Marketplace Open Enrollment: November 1, 2017-December 15, 2017
ACA vs AHCA: Know the Facts and Join ARxC in Taking Action
(June 26, 2017)
At ARxC, we are dedicated to the protection of quality, comprehensive, and affordable health care for all Americans. The Affordable Care Act or ACA (also known as ‘Obamacare’) ensures these protections are in place. The law, while not perfect, provides access to the care and treatment their providers prescribe.
To date, the ACA has provided health insurance to 20 million Americans, many of whom are living with chronic and serious health conditions. This has led to more than 90% of Americans having health insurance. If the newly insured, many of whom were previously uninsured or underinsured, lose access and coverage for even one day, their health and well-being can be immediately jeopardized. Therefore, providing them with continuous coverage and consistent care and treatment must be the number one priority.
Furthermore, we cannot afford to lose the numerous ACA patient protections, which have improved access to quality health care for all beneficiaries, including those who already had health coverage. The ACA ensures all Americans, except for those remaining on grandfathered health plans, can access health insurance that cover essential health care, with contraceptive care and preventive services being free so that health problems can be avoided or treated at an earlier stage. However, due to these quality standards and the uncertainty of our health system, there are a few select counties in Washington, Nevada, Missouri, and Ohio where insurers are projected to not offer affordable coverage options. Despite the Republican Administration’s claims that this is an indication of a crumbling infrastructure, these states are independently taking action to fill these gaps (see how Nevada is working to cover their uninsured).
Finally, it is important to stress that why the cost of health care continues to rise in our capitalist country, the ACA has, for the first time in 50 years, slowed this rise in costs. This is despite the fact that health insurers are making record profits off of their beneficiaries.
Many Georgians are feeling unsure and ill from the proposed changes to the ACA. This is understandable given the rhetoric and politics that have infiltrated our health system. It is important to remain beholden to the principles that remain critical to a thriving health system: accessibility, affordability, quality, responsiveness, choices and transparency, and innovative patient-centered care.
Experts from across the country have analyzed the American Health Care Act (AHCA) put forward by the House on March 6, 2017 and have come to the conclusion that both bills go directly against the core principles of a thriving health system.
The AHCA would:
· Take health insurance from 23 million people, 82 percent of whom are in working families.
· Take coverage from the tens of millions of low and moderate income individuals who gained it through Medicaid expansion.
· Cause health care premiums to spike drastically for millions more. (Go to NASHP's State Chart Book: Comparison of Predicted Premium Differences across Counties under the ACA and the AHCA to see how premiums will be affected in Georgia).
· Give hundreds of billions of dollars in tax breaks to the wealthy, insurance and drug companies, while eliminating tax credits for working families.
· Allow the nation's largest corporations to limit or take away health care coverage for their workers.
· Double the number of uninsured children in the country, leaving an additional 4 million children uninsured.
· Cut funding of Planned Parenthood health centers that provide an array of preventive and basic health services to millions of women.
· Eliminate the Public Health Prevention Fund which supports a variety of programs dedicated to preventing disease and promoting health.
AHCA changes to the ACA include a number of reforms to the health care system such as:
· Repealing the individual and employer mandates created by the ACA, which will cause premiums and deductibles to rise.
· Doubling the cap on how much individuals can contribute to their personal Health Savings Accounts (HSAs) each year and expanding where these dollars can be used.
· Giving power to the states with the biggest entitlement reform in a generation putting Medicaid on a budget.
· Fundamentally, the AHCA will affect the lower-income, older Georgians who live in rural areas where health insurance premiums are higher.
The Congressional Budget Office (CBO) independent analysis found the Republican House’s version of the AHCA (the CBO report for the Republican Senate bill released June 22, 2017 will not be available until later in the summer):
- Could lead to 23 million Americans losing their health insurance by 2026. But the plan would also reduce the federal deficit by nearly $340 billion over that 10-year period in large part by cutting Medicaid and on eliminating tax credits for people that help them buy individual health insurance.
- An estimated 750,000 Georgians — many of them poor and older — could lose their health insurance.
- The data offers a glimpse into how the AHCA could fundamentally change access to health care in the Peach State. Georgia already has the third highest rate of uninsured in the nation.
ARxC Update: Status of ACA Reconciliation to proposed AHCA
(June 22, 2017)
· The Republicans in the House passed H.R.1628 (the AHCA) on May 4, 2017 and was sent to the Senate on June 7, 2017. Leadership would typically put the language through its own committee process but the Senate has decided to skip this step.
· Instead, several groups of Senators have privately negotiated a consensus on how they would alter the AHCA. The Republican Senate version of the AHCA was released publicly on June 22, 2017.
· With a CBO score released, the bill goes to the Senate floor. Senate rules require 20 hours of debate before a vote followed by unlimited amendments. Only 51 votes are required to pass budget reconciliation in the Senate.
