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January 2017 eNews
Health Law PA News

Click here for the January 2017 Health Law PA News.
  • Large Numbers of People Impacted By Change in Medicaid Physical Health Plans
  • Community HealthChoices Goes Forward
  • Much At Stake As New Administration Develops Health Care Proposals
  • Marketplace Open Enrollment Ends January 31, 2017
  • Pennsylvania Awarded Innovative Behavioral Health Grant
  • DHS Working to Improve Access to Medicaid for Those Leaving Jails and Prisons
  • PA Budget Address Scheduled for February 7th
The Health Care Plan Pennsylvanians Want

This month President Trump and Republicans in Congress began their effort to repeal and potentially replace the Affordable Care Act.  Although many Pennsylvanians support Donald Trump — people who are enrolled in marketplace coverage or Medicaid coverage created by the law— the repeal fervor in Washington seems disconnected from the concerns of working people.
This disconnect was reinforced for me when I read a summary of the Kaiser Family Foundation’s two focus groups in Pennsylvania: one with Trump voters enrolled in the Affordable Care Act marketplaces, and one with Trump voters receiving Medicaid.  The sessions, with 8 to 10 men and women each, were held in late December 2016 in Cumberland County PA.  Though the participants did not agree on everything, they expressed remarkably similar opinions on many health care questions:
  • They were not, by and large, angry about their health care; they were simply afraid they would be unable to afford coverage for themselves and their families. They trusted Mr. Trump to do the right thing but were quick to say that they didn’t really know what he would do, and were worried about what would come next.
  • They spoke anxiously about rising premiums, deductibles, copays and drug costs. They were especially upset by surprise bills for services they believed were covered. They said their coverage was hopelessly complex. Those with marketplace insurance — for which they were eligible for subsidies — saw Medicaid as a much better deal than their insurance and were resentful that people with incomes lower than theirs could get it.  They expressed animosity for drug and insurance companies, and sounded as much like Bernie Sanders supporters as Trump voters. 
When asked about policies found in several Republican plans to replace the Affordable Care Act — including a tax credit to help defray the cost of premiums, a tax-preferred savings account and a large deductible typical of catastrophic coverage — several of these Trump voters recoiled, calling such proposals “not insurance at all.”  One of those plans has been proposed by Representative Tom Price, Mr. Trump’s nominee to be secretary of Health and Human Services. These voters said they did not understand health savings accounts and displayed skepticism about the concept.
Obamacare has disappointed some of these voters — people of modest means — but they could be even more disappointed by Republican alternatives to replace it. They have no strong ideological views about repealing and replacing the Affordable Care Act, or future directions for health policy.  What they want are pragmatic solutions to their insurance problems.
People’s health is at stake. Lives are on the line.  The 1.1 million Pennsylvanians who gained health insurance through the ACA — 400,000 with Marketplace coverage and 700,000 through Medicaid — will lose without a comparable replacement.    
In the weeks and months ahead PHLP will keep readers informed as repeal and replacement plans become real.  We’ll highlight disconnects such as HHS nominee Price’s who repeatedly (and falsely) stated during his confirmation hearing this month that Medicaid beneficiaries have health care coverage on paper only, and lack access to quality care.  And PHLP will identify opportunities for readers to contact federal policymakers and influence their decisions.   
Laval Miller-Wilson
Executive Director

PHLP Secures Special Equipment to a Family Van so that a Person with Disabilities 
Can Live An Active & Independent Life

Through a program known as home and community based waiver, Pennsylvania’s Medicaid program permits adult residents who are physically disabled to be cared for at home.  Sometimes home adaptation and vehicle modifications are necessary to assure that person’s safety, to move within the home, or to provide access between the home and community.  But securing those modification services are not easy.  Too often it’s stressful and expensive. Donna knows this all too well.

Donna’s 27-year-old son Scott has Cerebral Palsy and relies on a wheelchair for mobility. To travel Scott needed a wheelchair lift added to the family van because his parents could no longer lift him. However, the cost for the lift was so prohibitive Donna took out a loan to cover half of the cost.

Because Scott was in a Medicaid waiver program funded by Pennsylvania’s Office of Long Term Living (OLTL), his family was eligible to have vehicle modifications completely covered. After some initial miscommunications about the requirements, Scott’s family gave OLTL the appropriate paperwork. But weeks dragged on with no reply and no service.  Finally, United Cerebral Palsy of Central PA reached out to PHLP on the family’s behalf.

PHLP contacted OLTL urging them to approve the vehicle modification.  Within 5 days the requested wheelchair lift was approved!

Now Scott can join his family when they travel, which increases his quality of life. Furthermore, the company that installed the vehicle lift agreed to refund the money Scott’s parents initially paid since the lift will be fully paid for by the waiver.

PHLP’S mission is to help older adults, people with disabilities, and those who care for them access long term support and needed services. Please consider a donation to support our work.

Donate to PHLP
What We're Reading

Hospitals in Safety Net Brace for Health Care Law’s Repeal, Abby Goodnough, The New York Times, December 28, 2016

“Before the health law, the hospital had to absorb the cost of caring for many uninsured patients like Mr. Colston. Now, with ... the Republican-controlled Congress vowing to dismantle the law, Temple and other hospitals serving the poor are bracing for harsh financial consequences that could have a serious effect on the care they provide.

