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Affordable Care Act (ACA)

What Delaying the Health Care Law's Employer Responsibility Requirement Means for Real People

Yesterday's surprise announcement that the Obama Administration is postponing implementation of the health reform law's requirement that firms with more than 50 workers provide affordable, comprehensive health insurance or pay a small penalty set off a flurry of commentary and speculation. Much of this reaction focused on how the decision will affect larger employers and their workers — that is, very little — and others weighed in on the political implications of this move. The biggest impact on large employers is if they do not provide the requisite health insurance they will not have to pay the penalty for one more year. But little analysis and commentary considered what this decision means for low-wage workers' access to health insurance exchanges, nor the outreach and education challenges it creates. 

With or without this postponement, beginning January 1, many workers whose employers do not offer coverage, or whose employer offers coverage that does not meet minimum standards for premium affordability and sufficient benefits, will qualify for help with premiums and cost-sharing for coverage they purchase in the health insurance exchange operating in their state. These marketplaces will offer participants a choice among fully-vetted health plans that meet state and federal standards. Workers with good employer-sponsored health insurance won't be able to receive subsidies to purchase coverage in the exchange, but those workers without access to good employer-sponsored coverage, or coverage that exceeds 9.5 percent of their incomes, will qualify for this help. 

Today, low-wage workers are more likely to pay a larger share of the premium for employer-sponsored coverage than workers with higher earnings.  Read more »

One Year Later: SCOTUS, the Affordable Care Act, and Unfinished Business

Today marks the one-year anniversary of the Supreme Court's historic ruling that upheld the constitutionality of the Affordable Care Act (ACA). In National Federation of Independent Business v. Sebelius,  the Court upheld the constitutionality of two major provisions of the ACA: the individual mandate and the Medicaid eligibility expansion. However, the Court made one very significant change to the terms of the Medicaid provision: It held that the federal government could not condition a state's current federal Medicaid funding on participation in the coverage expansion, thereby giving states the choice to opt-out of covering more people through Medicaid. 

Today, Medicaid programs in all states cover low-income individuals with disabilities, seniors, children, pregnant women, and parents. But federal money provided through the ACA will enable states to reach people younger than 65 whose income is below 138 percent of the federal poverty guideline ($15,856 annually for an individual; $26, 951 for a family of three in 2012). 

For the first time, low-income childless adults will have access to Medicaid coverage in many states. 

If all states take this federal money, approximately 15.1 million currently uninsured adults [PDF] would newly qualify for Medicaid coverage. Covering more people through the Medicaid program is especially important for low-income women who make up over 60 percent of uninsured women in the U.S. and are four times more likely than higher income women to report fair or poor health.  Read more »

Wait, There Wasn’t a Law Against That Already? Section 1557: a Title IX for Health Care

Strong federal protections against sex discrimination exist in the workplace and in schools, and have existed, for sixty and forty years, respectively. Of course, there’s a lot of work to do to enforce those protections and build on them. In health care, no such broad antidiscrimination law existed.

You may need to re-read that. People generally do a double-take when they hear there has been no big prohibition against sex discrimination in health care until just 3 years ago. “Did I really read that right??” You did.

We needed a Title IX, the federal law that prohibits sex-based discrimination in education program, for health care. Finally, now, we got one!

Section 1557 of the Affordable Care Act (Obamacare) adds this important protection against sex discrimination in health care. But, that’s not all.

For one, Section 1557 expands existing protections against discrimination in the health care area based on race, color, national origin, disability, and age. Specifically, the law protects individuals from discrimination based on race, color, national origin, sex, age, disability, gender identity, and sex stereotypes in:

  • the health programs or activities of recipients of federal financial assistance, like all operations of a hospital or the health plans of entities that receive federal grants;
  • federally-administered programs, such as Medicare or the Federal Employee Health Benefit Plan; or
  • any entity established under Title I of the ACA, including the health insurance exchanges being established in the states—the places people will go to compare their options for and purchase health insurance

Or, put more simply: the law’s reach is broad and impacts virtually all aspects of health care. Read more »

There Should Be A Law Against That. . . And Now, There Is! Federal Law (Finally!) Prohibits Sex Discrimination in Health Care

Did you know that until 2010, no federal law provided protection against sex discrimination in health care? What?!

Section 1557 is an antidiscrimination provision in the Affordable Care Act (Obamacare) that includes the first federal protection against sex discrimination in health care. For those familiar with Title IX, the federal law that prohibits sex discrimination in education programs, Section 1557 is like a Title IX for health care.  

And, today, the NWLC filed the first set of complaints under Section 1557 addressing a major issue for young women – the fact that they often don’t get maternity coverage if they are on their parents’ health insurance plan. NWLC filed complaints with the Office for Civil Rights (OCR) at the Department of Health and Human Services (HHS) against five institutions whose health plans do not provide pregnancy benefits to the dependent children of employees. Because the institutions receive federal funds, they cannot discriminate against any individual participating in any of their health programs, including their employee health plans. Read more »

Will Eden Foods Chairman Change His Tune Today to Save His Lawsuit against Birth Control Coverage?

Today in court, will Eden Foods’ President, Michael Potter, change his tune? Potter is one of the many for-profit business owners suing the government because he does not want to cover birth control in his employees’ health plans, as required by the health care law. Some speculate that Potter’s recent statements have cast doubt on his motivation and undermined his case. During today’s oral arguments his lawyers will attempt to reconcile his legal claims with his many statements to the contrary.

