ACTION ALERT! Access to Healthcare - We Need You!

ACTION ALERT!!!! ACCESS TO HEALTHCARE – 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 grants The PSI Government Relations Alert regarding pending Affordable Care Act (ACA) repeal legislation has been posted on the PSI website at:  http://www.patientservicesinc.org/News/ArticleID/1135 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 EXPANSION 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 members 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 level.  Market Stabilization Rule Additionally there 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 communities.  •  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 raise awareness!!   What Can You Do? Read about the proposed changes to the Affordable Care Act (ACA/Obamacare). Make a Public Comment: Go to http://www.regulations.gov 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 guide Join the Advocacy Committee at AHA – Meeting on March 27th at 6pm. Please email cindy@arizonahemophilia.org to RSVP Attend Legislative Day – April 2nd training, April 3 Lunch on the Lawn/Legislative Day. Sign up by email cristina@arizonahemophilia.org Look for our Action Alerts coming out as the healthcare changes unfold and help us create a voice for all of us! Email and call our Senators and Representatives Senators: John McCain and Jeff Flake Representatives:  Tom O’Halleran, Martha McSally, Raul Grijalva, Paul Gosar, David Schweikert, Ruben Gallego, Trent Franks, Krysten Sinema Share Your Story www.protecthealthcare.com Stay Informed Kaiser Family Found ation  http://kff.org/interactive/proposals-to-replace-the-affordable-care-act/ Commonwealth Fund, Georgetown Health Policy Institute, Urban Institute Sample Letter: 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 Stabilization rules. 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.

Affordable Care Act Update

New Report Shows Real Benefits of the Affordable Care Act for the People of Arizona

 

 On July, 31 of 2013 the Obama Administration issued a new report highlighting the benefits of the Affordable Care Act for the people of Arizona.  Thanks to the health care law, the 82% of Arizonans who have insurance have more choices and stronger coverage than ever before.  And for the 18% of Arizonans who don’t have insurance, or Arizona families and small businesses who buy their coverage but aren’t happy with it, a new day is just around the corner. 

 

“Soon, the Health Insurance Marketplace will provide families and small businesses who currently don’t have insurance, or are looking for a better deal, a new way to find health coverage that fits their needs and their budgets,” said Health and Human Services Secretary Kathleen Sebelius.   

 

Open enrollment in the Marketplace starts Oct 1, with coverage starting as soon as Jan 1, 2014.  But Arizonafamilies and small business can visit HealthCare.gov right now to find the information they need prepare for open enrollment.

 The health care law is already providing better options, better value, better health and a stronger Medicare program to the people of Arizona by:

Better Options

 

The Health Insurance Marketplace

Beginning Oct 1, the Health Insurance Marketplace will make it easy for Arizonansto compare qualified health plans, get answers to questions, find out if they are eligible for lower costs for private insurance or health programs like Medicaid and the Children’s Health Insurance Program (CHIP), and enroll in health coverage. 

By the Numbers: Uninsured Arizonans who are eligible for coverage through the Marketplace. 

·         947,878 (18%) are uninsured and eligible

·         695,083 (73%) have a full-time worker in the family

·        338,111 (36%) are 18-35 years old

·         411,776 (43%) are White

·         50,017 (5%) are African American

·         366,713 (39%) are Latino/Hispanic

·         26,771 (3%) are Asian American or Pacific Islander

·         544,266 (57%) are male

866,371 (91%) of Arizona’s uninsured and eligible population may qualify for either tax credits to purchase coverage in the Marketplace or for Medicaid if Arizonatakes advantage of the new opportunity to expand Medicaid coverage under the Affordable Care Act.

Arizona has received $30,877,097 in grants for research, planning, information technology development, and implementation of its Health Insurance Marketplace. 

New coverage options for young adults

Under the health care law, if your plan covers children, you can now add or keep your children on your health insurance policy until they turn 26 years old. Thanks to this provision, over 3 million young people who would otherwise have been uninsured have gained coverage nationwide, including 69,000 young adults in Arizona.

Ending discrimination for pre-existing conditions

As many as 2,794,358 non-elderly Arizonans have some type of pre-existing health condition, including 410,684 children.  Today, insurers can no longer deny coverage to children because of a pre-existing condition, like asthma or diabetes, under the health care law. And beginning in 2014, health insurers will no longer be able to charge more or deny coverage to anyone because of a pre-existing condition.  The health care law also established a temporary health insurance program for individuals who were denied health insurance coverage because of a pre-existing condition. 4,861Arizonans with pre-existing conditions have gained coverage through the Pre-Existing Condition Insurance Plan since the program began. 

