WHP Profile / Perfil Personal: Spring Quiñones

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Spring Quiñones is a Bilingual Outreach Worker at the Washtenaw Health Plan (WHP). She primarily focuses on doing outreach to the Latino community to help them understand and obtain health care coverage, working to remove barriers and ensure that the Latino population enjoys equal access to health care services.

Spring Quiñones es una trabajadora de alcance bilingüe para el Washtenaw Health Plan (WHP). Ella se enfoca principalmente en ayudar a la comunidad latina para entender, obtener cobertura de salud, y eliminar barreras que les impiden disfrutar de acceso igual a los servicios de salud.

Prior to her start at WHP, Spring worked with Ann Arbor Public Schools as a Teacher’s Assistant for 6 years, working specifically with children with autism—which she absolutely loved. Spring first joined the WHP in 2013 under a federal grant from the Centers for Medicaid and Medicare Services (CMS) to work with immigrant and homeless populations, ensuring they had equitable access to healthcare coverage.  Her primary focus was enrolling children and their families from the Latino Community and collaborating with the Education Project for Homeless Youth (EPHY) to make sure that they had Medicaid, MiChild and or the Marketplace. Spring also brings her skills as a Certified Bilingual Medical Interpreter to help facilitate questions around medical issues.

Antes de trabajar en el WHP, Spring trabajo con las escuelas públicas de Ann Arbor como asistente de profesor por 6 años, específicamente ella trabajo con niños con autismo—lo cual fue algo que disfruto mucho. Spring se unió al WHP en 2013 bajo una beca federal de los Centros de Servicios de Medicaid y Medicare (CMS) para trabajar con inmigrantes y personas sin hogar, asegurándose de que ellos tuvieran acceso equitativo a la cobertura de salud. Su objetivo principal era matricular a los niños y sus familias de la comunidad latina y colaborar con el Proyecto de Educación para Jóvenes Sin Hogar para asegurarse de que ellos tuvieran Medicaid, MiChild, o el Mercado de Seguro. Spring también trae sus habilidades como una Intérprete Médica Bilingüe Acreditada para ayudar a facilitar preguntas sobre temas médicos.

Spring’s compassionate nature and dedication to her work is contagious. She goes above and beyond to make sure her clients feel listened to, and her involvement in helping the Latino community does not stop with her work at WHP.

Spring es una persona muy compasiva y dedicada, su pasión por su trabajo es contagiosa. Ella va más allá para asegurarse de que sus clientes se sientan escuchados, y su participación en ayudar a la comunidad latina no termina con su trabajo en WHP.

Spring and Frania at an outreach event for families providing information about healthcare.

Spring and Frania at an outreach event for families providing information about healthcare.

Spring is also involved with the Washtenaw County Spanish Healthcare Outreach Collaborative (SHOC), where she helps facilitate meetings with organizations to discuss issues affecting the Latino community.  This collaboration is a valuable resource for information and network building that helps to eliminate barriers facing the Latino community. Spring emphasizes the importance of practicing cultural humility when engaging and educating the Latino community about issues surrounding health care, recognizing that things such as immigration, language, and culture can have a significant impact on health care delivery and access to health care services. 

Spring también está involucrada con el Spanish Healthcare Outreach Collaborative (SHOC), donde ayuda a facilitar reuniones con organizaciones para discutir cosas que afectan a la comunidad latina. Esta colaboración es un recurso valioso para informar ycrear redes sociales que ayudan eliminar los obstáculos que enfrenta la comunidad latina. Spring enfatiza la importancia de practicar la humildad cultural al participar y educar la comunidad latina sobre asuntos relacionados con la salud, reconociendo que elementos como la inmigración, el lenguaje, y la  cultura pueden tener un impacto significativo en la entrega y acceso a los servicios de salud.

Milo curls up and his markings form a heart.  

Spring has two children, an 18 year old daughter, and a 19 year old son, and a dog named Milo. She is originally from Colombia and previously lived in New York, and has now lived in Ann Arbor for the past 11 years.

Spring tiene dos hijos, una hija de 18 años, un hijo de 19 años, y una mascota llamado Milo. Ella es originalmente de Colombia, vivió previamente en Nueva York, y ha vivido en Ann Arbor por los últimos 11 años.

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What Are Cost Sharing Reductions And Why Do They Matter?

