On July 1, 2010, the South Carolina Department of Health and Human Services (DHHS) filed a Medicaid state-plan amendment asking the federal government to make Managed Care mandatory for more than 500,000 Medicaid beneficiaries in our state, as well as allowing DHHS to qualify people for Managed Care who are currently ineligible.

This state plan amendment was filed without public input, comment or expertise.

CMS, the federal agency over Medicaid, is very concerned about DHHS’ lack of transparency and public input in this process. Consequently, it has set up a public hearing by telephone for Monday, August 23, at 10 a.m. This will be your opportunity as a South Carolinian to let CMS understand how DHHS’ proposed changes would impact you or the people you serve.

To participate, call (877) 251-0301 and provide the operator with the conference ID 93410633. CMS suggests you call in 10 minutes prior to the 10 a.m. start time. If you have further questions, contact Sue Berkowitz at sberk@scjustice.org.

The Kaiser Family Foundation has updated its health reform subsidy calculator to illustrate how government assistance for insurance premiums could work under the health reform law enacted this year. Beginning in 2014, tax credits will be available for moderate-income people under age 65 who are not covered through their employer, Medicare or Medicaid, and instead purchase coverage on their own in a health insurance exchange.

Users can examine the expected impact of the law for individuals and families at different income levels and ages by entering the relevant information into the calculator. The tool estimates the premiums and subsidies available in 2014, once relevant provisions in the health reform law take effect. It also illustrates the generosity of the coverage at different income levels, and displays the maximum out-of-pocket costs that people would face.

In many cases, coverage will be more comprehensive and accessible than what is typically available today in the non-group market, so premiums cannot easily be compared to what people buying insurance on their own are now paying. The subsidies do not apply to people with coverage available through an employer, where the firm is generally paying for a substantial portion of the insurance premium.

The updated calculator is the latest resource available through the Foundation’s health reform gateway, which includes summaries, explanations and analysis of the health reform law and its impact, as well as polling data, relevant research, and news from Kaiser Health News, the editorially independent news service established by the Foundation.

Affordable health insurance for people with pre-existing conditions will now be available to those who successfully enroll in a new high-risk insurance pool starting July 1^st.  Enrollment will be done through a new portal, http://www.healthcare.gov, which will go on-line that day.

One of the features of the health care reform law passed in March was the creation of new high-risk pools that would offer standard rates to those who have been rejected for health insurance due to a pre-existing condition.  Enrollees must have been without insurance for at least 6 months and have documentation that they were denied coverage.

South Carolinians will enroll in the high-risk pool being developed by the U.S. Department of Health and Human Services and is called the Pre-existing Condition Insurance Plan (PCIP).  The PCIP is expected to be active starting this August.  Our state is receiving $74 million under the new health care law to make premiums affordable.  The program will end in January of 2014 when the new health insurance exchanges are open and insurance companies will not be able to deny coverage or increase rates due to pre-existing conditions.

Sole proprietors and other small business owners that meet the enrollment criteria should act immediately to take advantage of the PCIP.  Demand for this program is expected to be very high and enrollment might be limited due to the budget.

From our Friends at the SC Small Business Chamber

Our new healthcare dictionary can help you decipher what all this really means!

Use the Tax Calculator to determine the tax credit you are eligible to receive under the new health care law.

Tax Credit Calculator

Health care reform turned an important political corner. A Gallup poll released yesterday finds that, for the first time in months, more Americans say that the Affordable Care Act is a good thing than think it’s a bad thing. And, though TPM’s PollTracker still finds that, on average, health care reform still has fewer supporters than opponents, support for reform has been growing (and opposition to it shrinking) uninterrupted for months.

Today’s Gallup poll finds that 49 percent of respondents were in favor of the new health care law and 46 percent were opposed. Previous polls showed that support for reform trailed opposition: for instance, a June 13 USA Today/Gallup poll showed the split at 46 percent for and 49 percent against. On April 11, the split was 45-49.

Gallup was careful to warn people against reading too deeply into the new numbers.

The 49% of Americans who today say passage of healthcare reform was a good thing, compared with 46% calling it a bad thing, is a bit more positive than the two prior readings in which the slight plurality called it a bad thing,” Gallup notes. “However, the four percentage-point increase since April in favorability toward the law, from 45% to 49%, is not statistically significant.

However, aggregate polling data finds that, overall, health care reform has been getting noticeably more popular, and opposition is the lowest it’s been in months. Ezra Klein at the Washington Post noted, “the bill’s spread looks better than at any point in the past year.”

See the Poll Data

Three months after President Barack Obama signed the law, that unsettling possibility is increasingly casting a shadow over its implementation, which the White House and its Democratic congressional allies had hoped a wary public would begin to embrace.

From our friends at Community Catalyst: National health care reform will have immediate benefits for Americans seeking quality, affordable health care. Focusing on the benefits that these policies will have on real people’s lives will help gain greater support for the new law, and put a human face on the issues that are being resolved.

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Seniors enrolled in Medicare

Lower Prescription Costs
In June 2010

• $250 rebate to people enrolled in Medicare Part D who reach the doughnut hole

In 2011

• 50% discount on brand‐name drugs for people in the doughnut hole

Focus on Prevention
In 2011

• No co‐payments for preventive services like mammograms and colonoscopies, and these services are exempt from deductibles

What does it mean?

Seniors who spend over $2,800 on prescription drugs and enter the doughnut hole will get more help paying for the medication they need. Seniors will also be able to get preventive care to stay healthier.

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Small businesses

Tax Credits to Help Cover Employees (for businesses with no more than 25 full-time equivalent employees, annual average wages of less than $50,000, and cover at least 50% of their employees’ premiums)

In 2010

• Tax credits to offset up to 35% of the employer’s portion of their workers’ premiums

In 2014

• Tax credits will increase to offset up to 50% of premiums

What does it mean? Small businesses who offer their employees health insurance will get help covering that expense, so they can invest in growing their businesses.

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People with chronic health conditions

No Lifetime Limits on Coverage
September 2010

• Health insurance companies can no longer place lifetime caps on coverage

Insurers Cannot Deny Coverage to Children with Pre‐Existing Conditions

September 2010

• Children with special health care needs will be able to get insurance that will cover necessary treatment of their illnesses

Special Insurance Available to People with Pre-existing Conditions
June 2010

• An interim high risk pool will provide immediate access to insurance for people who have not been able to get coverage because of a pre‐existing condition

What does it mean? Children and adults with chronic health care needs will not have to worry about running out of health benefits while fighting their illnesses. Currently, many people have no options for insurance coverage because of a health condition. And, while not a perfect solution, the temporary high risk pool will give them access to insurance until the new law covers everyone with pre-existing conditions in 2014.

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Young adults

Option to Stay on Insurance
September 2010*

• Health plans have to allow young adults to remain on their parents’ health insurance up to their 26th birthday

What does it mean? Young adults just starting out will continue to stay healthy and have protection in the case of an accident, and their parents will no longer have to worry about their children who cannot afford insurance.
* Note: Some insurers are implementing this provision early, allowing this population to be covered on their parents’ plans now. However, some employers are not offering this option and both must agree in order for consumers to receive this benefit earlier than the law mandates.