CHA Blog

• 17Aug

  Health Reform Gives Some Immediate Benefits for Californians

  Health Care Reform, Medicare and other health insurance, Prescription drugs, Resources No Comments

  Health care reform changes are vast and include many changes that will affect Americans now and in the future. While we’ve focused several articles on the changes affecting Medicare and Medicare beneficiaries, this article below, focuses on those affecting Californians old and young. Excerpted from the Passages HICAP Recap July-August 2010 newsletter (PDF), this article lists some of these changes and explains some of the immediate benefits impacting Californians.

  Small business tax credits

  503,000 small businesses in California could be helped by a new small business tax credit that makes it easier for businesses to provide coverage to their workers and makes premiums more affordable. Small businesses pay, on average, 18% more than large businesses for the same coverage, and health insurance premiums have gone up three 3 faster than wages in the past 10 years. This tax credit is just the first step towards bringing those costs down and making coverage affordable for small businesses.

  Closing the Medicare Part D donut hole

  Last year, roughly 382,000 Medicare beneficiaries in California hit the donut hole, or gap in Medicare Part D drug coverage, and received no extra help to defray the cost of their prescription drugs. Medicare beneficiaries in California who hit the gap this year will automatically be mailed a one-time $250 rebate check. These checks began being sent to beneficiaries in mid-June and will be mailed monthly throughout the year as new beneficiaries hit the donut hole. The new law continues to provide additional discounts for seniors on Medicare in the years ahead and completely closes the donut hole by 2020. (See our past blog article, Are You Eligible for the Part D Rebate: Q & A for more info.)

  Support for health coverage for early retirees

  An estimated 430,000 people from California retired before they were eligible for Medicare and have health coverage through their former employers. Unfortunately, the number of firms that provide health coverage to their retirees has decreased over time. On June 1, 2010, a $5 billion temporary early retiree reinsurance program started to help stabilize early retiree coverage and help ensure that firms continue to provide health coverage to their early retirees. Companies, unions, and state and local governments are eligible for these benefits.

  New consumer protections in the insurance market beginning on or after September 23, 2010

  • Insurance companies will no longer be able to place lifetime limits on the coverage they provide, ensuring that the 19 million California residents with private insurance coverage never have to worry about their coverage running out and facing catastrophic out-of-pocket costs.

  • Insurance companies will be banned from dropping people from coverage when they get sick, protecting the 2.7 million individuals who purchase insurance in the individual market from dishonest insurance practices.

  • Insurance companies will not be able to exclude children from coverage because of a preexisting condition, giving parents across California peace of mind.

  • Insurance plans’ use of annual limits will be tightly regulated to ensure access to needed care. This will protect the 16.2 million residents of California with health insurance from their employer, along with anyone who signs up with a new insurance plan in California.

  Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim. Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care.

  Extended coverage to young adults

  Beginning on or after September 23, 2010, plans and issuers that offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy until they turn 26, unless the adult child has another offer of job-based coverage in some cases. This provision will bring relief to roughly 196,000 individuals in California who could now have quality affordable coverage through their parents. Some employers and the vast majority of insurers have agreed to cover adult children immediately.

  Affordable insurance for uninsured with preexisting conditions

  $761 million federal dollars are available to California starting July 1 to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the Federal government. The program is a bridge to 2014, when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the Federal government will administer the program for those residents.

  Strengthening community health centers

  Beginning on October 1, 2010, increased funding for Community Health Centers will help nearly double the number of patients seen over the next 5 years. The funding could not only help the 1,049 Community Health Centers in California but also support the construction of the new centers.

  More doctors where people need them

  Beginning October 1, 2010, the Act will provide funding for the National Health Service Corps ($1.5 billion over 5 years) for scholarships to help the 1,049 Community Health Centers in California but also support the construction of new centers and loan repayments for doctors, nurses and other health care providers who work in areas with a shortage of health professionals. This will help the 9% of California’s population who live in an underserved area.

  New Medicaid options for states

  For the first time, California has the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status. For more information on health care reform issues visit: www.healthcare.gov.

  Also see our article, What Does Health Care Reform Mean for Beneficiaries? Summary of Key Provisions.

