Tuesday, November 26, 2013

HealthWatch WatchDog Season 6, Episode 8: “Walker's Coverage Gap”

Governor Walker recently announced a special session of the legislature to act on two bills that extend BadgerCare Plus coverage for certain parents for 3 months. Unfortunately, the coverage extension means that Governor Walker breaks a promise to start coverage for over 90,000 low-income, childless adults who expected BadgerCare Plus coverage on January 1, 2014.
Click here or on the image at the right to watch the episode!
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Miss an episode? Visit our WATCHDOG LIBRARY to catch up on topics from previous seasons! 

HealthWatch Wisconsin's 7th Annual Conference: "Marketplace Pathways to Health Care"
Join us in Madison February 20 & 21, 2014 as HealthWatch Wisconsin gathers state and federal policy makers, health care providers, public health, and advocates to learn about Marketplace enrollment and coverage, the latest on other health reform policies, and strategies to help guide people to the health care and coverage they need and deserve.

Saturday, November 16, 2013

The Coverage Swap

Governor Walker announced on Thursday that he will call a special session of the Legislature to take up two bills, the most noteable is one to continue BadgerCare Plus benefits for parents between 100% and 200% of the Federal Poverty Level until the end of March and extend HIRSP benefits (State HIRSP) as well. How will the state pay for postponing the cuts? With a coverage swap--by not expanding Medicaid for low-income, childless adults.  About 80,000 of Wisconsin's lowest income, childless adults will remain uninsured for an additional 3 months. They could shop the Marketplace, but they would not be able to get subsidies since this is the population that was supposed to get Medicaid. We discuss this more inside this Newsletter!
Also in this issue, President Obama addressed the nation proposing what he calls a "private insurance fix." But what is the consequence of extending some of these plans? In this edition of the Update, we look at the federal Marketplace HealthCare.gov, the insurance company and state decisions that may be making things worse.
Read about these breaking news items, case tips, HealthWatch coalition activities, recent articles and more in this week’s Update newsletter. Thanks to all of the current members, subscribers, and supporters--you make the HealthWatch Update possible!
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Mental Health Parity Decades in the Making
On November 8, the US Department of Health and Human Services (HHS) together with the Department of Labor and Treasury jointly issued a final rule to implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA). The Act, among other things, ensures that health plan features (like co-pays, deductibles, visit limits) are not more restrictive for mental health and substance abuse disorders than for other medical and surgical benefits. A press release issued by HHS outlines the consumer protections in the final rule:
  • Ensuring that parity applies to intermediate levels of care received in residential treatment or intensive outpatient settings
  • Clarifying the scope of the transparency required by health plans, including the disclosure rights of plan participants, to ensure compliance with the law
  • Clarifying that parity applies to all plan standards, including geographic limits, facility-type limits, and network adequacy
  • Eliminating an exception to the existing parity rule that was determined to be confusing, unnecessary, and open to abuse.
The Kaiser Health News released a podcast with conversation about the long-awaited mental health parity law regulations. 

Obamacare y Usted

The Kaiser Family Foundation, known for producing handy tools and resources to explain health reform, has done it again. On the heels of their very successul premium calculator, they have created a new Spanish Language consumer resource center to explain "how the ACA may impact individuals and families throughout the United States." The site features a new Spanish Language subsidy calculator to help consumers estimate premiums and tax credits in the Marketplace. Organizations are invited and encouraged to embed the calculator on their own websites for free. The website also features the "Obamacare and You" factsheet, now in Spanish (Obamacare y Usted.)

Share Your BadgerCare, Medicaid, or Marketplace Story!

Are you one of the more than 90,000 parents who will lose BadgerCare Plus coverage in 2014?
Are you under 100% FPL and moving to BadgerCare?
Are you a mother or father just making ends meet who's concerned about the new changes to BadgerCare coverage?
Are you not sure WHERE TO GO for help?
Tell us your health care and coverage story! As 2013 comes to a close, the health care landscape in Wisconsin is changing. If you or a loved one will be changing insurance, losing BadgerCare Plus or going to the Marketplace to purchase insurance for the first time, we’d like to hear your story! There are many ways to contact us:

Support Our Efforts with a Tax-Deductible Contribution!

Support ABC for Health as we pursue our mission of helping people in Wisconsin secure access to health care and coverage. Our staff works tirelessly with the thousands of families and individuals who contact our office each year. To continue, we do need your help and support. A tax-deductible financial contribution will support direct legal, advocacy, and education services to families in Wisconsin.

Thursday, November 14, 2013

Governor Walker Calls for Special Legislative Session To Postpone BadgerCare Plus Cuts

