South Carolina Healthcare Voices

Public Hearing on S.C. Medicaid Managed-Care Plan

scjustice — Thu, 12 Aug 2010 14:59:02 +0000

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.

Check Out Our New Healthcare Commercial

scjustice — Wed, 21 Jul 2010 20:23:18 +0000

Interactive Calculator Estimates Premiums and Subsidies Available in 2014

scjustice — Wed, 14 Jul 2010 20:03:05 +0000

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.

Whose freedoms are being protected?

scjustice — Mon, 12 Jul 2010 20:11:29 +0000

Whose freedoms are being protected?

Lawsuit by 20 states says health care law violates states’ rights

By Armand Derfner: Special to the Post & Courier

July 11, 2010

Editor’s Note: This is the third in a short, occasional series of guest columns by two local constitutional law experts exploring pertinent issues of the day.

Why are South Carolina and 19 other states suing to declare the new federal health care law unconstitutional?

I know they believe the law is bad policy and too expensive, but that’s not a constitutional issue, and that’s not what their lawsuit is relying on. No, the 20 states say the lawsuit is about individual freedom, states’ rights and the 10th Amendment. Specifically, they say the new law infringes on their citizens’ individual freedom to choose not to have health care coverage, and it violates states’ rights and the 10th Amendment because it interferes with the states’ ability to protect that individual freedom.

But whose individual freedom is being protected from health insurance?

We’ll use Florida as an example because its numbers are listed in the lawsuit; the other states are similar. Florida has 3.6 million uninsured people living in the state. These people used to be “free” to go without health care coverage, but it’s only “freedom” when you have a choice. The only people exercising that freedom were those who could afford to buy insurance but chose not to. And how many of those 3.6 million do we really think that was? And how many people do we know who are clamoring today to go without health insurance?

So what does “states’ rights” mean here?

States don’t have “rights.” People have rights. States have responsibilities. A state’s main responsibility is to defend the rights of its citizens, and that responsibility is carried out using the states’ “powers” that are recognized in the 10th Amendment. We know that’s the purpose of the 10th Amendment because it’s part of the Bill of Rights — an individual guarantee along with freedom of speech and religion, the right to keep and bear arms, and all the other individual liberties in the Bill of Rights. Those individual rights are capped off by the 10th Amendment’s statement that “the powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved

to the States respectively, or to the people.” Those “powers” of government are there to protect the people, because sometimes we need help securing our rights. The states’ powers aren’t there for the states; they are there for us.

The principle represented by the shorthand term “states’ rights” is critical in a free society, because that’s how our freedoms as citizens are protected. Unfortunately, in our nation’s history the term states’ rights has been abused too often. States’ rights was used to defend slavery, and when we got done with that, states’ rights was used to shore up Jim Crow. This wasn’t just our part of the country either. A century ago, the U.S. Supreme Court held it was unconstitutional for Congress to pass a federal child labor law to keep 9-year-old children out of the cotton mills and coal mines. The Supreme Court said that was a states’ rights issue, even though the reason for the federal law was that states weren’t protecting their 9-year-olds.

The same is true of Florida and health care today. If Florida had figured out a way for those 3.6 million uninsured people to get medical care, we could complain that the federal government is interfering with Florida’s successful efforts for its citizens. But the reason Florida has 3.6 million people without health coverage is that the state hasn’t been using its powers to carry out its responsibilities. It dishonors the name of states’ rights to defend a “freedom” that 3.6 million people don’t have and that the state isn’t doing anything about.

I believe fervently in freedom and I worry constantly about the government — local, state and national — trying to run our lives. But it’s not real freedom these states are protecting when they say they’re just sticking up for all those good folks that don’t have health insurance and must not want it either.

Nor am I saying that people have a constitutional right to health care (or food, or housing), but if the federal government is trying to provide those benefits, don’t invent a states’ right to protect us from it.

Oppose health care if you like, but don’t oppose it on the backs of the uninsured, and don’t tell us that’s what “states’ rights” means.

Armand Derfner is a civil rights attorney whose arguments before the U.S. Supreme Court helped shape the 1964 Voting Rights Act. He is a constitutional law scholar-in-residence at the Charleston School of Law.

