WE NEED YOU!! There is so much
going on with access to healthcare both nationally and locally. We want you
to get involved in the Advocacy Committee so that we can take action to
stay informed and have a voice in the decisions being made. Here is some of
what is happening:
Repeal and Replace ‘ObamaCare’– What Does This Mean For All of Us?
Here is What We Know:
On March 6th the Republicans released a plan on how they will repeal and
replace the Affordable Care Act. The key measures include:
It replaces federal
insurance subsidies with a new form of individual tax credits and
grants to states.
Under new legislation,
Americans would no longer be penalized for not having health
insurance. But insurers would be allowed to impose a surcharge of 30%
for those who have a gap between health plans`
It will keep two of the
most popular features of the Affordable Care Act:
Forbids insurers to deny
coverage or charge more to people with preexisting medical conditions
People can stay on their
parent’s policy until age 26
Planned Parenthood will be
ineligible for Medicaid reimbursements or federal family planning
The PSI Government Relations
Alert regarding pending Affordable Care Act (ACA) repeal legislation has
been posted on the PSI website at:
The debate, starting in House committees
this week, is a remarkable moment in government health-care policy making.
The Affordable Care Act, former president Barack Obama’s signature domestic
policy achievement passed in 2010 with only Democratic support, ushered in
the most significant expansion of insurance coverage since the creation of
Medicare and Medicaid as part of President Lyndon B. Johnson’s Great
Society programs of the mid-1960s.
There is no precedent for Congress to reverse a major program of social
benefits once it has taken effect and reached millions of Americans.
Regardless of whether you are Republican or Democrat, liberal or
conservative, there are provisions in the Affordable Care Act that helped
many people with bleeding disorders gain health insurance coverage. This
has a significant impact on the lapsed time in getting treatment that can
reduce long-term damage and disability.
Medicaid would be
converted from its current form of entitlement to anyone eligible into a per
capita cap on funding to states, depending on how many people they had
enrolled. In states that expanded Medicaid under the ACA, which includes
Arizona, the government for now would continue paying for virtually the
entire cost of the expansion. Starting in 2020, however, the GOP plan would
restrict the government’s generous Medicaid payment — 90 percent of the
cost of covering people in the expansion group — only to people who were in
the program as of then. States would keep getting that amount of federal
help for each of those people as long as they remained eligible, with the
idea that most people on Medicaid drop off after a few years. States
would receive a set amount of money from the federal government every year,
regardless of the number signed up, which could force Arizona to make
difficult choices on what they will cover on Medicaid. It will
essentially shift the burden to the state in terms of managing the risk.
This is particularly concerning in Arizona because the Medicaid Expansion
was passed by the Arizona legislature with the caveat that if at any time
the federal government gives less than 80% to fund the expansion, Arizona
will back out.
Our community should care about Medicaid Expansion because it extended
AHCCCS coverage to allow those up to 138% of the federal poverty level to
be eligible for AHCCCS. It also extended eligibility to include adults.
Many of those who have bleeding disorders are on AHCCCS and this could
directly impact many of our members.
Concerns for those with Bleeding Disorders:
Lifetime Caps are not fully
addressed and could be impacted
Continuous Care – there is
a provision that that the insurers can charge a 30% surcharge if there
is a gap in coverage. This could make healthcare unaffordable for our
If Arizona is only given a
set amount for AHCCCS, it could negatively impact how much coverage
our members can receive.
If the federal government
covers less than 80% of the Medicaid Expansion, Arizona will back out.
This could jeopardize coverage for many adult members currently on
AHCCCS as well as those earning between 133% and 138% federal poverty
Market Stabilization Rule
are changes to the Affordable Care Act that will take effect THIS YEAR!
Centers for Medicare Medicaid Services has proposed the market
stabilization rule that is designed to help stabilize the individual and
small group markets on the Healthcare Exchange. This proposed rule would
amend standards relating to special enrollment periods, guaranteed availability,
and the timing of the annual open enrollment period in the individual
market for the 2018 plan year; standards related to network adequacy and
essential community providers for qualified health plans; and the rules
around actuarial value requirements.
