Promising Practice: Moving from Coverage to Care

Since passage of the Affordable Care Act, millions of people in the United States have gained health coverage, often with the help of professional enrollment assisters. But getting people signed up for insurance is just the first step toward ensuring that they get needed health care. This Promising Practice Policy Brief discusses the role that assisters can play in helping people understand their coverage and put it to use.

Promising Practice: Making Medicaid Part of the Welcome Home

Thanks to the Affordable Care Act, many adults are now eligible for health care coverage, such as Medicaid, that had been closed to them before. Among these newly eligible adults are many people leaving prison — and Medicaid can make a big difference in helping them transition back home. This Promising Practice Policy Brief discusses options for states.

Promising Practice — Making Medicaid Part of the Welcome Home

Price-Gouging AIDS & Cancer Patients? By-Product of a Broken System

Martin Shkreli wants you to swallow his bitter pill — and to thank him for making you pay $750 for it.

For 62 years, the drug Daraprim has been the standard method to treat parasitic infections that are particularly life-threatening to AIDS and cancer patients. It was relatively affordable — though low-income patients might take issue with calling an $18 pill “affordable” — and highly effective in treating these infections.

Then last month, Shkreli and his company, Turing Pharmaceuticals, came along and acquired rights to the drug. Their contribution to better the lives of these patients?

Jacking up the price 4,000 percent. Read more

Today in Montana: Big Win on Medicaid Expansion

Today, Montana Governor Steve Bullock signed SB 405 into law, making Montana the 29th state in the country to expand health coverage for low-income residents through Medicaid expansion.

Thanks to this bill, up to 70,000 Montana residents who are currently uninsured will be eligible for quality, affordable health coverage for the first time. It’s a big victory for Montana families and communities. But it didn’t come without a fight.

To an outside observer, the odds may not have looked good going into the 2015 legislative session. Medicaid expansion had already failed to clear the Montana Legislature once before. And the Montana chapter of Americans for Prosperity (AFP is the flagship organization in the Koch network) was throwing all its weight behind ginning up opposition and trying to scare moderate lawmakers away from the negotiating table.

But the Healthy Montana Campaign, a statewide coalition of 10 core partner organizations working in support of Medicaid expansion, was undeterred. Through three years of disciplined organizing, the coalition sent a clear message: when it comes to quality, affordable health care, we’re in it to win it. And that’s exactly what they did.

The Montana Organizing Project (MOP), an affiliate of the Alliance for a Just Society, played an integral role in the organizing that made this victory possible, mobilizing its base of members and leaders across the state, including in rural and eastern Montana, to join the fight.

MOP and HMC partners knew it would require a large-scale grassroots effort to overcome the Koch money on the other side. So they started early. And never quit.

In 2014, when MOP ran a nonpartisan civic engagement project focusing on low-income women voters that logged 19,000 phone calls, 3,500 doors knocked, and more than 3,000 “I pledge to vote” cards. They not only boosted turnout in their target universe – they also built a list of Medicaid expansion supporters, and prepared those supporters to take action.

As the 2015 session got underway, MOP mobilized its supporters to turn out at rallies, testify at legislative hearings, make calls to key legislators, and write letters to the editor.

Leaders in the Campaign expected an onslaught of opposition from Americans for Prosperity. But at the first legislative hearing, the Healthy Montana Campaign rallied 250 supporters, including businesses and statewide organizations. Americans for Prosperity turned out fewer than a dozen people in opposition.

Through this show of strength in numbers, partners in the HMC highlighted the difference between their grassroots support from Montana families and AFP’s astroturf opposition.

That set the tone for the debates to follow. And when AFP tried to run town hall meetings in the home districts of swing legislators to drum up opposition, they got out-smarted and out-organized: the targeted legislators showed up, won the crowds over, and turned them against AFP.

The final deal on Medicaid expansion in Montana isn’t perfect. It includes some provisions the HMC strongly opposed – like mandatory premiums (up to 2 percent of the recipient’s income), a co-pay of up to 3 percent, the ability to remove people who earn above 100 percent of the poverty level and fail to pay their premiums from the program, and a sunset provision.