Potter has spent weeks talking up in the media his opposition to the contraceptive coverage benefit. He’s stated that he opposes the contraceptive coverage benefit because he questions “what gives [the federal government] the right to tell [him] that [he has] to [cover birth control].” But here’s the thing: he’s admitted he would not have cared if it was “Jack Daniels or birth control”—it’s the principle. Potter’s admitted that the root issue—“the beginning and ending of the story”—is the government trying to tell him what to do. As he said, “[he’s] got more interest in good quality long underwear than [he has] in birth control pills.”

Today, during oral arguments for the preliminary injunction, his tune may change. Contrary to his many statements, his lawyers will try to convince a Michigan district court that Mr. Potter’s religious beliefs motivate his attempt to deny his employees (and their families) the comprehensive insurance they are entitled to. That’s because the claims Potter is making require a violation of religious exercise. But proving religious beliefs are at issue won’t be an easy task. When asked what particular religious belief led him to oppose the benefit, Potter said “Well, there isn’t any one particular religious belief… I find it hard to get my head around the question.” Read more »

MO Attorney General Won’t Appeal Ruling Striking Down an Exemption to the Contraceptive Coverage Requirement

Score one for sanity! Last Thursday, the Missouri Attorney General announced that he will not appeal a federal court ruling that struck down a Missouri law that would have required insurance issuers to issue polices without contraceptive coverage to employers who claim that birth control violates their “moral, ethical or religious beliefs.”

The law directly conflicted with the federal health care law’s contraceptive coverage requirement, which requires all new health insurance plans to cover contraceptives with no co-pay. In his announcement, the Attorney General aptly stated, “the attempt to deny contraceptive coverage to women in Missouri is just plain foolishness” and “cannot be supported by case law or sound policy.” Read more »

Most People Want States to Take Federal Money to Cover More Uninsured People through Medicaid

Cross-posted from the Daily Kos.

Across the country, states continue to debate and negotiate whether they will accept federal money to cover more uninsured people through Medicaid. But nearly two out of three people have already made up their minds that lawmakers should take this unprecedented opportunity to cover more people, according to a new survey sponsored by the National Women’s Law Center and Georgetown University’s Center for Children and Families.

The new health care law known as the Affordable Care Act (ACA) allocates money for each state to cover more uninsured people through Medicaid. It’s a great deal for states, since these federal dollars will cover 100% of costs in the first few years and will ultimately pay for 90% of the yearly costs of this coverage. But because last year’s Supreme Court decision made accepting these funds optional, in states that choose to turn down the money, some people will earn too little to qualify for tax credits to purchase coverage in the new health insurance marketplace, yet won’t be able to obtain coverage through Medicaid. In other words, these people will fall into a “coverage gap” and will get no help toward affording health coverage, while some people who make more money will still get help.

Read more »

Help Me Affordable Care Act, You’re My Only Hope!

A study published in the journal Women’s Health Issues last week highlighted a problem many women have confronted over the years when getting their birth control: even when you have insurance, the costs for contraception can be unaffordable. The study showed that, in 2010, on average women with private insurance paid $10 for a one-month supply of generic pills, $112 for an IUD, and $116 for an implant. The study also found that costs varied depending on your insurer, with some women having to pay more than $17 a month for generic pills, $305 for an IUD, or $308 for an implant. On top of these high costs, the study found that between 2007 and 2010, insurance companies shifted to women costs for long-acting contraceptives, like IUDs and implants. In 2007, a woman paid 13.8% of the cost of an IUD, whereas in 2010 she paid 17.5%.

If these price tags have you confused, there is hope. As I’ve mentioned on this blog before, the Affordable Care Act, often referred to as “Obamacare,” contains a provision that requires health insurers to provide coverage of the full-range of FDA-approved contraceptives without cost sharing. Read more »

Major Part of Obamacare Has a Chance in Virginia

It’s been an exciting few weeks for advocates who are urging Governors and state legislators to say yes! Last June, the Supreme Court upheld the health care law but let states choose whether or not to take the Affordable Care Act’s funding for covering more people through the Medicaid program. Ever since then, Virginia advocates have had their work cut out for them—making phone calls, knocking on doors, and educating anyone who will listen about the important benefits to the state of Virginia, hospitals and health systems, and to the women and families who will gain the most.

Last weekend, Virginia took a big step forward. The two-year state budget includes a compromise proposal that could lead to Virginia extending coverage to approximately 350,000 Virginians who currently lack health insurance. Under this proposal, a legislative committee will ultimately determine whether the expansion will move forward. Governor McDonnell is currently reviewing this legislation.

What’s at stake by covering more people?

  • Approximately 169,000 Virginian women would gain health insurance coverage
  • Combined with other reforms in the Affordable Care Act, it could reduce the percentage of uninsured women in Virginia from 17 % to 4 %
  • Accepting the money could save Virginia approximately $424 million in uncompensated care costs over the next ten years

Why I’m Gushing About the ACA’s Contraceptive Coverage Requirement as the U.S. Teen Birth Rate Hits a Record Low

The CDC published new data today showing that the teen birth rate in the U.S. dropped to a historic low in 2011. The CDC attributes this in part to teens using contraception more regularly and more effectively. This is great news for a number of obvious reasons. But what it makes me really excited about is how the Affordable Care Act’s contraceptive coverage provision could help reduce these rates even more in the coming years.

Yes, I recognize how wonky my excitement is, but think about it: these new statistics are from a period of time before the ACA’s contraceptive coverage requirement went into effect. Imagine what might be coming down the road for us as more and more women have access to contraceptive coverage without worrying that they won’t be able to afford the co-pay at the pharmacy. Read more »