Obamacare

A Word Of Advice: Don't Auto-Renew

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The new plans are out, and Open Enrollment is upon us! People who have been enrolled in Marketplace plans in the past may be getting notices offering for them to auto-renew their plans. That sounds easy, but it may not be in your best (financial, or health coverage) interests!

Provider Changes

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First, a plan may sound the same, but providers may decide to affiliate or disaffiliate from year to year. So you always to want to make sure that your doctors take your health insurance.

Financial Changes

The plans that are offered may change also. For instance, in Washtenaw County in 2019, there will be a new health insurance provider—Oscar—that has not previously been in the Michigan health insurance market. And even without that new insurer, some insurers may decide to charge less or more for their plans.

The pricing of these plans matters, because tax credits are based on the actual cost of the second lowest silver plan. That is the benchmark from which all tax credits get calculated.

Let’s say that your income is exactly the same between 2018 and 2019, and you qualify for tax credits. If you auto-renew, you could find yourself paying a whole lot more. Even if the plan has not changed, and the full cost of the plan doesn’t have a big difference, there could still be a big difference in tax credits.

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In this case, in 2018 the Pacesetter A plan was the lowest-cost plan, and in 2019 it is the third-lowest-cost plan. Even though the full cost of the plan only went up by $20, the subsidized cost went up a lot more. In this example, for the same exact plan, and with the same exact income, you could end up paying $70 more per month ($840 more per year), more than double what you paid the year before!

The Moral Of The Story?

Do not Auto-Renew.

Instead, give us a call at 734-544-3030; walk in to our Ypsilanti office M-F 9-4; or find local help at this link.

Remember, Open Enrollment on the Marketplace runs from November 1-December 15, 2018.

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Six Things I Learned about Healthcare While Working at the WHP

Editors Note: This post was written by a wonderful summer intern, Madeline Higgins, as a reflection on her work over the summer. Madeline is a student in the MPH program at the University of Michigan School of Public Health, and we are sure she will go on to do great things!

I was lucky to intern at the Washtenaw Health Plan this past summer, where I got to observe the services that WHP provides and work with a new program involving Community Health Workers. Meanwhile, the federal government was attempting to greatly reduce the Affordable Care Act, which had the potential to negatively impact the health of residents in Washtenaw County. While I learned many facts, protocols, and systems, the items listed stick out most in my memory.

 

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1. There is a significant gap in understanding of the reality of healthcare and policy impact from federal legislators.

I believe this stems from decision makers finding information that enforces their current worldview instead of looking at fact-based data. While watching and reading about the legislative process for healthcare reform, I was struck by the lack of listening and understanding from both sides of the aisle. While everyone utilized individual stories to demonstrate their points, there was little conversation about population-level health outcomes. After reading reports and statistics which utilized a population health framework, it is obvious to me that overall, the Affordable Care Act has positively impacted health in the US.

 

2. You can work minimum wage full time and not qualify for Medicaid (as a single individual household).

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I learned this towards the end of my time with WHP. I hadn’t done the math before, and it was hard for me to imagine living on the minimum wage in the Ann Arbor area in regards to housing costs, let alone health care. To me, this further demonstrates the need for a livable minimum wage.

 

 

3. Pre-existing condition protections help us all.

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At some point in our lives, we are likely to experience some health setback where we utilize the healthcare system. It is advantageous to us all to include people with pre-existing conditions in the insurance pool because one day that could be us!

 

 

4. Everyone has questions about healthcare- and it is important to find places to get good information.

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The Washtenaw Health Plan is a great place to ask for help! No matter your insurance plan, there seem to be terms and deadlines that won’t make a lot of sense until you ask an expert or seek reliable resources. I also wrote a blog post this past summer about reliable resources regarding health care access, and it totally changed the way that I look for information about health.

 

5. People who do direct service work can (and must) also do policy advocacy.

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Washtenaw County is organized and ready for action! I sat in on many meetings where people were putting their heads together to make sure they had the right information to talk to colleagues, legislators, and their clients about how federal policy change (for example, reduction in SNAP benefits) is detrimental to our community. This is vital to both keeping their jobs but also elevating the health status of the Washtenaw County population.

 

6. Above all, if healthcare was treated like a human right, the tone of this conversation would be very different.

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People at the WHP recognize that healthcare is more complicated than having access to insurance. Health is about access to nutritious foods, opportunities to relax, space to exercise, and of course the occasional donut from Dom’s. Working in the county government showed the interconnectedness of the systems that comprise of people’s access to health. I believe if we are more inclusive to people’s needs we can work together to improve the health of Washtenaw County.

