Tag Archive | "Affordable Care Act"

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Supreme Court Agrees to Review ObamaCare — Again


By Ann-Marie Adams, Staff Writer

WASHINGTON — In a carefully, crafted  effort to re-tool ObamaCare, the U.S. Supreme Court last Friday agreed to tackle a case related to the Affordable Care Act signed into law in March 2010.

At the heart of this case, King v. Burwell, is whether health insurance for middle-class and low-income residents should be subsidized by the federal government. Subsidies such as tax credits were included in the reform law. King v. Burwell, like the similar Halbig v. Burwell case, has a long history in thecourt system. On July 22, two U.S. courts delivered opposite rulings on the subsidies.

Without these subsidies, most small business owners or unemployed people wouldn’t be able to afford health insurance.

Halbig, one of several pending ObamaCare lawsuits, is expected to be heard again  by a full circuit court panel on Dec. 17. The King case would likely be heard next spring.

Proponents of the ACA said this is a move, though touted as an unlikely one to have direct impact on Connecticut, more than 80,000 Obamacare enrollees should watch closely. Connecticut is one of 14 states that administers its own health insurance exchange through Access Health CT.

This would be the third time the Supreme Court take up cases related to Obamacare delving slight blows to the law. In 2012, five justices upheld the requirement that most Americans must buy health insurance or pay a tax–a victory for President Barack Obama and Congressional Democrats. This ruling, joined by Supreme Court Chief Justice John G. Roberts Jr., was the most significant federalism decision since the New Deal in the 1930s.  Howev3er, the court limited  expansion of Medicaid, which provides health care to poor and disabled people.

In June 2014, the court ruled that the family-owned businesses should not be forced to provide insurance that covers contraceptive services because it violates the business owner’s religious beliefs.

This latest move does not bode well for the Obama administration. That’s because the legislative branch is run by the Republicans, who have tried to repeal the law 55 times.

However, Republicans will face an uphill battle in achieving this goal through the judicial branch. One conservative spokesperson said that incoming Senate Majority Leader Mitch McConnell should try a conciliatory approach.

“Republicans should use reconciliation to fully repeal Obamacare,” said Ken Cuccinelli, who heads the Senate Conservative Fund.

The law had originally required states to run their own healthcare exchanges. Most states in the South rejected that idea, forcing residents to move to other states that offer Obamacare.

According to a report by the nonprofit health policy organization, the Robert Wood Johnson Foundation. up to 7.3 million people are expected to be on this insurance.

 

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Deadline for Health Care Premium Payment Extended


HARTFORD — Jan. 10 was the deadline to make payments on the new insurance premiums under the Affordable Care Act, the nation’s health reform initiative that began  Jan. 1.

Not anymore.

Anthem Blue Cross Blue Shields and other insurance carriers on the state’s healthcare exchange have extended their deadlines for payment of the first month’s premium.

Although the coverage was to begin on Jan. 1,  insurance isn’t considered activated until payments are made for the first month on time.

The new deadline for Anthem and ConnectiCare is Jan. 15 for those who have signed up on the state’s health insurance exchange by Dece. 23.

HealthyCT’s deadline is Jan. 17.

Coverage was supposed to take effect Jan. 1, but isn’t considered activated until they pay their first month’s premium.

 

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Wyman Announces Director of CT’s Health Reform


HARTFORD — The state will now have a point person responsible for the massive overhaul of health reform since the 1960s.

Meet the Director of Healthcare Innovation: Mark Schaefer. Effective Jan. 1, 2014, Dr. Schaefer will lead “the broad stakeholder effort under the Affordable Care Act to transform healthcare delivery and health for Connecticut’s residents within the next five years.”

