AHCA: Crime and Punishment

Get ready to rumble.
The hemophilia community overall is not just deeply disappointed with what’s
happening in Washington DC regarding healthcare, it’s shocked, angry … and good manners prohibits me from using cruder language. It
won’t take the proposed healthcare bill lying down. Been there before when
government failed our healthcare in the 1980s.
The American Health
Care Act (H.R. 1628)
passed the House of Representatives on Thursday, May 6. Facebook lit up with
angry comments from the community when it knew the bill was headed for a vote.
Some people went so far as to threaten to unfriend anyone who didn’t agree that
this bill was a threat to our coverage and health. Some went so far as to say
that if you didn’t take a stand, you were “privileged,” and that the bill must
not impact you. Strong words and convictions. Advocates urged everyone, as
people with an expensive preexisting condition, to contact their congressperson
and ask them not to vote for this.
The AHCA’s stated overall
goal is to reduce federal spending over time. But it also carries a significant
risk of reducing the number of people covered—the Congressional Budget Office estimates
24 million by 2026— and their benefits.  The estimated federal savings of
$300 billion must be officially assessed by the CBO in order to pass in the Senate. And to complicate matters, the Senate may write
its own version of the bill instead of voting on the current one.
The key components of the ACA
(“Obamacare”) that were favorable to those with preexisting conditions like
hemophilia were: eliminating lifetime caps, keeping children on parents’
insurance until age 26, eliminating preexisting condition discrimination,
creation of the Marketplace exchanges, and expanding Medicaid.
Some components of the
AHCA that are of concern include:
• Giving states the
ability to run their own Medicaid program,
• Allowing states to
opt out of any mandate that insurers not raise insurance costs for Americans
with preexisting conditions
• Allowing states to
create a work requirement for people on Medicaid.
• Repealing the
employer mandate
• Repealing the tax
penalty for the ACA’s individual mandate
• Cuts $900 million in
taxes for individuals who earn over $200,000 annually, while also cutting $1
trillion in subsidies for Medicaid.
• Providing $100
billion under the “Patient and State Stability Fund” to help states manage some
of the costs of the most expensive patients
• Permitting
states to allow insurers on the exchanges to charge more (with no upper limit)
for patients with pre-existing conditions, although they still cannot be
technically denied coverage
• Allows insurers on
the exchanges to raise rates more for older people, penalize people who go more
than two months without continuous  coverage, and replace Obamacare’s
income-based and cost-based subsidies for exchange coverage with a tax credit
that only adjusted for age.
In today’s TV show This Week, House Speaker Paul Ryan
commented, “Under this bill, no matter what, you cannot be denied coverage
if you have a preexisting condition.” 
He tried to reassure viewers by adding, “You
can’t charge people more if they keep continuous coverage. The key of having a
continuous coverage provision is to make sure that people stay covered and they
move from one plan to the next if they want to. It’s kind of like waiting until
your house is on fire to then buy your homeowner’s insurance. You want to make
sure that people stay covered to keep the cost down.”
In response to the
passing of the House bill, Joe Kennedy III said this:
“In
a world view that scapegoats the Struggling and the Suffering, that sees fault
in illness, that rejects the most basic universal truth of the human existence:
that every single one of us, one day, will be brought to our knees by a
diagnosis we didn’t expect, a phone call we can’t imagine, and a loss we cannot
endure. So we take care of each other because but for the
grace of God there go I one day. And we hope that we will be shown that mercy
too. It is the ultimate test of the character of this country confronting our
chamber today. Not the power we give the strong but the strength with which we
embrace the weak.”
Facebook has been not
only a place to vent and share feelings and facts, but also has been a great
way to advocate. Facebook friend Randy wrote:
I just faxed my US
senators using Resistbot. Send a text message to 504-09 and put RESIST as the
message. Resistbot generates a fax to your senators and representative. (A fax
is apparently more effective than a phone call.) You’ll get a few prompts back.
We need them to vote NO on repealing the ACA. Lives are at stake – not to
mention wallets. Please copy, paste and share.
Facebook friend Jeff wrote: Insurers – not the government – define what pre-existing
conditions are, and they are free to be as liberal with their definitions as
they wish…
And
the only good thing to come out of all this so far? More people are becoming activists.
People are contacting their congressperson, some for the first time in their
lives. Young people are reading, learning, talking a stand. Conversations get
heated but also shed light; debates may divide but also deliver.

And
our community, as always, will take a stand against threats to our hard-earned healthcare
gains. Watch the news for continued debate on healthcare reform, and see you on
Facebook!

Welcome to the Jungle, I mean, Marketplace

This past week I
attended a useful and interesting meeting, NHF’s Social Worker Insurance Marketplace Workshop (funded by Baxter Healthcare and Pfizer Inc; thanks guys!).
Together with about 80 social workers from HTCs around the country, and some
chapter leaders, we listened to various consultants and government
representatives speak primarily about the “Marketplace,” the website of the Affordable
Care Act that allows people to choose a healthcare plan.

We’ve all heard
about the difficulties in dealing with this website— healthcare.gov—such as the
crash, and various other glitches. The good news is that many of these glitches
have been fixed; and now it’s time to get our bleeding disorder community on
board. Healthcare insurance is mandatory now; all US citizens (with notable
exceptions) must have insurance. The website is created to help people find the
lowest cost insurance that also provides all their essential healthcare needs.
Crafty Posters were created to help us visualize; good idea,
we needed the help!

There is plenty
of assistance in navigating the website. We actually tried the website live,
and it was pretty interesting, and yes, we even got stuck once or twice! For
us, we were stuck trying to find out if our HTC hematologist was in-network.

