We still have a ways to go before we hear the final yea or nay from the Supreme Court on the ACA.  This time on hand has left many to ponder…”what if?”  Well, there’s a lot to think about.  But, being that this is National Women’s Health Week, it seems appropriate to focus today on the effects on women’s health.

In this short clip, Jessica Arons, Director of the Center for American Progress’s Women’s Health and Rights Program explains the consequences that a repeal of the ACA would have on the millions of women who benefit from it.

Take a gander!

Not sure if anyone caught this, but a couple of months ago (3/19) Martha Stewart hosted National Physicians Alliance (NPA) President Dr. Valerie Arkoosh onto her show to talk about the Affordable Care Act. 

Valerie did an amazing job of explaining the law in a way that makes sense to a broader television audience, even spelling out many of the benefits available to specific populations, like seniors and children.  She also gave some insights into why this is such a contentious issue for many folks (i.e. politics, misinformation, and the individual mandate).  It’s worth a watch, if you get a chance!

 Watch the segment here.

Lois Uttley of Raising Women’s Voices and Gloria Steinem, Co-Founder, Ms. Foundation for Women

Just wanted to send a hearty round of applause to HCFANY’s own Lois Uttley and Jasmine Burnett, who were both honored last night with the Ms. Foundation’s annual Gloria Award. 

The Gloria Awards honor women activists who fight for change on behalf of women, families and communities.

Lois gave a speech to a packed room of over 400, promising that “Raising Women’s Voices NY will be working hard with our allies on creation of a state health exchange that will offer affordable coverage to more than 1 million un-insured New Yorkers.”

Also honored last night were Louise Gund, Artist, Conservationist, and Entrepreneurial Philanthropist, Sheila Nevins, President, HBO Documentary Films, Gert Boyle, Chair of the Board of Columbia Sportswear Company, Klarissa Oh, Executive Director of Oregon Abuse Advocates and Survivors in Service, and Felicia Brown-Williams, Regional Director of Public Policy of Planned Parenthood Southeast.

Congratulations to all these amazing women!

Guest Blogger, Maryanne Tomazic, Field Coordinator, Raising Women’s Voices

This weekend is Mother’s Day. My inbox is full of e-mails from various fruit, flower, and chocolate companies reminding me to send a gift to my mother. Unfortunately, my mom doesn’t like those traditional gifts. I once bought her a box of pears – to which she pointed out I could get twice as many pears for half the price at Costco. When I bought her a bouquet of white tulips, I received an angry voicemail reminding me that in Chinese culture, white flowers were synonymous with death. And chocolate – well that just brought on the rant of overpriced gifts with useless wrapping that is a ploy to make me waste my money on nothing.

“If you want to give me a present,” she always said. “Go to school, get good grades, and get a good job.”

The wish for a good job was just as much about financial independence as it was about the time-sensitive concern of insurance. Our health insurance company would only include me in the family plan if I was under 21 years old, or if I was under 23 and still in school.  In either scenario, upon graduation, I would need to have a job with health benefits by July or, much to my mother’s fear, become uninsured.

My mother didn’t have to worry because I was fortunate to get a job with great health benefits. But not all of my friends were as lucky. Many of them graduated and couldn’t find a full-time job or a job that offered health care coverage. They became uninsured and unable to afford the care they needed to stay healthy.

Luckily, my friends have the perfect gift for their moms this Sunday: the ability to stay insured.

Because of health care reform, children up to age 26 can stay on their parents’ health care plan as long as their own employer does not offer health benefits. What a relief for mothers across the country! No more worrying about that two month crunch to find a job, or the need to have their child stay in school simply to receive health insurance. Children don’t even need to be living at home to stay on their parents’ plan. They can maintain access to the medical care they need, during one of the most uncertain times of their life.