• 12Jul

  HHS Launches Health Care Options Website

  Health Care Reform, Medicare and other health insurance, Resources No Comments

  On July 1st, the US Department of Health and Human Services launched a new website (healthcare.gov)  to empower people with information and resources about their health care. The website is organized for 6 groups of users: 1) families with children; 2) individuals; 3) people with disabilities; 4) seniors; 5) young adults; and 6) employers. The site helps people find information on their insurance options, learn tips tailored to their particular condition/age on prevention and how to stay healthy, and understand the various components of the new health care reform laws.

  It also helps people compare hospitals using 44 quality of care measures. This section links to HospitalCompare.hhs.gov, a web tool created by the Centers for Medicare & Medicaid Services (CMS), HHS, and members of the Hospital Quality Alliance. In the past, this site only had data about the quality of care provided to hospital inpatients. As of July 7, 2010, however, it now has “data on the rates of outpatient MRIs for low back pain, outpatient re-tests after a screening mammogram, as well as two ratios that explain how frequently outpatient departments gave patients ‘double’ computed tomography (CT) scans when a single scan may be all that is needed….[It] also includes new measures that show whether outpatients who are treated for suspected heart attacks receive proven therapies that reduce mortality such as an aspirin at arrival, and how well outpatient surgical patients are protected from infection,” (see CMS press release). In the future, comparison information for nursing homes and dialysis centers will also be added, based on language in the Patient Protection and Affordable Care Act (PPACA) that requires broader quality of care information to be publicly available.

  The section on health reform is extensive and provides a summary of the legislation, links to the law’s text and major provisions, and detailed information on 7 major topic areas. These areas include: the pre-existing condition plan, how health reform strengthens Medicare, young adult coverage, early retiree coverage, small employer tax credits, the Patients’ Bill of Rights, and the $250 Part D donut hole rebate. This section also provides a timeline for what’s changing and when according to the health care reform law.

  As this is a new website, HHS invites comments and feedback to help make it even better. Some additional website improvements on the way include a full Spanish translation, which will be available at the end of July, and price information for private insurance plans, which will be available in October 2010.

  The website is a first of its kind, providing over 500 pages of information in a user friendly, easily search-able way. In fact, according to White House New Media Director, Macon Phillips, this site’s design was inspired and guided by the question, “How would [a travel website like] kayak.com approach health insurance?” The result is a design with simple, focused searching that allows users to answer a few short questions and quickly find the info they require.

  Questions and suggestions regarding healthcare.gov can be sent to public@who.eop.gov.

  For more information on health reform and Medicare, see our article, “What Does Health Reform Mean for Medicare Beneficiaries? Summary of Key Provisions.”

• 01Jul

  Obama Holds Tele-Town Hall Meeting to Discuss Health Reform with Seniors

  Health Care Reform, Low-income help, Medicare Advantage, Medicare and other health insurance, Medicare basics, Prescription drugs No Comments

  Early last month, President Obama hosted a ‘tele’-town hall meeting for Medicare beneficiaries about the Affordable Care Act and Medicare fraud prevention efforts in light of the first $250 donut hole rebate checks that were sent out mid June. This meeting can be viewed online at whitehouse.gov.

  In this video, President Obama discusses the following topics:

  (Note: By clicking on a linked question, it will take you directly to that section of the video.)

  • Why does it take 10 years to close the doughnut hole completely?
  • Will Medicare Advantage changes hurt benefits?
  • Is there more support for primary care?
  • How does reform affect living independently vs in a nursing home?
  • Are Medicare & Social Security going to run out of money for future generations?
  • What’s going to happen to COBRA subsidies?

  For more information on health care reform and Medicare, see our article, What Does Health Reform Mean for Medicare Beneficiaries? Summary of Key Provisions.

• 07Jun

  Update on the Medicare Physician Payment Cut & COBRA Subsidy Extension

  Medicare and other health insurance, Medicare basics No Comments

  In the end of May, the House passed the “extenders” bill (HR 4213), which would extend a series of expiring unemployment and tax benefits and delay the 21% cut to physicians’ Medicare payments until 2012. Physicians’ Medicare payment rates would be increased by 2.2% for the remainder of 2010 and by 1% in 2011, before the payment formula would revert to the current formula in 2012. The bill would also eliminate the extension of COBRA subsidies for unemployed workers.