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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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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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The Benefits of the ACA Go Beyond Health #thanksACA

The ACA is here to stay! For the moment. People talk about the Patient Protection and Affordable Care Act being beneficial for the health of individuals, but that is only the beginning.  There are benefits for women, hospitals, the economy, people who need mental health services, access to health care and much more! 

Maybe you know someone who quit a job they hated and started their own business because they could buy their own affordable insurance.

Maybe you know a family with a sick child who benefited from the removal of insurance spending caps.  

Maybe you know someone who was able to qualify for Medicaid and receive mental health services that allowed them to find a job and find stability in their life.

The expansion of Medicaid created the Healthy Michigan Plan and is making Michigan a better place to live. 

Please share widely or copy and paste.   jpg  or  pdf

Please share widely or copy and paste.  jpg or pdf

P.S. Remember these days?

On the left, President Obama signs the Patient Protection and Affordable Care Act of 2010. Note Rep. John Dingell on the right. On the right, Governor Snyder signs the bill authorizing the Healthy Michigan Plan.

On the left, President Obama signs the Patient Protection and Affordable Care Act of 2010. Note Rep. John Dingell on the right. On the right, Governor Snyder signs the bill authorizing the Healthy Michigan Plan.

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The Proposed American Health Care Act: What Would Replacing the Affordable Care Act Mean?

The American Health Care Act (AHCA) was introduced to Congress by Republican leadership on March 6, 2017.  The AHCA is a proposal that would replace the Patient Protection and Affordable Care Act (ACA, sometimes called Obamacare). The changes would reduce coverage options and make coverage unaffordable for many of the 20 million people who recently got covered under the Affordable Care Act. 

The Washtenaw County Board of Commissioners does not support any weakening of the ACA. Read the Resolution Opposing the Repeal of the Affordable Care Act and Supporting Additional Efforts to Strengthen Healthcare Access for All for in Washtenaw County

Groups that would suffer under the proposed changes 

Older Americans could be charged up to 5 times more than someone younger.  The ACA currently allows a 3 to 1 ratio. So if currently, the premium for a 20-year old is $200/month, the premium for a 64-year old could not be more than $600/month. Under the proposed law, a 64-year old could pay $1000/month.

States would need to pay much, much more for Medicaid. Currently, 31 states have expanded Medicaid.  The AHCA ends federal funding for new Medicaid enrollees post -2019. This means that states would foot the entire bill for new Medicaid recipients, which would be unaffordable to states and would force the Medicaid expansion to be severely curtailed or ended.  

Lower-income Americans would bear the brunt of the burden. People currently receiving ACA coverage, particularly those with low incomes, receive tax credits and cost sharing (lower deductibles and lower maximum out-of-pocket expenses) based on their income.  There would be no cost-sharing, which is a part of the ACA that benefits individuals under 250% of the poverty level (suggest an amount?). The AHCA replaces income-based tax credits and cost sharing with a universal tax credit. As can be seen in the map below, this benefits younger individuals and people with higher incomes.

Essential benefits would no longer be "essential" for people on Medicaid. Currently, there are ten essential health benefits, including treatment for substance use disorders, mental health, contraception. Under the proposed law, they would not be essential for people on Medicaid.

Contraception for low-income women is threatened. In addition to not requiring the same essential health benefits for people on Medicaid (thus making contraception "optional" for coverage), the proposed law bars Planned Parenthood from receiving reimbursements for services through Medicaid,  even though federal law already bans the use of federal funds for abortions.  Planned Parenthood is a major provider of contraception (and cancer screenings and prenatal care) for women across the country, particularly low-income women, whether on Medicaid or uninsured. 

Under the ACA, geography plays a role in determining tax credits and premiums. Under the proposed legislation, geography is not relevant. Thus, in high-cost states like Alaska, more people will be adversely affected.

Read more Seven Groups That Could Complicate GOP Plans To Repeal Obamacare By Perry Bacon, Jr.  March 7, 2017.

Who Wins and Who Loses Under Republicans’ Health Care Plan

The biggest losers under the change would be older Americans with low incomes who live in high-cost areas. Those are the people who benefited most from Obamacare.”
— Quealy and Sanger-Katz, New York Times, March 8, 2017

The New York Times map below shows how tax credits change for different age groups.   As your income goes up, you benefit across the board, but in general, older Americans will pay much much more.