Better Value

Providing better value for your premium dollar through the 80/20 Rule

Health insurance companies now have to spend at least 80 cents of your premium dollar on health care or improvements to care, or provide you a refund.  This means that 423,981Arizona residents with private insurance coverage will benefit from $18,711,067 in refunds from insurance companies this year, for an average refund of $71 per family covered by a policy.

Scrutinizing unreasonable premium increases

In every State and for the first time under Federal law, insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more. Arizona has received $3,000,000 under the new law to help fight unreasonable premium increases.  Since implementing the law, the fraction of requests for insurance premium increases of 10 percent or more has dropped dramatically, from 75 percent to 14 percent nationally.  To date, the rate review program has helped save Americans an estimated $1 billion.

Removing lifetime limits on health benefits

The law bans insurance companies from imposing lifetime dollar limits on health benefits – freeing cancer patients and individuals suffering from other chronic diseases from having to worry about going without treatment because of their lifetime limits. Already, 2,091,000 people in Arizona, including 769,000 women and 570,000 children, are free from worrying about lifetime limits on coverage. The law also restricts the use of annual limits and bans them completely in 2014.

Better Health

Covering preventive services with no deductible or co-pay

The health care law requires many insurance plans to provide coverage without cost sharing to enrollees for a variety of preventive health services, such as colonoscopy screening for colon cancer, Pap smears and mammograms for women, well-child visits, and flu shots for all children and adults.

In 2011 and 2012, 71 million Americans with private health insurance gained preventive service coverage with no cost-sharing, including 1,406,000 in Arizona. And for policies renewing on or after August 1, 2012, women can now get coverage without cost-sharing of even more preventive services they need.  Approximately 47 million women, including 916,996 in Arizonawill now have guaranteed access to additional preventive services without cost-sharing.

Increasing support for community health centers

The health care law increases the funding available to community health centers nationwide. In Arizona, 17 health centers operate 139 sites, providing preventive and primary health care services to 408,737 people.  Health Center grantees in Arizonahave received $67,579,387 under the health care law to support ongoing health center operations and to establish new health center sites, expand services, and/or support major capital improvement projects. 

Community Health Centers in all 50 states have also received a total of $150 million in federal grants to help enroll uninsured Americans in the Health Insurance Marketplace, including $1,435,991 awarded to Arizona health centers.   With these funds, Arizona health centers expect to hire 30 additional workers, who will assist 40,731Arizonans with enrollment into affordable health insurance coverage. 

Investing in the primary care workforce

As a result of historic investments through the health care law and the Recovery Act, the numbers of clinicians in the National Health Service Corps are at all-time highs with nearly 10,000 Corps clinicians providing care to more than 10.4 million people who live in rural, urban, and frontier communities.  The National Health Service Corps repays educational loans and provides scholarships to primary care physicians, dentists, nurse practitioners, physician assistants, behavioral health providers, and other primary care providers who practice in areas of the country that have too few health care professionals to serve the people who live there.  As of September 30, 2012, there were 274 Corps clinicians providing primary care services in Arizona, compared to 103 in 2008.

Preventing illness and promoting health

As of March 2012, Arizona had received $9,400,000 in grants from the Prevention and Public Health Fund created by the health care law. This new fund was created to support effective policies inArizona, its communities, and nationwide so that all Americans can lead longer, more productive lives.

 A Stronger Medicare Program

Making prescription drugs affordable for seniors

In Arizona, people with Medicare saved nearly $123 million on prescription drugs because of the Affordable Care Act.  In 2012 alone, 65,267 individuals in Arizona saved over $45 million, or an average of $689 per beneficiary.  In 2012, people with Medicare in the “donut hole” received a 50 percent discount on covered brand name drugs and 14 percent discount on generic drugs.  And thanks to the health care law, coverage for both brand name and generic drugs will continue to increase over time until the coverage gap is closed.  Nationally, over 6.6 million people with Medicare have saved over $7 billion on drugs since the law’s enactment.  That’s an average savings of $1,061 per beneficiary.  In addition, the average premium for a basic prescription drug plan in 2014 is projected to remain stable for the fourth year in a row, at an estimated $31 per month.