But the Campaign won on its two most important goals: making sure the final deal accepts all of the federal funding available for Montana, and ensuring that everyone earning up to 138 percent of the poverty level (about $16,000 for a single person) will be eligible. That means up to 70,000 low-income Montanans who’ve had nowhere to turn will be eligible for quality, affordable health coverage thanks to Medicaid expansion.

The passage of Medicaid expansion will also help small, rural hospitals across Montana – hospitals that may otherwise have faced closure due to funding shortfalls – to remain solvent, preserving access to health care for rural communities and preserving good-paying health care jobs in those communities.

The work for quality, affordable health care in Montana isn’t over, of course. While today’s signing of Medicaid expansion is a great stride in expanding health coverage, there’s still a lot of work to do to make sure getting health coverage translates into getting health care, especially for women, Native Americans, and rural residents. MOP and the HMC partners look forward to engaging in the Waiver process to ensure that as many Montanans as possible get covered and get on the path to quality care.

There’s a lot more organizing and more fights ahead to make health care reform fulfill the promise of eliminating race and gender-based disparities in health access and outcomes in Montana. The Montana Organizing Project will be in the thick of that work.

 

 

CHIP’s Two-Year Reprieve

This week, Congress passed legislation funding the Children’s Health Insurance Program for an additional two years. The bill passed with strong majorities and bipartisan support.

There’s the good news in that legislative development: the bill included none of the attacks on CHIP – including provisions specifically targeting immigrant children – that had surfaced in previous proposals. CHIP will remain strong as one of the country’s most important health coverage programs, thanks to a vigorous defense from community groups across the country.

But Congress has still put CHIP on a two-year deadline. With this kind of short-term funding, kids and their families – including kids with ongoing courses of treatment – can’t feel secure about their health care. Two years isn’t enough – no one’s health care follows that kind of legislative calendar, and kids’ health care shouldn’t be expected to.

A Question for Lawmakers Who Backtrack on Expanded Health Coverage: Seriously?

With two weeks left in the second enrollment period for Affordable Care Act health coverage, marketplace enrollment is projected to reach between 9 million and 9.9 million people this year. That’s a net increase of between 2 and 3 million people gaining coverage through the marketplaces. Millions more will gain coverage through Medicaid expansion.

That’s something to celebrate – but the celebration could be short-lived for many people. Instead of figuring out how to get more people health coverage in 2015, many newly-elected and re-elected state legislators and governors are actually plotting how to take health care away from people who just received it for the first time.

It’s a real threat to people who’ve just gained coverage through Medicaid expansion – especially in states where incoming lawmakers are openly hostile to anything related to the Affordable Care Act. Those at greatest risk of losing coverage are women and people of color.

In Arkansas, where 211,000 people recently gained coverage, the state legislature must reapprove the Medicaid expansion plan by a three-quarters majority again in 2015. The incoming Republican governor is unenthusiastic about the plan – and expansion opponents won seats in the legislature. That doesn’t bode well.

In Ohio, where more than 400,000 people have coverage under Medicaid, the state legislature is also required to reauthorize the program in 2015. And in New Hampshire, where more than 20,000 people enrolled in just three months, the new Republican majority in the NH House of Representatives will also take a fresh vote on the program as well.

The continuing failure of more than 20 states to adopt any expansion plans at all, and the prospect of newly elected legislators revoking expanded coverage for hundreds of thousands of residents, represents a serious health threat to women.

A recent 50-state report card on women’s health by the Alliance for a Just Society clearly shows that most of the states that rejected Medicaid expansion have poor or failing records on women’s health. When it comes to ensuring that women have access to health care, the majority of legislators in these states have turned their backs on women.

The 2014 Women’s Health Report Card ranks and grades every state in the country on 30 distinct measures of women’s health. The results: 17 of the 21 states that rejected Medicaid expansion received final grades of C, D or F – and 13 of those states received a D or F.

Politicians in these states are failing women, but they are especially failing women of color who are more likely to be working low paying jobs, not covered by health insurance, and are least likely to have access to medical care.

The number of black women without health insurance is at least 20 percent higher than for women overall in 17 states. The uninsured rate for Latina women is at least 50 percent higher in 44 states. Black, Latina, and Native American women without access to health care have dramatically higher rates of hypertension, diabetes and infant mortality than other women.