Under the Affordable Care Act, there are subsidies for insurance. Both parts of the subsidies--the Advance Premium Tax Credits (APTCs) and the Cost Sharing Reductions (CSRs)--are part of the law. To cover those costs, the government pays the insurance companies that participate in the Marketplace for these subsidies. President Trump has proposed just not paying the CSRs, BUT--as Vox explains--

If CSR payments were not paid, insurers would still be required to reduce cost sharing, but they would now have to do it without the government’s help. They would have to raise premiums dramatically to make up the lost revenue. The irony is that if plans do raise premiums, the federal government would be on the hook for much of those costs. The government absorbs premium increases through the tax credits that help people afford coverage. The law is designed to keep premiums manageable for people, so it falls on the government to cover any excess increases.

Some Background: Two Parts Make The Subsidies Work

There are two parts to the subsidies that people who get health insurance through the exchanges may receive.

Part 1--which most people are familiar with--is called the Advance Premium Tax Credits (APTCs). They assist people who are up to 400% of the poverty level ($98,400 for a family of 4), to help afford monthly premiums.

Part 2--which most people are not familiar with--are Cost-Sharing Reductions (CSRs). These support families whose income is between 138% of the poverty level (Medicaid cut-off) and 250% of the poverty level ($61,500 for a family of 4), by reducing what they would pay for co-pays, co-insurance, and deductibles.

 

For Consumers, Cost-Sharing Seems Like Magic

For households that qualify, cost-sharing applies to silver plans (only), and transforms them into something better--often much, much better. 

The truth is, if not for the CSRs, low-income families might be able to afford the premiums, but visits to the doctor could be cost-prohibitive, and high deductibles and maximum out-of-pocket costs would mean that getting sick could still turn a family's life upside down.

More than half of the people in the U.S. who got health care on an exchange got cost-sharing reductions (7 million out of 12 million)! 

Actuarial Value

Actuarial value is an estimate of the percentage of costs that--on average--a plan will cover. (For any one family, this might be a bit higher or lower.) Under the ACA, a household with income below 150% of the poverty level can get a silver plan that covers 94% of their costs; a household with income between 151%-200% of the poverty level can get a silver plan that covers 87% of their costs; and a household with income  between 201%-250% can get a silver plan that covers 73% of their costs.

Summary

Basically, taking away Cost Sharing does not save the government any money and will contribute to Marketplace insurers opting out of the Marketplace.  The only people who will be hurt are people who are low income but not low enough for Medicaid. Republicans were eager to eliminate cost-sharing when the repercussions would be seen as Democrat's fault but now that the the White House and Congress are Republican, we hope they do not want this cut to be seen as their responsibility. The ACA's solvency relies on Cost Sharing Reductions and Advanced Premium Tax Credits. #savetheACA

-Ruth Kraut 

Have a question?  Type it in the comments section and we will get back to you.

More Information:

Republicans are begging Trump not to sabotage Obamacare - Vox

What are cost-sharing reductions, and what happens if Trump ends them? - Michigan Radio

ACA Cost-Sharing Subsidies: How One Decision Could Disrupt Obamacare Marketplaces - Kaiser Family Foundation

Larry Levitt Tweets 

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What's Wrong With The Senate Health Care Bill?

UPDATE:  On 6/27/2017, Senator Mitch McConnell, facing mounting opposition, announced that he will delay a vote on his legislation to repeal the Affordable Care Act until after the Senate’s Fourth of July recess. However, after the July 4th break, this bill could come back, in the same or a slightly different form. If you are looking for sources to follow the debates on an ongoing basis, find them here.


The Congressional Budget Office released their analysis of the Senate Republican plan.  Here is what the bill means. 

 

22 million more Americans
would be uninsured by 2026.

New York Times, June 26, 2017 

New York Times, June 26, 2017 

The budget office projects that by 2026, 49 million people would be uninsured, compared with 28 million people if the current law remained in effect. (The total increase is 22 million due to rounding.) Note that the biggest increase in the uninsured comes in the first year, when it is estimated that 15 million people could lose their insurance.


15 million fewer people would
be enrolled in Medicaid by 2026.

New York Times, June 26, 2017 

New York Times, June 26, 2017 

The largest group to lose health insurance coverage would be people with Medicaid. In 10 years, the C.B.O. projects, there would be 15 million fewer Medicaid enrollees. In addition, Medicaid might cover fewer benefits, so even those who have Medicaid might lose certain types of healthcare.


Average premiums would decrease by 20 percent in 2026.  BUT the amount Americans spend on healthcare would be higher because plans would offer FEWER benefits and DEDUCTIBLES would be higher. 


Want to know how this bill will impact you?