So for all you young adults out there with mothers like mine – who hate traditional gifts and only want promises that your future is taken care of – you now have the perfect gift.  You won’t need to wrap it or even worry that it won’t come in time, because it is already here. Over 150,000 young adults in New York have gained coverage because of this provision, and you can be one of them too.

Happy Mother’s Day, Mom!

For more information about how moms benefit from health care reform, visit Countdown to Coverage or the Coverage Checklist: Moms and Our Families. Also check out our Twitter and Tumblr for pictures of moms & kids who love the benefits they get from health care reform!

See, as part of the ACA, insurers who offer health coverage to individuals and small businesses must spend at least 80% of what their enrollees pay in premiums on health care claims and quality improvement activities (in NY, state law actually requires this to be slightly higher, at 82%).  The other 20% or so can be used for administrative expenses like marketing and profits.  For large employer plans, insurers have to spend at least 85% on claims and quality improvement.

These new rules went into effect on January 1st of last year, which means the rebates have now started to trickle down to us real folks.   Here in New York, some of us have already gotten our rebates.  A new report issued by the Kaiser Family Foundation (KFF) is estimating that rebates in New York will average around $150 for people who buy insurance on their own, and $125 for small business enrollees.  For large employer enrollees, rebates are expected to average $142. 

In total, individuals and businesses in the US are expected to get back a total of $1.3 billion – that’s no small peanuts.  Thanks health reform!

Click here to read the full KFF report, titled “Insurer Rebates under the Medical Loss Ratio: 2012 Estimates.”

Or, to learn more, here are a couple more articles on the subject from around the Web:

• “Insurers Expected to Refund $1.3 Billion To 15.8 Million Enrollees Under Reform Law,” Bloomberg BNA
• “Small Businesses to Get IOUs From Health Insurers,” John Arensmeyer, Founder and CEO of the Small Business Majority, for the Huffington Post’s Small Business America

Well, today’s health reform update webinar was a success! Perhaps too successful – we had so many people sign up that the system went over capacity and many were not able to join in.

To compensate, HCFANY will be hosting a 2nd webinar presentation for folks who were not able to make it into today’s.  This will be held next Thursday, May 10th, at 1:00 PM.

Click here to RSVP

Again, please remember to RSVP as soon as possible as space is limited! 

To view the presentation from today’s webinar (which is the same which will be used for next week’s webinar) click here!

For an who were not able to make today’s or next week’s presentation, Thursday’s presentation will be recorded and posted on the web for future use.

The money is part of the more than $728 million that has been issued to support 398 community health center renovation and construction projects around the nation. This additional funding is expected to help community health centers care for more patients, and create new jobs.

This is all part of a larger series of capital investments that the ACA is financing for communtiy health centers.  Over the next five years, the law will provide $9.5 billion to expand services, and $1.5 billion to support major construction and renovation projects at community health centers. 

New York’s recipients are as follows:

Buidling Capacity Grant Award

• Sunset Park Health Council, Inc., (Brooklyn) – $5,000,000
• Community Health Center of Buffalo, Inc. (Buffalo) – $5,000,000
• Charles B. Wang Community Health Center, Inc. (New York) – $3,000,000
• Covenant House (New York) – $2,495,475
• William F. Ryan Community Health Center, Inc. (New York) – $4,658,340
• Open Door Family Medical Center, Inc. (Ossining) – $3,272,528
• Hudson River Health Care (Peekskill) – $4,500,000
• Hudson Headwaters Health Network (Queensbury) – $5,000,000
• Community Health Center of Richmond (Staten Island) – $2,790,150

Immediate Facilty Improvement Program Grant:

• Whitney M. Young, Jr. Community Health Center (Albany) – $500,000
• Montefiore Medical Center (Bronx) – $482,050
• Morris Heights Health Center (Bronx) – $500,000
• Brooklyn Plaza Medical Center, Inc. (Brooklyn) – $498,184
• Sunset Park Health Council, Inc. (Brooklyn) – $500,000
• Northwest Buffalo Community Health Center, Inc. (Buffalo) – $500,000
• Middletown Community Health Center, Inc. (Middletown) – $500,000
• Community Healthcare Network (New York) – $500,000
• Settlement Health and Medical Services (New York) – $490,000
• The Institute for Family Health (New York) – $500,000
• William F. Ryan Community Health Center, Inc. (New York) – $99,187
• Hudson River Health Care (Peekskill) – $420,000
• Finger Lakes Migrant Health Care Project, Inc. (Penn Yan) – $277,717
• Rochester Primary Care Network (Rochester) – $498,500

For a full list of recipients in every state, click here and here.