  The Senate, however, failed to pass the bill before their week-long Memorial day holiday break. Because the Medicare physician payment cut was set to be effective as of June 1,  CMS instructed Medicare contractors to delay processing medical claims for 10 business days, or until June 14.  This gives the Senate one week to review, amend the bill, and send it back to the House for a revote.

  For more information, see the following 2 articles:

  • ‘Extenders’ Bill Passes House
  • AMA to Campaign for Medicare Payment ‘Doc Fix,’ Physicians Increasingly Frustrated

• 24Mar

  Health Reform is Now Law – Immediate Changes Take Effect

  Health Care Reform, Medicare and other health insurance 2 Comments

  President Barack Obama signed historic health reform legislation on Tuesday, March 23, 2010. This legislation will provide security and stability for people with coverage, and new, affordable choices for those without insurance. The bill is expected to reduce the number of uninsured Americans by 32 million by 2014 (when the bill is fully implemented), and prevent people from becoming uninsured due to a loss of income, being between jobs, or due to health status.

  Many changes will happen within these 4 years of implementation and several changes, such as providing some financial assistance for Medicare beneficiaries who reach the Part D donut hole this year, will take effect immediately. As summarized in an article by Health Access, for Californians in 2010, the health reform will:

  1. Prevent people from being denied coverage based on “pre-existing conditions.”

  • Soon, people who are uninsured due to a pre-existing condition will be able to buy insurance through a special insurance program. Right now, Californians are left in a lurch: our state has a small, underfunded “high-risk pool” that currently has a waiting list–even though it is estimated that over 400,000 have been denied coverage due to health status.
  • Within 6 months of passage, no new health plan will be able to discriminate against children with pre-existing conditions.
  • In a few years, no insurance plan will be able to deny coverage to anyone for pre-existing conditions.

  2. Provide people with more security, by outlawing the worst insurance company abuses. Insurance companies will:

  • No longer be able to cancel insurance coverage retroactively when you get sick. Over 6,000 Californians had their coverage rescinded in the past several years, and health reform would end the practice of rescission.
  • No longer be able to put lifetime limits on the dollar value of benefits
  • No longer be able to place co-payments or cost-sharing on key preventive benefits

  3. Provide real relief to young adults and their families, to seniors, and to small businesses. Health reform will:

  • Allow young adults up to age 26 to stay covered on their parents’ insurance
  • Reduces prescription drug costs for seniors. Seniors whose spending falls into Medicare’s prescription drug donut hole will have hundreds of dollars of immediate help and the entire coverage gap will be eliminated over time.
  • Gives subsidies to small businesses. Small businesses choosing to offer coverage to workers will receive a tax benefit of up to 35% of premiums.

  The Senate also started its debate today on a package of “reconciliation” improvements that were passed by the House of Representatives. They are expected to vote on the package before the end of the Easter recess at the end of the week.

  More details on how health care reform will directly affect Medicare beneficiaries is coming soon. Note that no Medicare benefits will be cut due to reform; all legislative changes affecting Medicare are positive for beneficiaries. Medicare Advantages payments are frozen which could result in MA plans deciding to drop some of their non-Medicare covered benefits, and/or raise premiums and copayments. While CHA sees this as a positive step (MA payments being frozen) as MA plans on average cost Medicare 14% more than if the same services were provided through fee-for-service Medicare, many MA plans do not and have marketed these legislative changes as negative for their enrollees.

  Stay tuned for more info!

• 22Mar

  Health Care Reform Passed! House Approves Senate Health Reform and Corrections Bill

  Health Care Reform, Medicare and other health insurance No Comments

  On Sunday night (3/21/10), House Democrats approved the Senate health reform bill (HR 3590), which now proceeds to President Obama to be signed into law on Tuesday. The so-called “corrections” bill (HR 4872), which contains a series of changes favored by the House, was also passed and will be voted on by the Senate within the next week, requiring a majority vote (51 votes) to pass.

  Sunday’s vote is  major victory for ensuring a comprehensive and historic health reform package that provides more security and stability for those who have coverage, and new, affordable options for those that don’t. While 23 million are still predicted to be uninsured in 2019 under this legislation (1/3 of whom would be undocumented immigrants), it would expand coverage to 32 million uninsured in that same time frame and help control health care costs. It would also lower the federal deficit by $143 billion over the first 10 years and by more than $1 trillion over the second 10-year period. As President Obama noted in his televised address after the vote, “this isn’t radical reform,  but it is major reform.”