Lt. Gov.Nancy Wyman announced  the news on Monday, saying that Schaefer is expected to lead the project management office of the SIM from within the Office of the Healthcare Advocate, assuming day to day management of activities to implement the State Innovation Plan, published at www.healthreform.ct.gov.

healthcarereformState officials said the initiatives range from primary care practice transformation to workforce initiatives, community health improvement, consumer empowerment and the establishment and charge of four key task forces and councils.

The state will compete for funding of up to $45 million to implement some of the activities outlined in the Innovation Plan.

“I am confident that Dr. Schaefer has the expertise to lead the state forward on much needed transformation of our healthcare system. He has developed many of our most successful healthcare efforts during his career at the Department of Social Services, including the Connecticut Behavioral Health Partnership, the Integrated Care Initiative and health neighborhood shared savings model to improve care and reduce costs for Medicare/Medicaid eligibles, the Rewards to Quit program, the Person Centered Medical Home initiative and the selection of the Medicaid administrative services organization,”  Wyman said.

Schaefer was nationally recognized as a Medicaid Director and selected for the Medicaid Leadership Institute.  He recently designed and implemented the UConn Medicaid Partnership to improve Medicaid administration.

State Healthcare Advocate Victoria Veltri said, “I look forward to handing over the directorship of this critical initiative into his very capable hands and returning to my primary responsibilities as Healthcare Advocate.  Mark has the drive and skills to make Connecticut a leading state in the SIM.  I am proud to host him and the PMO within OHA.”

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Access Health CT’s Appeal Process for Frustrated Residents Should Be Less Painful


By Ann-Marie Adams

Access Health CT, Connecticut’s official health insurance marketplace, reported a single-day record number of individuals applied for coverage by midnight on Dec. 23: more than 6,700. This figure, officials of the state agency boasted, puts the total number enrolled from Oct. 1 to Dec. 23 at about 62,000.

Impressive.

But people whose applications were not processed, or who had been waiting on the phone for more than 90 minutes, are not impressed.

Almost 300,000 Connecticut residents do not have health insurance.  In Hartford County alone, 98,000 people lack coverage. Of that amount,  34,000 are in Hartford. Most of the uninsured in the capital city and the state are people of color and would have surely benefited from the Affordable Care Act, also known as Obamacare. It’s the first nationwide health reform since President Lyndon Johnson’s Great Society effort with Medicare in 1965.

Just think. If the state’s quasi-nonprofit agency had planned a more effective and inclusive enrollment period to meet the demand, many more people would have signed up, so that they could have had comprehensive health insurance effective Jan. 1.

Dr_AnnMarie_AdamsFor the thousands of people who did not get to enroll, hearing that they can continue to enroll up to March 31 without a tax penalty does not soothe the pain of learning they would have to wait another 30 days from enrollment for insurance to kick in, especially if they have a pre-existing need for insurance.  All they have to look forward to at this point is more snafus or bureaucratic mazes to navigate.

the-hartford-guardian-OpinionConsider this: For one individual, enrolling online was a chore that failed. On Dec. 3, she filled out an application and submitted it through Access CT’s portal. By Dec. 23, she had yet to receive confirmation that her application was processed. She also tried to log in, but was kicked off the site. So at about 4 p.m., she called the 800 numbers listed on Dec. 23. She received a recording saying that she should leave her number and someone would return her call the next business day.

This woman tried again several times until her last call at 10:06 p.m. — hoping to get someone on the phone. After waiting for about 30 minutes, someone answered and asked her name and age then put her on hold for 90 minutes. At 10 minutes before midnight, another agent came on the line and said that it was too late to enroll her.

It was a curious experience that demands answers: was the woman put on hold that long because she was over 40? Was Access CT screening calls so they could sign up mostly customers under 40? Why was there a recording throughout most of the day on Dec. 23, saying customers should call back the next day? How many people of color were signed up? If the state doesn’t have that number as reported earlier, then can we know why? And most importantly, how many of the 34,000 uninsured people in Hartford were signed up?

There were other reported issues. But the main concern now is whether those individuals who were put on hold for waits lasting about an hour or who were locked out of the site, would be considered enrolled.

