Supreme Court Victory May Signal New Chapter for ACA

“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” summarized Chief Justice John Roberts at the end of his landmark June 25th opinion in King v. Burwell. The decision upholds the right of people in states with federally-facilitated exchanges to get “premium tax credits”, the subsidies provided under the 2010 Affordable Care Act to help low and moderate income people afford health coverage.

 

Narrowly at issue in the case was a clause saying that subsidies are available in exchanges “established by the State”, leading to a legal challenge arguing that people in the 34 states that use healthcare.gov, the federally-facilitated marketplace, should not receive the subsidies. Chief Justice Roberts’s opinion, speaking for a 6-3 majority (Justices Scalia, Alito and Thomas dissented) makes clear that this language was a drafting error and totally contrary to the intent of Congress. Recent media interviews of those involved with drafting the law also support the decision.

 

In the 1990s, Chief Justice Roberts explained, New York and other states banned insurers from denying coverage or charging higher premiums to anyone due to their bad health. In response, many bought health coverage only when they got sick, forcing health insurers to increase premiums to account for an ever sicker risk pool, causing even more healthy people to drop their insurance (known as the “death spiral”). The ACA addressed this problem by adding two reforms necessary to make the system work: (1) a requirement that all Americans (with limited exceptions) maintain health coverage; and (2) the premium tax credits. In light of this history, Chief Justice Roberts said in his opinion, Congress could not have meant for residents of the 34 states not to get federal subsidies.

 

As a result of the decision, six million Americans will not be threatened with losing their coverage and health insurance markets are not facing chaos. But it’s also critically important that the ACA has turned a corner. The major legal challenges are over. A majority of Americans now support the law. As ACA supporters, we now have a new opportunity to increase our focus on making the law work rather than refighting the battles of 2009 and 2010.

Pride table

High rates of un-insurance among lesbian, gay, bisexual and transgender (LGBT) people have finally started to drop because of the affordable, nondiscriminatory health coverage options made possible by the Affordable Care Act (ACA). The LGBT uninsured rate fell from 24.2 percent to under 18 percent in the first year of operation of ACA health marketplaces, according to national Gallup surveys. But that was still significantly higher than the 13.2 percent un-insurance rate for the U.S. population as a whole.

That’s why Health Care for All New York is reaching out to uninsured LGBT New Yorkers as they participate in Pride celebrations in June and July. Raising Women’s Voices-NY, a HCFANY Steering Committee member, will be at every Pride Month celebration in the New York City area, handing out LGBT-specific information, and collecting contact information for uninsured people and connecting them to navigators who specialize in working with LGBT consumers for enrollment assistance.

Big selling points this year are the recent New York State policy announcements requiring health insurers to cover all medically-necessary transgender care. HCFANY’s LGBT Task Force is delighted to see that the New York Department of Financial Services responded to our concerns by issuing a guidance letter covering private health plans. HCFANY is also educating LGBT New Yorkers about the March 2015 partial lifting of transgender exclusions in state Medicaid coverage.

We’re letting LGBT New Yorkers know that if they are getting married, having a baby or experiencing one of a list of “qualifying life events,” they are eligible for a special enrollment period to apply for coverage through the NY State of Health marketplace. Low-income LGBT people can apply for Medicaid or Children’s Health Insurance Program coverage for themselves and their families year-round. The third open enrollment period for ACA health coverage starts on November 15.Pride outreach

RWV-NY Community Organizer Liza Lederer and summer intern Christianna Silva were at the Brooklyn Pride festivities on June 13, handing out materials and talking with uninsured LGBT people about how to get covered. More than 10,000 people attended Brooklyn Pride, which occupied six blocks in Park Slope Community. Many of the vendors at the festival were self-employed people interested in getting health insurance for the first time, reported Lederer. The following day, June 14, RWV-NY participated in Rockland Pride, which was held in the village of Nyack, and was attended by more than 2,000 people from the Rockland LGBT community.

 

Coming up on Saturday, June 27, will be Harlem Pride, where RWV-NY staff will do outreach to uninsured LGBT people in the neighborhood. Then, on Sunday, June 28, is the big Pride Festival in Manhattan, which draws more than 200,000 people from around the country. RWV-NY staff and volunteers will be leafleting and collecting names of uninsured people along the parade route and in the exhibit and vendor area that stretches over five blocks in the West Village. Pride activities in the New York City area will conclude on July 17, when RWV-NY will have a table at Bronx Pride, which will be held from noon to 8 p.m. in Crotona Park.

 

Rate review picture

New York’s Prior Approval law protects consumers

Each year health insurance companies in New York submit applications to the Department of Financial Services (DFS) that explain their requests to raise, lower, or maintain the premiums they charge consumers for health insurance coverage. Thanks to a strong state law, New York’s DFS can reduce rate increases proposed by health insurers if they find the proposed rate is “unreasonable,” “excessive” or “unfairly discriminatory.” Under the 2010 Prior Approval law, DFS may review rates in the individual and small group (2-50) markets. Most proposed rate increases will go into effect on January 1, 2016.

DFS considers many factors when deciding whether to approve a rate proposal, including the costs of medical care and prescription drugs and the insurer’s past claims experience and financial condition.

Consumers, consumer groups, and small businesses can submit comments to challenge rate proposals that they believe are too high, but the time period to comment is extremely short. Comments must be submitted within thirty days after the insurer’s filing is posted on the DFS website.

