate’s efforts to repeal and replace the Affordable Care Act (ACA) Time For Plan Bhave stalled, for now. Yesterday, Senate Majority Leader Mitch McConnell said that he was not going to move forward with a vote on the Senate’s health care reform proposal called the Better Care Reconciliation Act (BCRA). This announcement came after two more (for a total of four) Republican Senators publicly declared that they would not support the bill. The four Senators are: Rand Paul (KY), Susan Collins (ME), Jerry Moran (KS), and Mike Lee (UT).

In response, McConnell suggested that the Senate would instead vote on a “repeal only” version of a bill to dismantle the ACA and that they would deal with replacing it later. They would give themselves two years to “deal with it,” as the repeal would not take effect for two years, which would also be after the next midterm election.

A true “repeal” of the ACA means that it would be like the ACA never existed, including the elimination of all of the ACA’s consumer protections, Medicaid expansion, some Medicare benefits, individual and employer mandates, and taxes. A similar bill was passed in 2015, but President Obama vetoed it.  That bill was scored by the Congressional Budget Office in 2015, and it found that between 30 and 32 million people would lose access to health insurance coverage.

However, just hours after this decision to move forward with a repeal vote was announced, three Republican Senators (Shelley Moore Capito (WV), Susan Collins (ME) and Lisa Murkowski (AK)) said they would not vote for a bill that would irresponsibly take away coverage from millions of Americans, with no alternative.  Their opposition to a repeal vote with no alternative means that it would be unlikely to pass if all Senate Democrats opposed the bill as well.

The President has also announced his support for a full repeal vote, suggesting that he will just “let Obamacare fail.” Unfortunately, we just don’t know what that means.  It could mean that all federal agencies simply stop enforcing the consumer protections created in the law. It may also mean that the Department of Health and Human Services will stop paying for Americans to receive financial assistance to purchase health insurance.

After a meeting at the White House today, Leader McConnell has declared that he will call for a procedural vote to allow Senators to debate and offer amendments on the BCRA.  Without further negotiating it is likely that the Senate will have to go back to the drawing board and come up with other proposals. Many have suggested that the Senate should go back to holding open hearings on these issues and to work together, in bipartisan efforts to improve our health care system. We will have to wait and see.  Unfortunately, we are now only 3.5 months away from the start of open enrollment for 2018, and there is so much uncertainty.

One thing does seem certain, the efforts to provide accessible, affordable health care for all Americans must continue. If this is an issue that concerns you, you can keep talking to your elected officials about how important access to quality, affordable health insurance coverage is to the cancer community.

Do You Need Health Insurance Now?

If you do not have health insurance coverage, you can apply for Medicaid at any time if eligible, or buy 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, as we will continue to share ongoing developments in efforts to change our health care system.

Uncertainty puts Marketplace Financial Assistance in Jeopardy

A recent study found that the average family in America spends 10.1% percent of the family’s income just on health insurance premiums and deductibles. So it’s no wonder Marketplace-Financial-Assistance-Jeopardythat many Americans need a little help purchasing health insurance coverage. The Patient Protection and Affordable Care Act (ACA) made financial assistance available for people who buy health insurance in the marketplaces, based on their income level. However, due to uncertainty in politics, as well as policy and legislative changes, that financial assistance may be in jeopardy.

There are two different types of financial assistance in the marketplaces:

  • Premium tax credits reduce the amount that people pay for their monthly premiums to have health insurance.
  • Cost-sharing subsidies, also known as cost-sharing reductions, help to lower deductibles, co-payments and co-insurance. The way that cost-sharing subsides work is that the insurance company reduces what they charge individuals and, in turn, the insurance companies are reimbursed by the federal government.

Since the beginning of the year, uncertainty has put these financial assistance options in jeopardy. The new presidential administration had suggested that they were going to eliminate the cost-sharing reductions and that they would repeal the ACA, which would eliminate the premium tax credits, as well.

While health insurance companies are accustomed to dealing with uncertainty, like not knowing how many people will get sick during a given year, it is unusual for politics to create such uncertainly in the health insurance market.

Specifically, the uncertainty that will have the greatest impact is the fact that there has not be a clear decision from the President or Congress on if they are going to continue funding the cost-sharing reduction payments to insurance companies, and whether the individual mandate will be strictly enforced. The individual mandate was designed to insure that individuals do not wait to purchase insurance once they are sick. The IRS has already indicated that they will not strictly enforce the mandate moving forward.

Oliver Wyman, an actuarial consultant, states that these sort of ambiguities are new to actuaries who are in charge of setting the rates, and actuaries are predicting that 2018 insurance premiums are expected to increase between 28 and 40%.

