Archive for May, 2011

Vermont Takes Steps Down the Single-Payer Path

Thursday, May 26th, 2011

Today, Vermont Governor Peter Shumlin signed H.202 into law, which puts his state on a path toward creating the first single-payer health care system in the nation. H.202 was passed in Vermont with the strong support of both the House of Representatives (a 92-49 vote) and the Senate (a 21-9 vote). Importantly, the law ensures that the state will be in compliance with the basic coverage framework established by the Affordable Care Act (ACA) and then authorizes the state to build on this foundation in order to create a single-payer system, pending the necessary federal approval. It also creates a structure to help the state to address the issue of health care cost containment.

For those of you keeping score at home, the law has three major components:

  • – Vermont Health Benefit Exchange: The Exchange — established as a division within the Vermont Department of Health Access (the state Medicaid agency) — will facilitate purchase of affordable, qualified health plans in the individual and group markets and will meet all other requirements specified in the ACA for state Exchanges. Upon the implementation of Green Mountain Care (the name for the new single-payer system), the Vermont Health Benefit Exchange will cease operation.
  • – Green Mountain Care: Upon receipt of the necessary federal waivers and approval of a financing plan by the legislature, Green Mountain Care will be implemented to provide comprehensive, affordable, high-quality, and publicly financed health care coverage for all Vermont residents. Assuming that the necessary waivers are granted, the federal funding previously provided in the form of premium tax credits, cost-sharing subsidies, and small business tax credits under the ACA would be used to partially finance Green Mountain Care. The state will also seek to use Medicare, Medicaid, and CHIP funds as a financing mechanism.
  • – Green Mountain Care Board: A board will also be created to oversee the development and implementation of health care payment and delivery system reforms designed to control health care costs and maintain health care quality in Vermont. The board will have five members, nominated by a new Green Mountain Care Nominating Committee and appointed by the governor with the consent of the Senate.

The major policy question left to be resolved by the law is how Green Mountain Care will ultimately be financed. However, the law does set up a timeline for this to be resolved. In January 2013, financing plans for both the Exchange and Green Mountain Care must be submitted to the legislature for consideration. Another important question is whether — and when — Vermont will be able to obtain the various federal waivers it needs (including ACA, Medicaid, and Medicare waivers).

Vermont’s single-payer law demonstrates just how far the ACA’s coverage framework could take us in terms of reforming our health care system. While a single-payer system certainly isn’t required by the ACA, the law is potentially flexible enough to allow this as well as other approaches to increasing access, bending the cost curve, and improving quality of care.

For some additional commentary on the provisions of H.202, check out this post by our partners at the Vermont Campaign for Health Care Security Education Fund over at Say Ahhh and this interview conducted by Ezra Klein. For the latest updates on the single-payer effort in Vermont as implementation moves forward, check out the Vermont Public Interest Research Group’s campaign site.

—Patrick M. Tigue, Children’s Health Care Coordinator
New England Alliance for Children’s Health

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Posted in Affordable Care Act implementation | 1 Comment »

States and State Advocates Strengthen Rate Review Laws

Wednesday, May 18th, 2011

States Take Steps to Improve Oversight and Consumer Engagement
In the past few months, several states have taken dramatic steps to strengthen their rate review authority, protect consumers, and call out insurers on excessive rate increases. For example, earlier this year, California health insurers announced planned rate increases that would have driven premium costs up as much as 87 percent for some individuals. But in the face of increasing insurer profits, Insurance Commissioner Dave Jones elicited promises from California’s major health insurers that they would decrease and delay implementing proposed rate increases until the state had a chance to evaluate the accuracy of the insurers’ filing. This week, Consumer Watchdog released a report indicating state reviews of insurer rate increases found erroneous math and unsupported actuarial assumptions in rate filings submitted by health insurers. California legislators are moving legislation to give the insurance commissioner explicit authority to disapprove of or reduce proposed premium increases through the state Assembly.

And in New Mexico, the state’s Republican Governor recently signed into law a bill that enhances the state’s rate review authority. The new law includes strong provisions encouraging public participation by establishing a thirty day public comment period on proposed rate increases and requiring insurers to notify policyholders of any possible increase in their premium rate before the increase can be implemented. The statute further gives policyholders the right to request a public hearing on rate increases that the Insurance Superintendent has approved.