Covering preventive services with no deductible or co-pay

With no deductibles or co-pays, cost is no longer a barrier for seniors and people with disabilities who want to stay healthy by detecting and treating health problems early. In 2012 alone, an estimated 34.1 million people benefited from Medicare’s coverage of preventive services with no cost-sharing.  In Arizona, 434,397 individuals with traditional Medicare used one or more free preventive service in 2012.

Protecting Medicare’s solvency

The health care law extends the life of the Medicare Trust Fund by ten years.  From 2010 to 2012, Medicare spending per beneficiary grew at 1.7 percent annually, substantially more slowly than the per capita rate of growth in the economy.  And the health care law helps stop fraud with tougher screening procedures, stronger penalties, and new technology. Over the last four years, the administration’s fraud enforcement efforts have recovered $14.9 billion from fraudsters.  For every dollar spent on health care-related fraud and abuse activities in the last three years the administration has returned $7.90.

To see the report for Arizona visit: http://www.hhs.gov/healthcare/facts/bystate/statebystate.html

To hear stories about how the Affordable Care Act is helping people across the country visit: www.whathasobamacaredoneformelately.tumblr.com

 

Legislative Day 2013

Tyler Pulleys Experience

 

 

 

I went to the Lunch on the Lawn to meet with some legislators to help educate them on bleeding disorders.  We also wanted to see if they were in support of the Governors expansion of Medicad.  My mom and I met with 3 representatives.  One was with Rep. Larkin.  He was very interested in my factor and how much it costs every month.  All of the Representatives were very surprised at how much factor costs.  We invited them all to lunch on the Senate Lawn where we had mexican food and a mini Salsa Challenge.  It is important for us to go to Lunch on the Lawn every year so our legislators remember us and can help us with issues we might have.  And my dad had the best salsa for the 2nd year in a row!!!

Tyler Pulley- 12

Legislative Day 2013

 

 

Vickie Parra's Experience

 

Alyssa and I were hesitant, to say the least, to attend the Legislative Days Lunch on the Lawn.  This was our first time attending and really didn't know what to expect.  It was quite intimidating thinking about sitting down with Senators and Legislators, especially when you are not very political!  We arrived early and attended a meeting so that we would have some idea of what to expect.  That meeting was a breeze, raised my confidence and off we went to our meetings.  Only to have both meetings cancelled, I was disappointed but not for long!  While having lunch on the lawn, the Senator and Representative from our district sat with us and we were able to discuss the Medicaid Expansion.  We were invited into the Senate Session, were introduced and had a very pleasant experience.  We look forward to attending again next year!  As intimidating as it may sound, it is a fun/informative experience, and there are plenty of people around that are willing to help you. 

Washington Days Reflections

Diane Lee's Experience

(from left to right, Josh Schmidt, Yleana Hughes, Jessica klass,

 Sarah Fey, Jim Durr, and Diane Lee)

March 13, 2013

It was an honor to be selected to attend the National Hemophilia Foundation’s Washington Days on behalf of the Arizona Hemophilia Association this year.  The trip is a chance to really feel part of our democratic system of government while participating in a process advocating for our bleeding community.  This year the NHF had over 300 members attend to meet with the congressional leaders from all around the United States.  This was the largest turn-out for Washington Days they have ever had.  From Arizona, we were able to send a team of six and were able to meet with many of the Representative offices and Senatorial staff from Arizona. 

Our primary focus this year was to lobby for support of HR 460, The Patients’ Access to Treatment Act which would set regulations on insurance companies preventing them from creating a Tier IV prescription drug list in which they could charge a co-insurance of ten to thirty percent.  As you can imagine, this amount of co-insurance would make much of our factor and medications cost prohibitive to us even with insurance.

We also told our personal stories of how the local Hemophilia Treatment Centers (HTC)have benefited our families and requested that any cuts that may be made to budgets either spare or at least be fairly distributed across agencies.  The Center for Disease Control (CDC) and the Maternal and Child Health Bureau (MCHB) are agencies that fund and support our Hemophilia Treatment Centers and they have suffered deep cuts already.  We do not want any further cuts.

 

I was impressed at how receptive and respectful each of the offices were and how each staff member we met with expressed interest and was willing to listen to the constituent’s stories.  Many of the people we met with knew little of how expensive our medications were and I feel our stories helped to impress the importance of preventing the insurance agencies from pricing us out of our treatments. 