· Senate Republican leadership has indicated it is working with the goal of putting the bill to floor for a vote by July Recess (July 3rd-7th), it may be that we will not see a vote until just before Congress goes on Recess for the month of August.
· Since the Senate will not pass the same bill as the House, the legislation will either go to a conference committee or directly back to the House for a final vote. If unfortunately, the bill makes it through these steps, the AHCA would then be sent to the President for his signature.
CALL to ACTION
It is our job as citizens to tell our legislators that we expect these protective tenets of the ACA be upheld. How can I respond to ensure critical measures of protection under the ACA are upheld?
1. Please sign onto the “Protect Our Care’ letter and then share with everyone you know and post on your social media outlets. http://act.savemycare.org/page/s/let-us-testify
2. Call your Senator; write your Senator via Email and Fax. ASK your Senator to oppose any bill that violates the protections and affordable access to patients. Please tell your legislator your concerns about health insurance and your story stating your healthcare needs. Here are some talking points to tell your Senator:
· While it is not a perfect law, the ACA has provided health coverage and improved access to care for tens of millions of Americans living with chronic and serious health conditions, many of whom were previously uninsured or underinsured. If they lose access and coverage for even one day, their health and well-being can be immediately jeopardized.
· Therefore, we must provide them with continuous coverage and consistent care and treatment as a number one priority.
· Furthermore, we cannot afford to lose the numerous patient protections that the ACA provides, including the Essential Health Benefits, which have improved access to quality health care for all beneficiaries, including those who already had health coverage.
· Currently, patients are protected from discrimination on the basis of race, color, national origin, sex, disability and age by health programs and activities operated or funded by the U.S. Department of Health and Human Services, including Qualified Health Plans. These landmark protections are critical to fulfilling the requirement of preventing discrimination based on pre-existing health conditions and access to the healthcare that every American deserves.
· I urge you not to go back on the promise of affordable and quality care and treatment for everyone, especially those living with chronic and serious illness.
The numbers do not lie; the ACA actually started working. Twenty million Americans have health insurance who did not have it before. It is doubtful that most Americans will think that a plan that leads to many more people going without insurance is “better” than the ACA. Our legislators have a rare opportunity to make improvements in our health policy, but they must understand that providing secure insurance for everyone in the country needs to be a central feature of what they do. That is not an unreasonable demand, nor is it an impossible task. It will mean listening to the voices of patients, care-givers and providers. It is the job of our legislators to ensure determined and considerate leadership as they are about to become responsible for the health and well-being of all Americans. It is our job to remind them of this.
Many Republicans in Georgia are claiming Democrats passed the ACA in the same covert manner with which the Republicans are seeking to pass the AHCA (a bill that is proven to be an attempt to transfer funds from our health system and into the pockets of the top 1% wealthiest Americans). This claim is irrelevant when it comes to the health and well-being of Americans and the dangers that the AHCA poses from taking back coverage and eliminating patient protections. However, these claims are false. ARxC would like to refer the individuals making these claims to the Congressional Record of the ACA and the Congressional Record of the AHCA. Note that Congress – both Republicans and Democrats – took a total of 209 actions over 6 months and 6 days (from September 17, 2009 through March 23, 2010) to pass the ACA. Only Republicans have taken 17 actions beginning March 20, 2017 in hopes of passing the bill by June 30, 2017.
Summer 2016 Update on Georgia's Approach to Expanding Medicaid
In November 2015 the Georgia Chamber of Commerce – Health and Wellness Policy Committee’s Healthcare Access Task Force began a nine month study to develop policy options to increase quality healthcare access for Georgians.
In August 2016, the proposed alternatives to Medicaid Expansion were released in the Quality Healthcare Access Study: Proposed Policy Alternatives report. This report proposes three possible experimental, pilot, or demonstration projects (called 1115 Medicaid waivers) for state officials to consider to expand Medicaid to low-income Georgians.
As a member of the Cover Georgia Coalition, ARxC is glad to see movement towards implementing an approach for all Georgians to have healthcare coverage.
News organizations have put forward the following responses to this report:
- Cover Georgia: Cover Georgia Responds to Georgia Chamber of Commerce Task Force Report
- AJC: Georgia Chamber pitches conservative-friendely blueprint for Medicaid Expansion
- Georgia Health News: Task force unveils options to cover uninsured in Georgia
- WABE: Ga. Chamber Releases Plans for Expanding Health Care Access
Go to Expand Medicaid Now to sign the petition in support of the Expand Medicaid NOW Act (HB 823)
Sponsored by House Minority Leader Stacey Abrams and co-sponsored by Rep. Robert Trammell and Rep. Pat Gardner, the Expand Medicaid NOW Act (HB 823) would compel Georgia's Department of Community Health to expand state state Medicaid eligibility to individuals earning up to 138% of hte federal poverty level and provide health insurance coverage for nearly half a million Georgians.