Affordable Care Act Mandates Rate Review
The Affordable Care Act requires an annual review of unreasonable health insurance premium increases. Federal regulations, soon to be finalized, outline the process through which the U.S. Department of Health and Human Services (HHS), together with state regulators, will review and evaluate health insurance premium rate increases.

While several states currently have review processes requiring a comprehensive evaluation of proposed rate increases before insurers may charge consumers and businesses more for their premiums, other states are using the new federal rate review requirement to expand consumer protections. In February, HHS announced $200 million worth of federal grant money available to states to help them strengthen their rate review processes and states will finalize their application for this money this summer.

Together with their Insurance Departments, and independently, state consumer health advocates are making tremendous progress toward protecting consumers from unreasonably high insurance premium increase. At the end of this blog post you will find new resources Community Catalyst has developed to assist states in advocating for stronger rate review laws.

State Advocates are Helping to Improve Rate Review Processes
State consumer health advocates all over the country are taking the lead to guide their states toward revising and implementing stronger rate review laws. For example, in Pennsylvania, the PA Health Access Network is developing an online petition that they intend to use to encourage their insurance commissioner to hold public hearings on proposed rate increases, giving consumers and policyholders the opportunity to provide input on rate increases.

Advocates with Illinois’ Campaign for Better Health Care are supporting legislation that would give their insurance commissioner authority to disapprove or reduce proposed premium rate increases. Recent data released by the Illinois Department of Insurance shows that while insurance premium rates have increased 181 percent since 2005 for individuals and families in Illinois, the top five insurers brought in more than $28 billion in profits in 2010 alone.

And in Ohio, advocates at UHCAN Ohio are in the research phase of their campaign to improve the state’s rate review process, enhance transparency and consumer involvement as a means to protect individuals, families, and small businesses from rising health insurance costs. These advocates are in communication with officials at the Ohio Department of Insurance to better understand the current rate review process and gather data about increasing premium rates.

While we provide three examples here of state advocates working to strengthen their states’ rate review laws and two states where reform is on the horizon, many other states are progressing toward stronger, consumer protective rate review processes or currently have robust laws on the books.

Tools for States to Engage in Rate Review Reform
Because most states will continue to oversee health insurance premium rate increases in their markets, Community Catalyst has designed a toolkit to assist state advocates in evaluating their state’s current rate review process and to develop advocacy resources supporting stronger rate review laws. Use the general fact sheet to explain rate review to policymakers and community organizers. The state-specific template is a guide to asking the right questions and gathering the right information and data to demonstrate the critical need for enhanced rate review authority in your state.

– Sarah Blumenthal,  blog contributor

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Recent Polls Find Strong Support for Taxing Sugar-Sweetened Beverages

Tuesday, May 17th, 2011

Childhood obesity is truly an epidemic. More than one in six children in the United States are obese, a rate that has tripled in the past 30 years. Childhood obesity is linked to a number of debilitating and costly diseases, including cardiovascular disease, diabetes, hypertension, several kinds of cancer, and other chronic conditions.

A significant body of research has demonstrated that consumption of sugar-sweetened beverages (SSBs) — such as sodas, sports drinks, and sweetened teas — is strongly linked to increased obesity in children. This is why various proposals to tax SSBs as a means of reducing consumption and raising revenues for initiatives to fight childhood obesity have been the focus of intense discussion in 14 states during 2011 alone.

A recent poll commissioned by The Boston Foundation and NEHI as part of their Healthy People/Healthy Economy coalition’s work found that 69 percent of Massachusetts voters would support applying the state sales tax to soda and candy (these items are currently exempt) if the revenues from the tax were used to fund childhood obesity reduction efforts. The Alliance for a Healthier Vermont also recently conducted a poll that found a similar result, with nearly 60 percent of Vermont residents expressing support for a penny-per-ounce excise tax on SSBs.

These poll results should encourage all of us who are deeply concerned about the childhood obesity epidemic to press forward with taxation proposals and continue to work to strategically engage the public about the importance of using a variety of policy tools to make progress in the fight against childhood obesity. Our children deserve a healthy future and taxing SSBs is one important way to help ensure this. These polls suggest that the public thinks so as well.