Although there are many assisters and navigators who have worked hard during the last several months, The Hartford Guardian has witnessed much bumbling during the enrollment period here. In fact, there were numerous warnings, one from Hartford Mayor Pedro Segarra himselfsaying that “if you don’t market it and recruit people in an appropriate place, you could still end up with a lot of uninsured.” And that is the case — because of the incompetence and arrogance of those who guided the enrollment campaign.

There is also clearly conflict of interest and cronyism involved in how resources and marketing efforts were distributed, especially in Hartford. And these strategies and conflicts impacted the number of people and which segments of the population got enrolled on the exchange.

For instance, The Guardian couldn’t help but notice that the so-called Navigator for the city of Hartford was the Hispanic Health Council, an agency whose founding member is Mayor Segarra. We also couldn’t help but notice that Juan Figueroa, who was president of Universal Health Care Foundation of Connecticut, is now Segarra’s acting chief of staff. Figueroa also had a hand in crafting strategies leading up to the state’s health reform push that began in January 2013. And he sits on the board of director for a news outlet charged with being the official organ of everything positive about Access Health CT.

We also noticed that resources were directed to community papers, which quietly ignored the fact that there was reportedly only one person in the North End to cover half that populous section. And that most of the marketing efforts in the city targeted the South End of Hartford, just one of the city’s 17 neighborhoods.

We are happy to see that Access Health CT has taken steps to correct its errors and is now “actively reaching out” to those people who were on hold Dec. 23. These frustrated applicants should indeed now be considered eligible for coverage effective Jan. 1.

However, appeal process in place for others should also take into account the insufficient recruitment efforts made in some city neighborhoods, which were seemingly overlooked because of sub-par marketing strategies and outreach.

An we hope the appeal process won’t be as painful as it was waiting online for 90 minutes without a positive outcome.

Individuals interested in filling an appeal should either call 855-805-4325 or mail their appeal to Access Health CT Appeals, P.O. Box  # 670, Manchester, CT 06045-0670. 

Dr. Ann-Marie Adams is founder and editor of The Hartford Guardian. Follow her on twitter.

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Medical Groups Sue United Healthcare


HARTFORD — The Hartford County Medical Association joined the Fairfield County Medical Association to file a federal court lawsuit challenging UnitedHealthcare’s termination of more than 2,000 physicians who participate in United’s Medicare Advantage Networks.

These terminations are due to take effect Feb. 2014.

According to the lawsuit, UHC’s actions violate the Medicare regulations, and are in breach of UHC’s agreements with its physician members.  The suit explains that UHC’s actions have “a significant adverse impact not only on the terminated physicians, but on their longstanding elderly and disabled patients, who must now either find new physicians (including traveling farther distances to find a participating MA provider), switch plans to continue treatment with the terminated physician, or incur significant additional out-of-pocket costs to continue treatment with an ‘out-of-network’ provider.”

The lawsuit further notes that “patients may be forced to change and to reluctantly go elsewhere for medical care, which is particularly difficult for the elderly and/or disabled.

There will likely also be patients so discouraged by United’s changes that they may even be unwilling to seek covered preventative care.  This will shift the geriatric population to a crisis-oriented culture which further impacts the health and safety of Medicare beneficiaries and increases the cost of their healthcare, a situation that the Affordable Care Act was meant to address.”

“UnitedHealthcare’s plan will mean the termination of more than 2,200 physicians statewide, that’s almost 20 percent of its entire network and that it turn would have an adverse impact on the delivery of medical care to patients,” according to Dr. Robin Oshman, President of the Fairfield County Medical Association.

Dr. Bollepalli Subbarao, President of HCMA., concurred and added that ” we cannot sit back and let this happen, to our doctors, or to our patients, especially when UnitedHealthcare said that this has nothing to do with the quality of physicians terminated, and in our opinion is all about profits.”