Since the election, hospitals have been among the loudest voices against wholesale repeal of the health law. In a letter to Mr. Trump and congressional leaders this month, the two biggest hospital trade groups warned of “an unprecedented public health crisis” and said hospitals stood to lose $165 billion through 2026 if more than 20 million people lose the insurance they gained under the law. They predicted widespread layoffs, cuts in outpatient care and services for the mentally ill, and even hospital closings.”

If Not Obamacare, Then What? Olga Khazan, The Atlantic, December 20, 2016

“Thus goes yet another attempt to solve the health-care riddle of the hour: If not Obamacare, then what? People who don’t like the Affordable Care Act voted overwhelmingly for Trump. Republican policymakers, including President-elect Donald Trump, have vowed to repeal it. But a clear replacement plan that would beat Obamacare’s costs, coverage levels, and attempts at socio-economic fairness has yet to materialize. So, everyday Americans dissatisfied with the current insurance system are left puzzling through the actuarial tangle: What’s fair, and what’s not? And how to make it work better than it does now?”

Pennsylvania to try new payment model for rural hospitals, Steve Twedt and Karen Langley, Pittsburgh Post-Gazette, January 10, 2017

“Pennsylvania will be testing what state officials termed a historic new payment model for rural hospitals designed to improve the health of Pennsylvania’s rural residents and help the hospitals they depend on stay financially solvent.

With $25 million in funding from the U.S. Centers for Medicare and Medicaid, the Pennsylvania Rural Health Model will try an innovative payment structure in which hospitals will be paid a set amount each month, instead of being reimbursed for services provided.”

PA Insurance Commissioner Promises to Fight for Health Insurance Consumers, Urges Congress to Keep Parts of Affordable Care Act That Have Helped 1.1 Million Pennsylvanians Get Access to Coverage, PR Newswire, January 17, 2017

“Commissioner Miller said that so far more than 413,000 Pennsylvanians have selected health insurance plans through for 2017.In 2016, 78 percent of individuals who shopped on the federal marketplace received subsidies to help pay their premiums.  With subsidies available for individuals with incomes up to $47,580 and families of four up to $97,200, the federal Department of Health and Human Services estimates that three-fourths of returning marketplace consumers will be able to find a health plan for less than $100 a month in premiums, after subsidies are applied.  Gov. Wolf's expansion of Medicaid under the ACA has also provided access to health coverage for nearly 700,000 additional Pennsylvania citizens.

In the first year of Pennsylvania's Medicaid expansion, almost 63,000 newly eligible Medicaid enrollees accessed drug and alcohol treatment. This coverage is essential in battling the opioid and heroin public health crisis that took over 3,500 lives in Pennsylvania in 2015.”

50-State Survey of Medicaid Eligibility and Enrollment Policies in 2017: A Baseline for Measuring Future Changes, Kaiser Family Foundation, January 12, 2017

“In addition to the impact on coverage, repeal of the ACA could alter Medicaid eligibility, enrollment, and renewal policies and processes in every state. The ACA standardized and streamlined these processes to move to a modernized, technology-driven approach. Following several years of state efforts to implement these processes through major upgrades to state eligibility systems, 50 states currently have an online application for Medicaid, 41 states offer an online account for enrollees to manage their Medicaid coverage, 39 states can determine Medicaid eligibility decisions within 24 hours, and 42 states are processing automated renewals. Since Medicaid systems coordinate or are integrated with Marketplace systems in all states, changes to the Marketplaces would also affect Medicaid.”

Obamacare repeal jeopardizes mental health, addiction coverage, Jayne O'Donnell and Terry DeMio, USA TODAY, January 8, 2017

“The people helped the most by the ACA are the ones most likely to suffer from poor mental health and addiction. Nearly 30% of those who got coverage through Medicaid expansion have a mental disorder, such as anxiety or schizophrenia, or an addiction to substances, such as opioids or alcohol, according to the federal Substance Abuse and Mental Health Services Administration. That compares to the more than 20% of the overall population — 68 million people — who experienced a diagnosable mental health or substance abuse disorder in the past year, the American Psychiatric Association says.”

The Heroism of Incremental Care, Atul Gawande, The New Yorker, January 23, 2017

“Success, therefore, is not about the episodic, momentary victories, though they do play a role. It is about the longer view of incremental steps that produce sustained progress. That, such clinicians argue, is what making a difference really looks like.”

How Repealing Portions of the Affordable Care Act Would Effect Health Insurance Coverage and Premiums, Congressional Budget Office, January 2017

“[A little over a year ago], CBO and JCT offered a partial assessment of how [the Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015] would affect health insurance coverage, but they had not estimated the changes in coverage or premiums that would result from leaving the market reforms in place while repealing the mandate penalties and subsidies. This document—prepared at the request of the Senate Minority Leader, the Ranking Member of the Senate Committee on Finance, and the Ranking Member of the Senate Committee on Health, Education, Labor, and Pensions—provides such an estimate.”

Devastation, Death, and Deficits: The Impact of ACA Repeal on Pennsylvania, Marc Stier, Pennsylvania Budget and Policy Center, January 19, 2017

This report asserts that ACA repeal in Pennsylvania- especially the repeal of Medicaid expansion and tax credit subsidies through Marketplace- would result in 1.1 million Pennsylvanians losing their health insurance, over 137,000 Pennsylvanians losing their jobs, and $1.4 billion added to the state's structural deficit. 
Helping People in Need Get the Health Care They Deserve.
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