—Patrick M. Tigue, Children’s Health Care Coordinator
New England Alliance for Children’s Health

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Posted in children's health | 2 Comments »

The Insider: Move Over, Bristol: Mitt Romney’s Great Tap Dance

Friday, May 13th, 2011

If you are blessed, or cursed, with a certain kind of sense of humor, the current health care debate offers a rich field for laughs, if only of the sardonic kind. First up is the spectacle of House Freshman Republicans, many of whom owe their seats to the party’s relentless demagoguery on Medicare, whining about the drubbing they’ve been taking from their constituents over the vote they took to undermine Medicare and Medicaid.

But my favorite is the amazing tap dancing of former Governor Mitt Romney as he tried yet again to have it both ways on health care reform in Massachusetts. In his USA Today op-ed and his speech in Michigan, Mr. Romney basically offered up a strange amalgamation of a defense of the Massachusetts law coupled with a rehash of old ideas for national reform that have been analyzed in the past and found to be ineffective and inadequate to address the problems he correctly identifies (the high number of uninsured, high cost and uneven quality).

As for the specifics of the “new” Romney plan:
He offers no evidence that the state flexibility he touts will address the problems he identifies. If you look at what states have done (and not done) with their Medicaid programs, you have to conclude that, absent some incentives or requirements to do so, states will not solve these problems on their own. President Obama has already come out in favor of state flexibility as long as states can meet certain minimum benchmarks for the quality of health plans and for reaching the uninsured. Mr. Romney appears to be embracing the idea of state flexibility without any accountability for actually achieving results.

He relies on innuendo and unsupported allegations — e.g. the ACA will harm US economy; the big federal bogey man will get your health care — but he doesn’t actually make an argument or provide evidence to back up his allegations.

Mr. Romney claims he will address the problem of the uninsured with no new taxes, but he also proposes several new federal tax expenditures (which will not be enough to make a real dent in problem of uninsured) with no offset in savings or revenue (unless he is proposing to take it out of the hide of the states with the Medicaid block grant).

He embraces Medicaid block grants that have been shown to shift costs to states and leave them without the resources to maintain current coverage levels, let alone expand coverage.

Romney offers only tepid insurance reforms. For example, insurers couldn’t deny coverage based on pre-existing condition, but he doesn’t say whether they could charge you more based on health status.

He also embraces the sale of insurance across state lines which would produce a race to the bottom that undermines coverage for those who need it most. It would also enormously complicate the job of state regulators who want to provide basic protections, such as requiring insurers to meet reserve requirements, let alone enforce patient rights and quality standards.

Mr. Romney repeats the standard Republican talking point about liability reform. Impartial analysts have concluded that malpractice reform offers a modest opportunity for cost containment but also limits people’s ability to get redress for injuries. Since most wrongfully injured patients are never compensated in any way, any fair malpractice reform proposal would have to address this problem as well.

And of course there are the usual paeans to making health function more like a “normal market.” Never mind that there are so many market failures in health care and they are so fundamental, (Do you really want the same legal and ethical relationship with your doctor that you have with the guy who sells you shoes? No offense meant to shoe salesmen.) that the attempt to make health care more of a market a.) is bound to fail and b.) will have all kinds of negative consequences along the way. Thoughtful people have concluded that in order to make competition work in health care you actually need a very active role for government (e.g. Health Insurance Exchanges, subsidies, universal coverage, etc.).

No matter. It appears that Mr. Romney has concluded that this is what potential donors and Republican primary voters want to hear. He seems to be working overtime NOT to distinguish himself on health care and to repudiate any claim he might justifiably make to leadership on the issue. But judging by the reactions of a number of conservative media outlets and think tanks, it’s not clear that the effort will be successful. If things don’t work out, there is no need to worry. Mr. Romney can always take his tap-dancing act to Dancing with the Stars.

– Michael Miller, Policy Director

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Posted in Health Reform Insider | 1 Comment »

Does Your Local Hospital Make the Grade on Community Benefit? Now There’s a Way to Tell

Thursday, May 12th, 2011

This year, the public will have unprecedented access to critical new information about how hospitals in their communities fulfill their obligations to the people they serve.