Both said that representatives from both FCMA and HCMA note that UHC’s terminations are misleading many Medicare beneficiaries are not being informed that their medical provider is no longer available, they said.

The lawsuit also alleges that United is “shifting the financial burdens imposed by the Affordable Care Act from itself, a multi-billion dollar company, to the providers and patients, all with the aim of maximizing revenues.”

This, they said, is an attempt to undermine clear legislative policies and is being done solely for the sake of profits.

Both groups are seeking a court declaration that United’s attempted terminations are illegal. They also want an injunction preventing UHC from terminating any of the Associations’ physician members.

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Murphy to Co-Host Healthcare Reform Conference


HARTFORD —  In less than one week before the Affordable Care Act is set to launch, Sen. Chris Murphy (D-Conn) will co-host a large-scale health policy conference with the Yale Institution for Social and Policy Studies.

The aim of the conference, scheduled for Sept. 27 at 10 a.m. at Yale’s Kroon Hall on Prospect Street, is to examine the policies contained in the Affordable Care Act–otherwise known as Obamacare– and discuss what the law means for Connecticut residents, officials said. The discussion will also center on what’s next and how to improve the law.

Entitled “Ready to Launch: The Affordable Care Act and US Health Policy,” the event coincides with the Oct. 1 launch of the health insurance marketplace in Connecticut, and it  will bring together leading policymakers, academic experts, and the medical community to engage and educate the public about how the ACA impacts Connecticut residents and businesses owners.

Some of those guests include Diana Rowland, Executive Vice President, Kaiser Family Foundation, Jonathan Swartz, Regional Medical Director, Montefiore Medical Group and  Jacob Hacker, Director of the Yale Institution for Social and Policy Studies.

Ready to Launch: The Affordable Care Act and US Health Policy is open to the public and is free of charge.

To register for the event, please visit http://isps.yale.edu/conferences/aca-ready-to-launch#.UkHCfYZeZQQ . The event will also be livestreamed through the link below for those unable to attend in person.

 

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Access HealthCT to Debut Spanish Infomercials


HARTFORD — Access Health CT will premiere an innovative television series that brings the benefits of Health Care Reform directly to the uninsured and underinsured Latino populations of Connecticut.

Courtesy of Univision, AcessHealthCT

Courtesy of Univision, AcessHealthCT

The program, MERCADO DE SALUD (www.MercadoDeSaludCT.com), is a long-form edutainment series of shows, segments and capsules and will debut Sept.  7 at 11 a.m. on Univision 18 Hartford and will air through March 2014. The driving mission behind MERCADO DE SALUD is to engage, entertain and educate the Latino community of Connecticut about enrolling in quality, affordable health insurance plans through Access Health CT, the state’s official health insurance marketplace.

“A staggering 344,000 people are uninsured in Connecticut and approximately 25 percent are from our Latino community,” said Access Health CT CEO, Kevin Counihan. “To help reverse that statistic, we created MERCADO DE SALUD, a culturally relevant TV series that informs the community about how to gain access to the coverage they need. MERCADO DE SALUD provides the necessary knowledge and tools to engage and empower Latinos for a healthier tomorrow.”

The television segments are only one component of a robust state-wide marketing and outreach campaign. The campaign includes high-impact, high-visibility vehicles such as broadcast, cable, radio and print, plus community outreach via fairs, festivals, neighborhood canvassing, storefront locations and in-person Assisters – all with the goal of educating, engaging and enrolling the uninsured of Connecticut.

MERCADO DE SALUD television segments will provide essential details about the Affordable Care Act (ACA) and what it means for Connecticut’s Latino community. The program features experts who will provide details about how the new law impacts individuals, families and small businesses.  MERCADO DE SALUD will be co-hosted by Ana Alfaro, the beloved and well-known public advocate and host of “El Show de Analeh.”