Are you a WOMAN?          Do you have a PRE-EXISTING CONDITION?          Do you need MENTAL HEALTH SERVICES?        SUBSTANCE USE ABUSE?          Live in a RURAL area?        Planning to START YOUR OWN BUSINESS?        SELF-EMPLOYED?      

Compare Proposals to replace the Affordable Care Act with this tool from the Kaiser Family Foundation. 

Comparison tool from the Kaiser Family Foundation, June 27, 2017.

Comparison tool from the Kaiser Family Foundation, June 27, 2017.

Thank you and keep up the good fight, 

-Meredith Buhalis 

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Capping Federal Money for Medicaid to States Will Devastate Millions of People

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This blog post is cross-posted from Public Health Awakened and addresses potential changes from repealing the Affordable Care Act- June 2017

Proposed changes to Medicaid will lead to:

  • More people getting ill or dying prematurely, including children.

Low-income children are less likely to die in childhood or adolescence when states expand Medicaid (Howell & Kenney, 2012; Wherry & Meyer, 2013). Cuts that Republicans suggest would end core services to keep kids healthy that past administrations on both sides of the aisle have supported and expanded, including: well-child visits and check-ups, developmental screenings, immunizations, and treatment for vision and hearing, oral health, lead poisoning, mental illness, addiction, autism, and behavioral health issues (Sharfstein, 2017). For low-income adults, expanding Medicaid is significantly associated with less death and better self-reported health (Sommers, et al., 2012). Cutting Medicaid will reverse these trends in children and adults.

  • More seniors unable to meet basic needs.

For seniors, including those who may struggle to make ends meet, have high medical costs, live in nursing homes, or live with the effects of a stroke, dementia, losing their vision, etc., Medicaid covers long-term care and basic services for everyday life — like eating, bathing, or doing laundry — that are not covered by Medicare (Kaiser Family Foundation, 2016).

  • Millions of people having health coverage taken away from them.

Estimates are that 14 million people would have Medicaid coverage taken away — more than half of the 23 million more who would be uninsured by 2026 under changes to health care proposed by many Republicans (Congressional Budget Office, 2017). This would reverse the recent expansion in coverage to millions of people under ACA.

  • Harder financial times for working people, people with disabilities, seniors and adults who already struggle to make ends meet.

Reduced Medicaid coverage will worsen health disparities for already at-risk populations. People who lose coverage will have to make tough financial choices and will be less likely to get needed health care, for themselves and for their children (Chatterjee & Sommers, 2017).

Currently Medicaid covers (Kaiser Family Foundation, 2017):

  • Pregnant women: 49% of all births are covered by Medicaid
  • Children: 39% of all children, and 76% of poor children
  • People with disabilities: 30% of adults with disabilities (excluding and 60% of children with disabilities
  • People in long-term institutional care: 64% of nursing home residents
  • People in treatment for HIV/AIDS: 41% of adult AIDS patients and 90% of children with AIDS
  • Wider disparities across states and geographies in access to care.

States with older and sicker residents, as well as rural states, will be most affected (Lambrew, 2005). Safety-net hospitals, nursing homes, and clinics in low-income and rural areas that rely on Medicaid funds may close, and there will be less care for all residents of these already-underserved areas (Kaiser Family Foundation, 2012). Even people who can afford care will have to travel further to providers, and the proposed changes would eliminate Medicaid transportation services. States will likely control costs by paying providers less, and over time fewer providers will accept Medicaid patients (Sommers & Naylor, 2017). In addition, setting the amount of money that states get from the federal government would “lock in” current disparities in Medicaid funding, eligibility, and benefits packages across states: states that currently have less generous packages would not be able to “catch up” to more generous states (Holahan, et al., 2017).

  • Cuts in health services or states paying more money in the long run.

Reduced Medicaid coverage would reduce access to health care but not reduce health needs. Instead, health care use would likely shift to more expensive acute care services (e.g., emergency departments). Furthermore, untreated health conditions would lead to more severe health needs, leading to higher costs in the long run. An uninsured child costs the community $2,100 more than a child covered by Medicaid (Children’s Defense Fund, 2017).

http://publichealthawakened.com/protect-medicaid-and-health-equity/

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Buenas Noticias: Medicaid Puede Ser Su Seguro Secundario

Una Tarjeta de Identificación de Medicaid

Una Tarjeta de Identificación de Medicaid

Hay muchas cosas buenas acerca de Medicaid - tiene cobertura médica, de visión y dental; copagos bajos; puede solicitarlo en cualquier momento; y usted puede utilizarlo como un seguro secundario.