For the past several years, there’s been a need for a well-defined standard by which to judge how well local hospitals support, engage, and invest in the broader health of their communities. Because so many people lack adequate health insurance coverage, this debate has primarily centered on the lack of transparency in how hospitals provide charity care, their methods for billing and collecting on past-due accounts, and the impact of both on access to care in their communities. Many states require minimal reporting on charity care or billing, and often those reports aren’t public.

That is slowly changing, thanks in large part to the Internal Revenue Service (IRS). As the federal agency charged with overseeing federal tax-exempt status, it has a particular interest in understanding whether non-profit hospital behavior on billing, charity care, and related activities is up to snuff. In 2008, it introduced a new mandatory reporting form, Schedule H, that asks non-profit hospitals a series of pertinent questions such as: Did Hospital X have a charity care policy? If so, how did it determine who was eligible, and how did it let patients know such programs were available? How did its billing and collections policies — if it had them — apply to patients who qualified for financial help?

These hospitals have to publicly report not just how they’re spending on community benefit and charity care, but also how much with regard to their total expenses. And that’s where things have gotten interesting.

Short of the Mark: Investigation Shows a Wide Range in Practices
Schedule H data is just becoming available this year, and it’s already being evaluated by industry insiders. A recent survey by Modern Healthcare Magazine found that nine out of 10 hospitals devote less than five percent of their total expenses to charity care — the average amount reported is just 2.5 percent of all hospital expenses. The findings, which are the result of the magazine’s analysis of Schedule H tax reporting of 156 hospitals from 20 large health systems, are detailed in the article Short of the Mark.

The study also draws attention to how hospitals reported the amounts of bad debt they attributed to patients who are unable to pay and fall within the hospital’s charity care guidelines. For community groups and advocates, this data is telling. A high number can signal that hospitals’ processes for identifying and qualifying patients for charity care are lacking, or that hospitals’ standards for eligibility in charity care programs don’t match the demographics of their communities.

So how did hospitals in the sample stack up? Eighty-three of the 156 hospitals reported that none of their bad debt could be traced back to patients eligible for charity care — a good outcome that indicates hospitals made efforts to ensure qualifying patients received charity care. By contrast, 12 hospitals said that at least half of their bad debt costs are made up of bills sent to consumers who would be considered eligible for charity care; some hospitals, like BJC Healthcare, reported that 81 percent of its bad debt could be attributed to patients qualifying for charity care.

Why this matters in a Post-ACA World
Why should people care how much charity care their local hospital is providing? With the Affordable Care Act law of the land, isn’t this an issue for a pre-health reform world?

On the contrary. For one thing, most of the coverage protections in the ACA don’t get phased in until 2014, leaving the approximately 50 million uninsured Americans vulnerable to medical debt. A study released this week by the Department of Health & Human Services showed that most uninsured families can’t pay hospital bills: On average, they can only afford to foot the entire bill of approximately 12 percent of hospital stays. Furthermore, while the ACA makes great progress in covering millions of currently uninsured Americans, not everyone will be covered. Affordability exemptions, immigration status, and enrollment considerations will all play a role in a continued uninsurance rate, even after full implementation. Even then, some newly insured may find it difficult to afford their health care-related costs, making them technically under-insured. This can lead to hospital bills and other kinds of medical debt that can follow a person for years. These populations will still rely on some form of charity care, so it’s critical hospitals get it right.

Second, Schedule H interfaces with the ACA in several key ways. We’ve written before that the law draws a new line in the sand for non-profit hospitals. To qualify for tax-exempt status, hospitals must provide a range of benefits to patients including charity care (now called “financial assistance”) policies and community benefit plans that engage their communities. Schedule H, though new, has already been adjusted to account for the new rules for Tax Year 2010. This time next year, a hospital will also have to report the steps it’s taken to qualify patients for charity care before it sends them to collections. That’s new, courtesy of the ACA, and it’s a powerful starting point for community members who may want to work with the hospital on improving its practice.

Third, non-profit hospitals benefit considerably from community investment. The Joint Committee on Taxation estimates that non-profit hospitals receive $12.6 billion per year in local, state, and federal tax exemptions. In return for this transfer of revenues from taxpayers, non-profit hospitals are expected to provide some benefit to their communities, including charity care. By making more information publicly available, Schedule H gives hospitals opportunities to broadcast what they are doing to “repay” that investment. It also gives communities unprecedented insight into hospital budgeting, prioritization and policies on debt collection, billing, and financial assistance, seeding questions and informing community partners’ conversations with their local hospitals.