  Many health care consumers, both the insured and the uninsured, will benefit greatly under the proposed bill. In addition, most consumers will be required to have coverage, yet significant reforms and relief will be available to help people meet that requirement.

  Below are some highlights summarized by Health Access on how the bill will affect those currently with insurance and those without.

  IF YOU ARE INSURED, nothing requires you to change your coverage; but it will make your coverage more secure and stable:

  • It makes it more likely your employer continues to offer coverage, and set minimum standards for such coverage.
  • It improves Medicare; It expands and streamlines Medicaid.
  • It fixes the “individual market,” giving individuals the bulk purchasing power of large purchasers, preventing “junk” insurance, and stopping denials for health status.
  • It provides the foundation to bring down the overall costs of health care.

  IF YOU ARE UNINSURED OR UNDERINSURED, you will need to get coverage, but there will be new help and new options to ensure coverage is:

  • AVAILABLE: No denials or different rates for pre-existing conditions.
  • AFFORDABLE: Subsidies/affordability credits for low- & mid-income families, so you don’t have to pay more than a percentage of their income (based on a sliding scale up to 9.5%).
  • ADEQUATE: Minimum benefit standards and a cap on out-of-pocket costs, so no one goes into significant debt or bankruptcy.
  • ADMINISTRATIVELY SIMPLE: The Exchange provides choice and convenience, making it easy to sign up for and compare plans.
  • ALSO: Other efforts attempt to bring down the cost of coverage.

  Summary of Major Provisions that Would Take Effect Within the 1st Year
  Some provisions in the legislation would take effect almost immediately and continue through 2018. Others wouldn’t take effect until 2014. Within its first year, the legislation would:

  • Prohibit insurance companies from rescinding the coverage policies of consumers who become ill;
  • Ban health insurers from denying coverage to children with pre-existing conditions;
  • Eliminate lifetime coverage limits and restrict annual coverage limits;
  • Allow young adults to remain under their parents’ health plans until age 26;
  • Provide uninsured adults with pre-existing conditions the opportunity to obtain coverage through a new program that would expire in 2014, when the new state-based insurance exchanges begin operating;
  • Provide sliding scale subsidies based on income (where consumers pay based not on how sick they are, but on what they can afford);
  • Provide eligible seniors a $250 rebate to bridge the “doughnut hole” coverage gap in the Medicare prescription drug benefit;
  • Give some small businesses a tax credit to help them provide coverage to employees; and
  • Provide momentum to do more in health care policy and reform in the coming days, weeks, months and years.

  See the bill texts for more information.

  • Senate Reform Bill – HR 3590
  • Corrections Bill – HR 4872

• 14Jan

  Hospital Errors Rise in California – Medicare Refuses to Pay for Avoidable Mistakes

  Medicare and other health insurance, Medicare billing and claims No Comments

  The number of reported hospital errors increased across California during the last year, according to data from the state Department of Public Health.

  While a 2006 state law requires officials to publicly report hospital errors, California’s DPH has not yet reported the information to the state Legislature.

  California hospitals reported 1,538 serious and preventable events for fiscal year 2008-2009, up from last year’s reported 1,224 errors. About 90% of the reported errors are currently under investigation, according to a recent article from the Sacramento Business Journal, 1/8.

  Health insurers and hospitals are working to reduce the incidence of preventable medical errors through new policies and procedures. Medicare has also chosen not to pay for preventable medical errors, and many major health insurance companies are following suit.

  In addition, hospitals are enacting new safety protocols in an effort to prevent such events. One system gaining more attention from lawmakers stems from a unique and successful strategy used in Pittsburgh to improve the quality, safety, efficiency and cost of hospitals in the area. The system took its ideas from one of the most efficient companies, Toyota. While this approach, modeling after an industry, may seem a bit strange and impersonal, hospital after hospital in the Pittsburgh area saw and sustained dramatic improvements. This approach is now being considered for other hospitals throughout the country. To learn more, see the book, The Pittsburgh Way to Efficient Health Care.

  Here’s a chart that outlines the types and numbers of medical errors in California last year.