¿QUÉ SIGNIFICA ESTO?

Imagínese que tiene un plan de seguro de empleador, pero tiene un deducible alto, y tiene que pagar de su bolsillo por sus primeros $ 3,000 antes de que el seguro pague cualquier cosa. Si usted es elegible para Medicaid, Medicaid será el segundo seguro (lo que significa que su seguro de empleador se factura primero), y Medicaid recogerá lo que el seguro del empleador no cubre.

Medicaid como un seguro secundario puede reducir significativamente sus facturas!

OTROS BENEFICIOS
 

Hay algunos otros beneficios, también. Por ejemplo, usted puede tener una buena cobertura médica, pero sin cobertura de visión o dental. Como seguro secundario, Medicaid puede pagar beneficios de visión y dental.

Nota: Medicaid no puede ser un seguro secundario para los planes de Marketplace. Si usted es elegible para Medicaid, no puede obtener cobertura de Marketplace subvencionada. Pero si usted tiene cobertura de empleador, a veces Medicaid como un seguro secundario puede ser muy útil.

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Necesita lentes? Medicaid lo Cubre

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Su visión es importante y si tiene Medicaid, ya sea Healthy Michigan Plan, Healthy Kids, MIChild o un programa tradicional de Medicaid, puede obtener exámenes de la vista y lentes.

Los exámenes de la vista son una parte importante del cuidado de la salud. Los exámenes de rutina ocular pueden detectar problemas de visión, enfermedades oculares y otros problemas de salud. Para los exámenes de rutina usted normalmente visitara a un optometrista. Un optometrista realiza exámenes de la vista para detectar problemas de visión y de salud. Los optometristas también pueden brindar atención a personas viviendo con baja visión, atención antes y después de una cirugía y recetar gafas y lentes de contacto.

LENTES, EXÁMENES Y MÁS


¿QUÉ CUBRIRA MEDICAID?
 

  • Medicaid cubre exámenes oculares rutinarios e integrales que pueden incluir una variedad de pruebas como pruebas de campo visual, dilatación pupilar, ceguera de color, glaucoma y muchos otros.
  • Medicaid cubre los exámenes de glaucoma para personas con mayor riesgo de glaucoma.
  • Medicaid cubre anteojos que incluyen los marcos, lentes, accesorios, reparaciones y reemplazos de gafas. [Para las personas de 21 años o menos, las gafas se pueden reemplazar dos veces al año si se rompen, pierden o se roban las gafas - de lo contrario, la regla es una vez al año.]
  • Medicaid cubre bifocales y trifocales, o para dos pares de lentes de visión única (visión de cerca y de distancia) si los bifocales no funcionan. Los lentes sobredimensionados, no lineales, multi-focales progresivos y las transiciones no son un beneficio cubierto de Medicaid. Sin embargo, si usted quiere comprar estos, usted puede pagar los costes adicionales.
  • Medicaid sólo cubre los lentes de contacto si se consideran médicamente necesarios y si no hay otro tratamiento alternativo. Si no son médicamente necesarios, pero usted los quiere, usted puede pagar por ellos por separado.
  • Medicaid cubre marcos de seguridad.
  • Las personas que seleccionan marcos y lentes que no están cubiertos deben pagar la diferencia en costo.
  • Medicaid también cubre los ojos de prótesis.

 

¿Y LOS PROBLEMAS SERIOS DEL OJO? TAMBIEN ESTAN CUBIERTOS

¿Qué pasa si usted está preocupado por perder la visión, dolor en los ojos u otras cosas que pueden indicar un problema ocular grave? Si tiene más problemas oculares graves (como cataratas, retinas separadas o glaucoma), necesita un oftalmólogo. Un oftalmólogo es un médico que se especializa en el cuidado de los ojos y la visión. Los oftalmólogos realizan exámenes oculares, diagnostican y tratan enfermedades, realizan cirugías y recetan medicamentos, gafas y lentes de contacto.

Un oftalmólogo es visto a través de su beneficio de salud física de Medicaid, y no su beneficio de la visión de Medicaid. Para acceder a un oftalmólogo, la mayor parte del tiempo necesitará una referencia de su proveedor de atención primaria, al igual como si necesitara ver a un cardiólogo, un alergista o algún otro especialista.

NOTA: Si tiene un plan de mercado o de empleador, por lo general cubrirá la especialidad médica de oftalmología (por ejemplo, si tiene cataratas), pero los anteojos sólo estarán cubiertos si tiene un plan de visión especial.