What can advocates do?
The results of the Modern Healthcare survey, combined with new data from HHS about what the uninsured can afford to pay, are troubling. These reports demonstrate that there are critical gaps between what some communities need and what hospitals provide. However, the hospitals that are doing the right things are to be commended, and their practices should stand as a model for others.

Whichever end of the spectrum a community’s hospitals are on, the Schedule H provides advocates with unprecedented access to information and, therefore, critical opportunities to engage. Hospitals that are leaders in this area should be open to hearing from the community about ways that their programs can be tailored and enhanced — especially now that the ACA requires hospitals to regularly assess their communities’ health needs and to seek input from community members and public health experts in the process. Hospitals that have some work to do in this area may benefit from the same consumer input.

Consumer advocates are uniquely positioned to facilitate hospital-community discussions, to help identify areas of common ground and negotiate areas of disagreement, and to play a watchdog role where necessary. Over the next few months, Community Catalyst will offer more information and resources for groups who are interested in working more directly on community benefit issues.

In the meantime, though, we want to hear from you: Have you looked at your local hospitals’ Schedule H? What have you found, and what information would be most helpful to your work in the near future? Please feel free to email Hospital Accountability Project Director Jessica Curtis with responses (jcurtis@communitycatalyst.org).

– Jennifer Lemmerman, Field Coordinator

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Posted in Hospital Accountability/Charity Care | 4 Comments »

On This Mother’s Day, the Affordable Care Act Keeps Working for Our Children

Monday, May 9th, 2011

Having celebrated Mother’s Day with my mom this past weekend, I know that despite leaving home over a decade ago, she’s still always looking out for me. And she is not alone. Moms (and dads, too) across the country are making sure their young adult children are well taken care of even after they leave home by adding them on to their health insurance plans. Most young adults under 26 are eligible to remain on their parents’ plans if they don’t yet have access to employer-sponsored plans.

This provision from the Affordable Care Act (ACA) was always very popular with the public—but until recently, no one was sure just how successful it would be. Initial indicators suggest this option may turn out to be an even bigger success than many of us originally anticipated.

The United States Department of Health and Human Services (HHS) previously produced a mid-range estimate that projected 1.2 million young adults to gain new coverage under this provision in 2011. Just last week, it was reported that at least 600,000 young adults have already been added to their parents’ plan — and we’re just a third of the way through the year. This suggests that there’s a shot to reach the high estimate prepared by HHS of over 2.1 million young adults gaining new coverage in this year alone.

Another piece of good news is that young adult children in military families are also eligible to take advantage of this option. Eligible children of service members up to age 26 can purchase health care coverage under their parents’ TRICARE plans, retroactive to January 1, 2011. These children were not originally included in the ACA provision and, until this year, lost access to their parents’ plans at age 21 (or 23 for full-time college students).

If you’re interested in learning more about the ACA young adult coverage provision, check out both this blog post by HHS Secretary Sebelius as well as the state-specific resources prepared by our partners at Young Invincibles at their Getting Covered website. We’ve also blogged about the young adult provision previously.

The ACA’s success in improving young adults’ access to health insurance coverage is just one of many ways that it’s helping children. Don’t forget that the ACA also requires that insurers cover children with pre-existing conditions and increases access to preventive care by eliminating cost-sharing for preventive services.

In short, the ACA is giving moms across the nation reason to feel confident that their children have better access to coverage and care. Healthy children — now there’s something every mom wants for Mother’s Day!

—Patrick M. Tigue, Children’s Health Care Coordinator
New England Alliance for Children’s Health

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When “State Flexibility” Means “Cutting Vulnerable Americans off Health Insurance”

Friday, May 6th, 2011

On Tuesday, Senator Orrin Hatch and Congressman Phil Gingrey unveiled new legislation, The State Flexibility Act, which they touted as providing states with “greater Medicaid flexibility in order to innovate and better target health care spending.” Let’s be clear: the only “flexibility” this bill provides is to cut seniors, people with disabilities and low-income children off health coverage.