Ultimately, the uncertainty around cost-sharing reduction payments, and the lack of enforcement of the individual mandate is projected to be responsible for the bulk of premium increases for 2018 and has already led some insurers to pull out of the marketplaces in some states, to avoid having to deal with the uncertainty.

This uncertainly, along with the current proposals for health care reform being discussed in the U.S. Senate, have the potentially to significantly impact the cancer community.

Stay tuned to our blog for the latest updates on proposed changes to our health care system.

Senate Health Care Proposal – Take 2 

Yesterday, the U.S. Senate released its revised proposal to overhaul health insurance in Senate Health Care ProposalAmerica.  Unfortunately, this new version of the Better Care Reconciliation Act (BCRA-2) would still cause significant harm to the cancer community.

For clarity, here we will focus just on the changes to the Republican proposal that we will refer to as BCRA-2.  Read more about the first version of BCRA.

The major provisions to take note of in this new version include:

  1. Cutting the Medicaid program so significantly that 15 million fewer people would have coverage, according to the Congressional Budget Office.
  2. Allowing insurers to sell plans with bare-bones coverage (“junk insurance”), as long as they also sell at least one policy that meets the ACA’s requirements. The concern is that by allowing individuals to purchase this less adequate, but cheaper coverage, healthier people would gravitate towards these plans, and people with pre-existing conditions would stay in marketplace plans, which would result in an unbalanced risk pool, and higher premiums for people buying marketplace plans. In addition, it would lead to higher medical debt for individuals buying junk insurance if they need medical care and find out that they only have bare-bones coverage. This was exactly a problem that the ACA was trying to address by creating minimum standards of coverage for plans being sold.
  3. Allocating $45 billion to deal with opioid abuse, a clear concession to two Republican Senators’ request.
  4. Adding $70 billion to help states stabilize their insurance marketplace.
  5. Keeping an ACA provision that places a 3.8% net tax on investment income and a 0.9% payroll tax on individuals making more than $200,000 annually.

While the BCRA-2 does contain some minimal improvements from the Senate’s original version, it ads changes that would be more harmful to the cancer community and others with pre-existing medical conditions. And, the overall impact of this proposal is still detrimental to most Americans.

Next Steps

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.

Moderate Senator Susan Collins (R-ME), has announced she wouldn’t support a procedural motion to allow debate on the bill. Conservative Senator Rand Paul (R-KY) also is unlikely to support the bill due to the fact that it doesn’t completely repeal the ACA. Therefore, Republicans can only afford to lose one more vote, if they want to pass the BCRA-2. Three other moderate Republicans have expressed serious concerns about this legislation: Dean Heller (R-NV), Shelley Moore Capito (R-WV), and Rob Portman (R-OH).  Senate Majority Leader Mitch McConnell has indicated that he wants a vote on BCRA as early as next week.

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.

Senate Delays Health Care Vote, But Our Work Is Not Done

On Friday we shared details about the Senate health care bill, and in the last few days there have been new developments. Senate-Delays-Health-Care-Vote-Post

First, the Congressional Budget Office (CBO) released its report on the Senate health care proposal and unfortunately the news is still alarming.The CBO estimates that under the Senate’s version of the Better Care Reconciliation Act (BCRA) 22 million Americans would be uninsured by 2026.

Second, the Senate changed their proposal and added additional provisions that would make it harder for people to get insurance. For example, the proposal now includes a requirement that if someone has a gap in health insurance coverage of more than 63 days, they would have to wait six months before they could purchase insurance.

Since last Thursday, many Senators and Governors have expressed a concern that the vote on BCRA was being rushed and shared their concerns with Senate Leadership. The proposal is also opposed by health care groups, professional associations, and many in the cancer community. Because of these concerns and opposition, Senate Leadership have postponed the vote, which will no longer happen this week.  However, a vote could be scheduled at any time so our work is not done.

It is vital to continue talking to your elected officials about how BCRA would impact you and your communities.  This week, Senators and Members of Congress will head home to their local districts. You can call their offices and ask to have a meeting (although keep in mind that their schedules may already be full), but if you are out celebrating the 4th of July and you see your elected officials in your community, don’t be afraid to talk to them!

Here are a few easy ways to make your voice heard, even if you aren’t able to see your elected officials in-person:

  1. 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.
  2. Use social media. Our friends at Justice in Aging have created this wonderful social media kit. You can also find the Facebook and Twitter handles for the current members of Congress here.
  3. Contact your state Governors and express your concerns. They have a powerful voice in this process as well.

As always, stay tuned.  Will continue to provide updates as more information becomes available, about this issue that affects all of us.

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.