¿CÓMO PUEDO ENCONTRAR UN LUGAR PARA CONSEGUIR MIS GAFAS?

Para obtener una lista de los Proveedores de Visión que aceptan Medicaid, por favor llame a su plan individual o visítelos en los enlaces web y siga las instrucciones proporcionadas.

AETNA BETTER HEALTH PLAN

Número de teléfono 1 866-316-3784 (TTY: 711)
En línea: https://www.aetnabetterhealth.com/michigan/find-provider

  • Haga clic en Medicaid, MIChild, Healthy Michigan Vision
  • Haga clic en visitar VSP
  •  Haga clic en buscar un médico
  •  Introduzca el código postal, la ciudad y el estado
  •  Ingrese Medicaid para la red de médicos
  •  Haga clic en Buscar

 

BLUE CROSS COMPLETE
Número de teléfono 1 800-228-8554 (TTY: 711)
En línea: http://www.mibluecrosscomplete.com/find-doctor.html

  • Haga clic en buscar un médico
  • Haga clic en la búsqueda avanzada
  • Introduzca la ciudad y el estado o condado, municipio
  • Para la especialidad haga clic en, optometría, optometrista
  • Haga clic en Enviar

 

MCLAREN HEALTH PLAN  McLaren Medicaid o McLaren Healthy Michigan

Número de teléfono 1 888-327-0671 (TTY: 711)

En línea http://www.mclarenhealthplan.org/medicaid-consumer/Find-a-Provider-medicaid.aspx

En línea: http://www.mclarenhealthplan.org/healthy-michigan-member/Find-a-Provider-medicaid.aspx

  • Haga clic en la optometría de tipo especial o
  • Haga clic en condado, aumente Washtenaw
  • Introduzca código postal
  • Haga clic en Buscar

 

MERIDIAN HEALTH PLAN  Meridian Medicaid o Meridian Healthy Michigan

Número de teléfono 1 888-437-0606 (TTY: 711)
En línea: https://corp.mhplan.com/en/member/michigan/meridianhealthplan/benefits-resources/tools-resources/provider-search/

  • Haga clic en más opciones de búsqueda
  • Introduzca código postal
  • Ingrese los resultados en un radio de 30 millas
  • Haga clic en optometría para optometristas
  • Haga clic en Buscar
  • Haga clic en el número de página

 

MOLINA HEALTH PLAN

Número de teléfono 1 888-898-7969 (TTY: 711)
En línea: https://providersearch.molinahealthcare.com/Provider/ProviderSearch?

  • Para el plan de cobertura seleccione Medicaid / Healthy MI Plan / MIChild
  • Haga clic en buscar por condado
  • Introducir estado
  • Entrar condado
  • Para el tipo de proveedor, seleccione
  • Para la especialidad seleccione optometría
  • Haga clic en Buscar

 

UNITEDHEALTHCARE Plan

Número de teléfono 1 877-892-3995 (TTY: 711)
En línea: http://www.americhoice.com/find_doctor/first.jsp?xplan=uhcmi&xtitle=Doctor

  • Desplácese a la parte inferior derecha y seleccione buscando la pestaña de beneficios de visión y haga clic en el enlace
  • Te lleva al sitio de VSP
  • Haga clic en buscar un médico
  • Introduzca el código postal, la ciudad y el estado
  • Ingrese Medicaid para la red de médicos
  • A continuación, haga clic en Buscar

-T. South Peterson

 

Otros Recursos

MIChild esta cambiando, y generalmente significara una mejor cobertura para los niños de Michigan.

Good News: Medicaid Can Be Secondary Insurance

Updated** Medicaid Dental: How to Use it and Where to Go...

Actualizado ** Entendiendo el Deducible de Medicaid, o "Spenddown"

Am I eligible for Medicaid? 

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Good Sources For Following Debates About The ACA and AHCA

Keeping up with the proposed legislation for healthcare can be difficult! With changes happening so quickly, it can be hard to understand the implications of healthcare policies for you and your family.

For example, we are currently tracking the American Healthcare Act, or the AHCA (H.R. 1628), which is sitting in the U.S. Senate. Check congress.gov to see the bill’s current position in the legislature. We also recommend finding trusted resources that will break down the more complicated aspects of the bill.

Trusted Healthcare Websites

Here are a few we like to use:

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Checking Facts

Social media is a great way to stay on top of the news if you don’t have time to sit down and watch the news or read an article. Just be careful of your sources! We recommend using Politifact (http://www.politifact.com/) or FactCheck (http://www.factcheck.org/) to check what politicians are saying.

Do You Like Twitter?