“The State Flexibility Act” Cuts Costs by Cutting Care
The State Flexibility Act repeals a provision in the Affordable Care Act (ACA) that prohibits states from cutting Medicaid eligibility for most adults until 2014 and for children until 2019. Eradicating this protection, known as the Maintenance of Effort (MOE) requirement, would jeopardize access to care for millions of vulnerable Americans. It would:

  • • allow states to cut long-term care for thousands of seniors suffering from Alzheimer’s, Parkinson’s, and other chronic conditions.
  • • put Americans with disabilities – such as multiple sclerosis, AIDS, and severe mental illness – at risk for losing access to services that allow them live independently.
  • • mean millions of children throughout the country could lose their health coverage and no longer be able to see a doctor when they got sick or injured.

States Already Have Flexibility to Cut Costs by Improving Care
If Senator Hatch and Congressman Gingrey are truly interested in promoting “state flexibility”, they should work with states to fully utilize the tremendous flexibility states already have in designing payment and delivery systems. As we have pointed out time and time again, there are countless ways states could reduce their Medicaid costs by improving care for beneficiaries, and no state has taken full advantage of that flexibility.

For example, as we discussed in our recent policy brief, states currently have the authority to move from a payment system that reimburses providers for more services, toward one that pays for better health outcomes. Maryland recently began tying hospitals’ payment levels to their rates of preventable complications like hospital-acquired infections, so that hospitals that did a better job at preventing these life-threatening complications would get more money, and hospitals with higher rates of infections and other complications would get a bit less. Infection rates – and the costs associated with those infections – dropped dramatically in Maryland as a result of this innovative payment reform. Despite this success, few states have followed Maryland’s lead.

Another state option, created by the ACA, provides states with additional federal matching dollars to set up health homes for Medicaid beneficiaries with chronic physical or mental illnesses. Health homes have been shown to save money by better coordinating the complex care of high-risk beneficiaries and helping them avoid costly ER visits, hospital readmissions, and duplicated tests and procedures. About half the states are exploring the option, though so far only a few have made a commitment to move forward.

These are just two examples illustrating how states can reduce Medicaid spending by better serving the needs of their beneficiaries (for more ideas, check out these resources developed by Community Catalyst’s Integrated Care Advocacy Project). Until states have taken full advantage of opportunities like these, there is no excuse for proposals like the State Flexibility Act that could undermine care for millions of seniors, people with disabilities and low-income children.

— Katherine Howitt, Policy Analyst

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Posted in Medicaid | 1 Comment »

The Insider: “Win or go home.”

Thursday, May 5th, 2011

Looming vote over debt ceiling is next critical hurdle for ACA & other health programs
Getting the ACA implemented is like playing in the NCAA basketball tournament—reformers face multiple hurdles, and in each case, failure to clear them could mean the inability to implement the ACA. In some cases, such as the current debate over raising the debt ceiling, there’s more than the fate of the ACA at stake: the future of Medicare and Medicaid are also on the line. Although many Democrats have called for a “clean vote” on the debt ceiling, others have joined many Republicans in saying they won’t vote to raise the debt cap unless they get “concessions” (i.e. cuts) on entitlement spending (i.e. Medicare and Medicaid). Members of the Obama administration have essentially already conceded.

From a health care point of view, cap proposals that establish an arbitrary ceiling on federal health spending as a specific percentage of GDP are just as bad as specific proposals for Medicaid block grants or Medicare vouchers. Block grants and vouchers become the inevitable mechanism to enforce a cap, shifting costs onto states, providers and beneficiaries. A cap is also a bad idea because it undermines the “countercyclical” effect of federal health spending. Public health spending rises during an economic slowdown as more people qualify for Medicaid (and in the future for ACA tax credits). This natural increase in public health care spending during tough times stabilizes the health care system and the economy. A cap would interfere and make the health and economic consequences of recession much worse.