The trip was a fantastic opportunity for our Association to speak out and advocate for our community and I would be greatly honored to continue to speak out on behalf of our needs.

 

Together our voices cannot be ignored.  We will be heard!

 

Cindy: Healthcare Reform Update

Healthcare Reform Update

As you may know, the Supreme Court ruled that the Affordable Care Act (aka Obamacare) was constitutional. What that means is that the government can require that individuals have health insurance. However, the Supreme Court also ruled that the states do not have to expand Medicaid from 100% federal poverty level (FPL) to 133% (FPL) as was required in the Affordable Care Act (ACA).

Why does all of this matter to you? The ACA has certain requirements for the states. Arizona has to decide:

I.              What the Essential Health Benefits benchmark plan will be and report to the federal government by September 30th. Governor Brewer chose the State Employee Benefit-United Healthcare EPO with pediatric dental and vision coverage supplemental by the FED-VIP plan as the benchmark plan. It will be important to understand what is included in this plan regarding pharmacy benefits, factor product choices, etc. The plan is about 80 pages long. We are currently assessing it and will make sure to make our voices heard on any concerns for our community.

II.            Whether Arizona will operate its own Health Insurance Exchange or opt to have the federal government run it.  The exchanges are designed to help small businesses provide coverage for their employees and for individuals who are not insured through their employer. On November 28, 2012, Governor Brewer notified the feds that Arizona will not create a state-run health insurance exchange. Arizona is one of 17 other states that have rejected a state-run exchange. The federal government has the authority to step in and create exchanges in states that do not build their own.

III.           Whether to expand Medicaid from 100% FPL to 133% FPL. Children are automatically increased but the area of concern is the childless adult population, of which we have many. The ACA set up its mandates that anyone who falls above 133% FPL has access to the Exchange and will receive subsidies to help defer the costs of premiums and out of pocket costs up to 400% FPL. So if Arizona does not expand, there is potentially a gap between 100% FPL and 133% FPL. It gets even more complicated. ACA says that it will provide 100% federal funding match for newly covered populations. Medicaid does not require coverage of childless adults so these adults would qualify for 100% federal matching.  However, in Arizona through Proposition 204, AHCCCS covered children adults since 2001 up until it was discontinued through attrition starting in July 2011. On November 9, 2012, AHCCCS submitted a waiver amendment to the Center for Medicare and Medicaid Services (CMS), the federal agency that partners with states to administer their Medicaid programs. This amendment allows AHCCCS to maintain its current authority to offer coverage to childless adults at an enhanced federal medical assistance percentage (FMAP), within available resources. Without CMS approval, AHCCCS will no longer have the federal authority to cover childless adults in its program beginning January 1, 2014. If the waiver is not approved, and no other action is taken, AHCCCS will have to eliminate coverage for all remaining childless adults enrolled in AHCCCS beginning January 1, 2014.  Whether Arizona can obtain the enhanced federal match rate is critical in the Governor’s decision making as to whether the State can consider restoring coverage for childless adults. So Arizona has three options regarding the expansion of AHCCCS:

1.    Do nothing. Stay at 100% FPL and continue to reduce childless adult coverage through attrition. This means that the childless adult population will continue to decline as re-enrollment drops off. Childless adults will not be covered.

2.    Keep covering up to 100% FPL and cover childless adults up to 100% FPL

3.    Expand AHCCCS to cover up to 133% FPL

 The deadlines for implementing the Health Insurance Exchanges:

            *By October 2013 the exchanges must be operational and enrolling new   patients.

            *By January 2012 the exchanges must be fully operational and coverage begins

            *By January 2013 the exchanges must be self-sustaining (must pay for     themselves)

There is not deadline for the Medicaid expansion. The amount of federal matching to the states is just decreased each year.

The Arizona Hemophilia Association is closely monitoring the ACA as it is implemented in Arizona. We have been in contact with the governor’s office and have voiced our concerns on several occasions. We will continue to be vigilant in trying to protect product choice, out of pocket costs and provider choice. With the recent developments by the decision to have a federally run exchange, we are not sure whether the chosen benchmark plan for Arizona will still continue to be used as a guide or whether the federal government will implement something different. As soon as we know more, we will let you know. If you would like to join the advocacy committee or have any questions, please let me know. Email me at cindy@hemophiliaz.org.

-Cindy