Thankfully, we here at HCFANY are on top of it! We’re hosting a webinar this Friday, May 4th from 12:00 Noon – 1:00 PM, to update everyone on what’s been going on with health reform in general, and then more specifically on the Executive Order to establish a NYS health insurance Exchange.

The webinar is free and open to anyone who wants to join, but space is limited! So, be sure to RSVP today to reserve your spot on.  If you have any questions, be sure to bring those too as there will be time for Q & A.

Click here to RSVP!

If you won’t be near a computer during that time, but still want to listen in to the audio portion only, you can do so by dialing (712) 432-0080 and using the passcode 178-816# when prompted. 

Hope you can join us!

In case you missed it, the NY Times broke a story last week out of Minnesota about a practice that is becoming more and more common around the country: Hospitals that are embedding debt collectors as employees to try and get patients to make good on their debts – sometimes even before they are treated.

Now, we know that with so many folks walking around with no insurance many hospitals are in a pickle.  After all, lack of insurance – or lack of good insurance for that matter – has never stopped anyone from getting hit by a bus.  Then again, most hospitals do receive millions each year to compensate them for unpaid medical bills and to provide financial assistance. 

But, regardless of how you look at it, the whole practice just seems extremely underhanded.  Often patients – who are vulnerable, either recovering from or still in need of medical care – don’t even realize that they are talking to a debt collector. 

Thankfully, there may be some changes coming down the line that may put the kibosh on these types of sketchy hospital practices.  A recent guest blog on Community Catalyst’s Health Policy Hub points out that the Affordable Care Act now requires non-profit hospitals to screen patients to see if they are eligible for financial assistance before engaging in “extraordinary collections practices.”  Of course, how this all plays out will remain to be seen.  At any rate – it’s definitely an issue to watch!

Click here to read the full story, titled “Debt Collector is Faulted for Tough Tactics in Hospitals,” via the New York Times.

Click here to read the Health Policy Hub blog post, titled “The Debt Collector Will See You Now,” from guest blogger Amanda Moore of the Sargent Shriver National Center on Poverty Law

A new report put out by the Employee Benefit Research Institute (EBRI) looks at national trends in employer-sponsored benefits between 1997 and 2010.  Not surprisingly, what they are finding looks pretty darn grim.  During that time:

• The percentage of workers who are offered health insurance benefits by their employers has declined from 70.1% to 67.5%, and the number of workers covered by those plans fell from 60.3% to 56.5%.
• The percentage of workers who actually take up coverage when offered it from their employers also fell from 86% to 83.6%.
• The percentage of workers who turned down employer health insurance offers because they could not afford it went up from 23.2% to 29.1%.

This is pretty troubling stuff, but we’ve known for a while that health insurance costs are getting to be too much for many employers and more and more have to either raise prices for employees or drop coverage altogether.  This is also the same reason why the Affordable Care Act came about.  Essentially, the “free market” is pricing too many of us working folks out of decent health care.  Once implemented, a New York Health Insurance Exchange should start to alleviate this problem for a lot of folks and employers in our state. 

Click here to read the full EBRI report, titled “Employment-based Health Benefits: Trends in Access and Coverage 1997-2010.”

Got 5 minutes to kill? Or, maybe you are super busy but need to cleanse the ol’ mental palate? Well, the Kaiser Family Foundation just put out a nifty little quiz to test your knowledge on the uninsured.  Why not give it a try?