Battle for hearts and minds—untangling the polls
As the debate unfolds over the future of federal health programs, there are questions about where the public stands. For example, a recent Kaiser poll seems to indicate that the public is very malleable on the issue of Medicare changes. But what results really show is that it is possible to mislead the public with incomplete information. A NPR analysis of the Kaiser polling found the devil is in the details, or how polling questions are framed. Pollsters gave supporters of a voucher program an anti-voucher talking point and were able to move most of them to opposition. Those who opposed vouchers also moved to pro-voucher in response to a pro-voucher point, though not as much. But here’s the rub – the anti-voucher point did not go far enough. It did not point out that the amount of savings from health care cuts was essentially equal to cost of tax cuts for wealthy Americans, and they didn’t offer alternative debt reduction plans for people to choose from. IF people understand the plan, they overwhelmingly oppose it. The question is not whether the public supports Medicare cuts (they don’t). It’s how effective the disinformation campaign will be in fooling the public and how strong the defense of health programs will be.

With that defense in mind, it’s encouraging to see organizations such as AARP getting into the fray. The reaction at town hall meetings from the recent Congressional recess is also encouraging. And public pushback seems to be having an effect. Even Tea Party darling Rep. Michele Bachmann (R-Minnesota) has waffled on her position, and Republicans seem to be losing their appetite for a showdown over Medicare.

– Michael Miller, Policy Director

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Save the Exchange!

Tuesday, May 3rd, 2011

States around the country have spent the last few months working hard to set up Health Insurance Exchanges – competitive health insurance marketplaces that help people compare and enroll in quality health insurance. However, over at the U.S. House of Representatives, things look a little different. As part of the House Leadership’s continued attempts to “repeal, replace, defund” the Affordable Care Act, House Members will vote on H.R. 1213 today, which would repeal any funding to help states create the Exchange marketplace over the next three years.

Exchanges are one of the cornerstones of the ACA. They are an accessible, consumer-friendly portal for individuals and small businesses to compare health plan options and choose the best plan for them. The Exchanges will make it easier for people who have been uninsured, had difficulty affording insurance, or had trouble paying for coverage for their employees, to get and keep health insurance. It will also make it easier for people to know what is in the health plan they purchase because there will be standards for what insurance plans need to provide to participate in the Exchange.

In a time of record state budget deficits, state governments need financial help to build an infrastructure to support the Exchange – all but one state (Alaska) have already received federal dollars and have to plan for their Exchanges.

Without funding assistance from the federal government, states have two choices: spend their own money to establish an Exchange or stop the work they’ve already begun and waste money already spent. Both options are untenable. Things like updating IT systems, creating seamless enrollment through the Exchange, and providing information to consumers and small businesses about the changes to the insurance market are considerable investments.

The official budget estimate of H.R. 1213 says states that continue the work with their own funds are likely to charge insurers more to make up their costs – and the insurers will pass along the cost to consumers as higher premiums. Fewer people will get subsidized coverage as states struggle to get their Exchanges up and running. In fact, most of the savings from the bill come from less federal spending on subsidies, not from the elimination of the state planning grants.

States get that Exchanges will create an important marketplace for small businesses and consumers to find health insurance. Even in states with political leadership that is not wholly supportive of the ACA, policymakers have continued to pursue the creation of Exchanges and use federal funds to move the planning process forward. Exchange planning has also brought together and been supported by diverse stakeholders like providers, insurers, consumer advocates and business. (To find out what helps to build a consumer-friendly Exchange, check our Top Ten.) Apparently, Congress isn’t paying attention to these efforts to move forward.

Today’s vote in the House to repeal funds to help states to set up Exchanges will mean a return to a health care market that is less transparent, less consumer friendly, more costly and more difficult to navigate. It means people will continue to fall through the cracks. Americans don’t want to go backwards to a broken health care system. They don’t want Congress to take away from them the health security Members enjoy themselves. They want to move forward.

Here are some actions you can take on H.R. 1213 and Exchanges:

  • – If your Representative votes for H.R. 1213, call and tell them their vote is bad for consumers and bad for the state. Let them know that you want your health care system to move forward, not backward.
  • – Write a blog about the importance of the Exchange and what’s happening in your state. Let your supporters know if your state is moving forward on an Exchange and the important role for consumers to play in its development.
  • – Talk to media about the vote. Explain the importance of an Exchange, your state’s progress in creating an Exchange, and how the Exchange will help consumers in your state.

– Christine Barber, Senior Policy Analyst and
Reena Singh, Field Coordinator

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