We all know the Affordable Care Act will benefit women in numerous ways—free preventive care, access to affordable health insurance, help for small business owners—but the message is not getting through to the women of America and the people who care about them. Millions of women have already benefited from the health care law, and millions more will once it’s fully implemented. But these provisions won’t be of any help if the women they are meant to benefit aren’t even aware of them.

Please join us Wednesday, May 16, 2012,  1:00 – 2:00 PM EDT, for our next Health Action conference call where we will discuss how women will be helped by the health care law and how best to communicate these benefits to women and their families.

Please click HERE to RSVP

We will be joined on the call by Lorena Garcia of Colorado Organization of Latina Opportunity and Reproductive Rights (COLOR), Kathleen Stoll of Families USA,  Judy Waxman of National Women’s Law Center, and Byllye Avery and Lois Uttley of Raising Women’s Voices . The call will focus on how women benefit from the Affordable Care Act. We will also discuss strategies, messages, and tactics to help state advocates reach the women in their communities.

Please click HERE to RSVP
Wednesday, May 16, 2012
1:00 PM EDT/10:00 AM PDT

Women have been shortchanged by our health care system for years, but thanks to the Affordable Care Act it will be easier for women to get the health care they need. Please join us next Wednesday to discuss how best to ensure the women in our lives take advantage of these new developments.

Consumers nationwide would have received an estimated $2 billion in rebates from health insurers if the new medical loss ratio (MLR) rule enacted as part of the Affordable Care Act had been in effect in 2010, according to a new Commonwealth Fund analysis. The MLR rule, which went into effect in 2011, aims to control private insurance costs for consumers and government by requiring that a minimum percentage of premium dollars go toward medical care and health care quality improvement, as opposed to administrative costs and corporate profits. 

In their study, Mark Hall of Wake Forest University and Michael McCue of Virginia Commonwealth University estimate how much consumers in each state would have received in total rebates, and the number of insurers that would have been required to give rebates if the rule had applied in 2010. Insurers must meet a minimum MLR of 80 percent in the individual and small-group markets, and 85 percent in the large-group market, and issue rebates if they do not. 

Read the issue brief and use this interactive table to find the estimated total rebate and annual rebate per person for each state. 

The individual insurance requirement that the Supreme Court is reviewing isn't the first federal mandate involving health care.

There's a Medicare payroll tax on workers and employers, for example, and a requirement that hospitals provide free emergency services to indigents. Health care is full of government dictates, some arguably more intrusive than President Barack Obama's overhaul law.

Most of the mandates apply to providers such as hospitals and insurers. For example, a 1990s law requires health plans to cover at least a 48-hour hospital stay for new mothers and their babies. Such requirements protect some consumers while indirectly raising costs for others.

One mandate affects just about everybody: Workers must pay a tax to finance Medicare, which collects about $200 billion a year.

It's right on your W-2 form, line 6, "Medicare tax withheld." Workers must pay it even if they don't have health insurance. Employees of a company get to split the tax with their employer. The self-employed owe the full amount, 2.9 percent of earnings.

The report shows:

• 33 percent of the U.S. population under age 65 would be explicitly exempt from the individual responsibility requirement, most because their incomes fall below the tax filing threshold. Most of these people already have health insurance through an employer, the private market, or public coverage programs.
• 58 percent of the U.S. population under age 65 are potentially subject to the individual responsibility requirement but are already insured through an employer, the individual market, or public coverage programs and therefore would not face penalties.
• Three percent of the U.S. population under age 65 are potentially subject to the individual responsibility requirement and are uninsured, but would be eligible for Medicaid, so they could receive coverage at no or low cost and not face penalties.
• Four percent of the U.S. population under age 65 are potentially subject to the individual responsibility requirement and are uninsured, but would be eligible for exchange subsides to obtain insurance. If they did so, they would not face penalties.
• Three percent of the U.S. population under age 65 (2% of the total population) are potentially subject to the individual responsibility requirement, are currently uninsured and not offered financial assistance under the ACA. These people could face a penalty if they did not obtain insurance.