Read the article at the Post & Courier

Act Now! Enrollment in High-Risk Insurance Pool Starts July 1st

scjustice — Thu, 01 Jul 2010 13:30:49 +0000

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

Confused by Healthcare Lingo?

scjustice — Tue, 29 Jun 2010 19:13:57 +0000

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

Do You Own A Small Business?

scjustice — Thu, 24 Jun 2010 15:28:56 +0000

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

Tax Credit Calculator

What Waterloo? Opposition To Health Care Reform Declines

scjustice — Thu, 24 Jun 2010 13:41:00 +0000

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

Health Safety Net Fraying

scjustice — Tue, 22 Jun 2010 20:24:59 +0000

WASHINGTON —Despite passage of the landmark health care overhaul this spring, the nation’s health system is continuing to fray, raising the prospect that the country could experience a crisis before the law establishes a health care safety net in 2014.

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.

Instead, state governments struggling with budgets savaged by the recession are contemplating further cuts in health care aid for the poor, despite the promise of more federal dollars.

At the same time, several million unemployed Americans and their families who have used federal assistance to hold on to health insurance from work will lose coverage in coming months as the special assistance program expires.

Those with jobs face their own challenges as employers continue to look for ways to pare back health benefits and shift more costs to employees, if not drop health coverage altogether.

And people in all walks of life face rising health care prices and skyrocketing insurance premiums, which in many places are rising at double-digit rates this year.

“If the economy does not improve substantially, we may be taking some steps backward before we take steps forward,” warned Ron Pollack, a leading supporter of the health care overhaul who heads the consumer group Families USA.

Even Obama’s senior health care adviser acknowledged that the road ahead may be rough.

“Will plans continue to raise prices? Will some people continue to lose coverage? I think the answer is yes,” said Nancy-Ann DeParle, head of the White House Office of Health Reform. “It is something we are concerned about.”

DeParle called the next several years a “bridge period” until 2014, when Americans will get guaranteed access to health coverage along with billions of dollars of federal subsidies to help them pay their insurance bills.

The Obama administration believes that a series of initiatives in the new health care law will help hold the line during this implementation period.

Since the law’s passage, administration officials have moved quickly to begin offering new tax breaks to small businesses to encourage them to offer their employees health benefits. The administration is developing new regulations designed to increase oversight of insurance companies and prevent major rate hikes.

The Department of Health and Human Services is working with states to set up high-risk pools for people who have been denied coverage.

“I think we have tools that will help make thing better than they would have been” if the health care legislation had not passed, DeParle said.

While the Obama administration works to ease the transition, the same forces that helped spur passage of the overhaul legislation are taking a relentless toll on the country’s health care system right now.

And early research suggests that some of the short-term aid in the health care law, such as $5 billion for new high-risk pools, may be inadequate.

“This is not about health care reform,” said Helen Darling, president of the National Business Group on Health, a group of large employers that provide coverage to about 50 million workers, retirees and dependents. “It’s just existing pressures on the system. … It’s business as usual.”

Small businesses, which already are less likely to offer their employees health benefits, are under even more pressure.

“Costs are out of whack and nothing can change that in the short run,” said Len Nichols, a health care economist at George Mason University.

Nichols and many other experts believe that provisions in the new law to make the health care system more efficient could slow cost growth in the longer run.

So far, federal and state officials have managed to hold together a safety net with the help of billions of dollars of stimulus spending authorized by Congress last year.

Washington provided an estimated $2billion in 2009 to help more than 2 million people and their dependents hold onto their health benefits after being laid off.

But now, under pressure to control spending, Congress appears certain to end the COBRA assistance.

Democrats on Capitol Hill are moving to provide states with some extra money to prop up their Medicaid programs for the poor, which have seen a huge surge in enrollment since the recession began.

But for many states, even the extra aid is not expected to be enough this year.

Quick Wins: Who Will Be Helped Right Away By the New Health Care Reform Law?

scjustice — Mon, 14 Jun 2010 14:59:33 +0000

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.