Each website
will have on-line or Internet guides, to help you live. They are called various
names: Assisters, navigators, certified application counselors, in-person
assistance, marketplace call center, agents and brokers. Most people are used
to calling them “Navigators.” (I can’t help but think of “Engineers,” a la
Ridley Scott’s Prometheus)
Navigators, Engineers: whatever you
call them, they are here to help

Jim Romano, from Patient Services Inc (PSI), gave a
presentation about how PSI has been chosen to train qualified applicants to
become  Certified Application Counselors (CAC), to
help people navigate the Marketplace. This is truly a great coup for PSI, and I
can’t think of any other group better qualified to train. PSI will train CACs
in different states, and pay their fees (yes, you have to pay for the pleasure
to become a CAC to help people navigate their state Marketplace! One point from
an audience member who underwent the training: the training wasn’t very
hemophilia-focused, and needs to be more focused.

Jim noted that there were still some
difficulties to overcome in each state. Ed Kuebler, a social worker from Texas,
slyly asked, is the difficulty level in some states… political? This garnered
many laughs! Ya think?

There are many
marketplaces, as each state as their own. All the marketplaces have different
funding sources, based on what type of marketplace it is:

FFM: Federally facilitated marketplace
SPM: State partnered marketplace. The federal government has some role
in this.
SBM: State based marketplace and the fed has no role in it.
How many people
have enrolled since the site was unveiled in October?
                  By
Dec 28: 6 million Americans gained coverage through Marketplace and Medicaid
2.2 million of those enrolled in private plans
80% received help in paying for premiums
53 million visits to healthcare.gov and state marketplace websites
11 million calls to the federal and state call centers
Different
healthcare plans are designated by “metal.” The more precious the metal, the
higher priced the plan, but also the more coverage. Enrollment by Metal?
                  60%
are choosing Silver plans
20% Bronze
13% gold
7% Platinum
1% catastrophic plans
Ed Kuebler thinks we need more help than
navigators (kidding–a gift from a friend)

There are still
consumer problems using the Marketplace:
                  An
inability to complete application on line

                  Applications
get “stuck” (freeze) or lost
                  Info
is not transmitted after the plan is submitted
                  If
not sure you’re insured, call insurance company (not the website) to check
                  If
you don’t pay 1st month premium by certain date, you will not get
insurance!
Don’t despair! I
found it actually fun to hop on Colorado’s state Marketplace and select a plan.
Another useful
website is Marketplace.cms.gov, which has FAQs, tip sheets, paper application,
and materials in Spanish. And Healthcare.gov, which does premium estimate, on
line application. When you log on, you will see this banner!
Michelle Rice (L), Mary Garvey (R) of NHF; Tiara of PSI (C):
all great speakers and resources!

Enroll by February 15 for
coverage starting March 1
So contact your
social worker for help if you are not yet enrolled; don’t miss the deadline!
Next week I will
cover more of the NHF Social Worker Insurance Marketplace workshop.

Insurance Buyer Beware!

While catching up on some insurance reading, I came across this article, which gives some food for thought. I’ve been giving insurance symposia around the country, and we have been focusing this year on the “Marketplace” websites, but this never even crossed my mind!

“Buyer Beware: Obamacare creates an opening for confusion and
scams”

Kate Pickert
Government Bureaucrats aren’t the only ones preparing for a
key component of President Obama’s signature health care law that goes into
effect this

fall.

Health care exchanges, the marketplaces where people can buy
soon-to-be required insurance, launch Oct. 1, and experts warn that their debut
could create a prime moneymaking opportunity for illegal scammers and others
looking to capitalize on consumer confusion. “There are people licking their
chops and saying, ‘A sucker is born every minuet,’” says Elizabeth Abbott of
the consumer group Health Access California.
There are two main types of potential snares for consumers:
outright cons and insurance-like plans that give the impression of offering
more coverage than they actually provide. Regulatory agencies are already on
high alert for fraud. Both the Federal Trade Commission and the Better Business
Bureau have posted warnings about Obamacare-related identity theft. And in
Pennsylvania, one enterprising insurance broker set up a website with the
official state seal and the title Pennsylvania Health Exchange. The site was
removed after a warning for the state insurance department.
Some quasi-insurance products expected to proliferate come October
are ‘discount medical plans,” which promise lower health care costs in exchange
for a recurring fee. Many of these plans lure customers with language that
implies comprehensive coverage, but the reality is far more limited.
“The problem is, people pay the money, buy a plan, and when
they get sick, they find out they don’t’ have the financial security they
thought they had,” says Minnesota attorney general Lori Swanson, who has sued
several discount medial plans for deceptive market practices. Consumer
watchdogs are also wary of plans that reimburse consumers with set amounts for
doctor visits or hospital stays, regardless of the actual costs.
Obamacare bans some forms of skimpy coverage, but with
enforcement left to the states—some of which are less than enthusiastic about
the law—don’t count on those misleading plans disappearing overnight. “Will the
states crack down on them?” asks Timothy Jost, a law professor at Washington and
Lee University and an expert on insurance regulation. “Well, a number of states
aren’t enforcing the Affordable Care Act at all.”
Time August 19, 2013

Great Book I Just Read
Into the Abyss: An Extraordinary True Story [Kindle]
Carol Shaben

A small commuter plane goes down on a subzero night in 1984 in Canada; only four of nine people survive: the 24 year old pilot, the first Muslim politician in North America, a policeman and his handcuffed prisoner. The next 36 hours reveals each man’s character, impacts them for life, and bonds them to one another for life. The prisoner saves the lives of the other three and becomes a national hero. This amazing story, expertly told, delves deep into the minds and hearts of each man before and during the accident, and follows them 20 years later to see what has become of them. The incident helped to change Canadian aviation. The author is the daughter of the politician, one of the survivors. Five/five stars.

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