For an excellent two page fact sheet on the ACA prepared by First Focus, click here.

LIVE WEBINAR: IMPLEMENTING HEALTH REFORM IN THE STATES

What are the trends? What are the implications for states if the Supreme Court strikes down parts the reform law, or the entire law?

WHEN: Tuesday, March 27, 2 p.m. Eastern Daylight Time

SPONSORS: Association of Health Care Journalists (AHCJ), Alliance for Health Reform, Robert Wood Johnson Foundation 

TO WATCH THIS LIVE WEBINAR: Log onto www.allhealth.org a few minutes before 2 p.m. Eastern Daylight Time on the 27th. No charge. No registration needed. The webinar will be archived by the Alliance and by the Kaiser Family Foundation (www.kff.org). To ask a question before or during the webinar, emailZackThompson@allhealth.org

The health care overhaul law passed by Congress in 2010 sets out national goals and requirements. But many of the key decisions implementing the law are left to the states.

For example, states have a lot of leeway in how they set up health insurance exchanges, where uninsured individuals and small business will be able to buy coverage starting in 2014. But only 15 states have actually passed legislation establishing an exchange, or have a governor who has set one in motion by executive order. Florida and Louisiana have said they will refuse to set up exchanges, meaning the federal government will organize exchanges in those states. On the other end of the spectrum, states such as Vermont and Oregon are working to change their health care systems in ways that go beyond the Patient Protection and Affordable Care Act.

The law provides for Medicaid expansion that will bring an estimated 16 million additional Americans under the Medicaid umbrella. But will states aggressively promote the program to these newly eligible individuals? What if the Supreme Court rules that the Medicaid expansion is unconstitutional?

This webinar will bring you up to date on what’s happening in the states with implementation of the Patient Protection and Affordable Care Act. By watching, anyone dealing with health issues will be better able to answer questions on this topic for constituents and members.

The Misleading Arguments In The States’ Medicaid Coercion Brief

Posted By Sara Rosenbaum On January 19, 2012 @ 10:48 am In All Categories,Health Law,Health Reform,Medicaid,States | Dr. Rosenbaum is one of the most compelling and effective spokespersons for those of us who are Medicaid recipients.

On January 10^th, the states filed their latest arguments in their bid to have the ACA’s Medicaid expansion declared an unconstitutional coercion ^[1].  Following an effort to piece together a coercion doctrine from dicta found in a handful of Supreme Court cases, the states assert that the “[t]he ACA is Premised on the Understanding that It Forces States to Expand Medicaid” (page 33) and that “the ACA revolutionizes Medicaid to make it serve the mandate and the ACA’s broader goal of near-universal coverage.” (page 34)

This revolution, according to the states, is accomplished by the fact that the minimum essential coverage requirement reaches all persons other than those who are exempt as a result of incarceration, covered by a religious or conscience exemption, or not lawfully present in the U.S ^[2]. (26 U.S.C. §5000A(d))  Furthermore, the states argue, because Medicaid is expressly identified as an acceptable form of minimum essential coverage ^[2](26 U.S.C. §5000A(f)(1)(A)(ii)), and because individuals with incomes below 133 percent of the federal poverty level (the upper Medicaid eligibility threshold) are ineligible for advance premium tax credits through state health insurance Exchanges, Medicaid effectively becomes the only option for fulfilling the minimum essential coverage requirement.

In other words, argue the states ^[1], “[t]he lack of any contingency plan” (page 35) for the poor means that “Congress transformed Medicaid from a program designed to provide insurance to certain discrete categories of the needy, with substantial state discretion as to eligibility and the level of coverage, into one designed to provide a minimum level of coverage to every needy person.” (page 34)  For this reason, the states claim, “State participation in Medicaid [is] not a matter open to choice.” (page 34-35)

But this argument conveniently ignores several crucial facts.