New York Times By KEVIN QUEALY and MARGOT SANGER-KATZ MARCH 8, 2017

New York Times By KEVIN QUEALY and MARGOT SANGER-KATZ MARCH 8, 2017

Read more: Who Wins and Who Loses Under Republicans’ Health Care Plan By Kevin Quealy and Margot Sanger-Katz, March 8, 2017.

 

Use the tools below to compare proposed plans and premiums based on age, income, community, gender and more.

Compare Proposals to Replace The Affordable Care Act 

The Kaiser Family Foundation has a comparison tool that allows comparison of the ACA to the AHCA and other replacement proposals.  Comparisons can be made across various areas: Women's Health, Individual Mandate, Medicaid, Medicare, Cost-Sharing and more.  

Tax Credits under the Affordable Care Act vs. the American Health Care Act: An Interactive Map

This map allows you to compare premium assistance across age, income, and location for the ACA and the AHCA in 2020.  The AHCA does not adjust premium assistance based on income or geographic location.  Under the AHCA, a 40-year-old who makes $20,000 receives the same $3000 premium assistance as a 40-year-old making $75,000.  Depending on where you live, this could pay your whole insurance premium or only a portion of it. 

Click here to compare your costs now with what they would be under the AHCA. 

 

How Many People Are Affected by Obamacare
Premium Increases? (Hint, It’s Fewer Than You Think)

Why the urgency to replace the Affordable Care Act? Republicans claim that premium increases are driving this choice. But how many people are actually affected by premium increases?

This interactive infographic explains that only 3% of people are affected by rising premiums.  

Read more How Many People Are Affected by Obamacare Premium Increases? (Hint,
It’s Fewer Than You Think)
 By Troy Griggs, Karen Yourish, and Margot Sanger-Katz. March 9, 2017.

 

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Washtenaw County Opposes Repeal or Weakening of the Affordable Care Act

The Washtenaw County Board of Commissioners passed a resolution Feb. 1 to oppose any repeal or weakening of the Affordable Care Act (ACA). The resolution cited the vast number of county residents the ACA has helped, as well as the local economic opportunities it has provided.

“The Affordable Care Act is helping people – the uninsured rate in Washtenaw County has dropped by half since 2010,” says Andy LaBarre, chair of the Washtenaw County Board of Commissioners. “As a community, we want to support residents’ health and productivity. Maintaining what we’ve gained with respect to affordable health coverage is one clear way to do this.”

The Affordable Care Act is helping people – the uninsured rate in Washtenaw County has dropped by half since 2010.
— Andy LaBarre, Chair of the Washtenaw County Board of Commissioners

The Washtenaw County Board of Health also passed a similar resolution.

“A repeal of the ACA would be detrimental to Washtenaw County in so many ways.” says Felicia Brabec, Washtenaw County Commissioner and member of the Washtenaw County Board of Health. “More people have affordable coverage, and that coverage is not necessarily tied to their employer. This encourages entrepreneurship. It also promotes preventative health care and mental health in our community.”

The Washtenaw Health Plan sent a letter encouraging the continuation of the ACA, and supporting additional efforts to strengthen access to care, to federal legislators. The Board of Commissioners also resolved to send the resolution to the federal and state legislative delegations representing Washtenaw County.

Both the resolution and the letter outline how the Affordable Care Act has benefited Washtenaw County. For example, over 16,000 individuals in Washtenaw County have enrolled in the Healthy Michigan Plan (the Medicaid expansion), and 13,500 have enrolled in Marketplace insurance. That is nearly one in ten Washtenaw County residents who now have insurance due to the Affordable Care Act.

The Affordable Care Act also benefits those who are self-employed or whose employers do not offer them insurance, young adults up to age 26 who can stay on their parents’ health plans, and individuals with pre-existing conditions. A University of Michigan study found that the Medicaid expansion has created 30,000 jobs, and has provided $2.3 billion in economic activity across the state.

For personal testimonies of how the ACA has helped individuals locally, watch these two videos, created by the Washtenaw Health Plan and Washtenaw County Public Health, about a dance instructor and a graduate student who were able to find insurance through the ACA. 

Want to tell your story of how the Affordable Care Act helped you? Email us directly!

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