It’s short – 10 questions – but some of them are a little tricky.  I’m proud (and relieved) to report that this blogger got 10 out of 10 right.  So, go ahead – test your brain power! You might learn something new.  And if you don’t, well, then you can go ahead and brag about it to all of your friends.

Click here to take the quiz.

There’s an article out by Nina Bernstein about the latest in what seems to be an ever-growing list of insurance company shenanigans.  This time, it has to do with provider reimbursement rates for out-of-network care. 

You see, back in 2009 the state reached a settlement with insurance plans that required them to create a new database which used a fair method for calculating reimbursements to providers.  The insurance plans dutifully did as they were told and created this new database, at a cost of $95 million.  The problem is, they never used it.

Instead, they came up with a different way to price reimbursements, which ends up costing patients who must rely on out-of-network care much, much more. And, while this issue of pricing out-of-network reimbursements is a complex one and definitely part of a much larger problem surrounding health care costs in general, it really does highlight the need for improved health insurer regulations.  This issue is of particular importance at this moment while our state policymakers are busy designing how our forthcoming state health insurance Exchange will work.  Clearly this is an opportunity to make some much needed changes to our system!

Anyways, the article is a good one, and you should definitely check it out when you get a chance.  Click here to read today’s article in the NY Times, titled, “Insurers Alter Cost Formula, and Patients Pay More.”

Yesterday, the NYS Department of Financial Services (DFS) announced that they had fined Rochester-based Excellus Health Plan $995,000 for violation of several insurance laws.

Apparently, between 2003 and 2007, the company improperly denied 166 emergency room claims and failed to explain coverage to plan members in 337,689 instances.  Excellus has stated that the denied claims had to do with a computer error and that consumers have since been reimbursed for these improperly denied claims. They didn’t seem to have a good excuse as to why they never sent an explanation of benefits to the other 337,689 folks, and what effect that had, suffice to say that all but a few claims in those cases were covered.

Kudos to the DFS for catching these big errors! Hopefully it will give our insurance plans a better incentive to make sure that nobody else is asleep at the switch in the ol’ quality control department.

Click here to view the DFS press release on the matter.

Click here to view the stipulation signed by Excellus in agreeing to correct the violations.

If so, then you are in luck! Yesterday, HCFANY’s own Elisabeth Benjamin made a guest appearance on WNYC’s Brian Lehrer Show to talk about Governor Cuomo’s Executive Order and what it means for New York.

Specifically, she goes over what’s at stake for consumers, why the Governor needed to take action via Executive order, and how the Exchange will actually work.

Click here to listen to an audio recording of the show.

Correction to the webcast: In New York State, more than 800,000 small business workers have lost their employer health insurance in the past decade.

He did it!!! Today at noon, Governor Cuomo issued an Executive Order to establish a New York State Health Insurance Exchange (#42).

It’s been a long and rocky road in getting this thing established.  And, while this has proved to be a contentious issue in our state legislature, no amount of partisan folly can deny that this is New York’s best shot at cutting costs and making the health insurance market work for our state’s working families and small businesses.

While an Executive Order is not the best scenario we could have hoped for, we’re happy to see that Governor Cuomo has held his ground on this issue and is moving forward to address the long-standing problems that have plagued our health insurance market.

It looks like the Exchange will be housed in the Department of Health and will have regional advisory committees consisting of “consumer advocates, small business consumer representatives, health care providers, agents, brokers, insurers, labor organizations, and any other appropriate stakeholders.”  These committees will “provide advice and make recommendations on the establishment and operation of the Exchange, including recommendations about relevant regional factors, and shall provide opportunities for public input on such matters.”

We’ll keep you posted when we know more about how this will play out, but for now let’s just all take a moment to sit back and breathe a BIG sigh of relief!

 A copy of the Governor’s press release and Executive Order can be found by clicking here.