If you like twitter, many healthcare journalists frequently tweet relevant articles. You can even make a "twitter list" of favorite tweet-ers. Here are a list of trusted healthcare reporters and organizations who will keep you in the know:

Julie Rovner (@jrovner), Correspondent at Kaiser Health News

Charles Ornstein (@charlesornstein), Reporter at Propublica

Jonathan Cohn (@CitizenCohn), Correspondent at Huffington Post

Andy Slavitt (@ASlavitt), Former Administrator of the Centers for Medicare and Medicaid Services

American Medical Association (@AmerMedicalAssn)

Health Affairs (@Health_Affairs)

Kaiser Health News (@KHNews)

NPR Health News (@NPRHealth)

Last, but not least, you can and should follow us @CoverageCounts!

--M. Higgins

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Why is Medicaid Important to Older People?

THE IMPORTANCE OF MEDICAID FOR OLDER PEOPLE


The recent discussions in Congress about rolling back Medicaid expansion, capping payments or converting the program to block grants will have a significant impact on older Americans.

Overall, one in five adults is covered by Medicaid and half of those adults are over age 50.  

For people who are 50-64 and not disabled, they are eligible for Medicaid under the Medicaid expansion, or the Healthy Michigan Plan. So if the Medicaid expansion goes away, they will lose their access to Medicaid. 

For adults who are 65+ or who are disabled, the Medicaid program works closely with Medicare to ensure they have access to the care and services they need.  In fact, 11 million Medicare beneficiaries rely on Medicaid to cover vital long-term home care and nursing home services, to help afford their Medicare premiums and cost-sharing, and more.  

To find out if you are eligible for Medicaid to help with Medicare, call the Area Agency on Aging and set up an appointment with a Medicare/Medicaid Assistance Program counselor.  You can also look at the Medicare Savings Program (MSP) categories and income limit chart.  If you believe you are eligible, apply for Medicaid and indicate that you have Medicare. 

Whether a person wants to age in their home or an assisted living facility, Medicaid fills the gap in services not covered by Medicare by serving as the primary payer for nursing home and community-based long term services and supports (LTSS) which would otherwise be altogether unaffordable for low-income older adults and people with disabilities.  Two in three nursing home residents on Medicare are also enrolled in Medicaid and two-thirds of all Medicaid spending for people on Medicare is for long-term services and supports.

Medicaid also pays for most home and community-based services that allow seniors and persons with disabilities to receive support services in their home as opposed to institutions.

Medicaid has been shown to break down barriers to treatment.  Of adults 50-64 with Medicaid, 50% suffer from multiple chronic health conditions.  These adults are less likely to skip refilling their prescriptions meaning their health problems are addressed instead of becoming the source of expensive hospitalizations.  Medicare recipients can qualify for Extra Help with their prescriptions.  The program is similar to Medicare Savings Program and you must apply.  Contact the Medicare/Medicaid Assistance Program.  

Federal cuts to Medicaid brought about by per-capita caps or block grants would drive states to make hard choices, likely leading states to scale back benefits, impose waiting lists, implement unaffordable financial obligations, or otherwise restrict access to services for older adults.

Adapted from Community Catalyst

Read more about Medicare/Medicaid programs

At the Washtenaw Health Plan, we can help you apply for the Medicare Savings Program.  We can also make appointments for you here with a Medicare/Medicaid Assistance Program counselor.  Call to make an appointment 734-544-3030 or just walk-in Monday through Friday 9am-4pm.  

Sources:

-Meredith Buhalis

Leave a question or a comment below and WHP staff will respond.  

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The AHCA: Who Loses?

Medicaid Expansion and Current Medicaid Funding

One of the provisions of the Affordable Care Act allowed states the option to expand Medicaid to cover adults under 138% of the Federal Poverty Level who previously had little or no access to affordable health insurance.  From 2014 through 2016, the ACA’s Medicaid expansion population was funded 100% with federal dollars. Beginning 2017, states gradually have to pick up some costs, but the federal government still picks up 90% or more of Medicaid expansion through 2020. Medicaid programs that existed before the ACA are funded via a much less generous split between state and federal tax dollars.  

What is a Medicaid Block Grant? 

Medicaid is currently an entitlement program, which means that everyone who qualifies is guaranteed coverage. States and the federal government combine funds to cover the costs.  Conservative Republicans are currently endorsing a change to this funding called "block granting" which is included in the health care bill that recently passed the House of Representatives, the American Health Care Act (AHCA).  Instead of an entitlement, states would take control of the program and the federal government would cap what it spends on it each year.  AHCA supporters claim it will save the federal government money and give states more control.  It would be a drastic change to the current system and the Congressional Budget Office projections are that at least 14 million people would lose affordable coverage.