• 06Jan

  COBRA Subsidy Extended to 2/28/2010

  Medicare and other health insurance No Comments

  In late December, President Obama signed H.R. 3326, a defense appropriations bill with a provision that extends the COBRA subsidy to involuntarily terminated workers until Feb. 28, 2010.

  The subsidy, originally from the American Recovery and Reinvestment Act (ARRA) passed in February 2009, was for people who involuntarily lost their jobs between September 2008 through December 31, 2009 and would last a period of 9 months. This bill extends the timeframe for people to qualify for the COBRA subsidy another 2 months and extends the amount of time people can receive the subsidy to 15 months.

  As mentioned in our earlier article, COBRA, the Consolidated Omnibus Budget Reconciliation Act passed in 1985, allows involuntarily laid-off workers to continue their health coverage for 18-36 months by assuming the premium payments formerly paid by their employers. As these health premiums are extremely expensive, the federal subsidy pays for 65% of a qualifying person’s COBRA premium, making this insurance much more affordable.

  In addition to extending the eligibility period and the duration of subsidy benefits, the H.R. 3326 COBRA subsidy extension provision makes a number of subtler changes in the subsidy program rules. The provision will:

  • Require a special notice describing the new subsidy provisions to go out to all “assistance eligible individuals” (AEIs) who have been on COBRA on or after Nov. 1, 2009, or whose qualifying event is an “involuntary termination” of employment occurring on or after Nov. 1, 2009.
  • Allow for a 60-day period for the retroactive payment of premiums for “assistance eligible individuals” whose subsidy period expired Nov. 30 and who failed to pay their premium for December coverage.
  • Let employees who are involuntarily terminated before Feb. 28, 2010, but get COBRA coverage that starts after Feb. 28, 2010, qualify for the subsidy.

  Employers and their benefits advisors will have to move quickly to comply with this legislation. The new statute requires employers to send extension letters within 90 days of enactment.

  The U.S. Department of Labor, the U.S. Department of Health and Human Services, and the Internal Revenue Service may all issue guidance concerning the subsidy extension.

  Update on California’s Cal-COBRA

  While the federal COBRA subsidy only applies to businesses with at least 20 employees, last year California lawmakers passed AB 23, a measure that expanded the state’s Cal-COBRA program to employers with 2 to 19 workers.

  Lawmakers wrote AB 23 to align with the federal subsidy’s initial expiration date of Dec. 31, 2009, but the state likely will lengthen the Cal-COBRA program to conform with the recent federal extension.

  Gov. Arnold Schwarzenegger’s administration doesn’t think additional legislation will be necessary to extend AB 23; the Assembly Health Committee will examine the issue.

  For more details on H.R. 3326, see the summary and full text.

  See our COBRA and Cal-COBRA sections for general information.

• 21Dec

  Health Reform Moves Forward as Senate Gets 60 Required Votes

  Medicare and other health insurance No Comments

  Early this morning, the U.S. Senate held a pivotal vote; it successfully gathered the required 60 votes to end the debate and move forward to subsequent votes to pass major health reform from the Senate floor later this week. Both California Senators, Barbara Boxer and Dianne Feinstein joined all 60 Democratic and Independent Senators to vote for the motion; all 40 Republican Senators voted against it.

  Next votes are planned for Tuesday and Wednesday, and final passage is planned for Thursday, December 24th.

  After passage, the next step is negotiations between the House and Senate to reconcile the Senate bill with the House health reform measure passed in November. Negotiations will most likely go into January with the goal of having a final agreement and final vote in both the House and Senate by the end of January.

  See the full text of the bill and the 380+ page “manager’s amendment” (contains several changes that allowed for the passing 60 votes this morning). This link also has a video clip of Senator Reid’s speech right before the 1 a.m. vote this morning.

  A Health Access blog article has a good summary of some of changes in the “manager’s amendment.”

  Related to a different aspect of the health reform debate, Kaiser Family Foundation recently held a live interview with key advocates in women’s and minority health and released a video on what health reform may mean for women of color.

  See: What Might Health Reform Mean for Women of Color?

• 27Oct

  Listen to a Rap on Health Care Reform!

  Medicare and other health insurance No Comments

  A couple of fellow advocates put together a rap on health care reform and posted it on Youtube. A 30 second version of it is also being entered into a nationwide competition for the best short informative clip on health reform.

  Enjoy!

  Zap the Crap Out of Health Care Rap

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