First, although the minimum essential coverage requirement nominally applies to all individuals with the above-noted narrow exceptions, the poor are excused because the Act exempts people with incomes below the federal income tax filing threshold ^[2] ($9500.00 for individuals and $19,000 for married couples filing jointly in 2011 ^[3]) from the financial penalty for failing to maintain minimum essential coverage. (26 U.S.C. §5000A(e)(2))  This means that the great majority of individuals and families eligible for Medicaid face no penalties for failing to enroll.

Second, the narrow swath of individuals and families whose incomes exceed the tax filing threshold but are below 133 percent of the federal poverty level (the upper bound of Medicaid eligibility) will qualify for the affordability exemption that applies to any person for whom the “required contribution for coverage” for any month exceeds 8 percent of household income ^[2]. (26 U.S.C. §5000A(e)(1)(A))  Within this group, virtually no one will fail to qualify for such an exemption. This is because of the cost of even a bronze plan.

The Congressional Budget Office has estimated that in 2016 a bronze individual plan will cost between $4500 and $5000 and family plan between $12,000 and $12,500 ^[4].  Thus, individuals with gross incomes below $56,250 to $62,500 and families with gross incomes below $150,000 to $156,625 – levels that are exponentially higher than the Medicaid cutoff of 133 percent of the federal poverty level ($14,483 for an individual and $29,275 for a family of four) simply are not subject to the minimum coverage requirement penalty.

Third, even in the extraordinary event that a bronze plan is considered affordable because its price is less than 8 percent of annual household income for a Medicaid recipient, an individual can file for a hardship exemption through the state health insurance Exchange ^[2], (26 U.S.C. §5000A(e)(5)), which presumably would be automatically granted given the individual’s ineligibility for premium tax credits despite exceptionally low income.

Fourth, whatever befalls the poorest people in states that opt to leave Medicaid rather than comply with the coverage expansion, this is the headache that Congress created for itself by excluding this population from the Act’s premium tax credit and Exchange provisions.  Congress made a reasonable judgment that using a tax credit approach to subsidize coverage for people who by and large are not taxpayers makes no sense. Lawmakers concluded – not surprisingly – that Medicaid remains the best way to help the poor, since it has been the mainstay source of health care financing for the poor for nearly a half century.

To minimize the burden on the states from having made such a choice, Congress agreed to cover 100 percent of the cost of the expansion for the first three years, and 90 percent over time.  This contribution is far higher than the law’s regular federal contribution levels for mandatory coverage groups, which range from 50 percent to 83 percent of program costs. Congress banked on the belief that states would remain in Medicaid, just as they have in response to multiple expansion mandates enacted in previous years, particularly given the economic value of the Act’s Medicaid expansion to states. Indeed, the Urban Institute projects that the Medicaid expansion actually will save states money ^[5] — $12 to $19 billion in 2020 alone — by reducing the cost of uncompensated care for Medicaid-ineligible indigent adults.  Since 1965, minimum eligibility standards, coupled with minimum expected coverage levels, have represented the Congressional approach to building Medicaid.  This time is no different.

Fifth, of course, all of the states’ finger-pointing at individuals’ obligations does not change the basic fact that Medicaid remains voluntary with states.  A state that doesn’t like the deal Congress is offering can leave the program at any time and figure out other ways to meet whatever it defines as its health care obligations toward its poorest residents.

One could argue that Congress should not have made so many operational and policy assumptions about the deal it was offering.  But Congress had good reason to rely on the states to agree to a major role for Medicaid in a broader national scheme: indeed, it was precisely this approach that was used by a Republican Congress and President in designing Medicare Part D, which is a national program of prescription drug coverage for Medicare beneficiaries, built in significant part through state financial contributions through Medicaid to Medicare’s coverage arrangement on behalf of dual enrollees.

One might take the position, of course, that Congress should have anticipated an exodus by some states and created a fallback system of Exchange coverage and premium credits for poor people living in states that choose not to participate in Medicaid. This might have been a viable policy choice, not to mention the moral and ethical thing as a means of assuring that most Americans truly will have access to affordable insurance coverage.  Congress did not make that choice, however, electing instead, perhaps, to revisit the issue in the event that such consequences should transpire.

One might fault this policy choice, but no amount of seething on the states’ part can paper over the fact that Medicaid remains a voluntary program.