“As a trusted broadcast partner to the Latino viewers, Univision 18 Hartford is proud to be a part of this unprecedented initiative to bring engaging educational content to the Latino community,” said Sulma Avenancio, General Manager for WUVN.  “Access Health CT’s innovative approach marks a new milestone in our mission to offer Latinos culturally relevant local content that makes a difference in their lives.”

Access Health CT will support the series with a comprehensive communications and outreach plan that includes a toll-free number for viewer questions and enrollment, a web page with show schedules and clips, online banners, text and mobile blasts, and public relations outreach.

For more information visit:  www.MercadoDeSaludCT.com

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Health Care Reform in Slow Gear for Hartford


Healthcare reform is coming to Connecticut on Oct. 1.

And with less than a month to go, Connecticut’s congressional delegation was scheduled to meet on Wenesday to help ramp up an awareness campaign in the city of Hartford and the state, hoping to convey the import of this major reform spawn by President Barack Obama’s administration.

Access Health CT, charged with the gargantuan task of setting up an online marketplace to help enroll people, have been traversing the state with informational meetings, sending out press releases to mainstream media, particular ethnic circulars and local gate keepers who traditionally disseminate information to their family and friends network. Access also attended community fairs, concerts and festivals. They are, indeed, aggressively getting the word out about Access Health CT. Last Wednesday, officials said they were ready for the Oct. 1 rollout.

But what it all means for Hartford residents, especially people of color, has yet to be told.

editorialbannerthumbCase in point: at an Aug. 6 block party in the Blue Hills neighborhood, a twenty-something white man approached a black woman sitting at a table. He mumbled something about insurance and was shooed away. When asked about the nature of the man’s spiel, she said she didn’t hear most of what he said, “just something about insurance.”

The Hartford Guardian was present and found it interesting that Access sent a white male into an all-black community to promote the Affordable Care Act. Why not hire someone from the neighborhood?

This health care program, also known as Obamacare, are for people without insurance, who cannot get insurance because of preconditions and a whole host of categories. Most likely, it is for people who are unemployed and underemployed, many of whom are black and Latino.

A recent phone conference with the ethnic press conveyed the importance of the Affordable Care Act and its impact on communities of color and the poor. Several callers wanted to know about resources for community outreach, or for doing substantive stories about the program.  That’s because implementation of Obamacare, as its sometimes called, is a $5 billion industry; and many companies will be cashing in. As usual, not many small and minority businesses have been in that loop during the early stages.

Additionally, many ethnic papers would like to go beyond referring people to a website and instead disseminate substantive information through a cultural lens. And it was evident in the recent conversation, which also illustrated the knowledge gap that will certainly have a ripple effect in communities of color, if not mitigated soon.

With less than 30 days to go, ethnic communities will have to play catch on mountains of information that have accumulated since January. But many also want to make one thing very plain. They are not interested in just being consumers of the health insurance marketplace. They want more.

On the heels of the 50th anniversary of the 1963 March on Washington for Jobs and Freedom, people of color are asking for not just civil rights but also economic justice.

How the state spends millions of dollars to implement this major healthcare reform will be a significant indicator on the question of equity and whether we will have to march on the Washington Mall again in another 50 years.

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Connecticut and Other States Seek “Best Practices” to Implement Health Care Reform


HARTFORD — By ANN-MARIE MESQUITA, Staff Writer

As the deadline to fully implement the Affordable Care Act nears, health care professionals gathered in Hartford on Monday to unpack mountains of data wrapped in regulations attached to the first major overhaul of the U.S. healthcare system since 1965.

This Act, also known as “Obamacare,” became a reality when President Barack Obama signed it into law on March 23, 2010. If implemented thoroughly, the Act would expand healthcare access and increase health coverage, key components to mitigate health disparities, experts say.

Enrollment for the program is set to begin Oct. 1, 2013. Medical coverage is to begin Jan. 1, 2014.