While it’s encouraging news that Wyoming, Montana, and even Idaho seem to be moving toward Medicaid expansion, it will also leave our nation with a disturbing illustration of how alive and well racial segregation is in America. Take a look at the map of states that are refusing coverage to their most vulnerable residents: being denied access to health care is the latest Jim Crow.

Lawmakers in states that haven’t expanded Medicaid yet should move quickly to adopt expansion plans this year. If they don’t, they will bear the responsibility for their states falling even further behind on women’s health, and worsening racial disparities in our health care system.

As for lawmakers considering a vote to take health care away from thousands of their constituents, all I can ask is: Seriously? Do you really want to do that?

It’s one thing to stand in the way of people gaining access to quality, affordable health care. But it’s something else when people have just experienced quality, affordable health care for the first time, and then you snatch it away from them.

I can’t imagine that many will take kindly to it. And just in case anybody’s forgotten, there’s another election just a couple years away.

LeeAnn Hall is the executive director of the Alliance for a Just Society, a national policy, research and organizing network focused on racial and economic justice. The Alliance has produced pivotal reports on state and national health issues including Medicaid, prescription drugs, and insurance industry practices for 20 years.

Hospitals and Clinics Feel the Pain of Medicaid Expansion Politics

This article by LeeAnn Hall, executive director of Alliance for a Just Society, was originally published in Huffington Post.

Is your state refusing to expand Medicaid? If so, it could be putting your health at risk, whether you’d qualify for Medicaid or not.

That’s because the Affordable Care Act (ACA) – the health reform bill — is about more than covering the uninsured. It’s also designed to strengthen the health care system for everyone. As a major source of health system funding, Medicaid – which covers low-income families, seniors, and people with disabilities — is a key part of that effort. You may not need Medicaid, but your hospital sure does.

As passed by Congress, the ACA made Medicaid expansion automatic. This expansion was slated to reach up to 15 million newly eligible working poor and near-poor adults and an additional 4 million who were previously eligible, but had not enrolled, injecting much-needed dollars into hospitals that had seen finances strained with growing uninsured rates.

However, when the Supreme Court ruled on the ACA in June 2012 it allowed states to opt out of expansion. With a stroke of the pen, the Court drove a gaping hole through health reform. Medicaid expansion would no longer be guaranteed across-the-board – it would now be the victim of contentious health-reform politics.

This decision proved disastrous for the families who had counted on Medicaid expansion for coverage and now find themselves in a terrible Catch-22. They earn too much for the meager Medicaid programs in states that have refused expansion. But, they also don’t make enough for coverage on the new health exchanges.

Yet these working-poor families aren’t the only victims of Medicaid expansion politics – hospitals and clinics are, too.

The costs of refusing Medicaid are staggering. Non-expansion states are passing up $423.6 billion in health care funds from 2013 through 2022. From 2014 through 2016, accepting Medicaid expansion would have provided $88 billion in health care funds. That’s $88 billion hospitals sorely need.

Meanwhile, the 27 expansion states will bring in an estimated $83.6 billion in additional health care funds.

Refusing Medicaid dollars is also a bad fiscal decision for states. That’s because the federal government will fully fund the expansion through 2016, with a gradual decrease over the next few years. Beginning in 2020, the federal government will provide 90 percent of funding — a matching rate that any investor would love.

The sad irony is that residents of opt-out states are contributing to the expansion through their taxes even if they can’t benefit from it. Meanwhile, residents of expanding states are seeing the investment in health care pay off.

Already, according to health-care rating agency Fitch Ratings, nonprofit hospitals and health care systems in expanding states are seeing benefits. Conversely, there’s already been a negative impact on hospitals in non-expanding states. This squeeze on hospitals is felt by all their patients.

The divergence between Medicaid-expansion states and refusing states will only grow. Under the ACA, the federal government is scheduled to scale back subsidies to hospitals with many low-income patients and high uncompensated care costs.

With automatic Medicaid expansion, the reduction in these “disproportionate share hospital payments” would have been offset by coverage gains — the hospitals wouldn’t need subsidies for the uninsured because almost everyone would be covered.

States that opt out of expansion are putting their hospitals at a double disadvantage.

There’s no reason to allow politicians to play these kinds of games with our hospitals and clinics. We should stand together to demand that the promise of Medicaid expansion — and a strong health care system — become reality in each of our fifty states.