 

Who would lose coverage? how? why?

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Working poor people who gained Medicaid under the ACA

14 million working poor people gained coverage under the ACA's Medicaid expansion program.  In Washtenaw County, over 17,000 people gained coverage. The AHCA would freeze funding for Medicaid by the year 2020, effectively ending Medicaid expansion. The AHCA would keep paying for people who signed up before January 1, 2020, but would not cover people who signed up after that date.  Many low-income people cycle on and off Medicaid as their employment changes seasonally, moves from part-time to full-time or as the economy fluctuates.  Once coverage ends, they would not be able to re-enroll.  

Seniors,  disabled people, and others who qualified for Medicaid before the ACA

The AHCA would adopt a policy known as a “per capita cap” for Medicaid that would hurt all beneficiaries. Currently the federal government matches state spending on Medicaid for everyone, not just those who get Medicaid under the Medicaid expansion. In 2020,  the AHCA would give each state a set amount of money per person and it would increase based on inflation, but it is not expected to keep up with medical costs. Consider the different costs to cover a 24-year-old, a 65-year-old and an 87-year-old. What would happen to the disabled, who need more coverage?  The federal government requires that certain populations are covered by Medicaid, but states would have to decide who would be covered with less money for Medicaid. States could spend less on Medicaid by removing either particular populations or certain types of benefits.

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Pregnant Women and New Mothers

Under the AHCA, states could apply for waivers that would allow them to not cover the 10 Essential Health Benefits covered under the ACA.  Prior to the ACA, 88 percent of independent market plans did not cover maternity care.  Read more here: Essential Health Benefits Under the AHCA (ACA Replacement).

 

States hit hard by the opiate crisis

The opioid epidemic has many more patients needing substance use disorder treatment. A per capita cap would cause problems if an epidemic hit or if new, expensive medications became available.  Medicaid programs are currently covering many people receiving treatment for substance use disorder. If  Medicaid funds were capped any advances or new outbreaks would financially burden the state.  

People in states that take a Medicaid “block grant”

A full "block grant" would mean that states receive a fixed amount of money for Medicaid over a 10 year period, only increasing with the normal inflation rate.  There are no provisions to increase funds based on increased state population or economic recessions.  States could cut benefits or change eligibility requirements and many people would lose coverage.  

"Block grants" would encourage more states to "innovate"  alternatives to current Medicaid coverage. Michigan's current MIHealth Account requires all Healthy Michigan Plan participants to pay into a health account as a way of collecting co-pays for many services.  The amount is determined by prior usage of services and participants are sent payment coupons quarterly.  Participants do not lose coverage for not paying, but delinquent payments can be recouped from state tax refunds.  Indiana also has a waiver that requires participants to contribute before their coverage starts.  If they don't pay the premium they are locked out of Medicaid coverage for 6 months.  

 

People with Pre-existing Conditions

Under the MacArthur Amendment added to the bill in late April 2017, states would also be allowed to waive an ACA provision that bans insurers from charging higher premiums to sicker people.  We would return to the pre-ACA world of people with pre-existing conditions being charged much more for insurance.  Here is an estimate from Sam Berger and Emily Gee using data from CMS, the Center for Medicare and Medicaid Services.  

Families with Chronic Conditions

Because of the Essential Health Benefit waiver, states could also choose to eliminate  "lifetime limits," which let insurers decide how much they would spend on one person.  Before the ACA, most caps were between $1 million and $2 million.  These types of caps dramatically affect families with very ill children. Prior to the ACA, families went bankrupt trying to get healthcare for their children. 

Low-income Americans not on Medicaid

The ACA offered tax credits based on income for people to purchase insurance on the Health Insurance Marketplace (healthcare.gov).  Under the AHCA, tax credits are much lower for many people because they are based on age, and not on income.  In addition, there would be no cost-sharing. Under the ACA, people who are lower-income have cost-sharing--much lower deductibles and lower maximum out-of-pocket costs. Under the AHCA, those cost-sharing supports are eliminated.

Older People on the Health Insurance Exchanges

Older people would receive a bigger tax credit but the increase would not cover for the fact that they could be charged up to five times more than younger people. 

Children in Special Education Programs

Under per capita caps and block grants, Medicaid funded school programs for students with disabilities could be reduced or cut completely. Because special education requirements are mandated, schools would need to pay for special education out of general funds.