The rate increases began to be posted on June 2.  Check the DFS website (myportal.dfs.ny.gov/web/prior-approval/rate-applications-by-company) to get the exact deadline for your own health insurer. Many comments are due before July 2nd.

 

You can make a difference!

Last year, many consumers were faced with double-digit rate increase proposals, but consumers weighed in and the average rate increases were almost cut in half.

In 2014, DFS reduced the average proposed rate increase from 12.5% to 5.7% for consumers on the individual market and from 13.9% to 6.9% on the small group market, saving policyholders in New York an estimated $1 billion!

This year, many consumers and small businesses are again facing rate increases over 10%. The weighted average for rate increases is 13.5% on the individual market and 14.3% on the small group market. Increases like these can seriously cut into family budgets and small business owners’ ability to provide health care for their employees.

 

What You Can Do:

1. Write a comment challenging your rate increase. You can do this online, through the DFS web page, or you can send it in by regular mail. The DFS web page shows you how.

To comment online:

2. Get others to submit comments

3. Get the word out on rate review and the need to act by writing a letter to the editor or through social media.

  • Sample tweet: My insurance company wanted to raise my premiums by X% next year! I spoke up and you can too! http://on.ny.gov/1ALYFCs #RateReview @HCFANY

 

What Your Comments Should Say:

Your comments don’t need to be long or complicated.  DFS wants to know how a premium increase would affect your life.  A short explanation is fine.  You may want to include:

  • The name of your insurance company and plan
  • How a premium increase would affect you and those covered by your plan
  • What changes you would have to make to afford the insurance
  • Whether you are likely to keep health insurance if the increase goes through

Your Comments Really Matter!

Full Manhattan panel

From left to right, Mark Hannay, LGBT Task Force Co-Chair; Star Morris of Callen-Lorde Community Health Center; City Council Health Committee Chair Corey Johnson; Jay Laudato, Executive Director of Callen-Lorde; David Sandman, Senior Vice President of the NYS Health Foundation; and Lois Uttley, LGBT Task Force Co-Chair.

Uninsured LGBT New Yorkers Urged to Sign Up for Affordable Care Act Health Insurance Plans by Feb. 15 Deadline

Guest Post: Lois Uttley, Director of Raising Women’s Voices – NY and C0-Chair of HCFANY’s LGBT Task Force

HCFANY LGBT Task Force members today launched a week of activities to inform uninsured LGBT New Yorkers about their coverage options and help them apply before the Feb. 15 enroll through the NY State of Health Marketplace. An estimated 1 in 4 LGBT people who would qualify for financial aid to buy health plans are still uninsured nationwide.

New York City Council Health Committee Chair Corey Johnson joined Task Force members for a kickoff press conference at the Callen-Lorde Community Health Center in Chelsea, one of several LGBT-friendly Navigator agencies participating in this week’s activities. “This week, we are getting the word out to LGBT New Yorkers in all five boroughs: Get enrolled, get covered! All New Yorkers deserve quality, affordable health insurance,” said Council Member Johnson, who facilitates the Council’s LGBT Caucus. “There is a wide variety of services available to help LGBT New Yorkers get enrolled and every effort must be made to inform the community about them. This is particularly important because there are well-documented health disparities that affect our community.”

NYS Health Foundation Vice President David Sandman noted the success of NY State of Health Marketplace so far in enrolling previously uninsured New Yorkers and the importance of the new coverage opportunities for LGBT people. “For LGBT New Yorkers, those benefits cannot come soon enough. Numerous studies have found that LGBT people are uninsured at disproportionately high rates.” The Foundation has been supporting the work of HCFANY and LGBT Navigator agencies such as Callen-Lorde.

Callen-Lorde Executive Director Jay Laudato explained his agency’s experience with providing enrollment assistance: “At Callen-Lorde, we were thrilled to be able to enroll nearly 3,000 individuals – many of whom were previously uninsured – with low and no-cost health insurance products under the Affordable Care Act..”

Other LGBT-friendly agencies participating in the week’s activities include the LGBT Community Center in Manhattan, Voces Latinas in Queens, GMHC, Mount Sinai Beth Israel, the Community Service Society and Make the Road NY, which has offices in Queens, Brooklyn and Staten Island. Information and enrollment events are scheduled in Manhattan, Brooklyn, Queens, Staten Island and Westchester County. All of these organizations belong to HCFANY’s LGBT Task Force, which has organized the week’s activities, said Task Force Co-Chair Mark Hannay.

“We want uninsured LGBT New Yorkers to know that you can apply for coverage without fear of discrimination or being turned down because of pre-existing conditions,” said LGBT Task Force Co-Chair Lois Uttley. She noted that same-sex married couples and any children they may have are eligible for family coverage. Under a new state policy, private health plans being offered in the NY State of Health Marketplace now must cover medically-necessary gender transition services. The state has also proposed lifting some of the existing restrictions on Medicaid coverage for medically-necessary transgender care.

LGBT Health Insurance Outreach and Enrollment Week is being organized by the LGBT Task Force of Health Care for All New York (HCFANY, www.hcfany.org), as part of a national week of activities, endorsed by the U.S. Dept. of Health and Human Services, to reach uninsured LGBT Americans with information about new health insurance coverage options created under the Affordable Care Act (ACA).

Organizations involved in planning and coordinating this week of events in New York include the Beth Israel Medical Center/Mount Sinai Health System, Callen-Lorde Community Health Center, Community Service Society of New York, LGBT Community Center, Make the Road New York, Metro New York Health Care for All Campaign, Raising Women’s Voices-New York and Voces Latinas.