Despite false rumors of a late-night Good Friday/Passover Executive Order & press event last week, nothing of substance has materialized.

So we’re waiting – along with the rest of our fellow New Yorkers – patiently.  Oh, so patiently… 

The American Cancer Society recently came out with an “Exchangeopoly” board game to illustrate the many processes that need to take place before the Exchange can become operational.  This includes not only making key policy decisions, but also lots of fun things like: issuing RFP’s, developing software platforms, hiring and training new staff, and developing marketing campaigns.  Best of all, it all takes place on an expedited schedule!

It really brings into perspective how much goes into building an Exchange.  And, not just any Exchange – a good, consumer-friendly one.  It also really makes one rue the day that last year’s legislative session ended with no vote on the Exchange bill from our State senate.  Another year to work on this would have definitely made things easier.  Of course, New York State is definitely not one to back down to a challenge.  We can get our Exchange going by 2014, we’re just going to have to work a bit harder to do so. 

Of course, we’re still waiting on that Executive Order…we’ll keep you posted once we have more details on that.  In the meantime, enjoy Exchangeopoly!

The final day of arguments focused on two main points: Can the individual mandate be separated from the rest of the law, and does the law’s Medicaid expansion put undue hardship on states?

On the first question on the severability of the mandate, opponents of the law claim that if the individual mandate is struck down then the entire law should just be scrapped.  The idea here is that the mandate is pivotal to too much for the law to work without it (funny, because the many different parts of the law already in place seem to be working just fine now, but maybe that’s just my own opinion).

On the flip side, supporters say that if the mandate is struck down then only one or two related bits of the law should go, but not the whole thing.  But, turns out its harder to argue for reworking the law and fixing the holes left should the mandate be pulled than to just go back to the drawing board (single-payer, anyone?).  And, if you read Henry Aaron’s recap (below) it appears that maybe the government didn’t actually want to win the severability argument anyways, because it will just make it that much easier for the court to strike down the individual mandate.

The second argument, regarding Medicaid, played out a bit differently.  Basically, under the ACA, the eligibility level for Medicaid is being expanded up to those who earn up to 133% of the federal povertyr level (just under $15,000 per year).  To pay for this increase in the Medicaid rolls, the federal government will pay 100% of the cost, and then 90% after 2020.  Just to give a reference point here, in New York the feds pay for about 50% of our Medicaid program.  So, yeah, even 90% is pretty generous. 

The point of contention here, however, is that the ACA also gives the Secretary of Health and Human services the power to take away all Medicaid funding for any state that chooses not participate in the expansion.  Opponents of the law say that this amounts to coercion.  Basically, they are saying that they don’t want to have to accept tons of free money to give more of their constituents free quality healthcare. 

But, just because the Secretary can take away Medicaid funding doesn’t mean she will.  Why punish the poor for having bad state policymakers?  Besides, there have been other Medicaid expansions in the past that carried similar requirements for states, and none of those ever resulted in a state losing funding.

 Again, the court arguments never really seemed to waiver from party lines.  Conservative justices tended to agree with opposing arguments.  More liberal justices went with supportive arguments.  But, that doesn’t necessarily mean anything at this point.  The real decisions will all be made behind closed doors in the next few months.  So, I guess that’s all she wrote for now!

To beef up a bit more on the proceedings of Day 3, here are a few good summaries from around the web:

• The Final Day of Legal Arguments over the Health Care Law (Henry Aaron, Brookings Institute)
• Health Reform in the Supreme Court: Day 3 Audio, Transcript (PBS Newshour)
• Supreme Court considers whether to let parts of health care law stand (CNN)

• Medicaid Expansion Caps Supreme Court Arguments (NPR)

However, media reports are now indicating that Governor Cuomo does not plan to turn his back on the millions of small businesses and families in New York who are being crushed by the cost of health insurance.  Instead, he plans to do what’s responsible and issue an Executive Order to establish a New York Health Insurance Exchange!

