Last week child health advocates from across the country came together in Washington, DC for the Georgetown University Health Policy Institute’s Center for Children and Families annual conference. This year’s conference theme was “Building a Strong Foundation,” including strengthening and protecting Medicaid, CHIP, and the ACA.
We heard from experts in the field on the Centers for Medicare and Medicaid Services’ (CMS) proposed changes to the Medicaid Managed Care regulations. These changes to Medicaid will affect millions of low-income kids in America. The proposed changes to the regulations would raise the standards for quality assurance and network adequacy, and strengthen other consumer protections. There were also presentations on the future of Medicaid and CHIP.
HCFANY’s Children, Youth & Families Task Force represented New York consumer advocates at the conference. Our own Lorraine Gonzalez-Camastra’s presented on “Health Coverage for People in Immigrant Families.” We also shared the news about recent New York consumer victories, like New York’s CHP effective date bill and our first-in-the-nation special enrollment period for pregnancy, in breakout sessions with consumer advocates from other states. State-based advocacy is stronger when we learn and share from one another!
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.
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.
Guest post by Yao He, Master’s Student in Public Health, Columbia University
Do high premiums discourage enrollment? Or, is a premium of any size a deterrent when it comes to seeking health insurance? How does cost-sharing (deductibles, co-insurance, etc.) play into whether people get the health care services they need? Does income level matter?
The web has been abuzz with talk of health care costs and how they affect our access to and use of health care services. Here’s a rundown on some of the more interesting pieces we’ve read of late:
It turns out that Medicaid premiums can cause enrollees to leave their plans. A new study looked at how income-dependent premiums prompted Medicaid disenrollment in Wisconsin. Medicaid beneficiaries in the state with incomes between 150-200 percent of the federal poverty line (FPL) are required to pay premiums starting at $10/month. Premium amounts increase with income. The study found that the mere presence of a premium – no matter the amount – could increase the likelihood of disenrollment by 12 percentage points. These findings offer food for thought as our own state continues to expand public health benefits. The New York State Legislature recently authorized a Basic Health Program that would include a premium of up to $20/month for beneficiaries between 150-200 percent of FPL, the same income level as those in the Wisconsin study.
If premiums can cause people to leave plans or stay uninsured to begin with, what is the effect of cost-sharing (e.g. deductibles, co-insurance) on people’s health insurance habits? And how might cost-sharing have an impact on health care costs? The answer depends in part on whether a person is healthy or sick, rich or poor…
A famous RAND Health Insurance experiment shows that the higher the cost-sharing in a plan, the less health care services people use – this makes people less costly for insurance plans to cover. But does this mean that higher cost-sharing plans result in health care savings? Not necessarily. More recent research shows that high-deductible plans with low premiums tend to attract healthier people who are naturally cheaper to cover. Moreover, the effect of high deductibles on health care cost reduction may not be sustainable. One study showed a remarkable 25 percent reduction in health care cost in the first year after the high deductible took effect, but reductions in following years were only around five percent.
The RAND study referenced above showed that lower use of care resulting from high cost-sharing does not have an adverse effect on most people’s health, especially if a person is generally healthy. However, this is not the case for those of us who are poor or sick. For people with chronic illness, cost-sharing can cause financial stress and may prompt some to skip recommended services, harming their health. If they happen to be older or live in low-income areas, they can be even worse off. Not surprisingly, less cost-sharing can ease the health and financial burdens on the chronically ill. For example, Medicaid and Children’s Health Insurance Program (CHIP), both public programs, allow those with chronic illness to get care more easily because these plans have very low levels of cost-sharing.
Finally, a new issue brief by the National Health Law Program provides a comprehensive look at how premiums and cost-sharing impact enrollment, service utilization, and health status in the Medicaid population. The brief leaves us with an important message: Medicaid can only serve its purpose to affordable coverage that meets the medical needs of the most vulnerable among us if it has the lowest possible premiums and cost-sharing. Since Medicaid beneficiaries have very low income, they are extra sensitive to the added burden of cost-sharing. At the same time, Medicaid beneficiaries are more likely to have chronic conditions and many health needs, which means unaffordable cost-sharing can force people to stop or delay using services that could improve health. This can bring bigger health issues in the future that cause more harm to people and require more expensive medical services.
Guest post from Maryanne Tomazic, Raising Women’s Voices
The national survey of 3,105 women took place in late 2013, before the end of the first open enrollment period of the new health insurance marketplaces. It showed that low income women and women of color experience high rates of being uninsured. While many women have enrolled in plans via the marketplaces (NY State of Health enrolled 189,888 women into qualified health plans as of the end of April!), others still cannot afford the cost of the qualified health plans. Still others live in states that, unlike NY, have not expanded Medicaid.
The survey also showed that cost is often a barrier to accessing health care services. Most women reported delaying or forgoing care because of cost: Two thirds of uninsured women, 35% of women with Medicaid, and 16% of women with private insurance. Other barriers to healthcare included being unable to take time off of work, not being able to get child care, and lack of transportation.
These survey results show that even though the Affordable Care Act has expanded and continues to expand coverage options and make insurance more affordable, steps are still needed to make sure women are able to get and use the care they need.
For the full report, click here.