In a press conference convened Thursday, November 14 at 1:30pm at the State Capitol, Governor Walker addressed a room of advocates, legislators, and media to announce that he is calling a special session of the legislature to act on two bills that would: 1. Delay by 3 months the termination of people from BadgerCare Plus above 100% FPL to allow more time for people to select health care plans in the Marketplace--that is, delay terminations until March 31; and 2. Delay by 3 months changes in HIRSP, the state's health insurance risk sharing plan, originally set to sunset December 31, 2013. Walker expects the Legislature to convene in late November. Walker stated, "It has become abundantly clear that the rollout of ObamaCare is failing.  We need to take decisive action to make sure the people of the state don't fall through the cracks."
In addition, Walker said he is asking Obama's administration to allow people to use subsidies to purchase any qualified plan, no matter where they purchase their plan--in or out of the Marketplace.
"Whether you're for or against it, the roll-out of ObamaCare has not gone as originally proposed...I'm not going to let the failures of the federal government let people get caught between two systems." Walker clarified that financially, "We don't need new GPR to do this." When answering questions from the media about whether federal funds could have helped, Walker added, "The failure of the ObamaCare rollout is the precise reason I didn't take the Medicaid Expansion money in the first place."
Many community leaders had recently pressured the Governor to delay the cuts originally signed into law on June 30 in the Governor's most recent budget. The state budget scheduled the termination of parents, caretakers and adults from BadgerCare Plus on December 31. With delays in the new Marketplace, due to poor functionality of healthcare.gov, advocates and community leaders were skeptical that the estimated 80,000 individuals being terminated from BadgerCare Plus coverage would be able to connect to the Marketplace by December 15, pick a plan, and pay their first premium, in order to secure coverage that would start on January 1, 2014 thus preventing a gap in coverage.
This special session of lawmakers will convene before their next scheduled meeting (January 14, 2014) with the hope that bills are voted on by early December.
Pressure to Extend the Deadline
Advocates and community leaders have been calling on Governor Scott Walker to defer cutting individuals off BadgerCare Plus if the federal marketplace is not operational by the end of November. Open enrollment continues through the end of March, but coverage can take up to several weeks before kicking in after people sign up, which may result in penalties.  An advocacy letter sent to Walker outlined concern for the 77,000 parents that may be out of coverage stating, “These concerns are magnified by the healthcare.gov technical glitches that have hindered enrollment thus far.” The letter asked Walker to lay out his contingency plan if enrollment through the exchange continues to present difficulties.
Milwaukee mayor, Tom Barrett, requested that Walker delay these cutoffs, not to debate the integrity of the Affordable Care Act or the changes to BadgerCare Plus in the last state budget, but to ask Walker not to take insurance away from 92,000 individuals and families until the federal system is running smoothly. Barrett wanted a three month delay in the BadgerCare cutoff.
And finally, in a letter dated November 12, U.S. Senator Tammy Baldwin raised concerns about the plan to terminate parents and offered solutions "to ensure our constituents maintain the health coverage they need." Baldwin stated, "Your current outreach plan calls for residents who will lose BadgerCare coverage to receive final notice at the end of November, leaving them just two weeks to enroll or they will lose coverage on January 1." Senator Baldwin also offers a number of solutions that the Walker Administration could pursue, including altering their current request to the Centers for Medicare & Medicaid Services so that BadgerCare enrollees maintain their current coverage through the end of March.
State Responsibility for How We Got Here
Rep. Sandy Pasch (D-Shorewood), too says there is state responsibility in this debacle. When speaking to the Shepherd's Express in Milwaukee, Pasch said Wisconsin had an opportunity to run its own exchange, and decided against it.

Wisconsin decided against more than just that. When Walker took office in 2011, he terminated former Governor Doyle's health reform efforts, transformed the Office of Health Care Reform into the "Office of Free Market Health Care" and then quickly closed it altogether, sent back exchange money, set back Consumer Assistance Program Funds, and rejected a Medicaid expansion. Wisconsin has been kicking and screaming against the law from the start. Wisconsinites are probably feeling a little tired of the opposition and angry at the obstacles to care and coverage.
The feds themselves will say they never anticipated that this many states would refuse to participate in creating their own marketplaces, instead pushing all their residents to the federal website. The volume, had states participated, would have been manageable. "The feds at CMS who set up our Marketplace are not off the hook either," says ABC for Health's Bobby Peterson. "They funded navigator programs in a hodge-podge way in Wisconsin and set up a $400 million Rube Goldberg Machine to enroll in the Marketplace."  Cancelled Insurance Policies:
President Obama held his own press conference today, easing complaints about cancelled insurance policies. The administration announced it will let health insurers extend existing health plans on the individual and small group market into 2014, even if the plans do not meet regulations imposed under the ACA. The only caveat is that insurers must "notify consumers" of the protections these plans lack.
President Obama was criticized for saying, "If you like your insurance, you can keep it." What he was actually saying is "you can keep your plan, unless your insurance company was offering such a terrible plan it could never conform to consumer protection standards and fairness that it won't comply with the law." Then the insurance company will most likely cancel your plan. The consequence to today's decision is to allow discriminatory plans to persist in the marketplace, in exchange for offering insurance companies "more time" to adjust to new regulations.
Health reform is not responsible for millions of Americans losing good health insurance plans. Health reform is responsible for raising the standards of coverage, and thus forcing the "junk health insurance" out of the marketplace. Consumer Reports published a study of low cost, low coverage plans, placing them in their own category of "junk." Their conclusion? No coverage is better than junk coverage.
"These are insurance company decisions," says Bobby Peterson in an interview with Wisconsin Public Television's "Here and Now." Plans made enough changes so that the plans are no longer eligible to be "grandfathered." If the insurance companies wanted to maintain those plans and enrollees, they could have done that.
We also know the following to be true: This happens all the time in the individual marketplace. BYU Professor of Political Science Richard Davis in an opinion piece to the Deseret News says, "They’ve been doing it for years to people they didn’t want to cover. The difference is the news media didn’t tell us about those cancellations."
Health care consumers are better off when they have plans that don't discriminate, even if that means some plans must disappear when they don't meet basic, minimum standards. Davis says, "No longer will consumers be left in a wild, wild west-style marketplace where insurers can offer whatever they want and call it health care insurance."