Call Governor Cuomo’s office TODAY to thank him and support his plan to issue an Executive Order to establish a New York Health Insurance Exchange this week!

CALL (518) 474-8390

No matter what happens in the Supreme Court, New York still needs to fix its insurance market.  While an Executive Order cannot accomplish everything that legislation would have done, it will still move the state government forward in helping New Yorkers in need.

Establishing an Exchange is vital for New York for three reasons:

1. With an Exchange, New York’s health care costs for those who get their insurance through small businesses will drop by 22%.  If small group premiums drop this significantly, businesses will be able to hire new workers instead of struggling to keep up with skyrocketing premiums.  In addition, folks who buy insurance on their own on the individual market will see costs drop by 66%! Lower health costs will make New York’s economy stronger.
2. There are currently over 2.8 million New Yorkers living without health insurance because they cannot afford it.  An Exchange will make quality, affordable health insurance options available to all, and 1 million New Yorkers are expected to newly gain coverage as result.
3. Establishment of an Exchange will allow New York State to draw down millions in federal funds to help get our Exchange up and running and helping New Yorkers as soon as possible.

Don’t wait! Call today!

So, Day 2 of the oral arguments on the ACA challenges before the Supreme Court wrapped up yesterday, and the debates heard were significantly more lively than those of Day 1.  First on the table was the basic question of whether or not Congress has the power to say that uninsured people have to buy health insurance. 

To this, Solicitor General, Don Verilli made the point that since Congress has the power to regulate the insurance market and anything affecting it, Congress can regulate people who don’t have insurance.

This brought about the second question of if this is within Congress’ power, to regulate health care in the name of commerce, then where do we draw the line on what they can and cannot make us buy? 

Here, of course, is where things started to get sticky.  Verilli basically made two points to the effect that health insurance is not like any old commodity here.  Health insurance is different in that:

1. Everyone uses health care and most use insurance at some point in their lives.
2. Folks who don’t have insurance but who use health care end up pushing additional costs onto those who do buy insurance (in economic terms, this is considered a “negative externality”).  These costs come in the form of hidden taxes on insurance premiums, charity care provided with tax dollars, etc., which all mean higher insurance rates.

Unfortunately, Economics 101 (or Insurance 101, for that matter) does not appear to have been a required course for many of our Supreme Court justices and several of the conservative justices seemed to have a lot of trouble wrapping their heads around that second point. 

Most unfortunately for all, that the basic question of where we draw the line between what Congress can and cannot make us do is pretty near impossible to define. Several of the justices questioned the idea that if Congress is allowed to require uninsured people to buy insurance, then this will open the door to allowing them to require anyone and everyone to buy any other old commodity like broccoli or electric cars.  However, the key difference between health insurance and other commodities (as good for us as they may be) is pretty stark if you are familiar with the insurance industry.  See, if you don’t buy broccoli or an electric car, it’s not going to push additional costs on those who do. More importantly, not everyone will need broccoli or an electric car in their lifetimes, but everyone will need health care at some point in their lives. And if folks suddenly and unexpectedly find themselves wanting some broccoli or an electric car, their life will not be at risk and so nobody is going to just give it to them and then shift the costs to others like they do with healthcare.

But, again, it’s not clear that this point fully came across to all of the justices.  So I guess we’ll see what happens.

In the meantime, here are a few links to some good summaries of yesterday’s events:

• Supreme Court divided over health care mandate (CNN Justice)
• The Second Day of the Supreme Court’s Hearing on the Health Care Law (from the brilliant Henry Aaron, of the Brookings Institute)
• Day 2 at the Supreme Court: Individual Mandate and the ‘Broccoli Possibility’ (Medscape Medical News)

And of course, to lighten your spirits, please enjoy a clip from everyone’s favorite Supremes (above). 

On the agenda for tomorrow, a recap of today’s arguments on: severability and…Medicaid!