The Patient Protection and Affordable Care Act (known as the Affordable Care Act or ACA) was signed into law on March 23, 2010 to improve access to quality health care.
Here are some of changes that the ACA has made to improve access to care for Americans and legally-residing residents:
- Makes Medicaid available to low-income citizens and immigrants with certain statuses - but this does NOT apply in Georgia (see below)
- Simplifies the health insurance application process - through HealthCare.gov or state-based health insurance exchanges
ARxC is working with a variety of partners to ensure Georgians receive the maximum benefit of the ACA by.
More information about Medicaid Expansion in Georgia is available at:
- Cover Georgia - www.coverga.org -> Access the Understanding Medicaid in Georgia and the Opportunity to Improve It chartbook developed by Georgians for a Healthy Future for more details on how you can join efforts to expand Medicaid
- Expand Medicaid Now - www.expandmedicaidga.com
In addition to ensuring individuals have adequate health insurance and access to health care facilities, ARxC works to facilitate access to the services and information they need to be advocates for themselves.
As a CMS Champion of Coverage, ARxC sends out updates about the Health Insurance Marketplace and guidance on how to use health insurance to access quality health care services. Here are a few key resources in this effort:
- HHS.gov/Healthcare: This website provides background information about the Health Insurance Marketplace, the Affordable Care Act, Prevention and Wellness Services, and other information related to the programs and services made available to help Americans access the services they need to be well.
- ACA 101 Webinars: The HHS Partnership Center host a series of webinars about the benefots made available by the ACA. These webinars are open to the public and include a question and answer session where participants can ask HHS staff questions.
- From Coverage to Care: From Coverage to Care is an initiative to help people with new health care coverage understand their benefits and connect to primary care and the preventive services that are right for them, so they can live a long and healthy life.
- Connecting Georgians to Coverage: Seedco and local community partners launched this resource to provide Georgians with valuable information so they can make informed choices about their new health insurance options and learn about the benefits of being insured.
Guiding documents for this principle:
2. Health Disparities
Health disparities are inequalities endured by certain groups, commonly defined by race, ethnicity, income, educational level, sexual orientation, and gender identity. These inequalities cause certain groups of people to endure a disproportionate burden of disease, disability and death.
Given the diversity of Georgians, addressing health disparities is the cornerstone of ARxC's best-practice health insurance model for Georgians.
Guiding documents for this principle:
For more information on health disparities and the ACA read ARxC's publication “The Role of Health Insurance in Addressing Health Inequity” (written by Haley Stolp, MPH).
3. Primary Prevention and Health Promotion
Today's fee-for-service model of care causes the health care system to thrive on specialty-driven care rather than prevention. ARxC fights to reverse this trend by advocating for a system that provides incentives for preventive medicine and wellness maintenance and reduces disparity in health care.
To optimize prevention initiatives, ARxC works to increase awareness of the preventive services recommended by the United States Prevention Services Task Force (USPSTF) that are available without cost-sharing for newly enrolled health insurance beneficiaries.
Moreover, we are committed to developing new and innovative means of maximizing uptake of evidence-based prevention and disease management practices.
Resources to maximize uptake of preventive services:
4. Integrity of the Doctor-Patient Relationship
ARxC fights to preserve the integrity of the doctor-patient relationship and prohibit payers from influencing patients' health care decisions.
To prevent insurance companies from interfering with the care provided to patients by their health care professionals, ARxC has partnered with the Georgia Healthy Living Foundation to support the Fail First Hurts program, an initiative that strives to end the discriminatory fail first practice. For more on this initiative please refer to the GHLF Fail First Hurts factsheet and the GHLF Fail First Hurts survey results.
ARxC's Specialty Tiers initiative and Testimony to Georgia Pharmaceutical Licensing Board are grounded in this commitment to full access to affordable and safe medications for all, especially people with serious chronic diseases.
Guiding documents for this principle:
5. Benefit Management and Access to Coverage
Because there is no universal health care system in the United States, Americans are individually responsible for finding a health insurance plan that best meets their health care needs at a cost they can afford.
To facilitate access to the health insurance, ARxC finds it vital that the ACA's Marketplace be consistent with the values of freedom of choice, freedom of practice and universal access for all patients by including the principles of the Health Insurer's Code of Conduct.
ARxC is also invested in assuring that payers cover and maintain coverage for vital services. In February 2014, ARxC expressed our strong opposition to the sudden and drastic changes to Medicare Part D that were proposed by the Centers for Medicare and Medicaid Services (CMS) in our letter to CMS Administrator Tavenner. ARxC then joined 200 organizations and groups demanding that the rule be withdrawn in a shared letter to CMS that was widely publicized. In response to the opposition, CMS claimed to no longer pursue the changes to Medicare Part D.
Guiding documents for this principle: