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Kellyanne Conway says people who lose Medicaid should just find better jobs. It’s not that simple.

Tuesday, June 27th, 2017

During a Fox & Friends interview Monday morning, White House counselor Kellyanne Conway suggested that, for the people who lose Medicaid coverage because of the more than $800 billion in cuts included in the Senate’s health care bill, the solution is as simple as finding a better job.

“Medicaid is intended for the poor, the needy, and the sick,” she said. “And what it has done is, under Obamacare, it has expanded the Medicaid pool of people who, quote, qualified beyond that. So if you have an able-bodied American who again is not poor, sick, needy?—?we’re not talking about the elderly who benefit, the children, the pregnant women, the disabled?—?if you’re able-bodied and you would like to go find employment and have employer-sponsored benefits, then you should be able to do that, and maybe you belong, as Secretary Price has made clear, in other places.”

But Conway’s talking point mischaracterizes the life circumstances of most Medicaid recipients, a majority of whom work low-income jobs that don’t offer health insurance and that keep them near the poverty line.

According to the Kaiser Family Foundation (KFF), 59 percent of Medicaid adults have jobs, and nearly 80 percent are part of working families. While many of those people might prefer to take advantage of employer-offered health care, a large percentage do not have that option. Only 46 percent of employers offer health care coverage, according to the latest KFF data.

Conway also ignored the fact that the Senate health care bill only requires insurance companies to pay for 58 percent of costs, a significant reduction from the standard under Obamacare. That means that low-income people kicked off Medicaid as a result of the Senate bill’s $800 billion in cuts would be required to pay much more out of pocket for their health care even if they can purchase private insurance.

It’s also not true that the Medicaid cuts included in the Senate health care bill wouldn’t have a negative impact on elderly people, children, pregnant women, or disabled people, as Conway suggested. By imposing per capita caps on benefits and eventually basing the amount of money states receive each year for Medicaid on the consumer price index (instead of inflation within the health care market, for instance), the Senate bill’s cuts will negatively impact all beneficiaries of the program, including the 35 percent who cite an illness or disability that prevents them from working.

Conway’s comments on Fox & Friends come the day after she appeared on This Week and flatly denied that the Senate bill’s $800 billion reduction in Medicaid spending constitutes a “cut.” Instead, she said the bill “slows the rate for the future, and it allows governors more flexibility with Medicaid dollars.”

The administration’s misinformation is having an impact?—?a recent poll indicated less than 40 percent of Americans know that the health care plan being pushed by Republicans includes any Medicaid cuts.

This piece was originally published at ThinkProgress on June 26, 2017. Reprinted with permission. 

About the Author: Aaron Rupar is an editor at Think Progress. He came to DC from Minneapolis, where he wrote for the City Pages and Fox 9, among other outlets.

Veto the Cold-Hearted Health Bill

Monday, June 26th, 2017

Donald Trump is right. The House health insurance bill is “mean, mean, mean,” as he put it last week. He correctly called the measure that would strip health insurance from 23 million Americans “a son of a bitch.”

The proposal is not at all what Donald Trump promised Americans. He said that under his administration, no one would lose coverage. He said everybody would be insured. And the insurance he provided would be a “lot less expensive.”

Senate Democrats spent every day this week pointing this out and demanding that Senate Republicans end their furtive, star-chamber scheming and expose their health insurance proposal to public scrutiny. That unveiling is supposed to happen today.

Republicans have kept their plan under wraps because, like the House measure, it is a son of a bitch. Among other serious problems, it would restore caps on coverage so that if a young couple’s baby is born with serious heart problems, as comedian Jimmy Kimmel’s was, they’d be bankrupted and future treatment for the infant jeopardized.

Donald Trump has warned Senate Republicans, though. Even if the GOP thinks it was fun to rebuff Democrats’ pleas for a public process, they really should pay attention to the President. He’s got veto power.

Republicans have spent the past six years condemning the Affordable Care Act (ACA), which passed in 2010 after Senate Democrats accepted 160 Republican amendments, held 110 bipartisan public hearings and conducted 25 consecutive days of public floor debate. Despite all of that, Republicans contend the ACA is the worst thing since Hitler.

That is what they assert about a law that increased the number of insured Americans by 20 million, prohibited discrimination against people with pre-existing conditions and eliminated the annual and lifetime caps that insurers used to cut off coverage for sick infants and people with cancer.

The entire cavalry of Republican candidates for the GOP nomination for President promised to repeal the ACA, but Donald Trump went further. He pledged to replace it with a big league better bill.

In May 2015, he announced on Twitter: “I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid.”

In September 2015, he said of his health insurance plans on CBS News’ 60 Minutes, “I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.”

In another 60 Minutes interview, this one with Lesley Stahl last November, he said, “And it’ll be great health care for much less money. So it’ll be better health care, much better, for less money. Not a bad combination.”

In January, he told the Washington Post, “We’re going to have insurance for everybody.” He explained, “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

But then, the House Republicans betrayed him. The nonpartisan Congressional Budget Office said the measure they passed, called the American Health Care Act (AHCA), would cut more than $800 billion from Medicaid. It said people with pre-existing conditions and some older Americans would face “extremely high premiums.”

Extremely high is an understatement. Here is an example from the CBO report: A 64-year-old with a $26,500 income pays $1,700 for coverage under the Affordable Care Act (ACA), but would be forced to cough up more than half of his or her income – $16,000 – for insurance under the House Republican plan. Overall, premiums would increase 20 percent in the first year. And insurers could charge older people five times the rate they bill younger Americans.

House Republicans said states could permit insurers to squirm out of federal minimum coverage requirements, and in states where that occurred, the CBO said some consumers would be hit with thousands of dollars in increased costs for maternity care, mental health treatment and substance abuse services.

In the first year, the House GOP plan would rob insurance from 14 million Americans.

So much for covering everyone with “great health care at much less money.”

It’s true that President Trump held a party for House Republicans in the Rose Garden after they narrowly passed their bill. But it seems like he did not become aware until later just how horrific the measure is, how signing it into law would make him look like a rank politician, a swamp dweller who spouts promises he has no intention of keeping.

By last week when President Trump met with 15 Senate Republicans about their efforts to pass a health insurance bill, he no longer was reveling in the House measure. He called it “cold-hearted.” He asked the senators to be more “generous,” to put “additional money” into their version.

Senators told reporters that President Trump wanted them to pass a bill that is not viewed as an attack on low-income Americans and provides larger tax credits to enable people to buy insurance.

Now that sounds a little more like the Donald Trump who repeatedly promised his health insurance replacement bill would cover everyone at a lower cost. Still, those goals remain amorphous.

The House bill is stunningly unpopular, almost as detested as Congress itself. President Trump seems to grasp the enormity of that problem. But even his calling it a “son of a bitch” doesn’t seem to have been enough to persuade senators that he’s serious about getting legislation that achieves his promises to leave Medicaid intact, cover everyone and lower costs.

Republican senators deciding the fate of millions of Americans must hear from Donald Trump that passing a health insurance bill that doesn’t fulfill his campaign promises is, shall we say, a cancer on the Presidency.

A veto threat would get their attention.

This blog originally appeared at OurFuture.org on June 21, 2017. Reprinted with permission. 

About the Author: Leo Gerard is president of the United Steelworkers.

The House GOP health care bill is a job killer, says a new report

Wednesday, June 21st, 2017

 In addition to potentially increasing the number of uninsured by 23 million and being unequivocally unpopular, House Republicans’ Obamacare replacement plan could leave nearly a million people unemployed.

That’s according to a new study published Wednesday by the Milken Institute School of Public Health at George Washington University and The Commonwealth Fund projects, which finds that the U.S. economy could see a loss of 924,000 jobs by 2026 if the American Health Care Act (AHCA) becomes law.

The study concentrated on coverage-related and tax repeal policies included in the AHCA. Some of the key provisions it said could add to job losses would:

  1. Phase out enhanced funding for Medicaid expansion by restricting eligibility in 2020, and imposing either a block grant or per capita caps.
  2. Replace premium tax credits with age-based tax credits. The premiums can be five times higher for older individuals, compared to the current threefold maximum.
  3. Allow states to waive key insurance rules, like community rating and essential health benefits. (The study does account for the Patient and State Stability Fund, a $8 billion grant meant to relieve states of high-cost patients.)
  4. Eliminate the individual mandate tax penalty and premiums hikes for people who do not maintain continuous coverage.
  5. Repeal numerous taxes and tax increases, like a tax on high-cost insurance (i.e. the “Cadillac tax”).

Short-term gain, long-term pain

Federal health funding stimulates the economy and job creation. Health funds pay hospitals, doctor’s offices, and other providers, and these facilities pay for their own respective employees and other goods and services, like rent and equipment. Health care employees and private businesses then use their earnings to purchase consumer goods like housing and transportation, circulating this money through the larger economy.

The GWU study found government spending or subsidies stimulate the economy more than tax cuts. Tax cuts do help, but only in the short term. The way AHCA is set up is that the tax cuts take effect sooner than federal funding cuts, which is why some states see net job growth by 2018. Then, when federal dollars are eventually pulled, states begin to see job losses by 2026.

Who’s most affected:

The employment rate among states that expanded Medicaid eligibility could disproportionately be affected, because those states received more federal dollars. New York, a state that expanded Medicaid, could be among the hardest hit with 86,000 job losses by 2026.

Between April 2016 and April 2017, New York added 76,800 jobs and the educational & health services sector saw the largest job gains, at 46,600 jobs. “The Affordable Care Act [ACA] contributed to that [growth],” Ronnie Kauder, senior research director at the New York City Labor Market Information Service, told ThinkProgress.

Kauder emphasized that the ACA wasn’t solely responsible for New York’s job growth, even in the health care sector. Uncontrollable factors like the state’s growing aging population and increasing life expectancy contribute to job growth as well.

New York has reaped the employment benefits of comprehensive health care, said Kauder. That’s in part because ACA encouraged states to test new models of health care delivery and shifted from a reimbursement system based on volume of services to value of services.

For example, New York received ACA grant funding to test effective ways to incentivize Medicaid beneficiaries, who struggle with chronic diseases, to participate in prevention programs and change their health risks. With that grant, New York created new programs at existing managed care organizations, which required new hires. The grant created positions like care coordinators, who connect and follow-up up with patients and providers in the program, said Kauder. “They are heavy on the training, but not licensed professionals,” she said.

But while she attributed some of New York’s job gains to the ACA, Kauder was skeptical that the GOP replacement plan would kill as many of them as the GWU study projects. “We don’t know what the state response will be,” he said. “It could be worse in Kentucky.”

The largest health care provider in New York, Northwell Health, hires on average 150 people a week. Northwell chief public relations officer Terry Lynam told ThinkProgress he doesn’t think the ACA directly contributed to a spike in job growth; however, it did help expedite the provider’s move from hospitals to outpatient care centers, also called ambulatory care, in an effort to slow rising health costs.

“What [ACA] has done was contribute to the ambulatory net growth [by cutting costs],” said Lynam. Northwell Health has 550 outpatient locations.

Northwell Health has qualms with the House GOP bill; specifically its cuts to Medicaid and change in coverage rules. “We are in a stronger financial position to survive that kind of reduction in revenue,” said Lynam. “But what about small providers serving low income areas, who need those Medicaid [dollars]?”

This blog was originally published at ThinkProgress on June 15, 2017. Reprinted with permission. 

About the Author: Amanda Michelle Gomez is a health care reporter at ThinkProgress.

The Trump administration has started rolling back the birth control mandate

Thursday, June 1st, 2017

Federal officials, under orders by President Donald Trump, have drafted a rule to roll back the Obama-era mandate that birth control be included under all employer insurance plans.

The final shape of roll back is still uncertain: The White House Office of Management and Budget (OMB) website says that it is reviewing the “interim final rule” to relax the requirements on preventative services. The rule change is specifically aimed at accommodations for religious organizations, some of whom have strongly objected to requirements that they include birth control coverage under their insurance for employees.

Typically, when an agency considers changing a rule?—?which can have immediate and sweeping policy impacts?—?they publish a preliminary version, solicit comments from the public, and incorporate the feedback into revisions before handing down the final change. If the OMB is reviewing the interim final rule, however, that means the rule has already been drafted by the relevant agencies and is in the last step before being published, according to the National Women’s Law Center.

“We think whatever the rule is, it will allow an employer’s religious beliefs to keep birth control away from women. We are sure that some women will lose birth control coverage,” Gretchen Borchelt, the vice president of the National Women’s Law Center, told the New York Times.

Under the current rules, implemented under President Obama, birth control coverage is considered part of preventative medical care and must be covered by all insurers with no co-pay. The mandate has guaranteed an estimated 55 million women access to birth control and other preventative services at no additional cost to them, regardless of their employer.

In 2013, the mandate saved women $1.4 billion on birth control pills, and since the law went into effect, there has been a nearly 5 percent uptick in birth control subscriptions, according to the NWLC. The increased access to contraceptives has also correlated with a sharp drop in unintended pregnancy and abortion rates.

These public health outcomes make it easy to see why the requirement has been widely lauded by women’s health advocates and providers.

“Without question, contraception is an integral part of preventive care; women benefit from seamless, affordable access to contraception, and our health system benefits as well,” the American College of Obstetricians and Gynecologists (ACOG) said in a statement about the mandate. “ACOG strongly believes that contraception is an essential part of women’s preventive care, and that any accommodation to employers’ beliefs must not impose barriers to women’s ability to access contraception.”

The law has been hotly contested, however, by religious organizations who object to having to include birth control in their insurance plans. Trump seized on their complaints while campaigning for the presidency, and in early May, fulfilled his pledges to evangelical Christian supporters by handing down an executive order on “religious freedom” that aimed to do two things: To make it easier for faith leaders to preach politics, and to allow employers to claim a religious exemption against providing contraceptive coverage for their employees.

Trump made the proclamation alongside representatives of Little Sisters of the Poor, an order of nuns who have been some of the most vocal opponents of Obamacare’s mandate that insurance include birth control coverage?—?taking the fight up all the way up to the Supreme Court.

“Your long ordeal will soon be over,” Trump told them when he announced the order.

Secretary of Health and Human Services Tom Price immediately issued a statement saying that he’d be happy to take have the opportunity to reshape the requirements on birth control coverage.

“We welcome today’s executive order directing the Department of Health and Human Services to reexamine the previous administration’s interpretation of the Affordable Care Act’s preventive services mandate, and commend President Trump for taking a strong stand for religious liberty,” he said in a press relief.

Price has long been a vocal critic of the birth control mandate on grounds of religious freedom, and has also been dismissive of its benefit to women.

“Bring me one woman who has been left behind. Bring me one. There’s not one,” Price said about women having trouble paying for birth control in an interview with ThinkProgress in 2012. “The fact of the matter is this is a trampling on religious freedom and religious liberty in this country.”

According to a recent survey by polling form PerryUndem, 33 percent of American women said they couldn’t afford to pay any more than a $10 copay for their birth control. Fourteen percent said that if they had to pay for birth control at all, they couldn’t afford it.

This article was originally published at ThinkProgress on May 30, 2017. Reprinted with permission.

About the Author: Laurel Raymond is a reporter for ThinkProgress. Previously, she worked for Sen. Patrick Leahy (D-VT) and served as a Fulbright scholar at Gaziantep University in southeast Turkey. She holds a B.A. in English and a B.S. in brain and cognitive sciences from the University of Rochester, and is originally from Richmond, Vermont.

A Winning Week for Corporations and Wall Street—Paid for by Your Health and Retirement

Friday, May 12th, 2017

Corporations and Wall Street won big last week, and working people will pay a high price for it. Here are three things Congress did for Big Business that will harm working people’s health care and retirement:

1. 7 million fewer people will get workplace health benefits. Last Thursday, the U.S. House of Representatives passed the so-called American Health Care Act by a vote of 217-213. This is the bill that President Donald Trump and House Speaker Paul Ryan (R-Wis.) are using to repeal much of the Affordable Care Act and that will cut health coverage for some 24 million people. The U.S. Senate now has to vote.

Professional lobbying groups that represent employers, like the U.S. Chamber of Commerce, are behind this bill because it guts the Affordable Care Act’s requirement that large and mid-size employers offer their full-time employees adequate, affordable health benefits or risk paying a penalty. According to Congress’s budget experts, within 10 years, this bill will result in 7 million fewer Americans getting employer-provided health insurance. Corporate interests also like the huge tax cuts in the House bill, especially the $28 billion for prescription drug corporations and $145 billion for insurance companies.

Big company CEOs—the people who now earn 347 times more what front-line workers earn—are probably salivating over the huge personal tax cuts they will get from the Republican bill. One estimate is that those with million-dollar incomes will receive an average yearly tax cut of more than $50,000. The 400 highest-income households in the United States get an average tax cut of $7 million.

2. As many as 38 million workers will be blocked from saving for retirement at work. The Senate voted 50-49 last Wednesday to stop states from creating retirement savings programs for the 38 million working people whose employers do not offer any kind of retirement plan. The House already had voted to do this, and Trump is expected to sign off on it.

In the absence of meaningful action by the federal government, states have stepped in to address the growing retirement security crisis. But groups that carry water for Wall Street companies, like the Securities Industry and Financial Markets Association, have been actively lobbying Congress and Trump to stop states from helping these workers.

3. More than 100 million retirement investors may lose protections against conflicted investment advice. The House Financial Services Committee approved the so-called Financial CHOICE Act on a party-line vote last Thursday. It now goes to the full House of Representatives, and then to the Senate. In addition to gutting the Consumer Financial Protection Bureau that protects working people from abusive banking practices and ripping out many of the other financial reforms adopted after the 2008 financial crisis, this bill overturns key investor protections for people who have IRAs and 401(k)s. A massive coalition of Wall Street firms and their lobbying groups has been fighting to undo these retirement protections by any means possible.

About the Author: Shaun O’Brien is the Assistant Director for Health and Retirement in the AFL-CIO’s Policy Department, where he oversees development of the Federation’s policies related to Medicare, Medicaid, Social Security, and work-based health and retirement plans. Immediately prior to joining the AFL- CIO, he held several positions at AARP, including the Vice President for the My Money Portfolio and Senior Vice President for Economic Security. O’Brien holds a Bachelor of Arts degree from American University and a law degree from Cornell Law School.

If you have a preexisting health condition, don’t even think about leaving your job

Tuesday, November 15th, 2016

If President-elect Trump follows through on his campaign promises, millions of individuals-immigrants, religious minorities, people of color-face a very grim four years. One of the worst hit groups will be Americans with significant health costs. The Trump transition team published a brief summary of the incoming president’s health plan on its website, and the news is not good for the elderly, the poor, and millions of Americans with preexisting conditions.

Much of the plan is vague. Trump plans to “Modernize Medicare,” for example, an unclear statement that is likely code for Speaker Paul Ryan’s (R-WI) plan to repeal Medicare and replace it with a voucher system that imposes much higher out-of-pocket costs on seniors. Similarly, Trump says he will “Maximize flexibility for States in administering Medicaid,” a statement that is probably code for Ryan’s plan to either “require states to provide less extensive coverage, or to pay a larger share of the program’s total costs, than would be the case under current law.”

A central prong of Trump’s plan, however, is to repeal the Affordable Care Act and replace it with, well, not much at all. Trump says he will “repeal the ACA and replace it with a solution that includes Health Savings Accounts,” which primarily benefit the rich and offer little or no benefits to low and middle income Americans. Trump will “enable people to purchase insurance across state lines,” a coded phrase which actually means that he will eliminate state regulation of insurance which requires coverage of treatments ranging from mammograms to maternity stays to well child care.

And then there’s his proposal for people with preexisting health conditions.

Prior to Obamacare, one of the most vulnerable groups was people with medical conditions who neither qualified for a government health program nor received insurance through their employer. Insurance companies would deny coverage to these individuals for conditions as severe as cancer or as routine as hay fever.

The reason why is that covering people with such conditions is expensive. A health insurance plan is a pool of money. Consumers contribute to that pool when they pay their premiums, and they take money out of that pool when they become sick or otherwise seek treatment. That means that, if someone tries to join the pool who has a preexisting condition, the insurer will try to keep them out because it will cost more to insure them than they will pay in.

The Affordable Care Act addressed this with a trio of reforms—a requirement that insurers allow everyone in, subsidies to help pay for coverage, and a financial consequence for people who fail to buy insurance. The final of these three reforms existed so that healthy people would not forego insurance, forcing insurers to cover only the most expensive individuals.

Trump plans to eliminate this framework and replace it with “high-risk pools,” essentially, a special insurance program for people with expensive preexisting conditions. In theory, high-risk pools can work to provide health coverage with such conditions, but they are an inefficient way to do so. And they have reliably failed when attempted by states.

At best, high risk pools are a way to maximize the insurance industry’s profits while shifting the costs of our health care system onto the taxpayers. If the government takes on the burden of insuring the most expensive individuals?—?and only the most expensive individuals?—?then that’s a bonanza for the insurance companies because they will be left with a pool of less expensive (and more profitable) consumers. Meanwhile, the costs of providing care for the most expensive health care consumers will fall upon whatever new government program President Trump creates to manage the high risk pools.

But that’s actually the best case scenario for Trump’s health plan. Because high risk pools take on the most expensive health care consumers, they are expensive to maintain. And when states attempted to set them up in the past, they did not fund them enough to cover more than a fraction of what was needed. As one report explained when Sen. John McCain (R-AZ) proposed high risk pools during his 2008 presidential bid, these pools “have not been a viable alternative for the medically uninsured because of high premiums…and inadequate funding to subsidize the full cost of providing insurance to a high-cost population.”

McCain’s plan is informative regarding what a Republican proposal for high-risk pools is likely to look like. The Arizona senator proposed spending between $7 to $10 billion on these pools. But that would only cover a fraction of the Americans who would lose their health insurance if Obamacare is repealed. A national program “funded at $7 billion per year would cover only 875,000 people,” and that was in 2008. Alternatively, “even if participants had to pay half of their own premiums, as is generally the case today in state high risk pools, less than 2 million Americans would be covered.”

Obamacare provides health insurance to about 20 million Americans.

Of course, Trump’s proposal is vague on details and especially short on numbers. So maybe he plans to fund the high risk pools enough to fill the gap that will be created by repealing Obamacare. The likelihood that Republicans intend to replace a policy they denounced as socialism with what would likely be a significantly more expensive government program, however, is small.

If there is any ray of light in Trump’s proposals, it is that he doesn’t appear to have set his eyes on pre-Obama laws that protect workers with employer-provided health plans that have preexisting conditions. Nevertheless, Trump is, in effect, planning to reinstate a problem known as “job lock,” where people in jobs that they would rather leave are forced to stay in them because it is the only way that they can obtain health benefits.

That means fewer people starting businesses, more people working into the years when they would rather retire, fewer jobs opening up for younger workers eager for new opportunities, and more people simply stuck in jobs that they hate.

On November 7th, it seemed like workers were finally free to take risks without having to fear that they would lose their health coverage. Only a few days later, that freedom is likely to disappear.

This blog originally appeared in ThinkProgress.org on November 11, 2016. Reprinted with permission.

Ian Millhiser is the Justice Editor at ThinkProgress. He is a skeptic of the Supreme Court, hater of Samuel Alito, and a constitutional lawyer of ill repute. Contact him at  imillhiser@thinkprogress.org.

500 Strong in Pennsylvania Bringing Healthcare to the People

Tuesday, December 31st, 2013

seiu-org-logoWhen SEIU members in Pennsylvania made a decision to make the Affordable Care Act a success in the Keystone state, they knew their main focus would need to be on door-knocking and reaching out to the community directly. And it was a good thing they did, as initial problems with theHealthcare.gov website made it difficult for many people to get information as the enrollment period began.

At its height, there were more than 500 SEIU members working full-time in Pennsylvania, visiting the houses of uninsured home care workers and other low income families who often were uninsured. They also passed out information at health fairs, farmers’ markets, and other public events in order to get folks started on the path to health care.

One of these SEIU members was Chris Sloat, a Licensed Practical Nurse from Wilkes-Barre. Sloat works at the Guardian Elder Care nursing home, and sees firsthand what a lack of health insurance can do to people coming into her facility.

“As a nurse, I see people with all sorts of conditions who could have been spared a lot of suffering if they’d had preventative care. People come in needing full-time care after suffering stokes in their 50’s.”

 

Chris spends countless hours going door to door and passing out information at public events in order to counter all the right-wing attacks that flood the state’s airwaves. “One day at the nursing home, most of the folks had their radios on and I counted six commercials in one hour that attacked the Affordable Care Act,” she said. “I can STILL remember the lines from those ads.”

Chris had dozens of conversations at people’s doors, when the first things out of their mouths would be “Obamacare? That terrible program?”. But after giving them the facts and having an honest conversation with them, they’d be grabbing the phone as she left in an attempt to sign up.

Chris Sloat not only was a champion for the Affordable Care Act this fall, but also personally benefitted from the law. Two of her children have been able to stay on their father’s health insurance plan because the Affordable Care Act mandates that children be allowed to stay on until they turn 26.

In addition, Chris previously had a somewhat high co-pay for her yearly mammograms, and at least once she had to forgo the procedure due to a money crunch. But thanks to the new law, Chris’s plan now offers free preventative care and she’ll never again have to worry about paying for potentially life-saving checkups like these.

This article was originally printed on SEIU on December 18, 2013.  Reprinted with permission.

Author: SEIU Communications

Failed By Florida

Thursday, November 21st, 2013

seiu-org-logoAlthough Marie Museau, a nursing assistant at Palmetto Hospital in Hialeah, Fla., works as a healthcare provider, she does not have health insurance. She and thousands of other healthcare workers in the Sunshine State spend their days attending to the health of others, yet cannot afford to visit a doctor themselves.

Museau makes too much to qualify for Medicaid and too little to afford the family health insurance plan she could purchase from her employer, which would cost her closer to $600 per month. “That’s almost half my take-home pay,” she said.

If Museau lived in Arkansas, Connecticut, Kentucky–or any one of 23 other states–she would qualify for fully paid healthcare thanks to the new healthcare law. The law transfers billions of federal dollars to the states, so they can expand their Medicaid programs to cover millions of additional working Americans.

However, because politicians in Florida have blocked the state from accepting the funding–which is fully paid by the federal government initially and later 90 percent federally paid–she and three of her children will continue to go without health insurance.

Museau has a fourth child–a son who requires intensive care at home after a car accident several years ago. She worries about her own health, and her ability to care for her injured son if she gets ill. “I have heart issues and need to see a cardiologist, but at this point I just can’t afford to,” she says.

Museau was failed by her state. By refusing to accept the $51 billion in fully paid federal funding, Florida politicians lost their chance to insure 1.2 million Floridians and create 120,000 new healthcare jobs in the state. All of this just to try to sabotage the new healthcare law and appease tea party extremists who are demanding its repeal.

The fight is not over. SEIU members have been working overtime to persuade Florida lawmakers, including Gov. Rick Scott, to finally accept these dollars that will give hardworking Floridians just like Museau the affordable healthcare they need.

“I’m hoping the state of Florida accepts that money,” Museau said. “It would really help me and my family.”‘

This article was originally printed on SEIU on November 20, 2013.  Reprinted with permission.

Author: SEIU Communications.

"It's good to know that at the end of the day you'll have the help if you need it."

Thursday, November 14th, 2013

seiu-org-logoJerry Depeine is a single father of two and works as a dietary aide at a West Palm Beach, Fla., nursing home. Despite working in a healthcare setting, Depeine doesn’t have insurance since he cannot afford the plans his employer offers.

For Depeine, getting sick often meant he’d have to miss more time from work than normal because he couldn’t always afford the treatment that would speed his recovery. “Not long ago, I had a throat infection and the prescription was too much for me to pay. I couldn’t afford it, so I just walked away. I just had to bear the pain and not go to work,” he explained.

Now Depeine is in the process of enrolling in one of the insurance plans created by the federal marketplaces–one that will cost less than his employer’s plan and will fit into his monthly budget.