Planned Parenthood Patients

The AHCA includes provisions banning federal dollars from going to groups like Planned Parenthood.  So even though the majority of Planned Parenthood services are birth control, pregnancy and STD tests, as well as cancer screenings such as breast exams and Pap smears, the AHCA will deny women access to these services.  Planned Parenthood is the largest provider of reproductive health services in the country. In fact, in many places across the country, Planned Parenthood is the only birth control clinic. Without Medicaid funding (which does not pay for abortions), these clinics will be forced to close, denying millions of women access to health care.  

Almost Everyone Loses

Many provisions in this bill will make it easier for insurers to charge more for premiums, require more cost-sharing and shift costs to the consumer.  High income (over $250,000/year) people win and everyone else loses.

The Washtenaw Health Plan

believes that healthcare is a human right. The Washtenaw Health Plan board is on record opposing repeal and weakening of the Affordable Care Act.

Questions? Leave a comment below and we will do our best to answer.  

-Meredith Buhalis

 

Sources:

Current Status of State Medicaid Expansion Decisions Map http://kff.org/health-reform/slide/current-status-of-the-medicaid-expansion-decision/

A 50-State Look at Medicaid Expansion  http://familiesusa.org/product/50-state-look-medicaid-expansion

Affordable Care Act Medicaid Expansion http://www.ncsl.org/research/health/affordable-care-act-expansion.aspx

State Medicaid and CHIP Profiles  https://www.medicaid.gov/medicaid/by-state/by-state.html

Everything You Need To Know About Block Grants — The Heart Of GOP’s Medicaid Plans  http://khn.org/news/block-grants-medicaid-faq/

These Are All the People the Republican Health Care Bill Will Hurt  https://www.vox.com/2017/5/4/15542990/republican-health-bill-ahca-medicaid-victims

An Early Look at Medicaid Expansion Waiver Implementation in Michigan and Indiana http://kff.org/medicaid/issue-brief/an-early-look-at-medicaid-expansion-waiver-implementation-in-michigan-and-indiana/

9 Things People Get Wrong About Planned Parenthood  http://nymag.com/thecut/2017/01/misconceptions-about-planned-parenthood.html

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Essential Health Benefits Under the AHCA (ACA Replacement)

What are Essential Health Benefits (EHB)?

The Affordable Care Act requires non-grandfathered health plans in the individual and small group markets to cover essential health benefits (EHB), which include items and services in the following ten benefit categories: (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services; (9) preventive and wellness services and chronic disease management; and (10) pediatric services, including oral and vision care.
— The Center for Consumer Information & Insurance Oversight - https://www.cms.gov/cciio/resources/data-resources/ehb.html

 

Prior to the ACA, health insurance was not required to cover the benefits above.  Health insurance could exclude prescriptions, pediatric services,  hospitalization, maternity and prenatal care and mental health services.  The EHBs are also tied to the limits on consumer spending for these services.  Currently, out of pocket costs for an individual cannot be more than $7,150 and for families the cost cannot be more than $14,300. Under the AHCA, states could apply for waivers and the costs for EHBs would no longer be capped.   

 

Let's compare the benefits in the ACA to the AHCA. 

While it is true that your monthly premium might be less under the AHCA, if you live in a state that gets a waiver, all the EHB may not be included in your health plan. If your health situation changes, you could pay much more for services that are currently included in all health plans.  

An Example

For example, a state could remove coverage for maternity or newborn care from the essential health benefits. Prior to the Affordable Care Act, most health plans did not cover maternity care, and pregnant women would have to pay the full cost of prenatal care, labor and delivery. That could happen again. 

In fact, women's healthcare is particularly targeted. Under the AHCA, Planned Parenthood would not be able to get Medicaid reimbursals for pap smears, birth control, or cancer screenings. Since Planned Parenthood is the largest reproductive health care provider in the country, it is likely that removing them as a provider--with or without removing the essential health benefit of contraception--will mean many more unintended pregnancies. For middle-income women, over the income cap for Medicaid, the birth and expenses would not be capped so you could pay $15,000 or more for a birth with complications.

The AHCA--the "replacement" for the ACA--goes next to the U.S. Senate. If you support comprehensive and affordable health care, let your senator know that you oppose the repeal of the ACA. 

Have questions?  Ask them in the comments section and we will do our best to answer. Call 734-544-3030 or Walk-in to the Washtenaw Health Plan office Monday - Friday from 9am - 4pm.   

-Meredith Buhalis and Ruth Kraut

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