Some contend this Act could significantly address health disparities.

healthbeatlogo“I think it could have a major impact of health disparities because proportionally to the population, individuals who are more likely to be affected by the Affordable Care Act are people of color,” said Dennis P. Andrulis, a senior research scientist at the Texas Health Institute. Andrulis was one of about 200 public health researchers, policy makers, practitioners and other stakeholders who attended the Institute of Medicine’s daylong conference entitled, Achieving Health Equity via the Affordable Care Act: Promises, Provisions, and Making Reform a Reality for Diverse Patients, at the Mark Twain House on April 22.

Of the 6.8 million newly eligible Medicaid recipients, about 45 percent would be people of color, a figure that mirrors the demographics in the country. Consequently, more than 60 provisions in the ACA are related to race, ethnicity, language and cultural competency to reduce disparities in urban and rural America, Andrulis said.

The work to see this ACT implemented, which will cost $5.1 billion, includes community outreach. It also includes materials to be developed for people with limited English proficiencies, low medical literacy and low reading skills. And already resistance, manifested at various levels, has begun.

In Texas, Andrulis said, discussions are centered on how to navigate the penalties for opting out.  Already, 14 states have opted out. And 12 states are undecided. Since it was signed into law, the U.S. House Republicans voted 39 times to repeal Obamacare. In the coming months, health advocates expect there will be persistent attempts by conservatives to dilute the potential of the law. Of course, Andrulis said, it’s in the Obama administration’s best interest to ensure effective implementation of this act.

To implement this sweeping act, it will be necessary to engage communities at the grassroots level, said U.S. Rep. John Larson (D-1st), who with Gov. Dannel Malloy and Lt. Nancy Wyman gave opening remarks at the daylong conference.

Connecticut is one of several states that have already opted in and have begun to expand Medicaid. Malloy said that the legislature has just started deliberating over this “monumental task” of expanding access by setting up health care marketplace to sell insurance to about 242,000 uninsured people in Connecticut.

Part of delivering services to traditionally underserved population also includes diversify the workforce that serves them. Groups such as Access Health CT have also begun that process, according to Access CEO Kevin J. Counihan.

It’s uncertain, however, how much progress has been made toward implementing networks to engage health consumers in Connecticut. But officials said they are working to ensure health equity, a term bandied about by stakeholders.

And what exactly is health equity?

According to Medical Director of Community Benefit at Kaiser Permanente Winston F. Wong, health equity is the proposition that people in the United States should achieve optimum health without barriers related to their social status, such as income, race, ethnicity, immigration, sexual orientation and other social factors.

Such has been the case for decades, said Wong.

“If you look at the mortality among African American men, their risk ratio is 1.8 times that of their white male counterpart,” he said. “And that pattern has been there for more than 50 years. So we haven’t actually made much progress, particularly around African American males.”

Wong added that with the growing Asian and Latino populations, there is also a reflection of continued disparities, such as diabetes among Hispanics. According to a recent report, up to 50 percent of Hispanics will develop diabetes in the next generation.

So between now and October, there is an emphasis on reaching these population with new information that would help mitigate acute health disparities.

Ignatius Bau, a health researcher, and other health advocates said officials at the top must have meaningful engagement with communities of color, to not just tack their logos on websites as “nice partners” but to also provide significant financial support to have impact. Additionally, there needs to be robust efforts to inform these communities in a timely manner, not close to major deadlines.

Bau also suggested that to truly address the existing health disparities among patient centered health homes and clinics, state officials and other high-level stakeholders should consider the following recommendations:

  • Educate and engage diverse and vulnerable patients, families, caregivers about medical homes
  • —Sponsors/payers for medical home initiatives can highlight opportunities for disparities reduction/health equity, including additional requirements and payments
  • —Monitor standards specific to health equity for compliance and improvement
  • Develop and disseminate technical assistance to medical home practices  on achieving health equity

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