Proposed changes will…
Shorten enrollment period- from 3 months to 6 weeks
• Change Special Enrollment- will cause 1-2 month delay in
enrollment and may not lower costs to insurance companies.
• Require patients to pay debt from previous unpaid premium
BEFORE same insurer will cover them. Currently, patients can
back-pay while maintaining coverage.
• Create continuous coverage requirements (in place of
individual mandate). If insurance gap is longer than 60 days, penalizes
people who are uninsured when they try to get insurance. Penalties can
include 90 day waiting period or increased premiums.
• Lower the number of Essential Community Providers- this will
reduce access to health care for low-income, medically underserved
• Summary from Health Affairs Summary from CMS (Centers for
Medicaid and Medicare Services)
What Is AHA Doing?
AHA responded to the
proposed Market Stabilization Rule with a public comment.
AHA is meeting locally with
the governor’s office and AHCCCS representatives to advise of our
concerns with the proposed changes
AHA is a member of Cover
AZ, a coalition to influence public policy on access to healthcare
AHA is hosting it annual
Legislative Day where we will discuss the changes with our Arizona legislators
AHA has started the Action
Alerts to keep you informed as we get the changes.
AHA sent 10 teens to NHF
Washington Days this week to talk with our federal legislators and
What Can You Do?
Read about the proposed
changes to the Affordable Care Act (ACA/Obamacare).
The government is ASKING
FOR OUR OPINIONS about how these changes will affect people like us in
the bleeding disorders community.
Guidance- Be specific about what changes would impact your life or
your family. Describe hardships or how you may be disproportionately
affected because of a chronic health issue like a bleeding disorder.
Below is an example letter. Please do not copy it directly, use it as a
Georgetown Health Policy Institute, Urban Institute
Since my first son
was born 14 years ago, I’ve been a member of the bleeding disorders
community. Two of my sons have severe hemophilia and require expensive
life-saving medication several times a week to maintain their health.
Because I have children with expensive chronic health conditions, I know
how important it is to have high-quality, affordable health care.
I also volunteer in the bleeding disorders community and have seen that a
bleeding disorder like hemophilia can affect a person’s entire life. One
bleed can cause permanent damage, chronic pain, disability, and even death.
Therefore, I want to make my voice heard regarding the proposed Marketplace
1. By shortening the open enrollment time, people who need coverage may not
be able to get it. The process for enrollment can be lengthy and for many
who are working multiple jobs having a shorter window, especially around
the holidays will make application overly cumbersome.
2. A change in the special enrollment rules will create unnecessary waiting
for patients and not necessarily lower the cost for insurance companies.
Data shows that the extra step of verification for special enrollment is
more likely to be done by older people. People with bleeding disorders
cannot wait 1-2 months for pre-verification. They need blood-clotting
factor several times a week and this wait could cause them significant
hardship in the form of bleeding episodes, missed work, and visits to the
ER, or even disability or death.
3. Patients should be able to pay their debt to an insurance company while
being covered. In AZ there is only one choice for insurance on the
marketplace. For example, if someone on this plan with a bleeding disorder
lost their job and couldn’t pay premiums then enrolled again and couldn’t
pay the debt all at once, they would be denied coverage. This would be a
significant hardship: bleeding, ER visits, loss of work, inability to pay
premiums, etc. This negative cycle does not help the patient or the health
care system. It would disproportionately hurt people like my children with
expensive chronic health conditions.
4. Essential Community Providers are important for the bleeding disorder
community to access health care. Many of our community are low-income and
medically underserved. Insurers are currently able to explain when they
can’t meet the number of ECPs in an area. Reducing a small administrative
burden for insurance companies would be a huge medical, emotional, and
financial burden for rural families with bleeding disorders.