Article printed from Health Affairs Blog: http://healthaffairs.org/blog

URL to article: http://healthaffairs.org/blog/2012/01/19/the-misleading-arguments-in-the-states-medicaid-coercion-brief/

URLs in this post:

[1] latest arguments in their bid to have the ACA’s Medicaid expansion declared an unconstitutional coercion:http://myfloridalegal.com/webfiles.nsf/WF/JMEE-8QDTNU/$file/11-400+ts+States+%28Medicaid%29.pdf

[2] reaches all persons other than those who are exempt as a result of incarceration, covered by a religious or conscience exemption, or not lawfully present in the U.S: http://www.law.cornell.edu/uscode/usc_sec_26_00005000---A000-.html

[3] $9500.00 for individuals and $19,000 for married couples filing jointly in 2011: http://www.irs.gov/publications/p501/ar01.html#en_US_2011_publink1000259853

[4] The Congressional Budget Office has estimated that in 2016 a bronze individual plan will cost between $4500 and $5000 and family plan between $12,000 and $12,500: http://www.cbo.gov/ftpdocs/108xx/doc10884/01-11-Premiums_for_Bronze_Plan.pdf

[5] the Urban Institute projects that the Medicaid expansion actually will save states money:http://www.urban.org/health_policy/url.cfm?ID=412361

It has been clear for some time that the political fight over the minimum-insurance-coverage requirement in the Affordable Care Act (ACA) would eventually reach the U.S. Supreme Court. What few would have predicted was that the question of the constitutionality of the latest in a long line of Medicaid expansions would also end up there.

In their appeal to the Supreme Court of the 11th Circuit Court of Appeals' rejection of their Medicaid claims, Florida and 25 other states argue that the ACA “coerces” them into expanding their Medicaid programs to cover all adults with incomes below 133% of the poverty level by making their receipt of any and all federal Medicaid funding conditional on such an expansion.1 Although the Constitution's 10th Amendment prohibits the federal government from forcing the states to carry out a federal program, it allows the federal government to require states to meet specific conditions if they accept federal money. The states, however, argue that they are being coerced into accepting the expansion, since Medicaid is their largest source of federal funding and since it offers the only basis for covering the poorest Americans under the ACA.

For the complete article from the New England Journal of Medicine, click here.

The day after his tiny victory in the Iowa caucus, GOP presidential candidate Rick Santorum took some time in his closing speech to compare social welfare programs to fascism.

The former Pennsylvania senator drew upon his grandfather's experience during Benito Mussolini's tenure in Italy (video starts at the 50-second mark) and linked Medicaid, food stamps and other U.S. initiatives to the authoritarianism experienced by his relative back in the 1920s.

"One wants to talk about raising taxes on people who have been successful and redistributing money, increasing dependency in this country, promoting more Medicaid and food stamps and all sorts of social welfare programs and passing Obamacare to provide even more government subsidies. More and more dependency, more and more government -- exactly what my grandfather left in 1925," Santorum said.

Two weeks earlier, Santorum made similar comments, noting that Obama's Affordable Care Act could be the "death knell" for America. He referenced the same story about his grandfather, citing worries that the United States could become the same "kind of country" as fascist Italy.

Wanna listen to his rant?  Go to http://www.huffingtonpost.com/2012/01/04/rick-santorum-social-welfare-programs-fascism_n_1183514.html

A federal match for the 12 states that expanded their health insurance programs for the poor prior to the passage of health care reform is one of many items being considered for cutbacks as the bipartisan congressional super committee tries to come up with $1.2 trillion in savings over 10 years.

Such a cut could result in a $660 million hit to Massachusetts in federal Medicaid funding between 2016 and 2020 if the committee adopts the portion of President Obama’s deficit reduction proposal that called for cutting Medicaid by $15 billion, according to an estimate provided by Markey’s office.

The other states that would be affected are: Arizona, Delaware, Hawaii, Maine, Minnesota, New York, Pennsylvania, Vermonth, Washington, Wisconsin, and Washington, DC.

Full story here.