Depeine looks forward to some of the preventive care that is a hallmark of the new law. He feels that regular checkups, which he’s never been able to afford, are a key to staying healthy. “Now that I’m turning 30, I want to get routine checkups so I can find out what going on with my body and stay informed about the status of my health,” he says.

Depeine is also looking forward to the protections he’ll have in case of an accident or a medical emergency. “It’ll make me feel safe and protected knowing that if something happens it’s not going to break me with all the medical bills,” he says. “It’s good to know at the end of the day you’ll have the help if you need it.”

Now that he is on his way to getting affordable insurance, Depeine shifted his focus to educating his fellow UHW-East members and folks in his community about the new healthcare law. “Everyone should know about their options, and everyone should be able to feel safe and secure in terms of their health,” he added.

This article was originally printed on SEIU on November 13, 2013.  Reprinted with permission.

Author: SEIU Communications.

Former Massachusetts Reform Head Warns HHS Not To Overreach On Essential Benefits

Thursday, January 13th, 2011

Igor VolksyThis morning, the Institute of Medicine began its second day of deliberations into defining what would constitute “essential health benefits” under the Affordable Care Act. Even though the law identifies general categories that insurers will have to cover beginning in 2014 — emergency services, mental health care, outpatient and inpatient care — these meetings are designed to help HHS reach more specificity on the issue. The agency is also required to ensure that the scope of essential health benefits “is equal to the scope of benefits provided under a typical employer plan.”

During the second session, John Kingsdale — the former director of the Massachusetts Connector Authority — predicted that defining “essential health benefits” will be “one of the more challenging parts in implementing the ACA” and warned the agency against “overreaching” in detailing which benefits insurers will have to provide:

KINGSDALE: The nation is highly divided by this and so whatever is put into the essential health benefits package that can be portrayed by those who tend to oppose ACA as unfairly burdening those employers or individuals, who want a different benefit package will be used as political fodder to tear down the ACA and I strongly believe that overreaching…could doom implementation. […]

There is a tendency to think about benefits in the context of negotiation for something more someone else would pay for and I think it continually surprises people to understand, ‘oh there are real people who cannot afford what we consider to be an ideal benefit package and they actually have to pay for it in premiums. ….This was very much about giving people decent coverage as opposed to primarily a policy of it just being about raising the standards of coverage and it seems to me when you have to make close calls about benefits, it’s important to return to that principle. Secondly, obviously, most benefits cost dollars no matter what you will hear about how they will save money and that the ACA will live or die on affordability. And thirdly, that there is a fair degree of consensus about minimum benefit steps and so that you will find most states don’t even mention most of the things that are covered typically by commercial insurance and there are additionally very few benefits that significantly improve [inaudible] or save dollars. So, I think it’s not difficult to find that essential minimum benefits package and then, as you can tell from my other principles, I would advise you to be very conservative about adding on to it. […]

My experience suggests revisiting and learning from cases and some flexibility and even phasing in would all be very helpful as you go down the path of defining a minimum benefit that will be extremely controversial.

Indeed, as CQ Healthbeat reported, it’s still unclear “if officials will seek a specific list of treatments or ask insurers to mirror benefits in particular plans, such as the Federal Employee Health Benefits Program.” Either way, they will have to balance Kingsdale’s suggestions with the concern that too loose of a definition would allow insurers to design plans differently — possibly even in such a way that would lead to adverse selection.

IOM will publish recommendations for HHS “by September, and HHS will issue its proposed rules by the end of the year, giving insurance companies time to adjust plans before the provisions take effect.”

This article was originally published on Wonk Room.

About The Author: Igor Volsky is Health Care Editor for ThinkProgress.org and The Progress Report at the Center for American Progress Action Fund. He also writes on LGBT Equality issues. Igor is co-author of Howard Dean’s Prescription for Real Healthcare Reform. Prior to joining the Center, Igor blogged at BodyPolitik.org and interned with ThinkProgress, Fairness and Accuracy in Reporting (FAIR), and the Hudson River Valley Institute at Marist College. Igor grew up in Russia, Israel, and New Jersey. Igor has appeared on MSNBC, CNN, Fox Business, and CNBC television, and has been a guest on many radio shows.

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