What's in Obamacare for people with high out of pocket costs?

Last night, a KING 5 town hall event on health care featured a question from MS Activist, Susan Brock. The town hall, titled "Health Care: Time to Get in the Game," answered many common questions that people with MS may have about the health law, like "what will happen to me if I'm on Medicare?" or "what will happen to my coverage at work?" Susan's question may be the most important though for people with MS - "What's in the law for people with a chronic condition like MS who experience high out of pocket costs?" 

I don't think Susan's question was answered sufficiently. The panelist answering the question had just talked about help that employers will get for paying for employees' coverage and so he answered the question with that in mind. However, Congressman McDermott did point out that there are no more annual or lifetime limits that often limited coverage for someone with extremely high costs. In addition and most importantly, everyone will now have an annual cap on out of pocket expenses (roughly $6300/year - not including premiums). And if you have a lower income (say because your MS prevents you from working full time), you'll have an additional help with your out of pocket costs. So in short, there's a lot to like in the Affordable Care Act if you currently have high out of pocket costs.

The KING 5 special will be on the air again on KONG 6/16 Sunday, September 7 at 6:00 p.m. and again on NWCN Monday, September 9 at 8:00 p.m. It's also available online - look for Susan's question at the 4:08 mark during the third segment. 

Keep checking back on this blog for more information on the new health care law. There's lots more to come! And if you want to know more about how you will be impacted by the health care law, speak to an MS Navigator at 800-344-4867 or check out more MS-specific information on our website.

Health care reform - what does it mean for you?

Come 2014, our health care landscape is going to look very different for people with MS. You can no longer be denied insurance coverage for your pre-existing condition, many of you will have limits on your out-of-pocket costs, and you could even get low-cost or even free health plans. Why? The Affordable Care Act will come into full effect.

Sounds great on the surface, but what does it really mean for YOU? We are starting to see some opportunities to learn more about these changes and we'll see many more in the months ahead. The National MS Society will be hosting a teleconference in early October aimed at the parts of the health care law most important to people with MS. We also have a great website geared towards getting you the information you need to know.

Healthcare.gov is another great resource for you. In many states, that's the new place you'll go to purchase affordable health insurance. In Washington, HealthPlanFinder will be your source to find, compare, and enroll in health insurance.

When you are purchasing health insurance, here are a few things for you to watch for:

• Make sure your neurologist is in your plan's network
• Check to make sure your MS drugs are covered
• Understand your total costs, including deductibles and cost-sharing - not just premiums

Purchasing health insurance can be confusing. Healthcare.gov and HealthPlanFinder will make it easier, but we encourage you to contact us if you have questions or are concerned about getting the best plan for you. We can help. Call the National MS Society at 800-344-4867. 

Help us make sure the health care law works for people with MS

People with MS often have a difficult time finding a good health insurance plan that is affordable and comprehensive. Too often, plans either cost way too much or don't cover your MS drugs. Luckily, help is on the way. 

The Affordable Care Act created a new way for people to compare and purchase health insurance that fits your budget and meets your needs. The Marketplace (also known as an exchange) will allow you to fill out one application and you'll be able to compare plans based on price, benefits, and quality. 

To make sure the Marketplace (called HealthPlanFinder in Washington) works for people with MS, we need some people who are willing to be "user testers" of the new website. You'll have a chance to make sure that the particular needs of people with MS are considered. If this interests you, please let me know at jim.freeburg@nmss.org or (206) 284-4254, ext 40237. We are looking for testers available August 5-9 and 12-16. You'll need to travel to Olympia for a three hour session. 

Healthplanfinder will open October 1, with coverage starting January 1, 2014. Individuals outside of Washington can find their exchange at Healthcare.gov. 

Changes are coming to your health insurance

The Affordable Care Act was signed into law by President Obama three years ago tomorrow and we are on the cusp of the major changes taking effect. To help you get a better sense of what this means for you, I thought I'd share with you this recent press release from the Office of the Insurance Commissioner that summarizes these changes quite nicely. Read on.... 

OLYMPIA, Wash. – Three years after the passage of the landmark Affordable Care Act and Washington state is now on the cusp of the biggest health care reform in decades.

“We’re busy at the state and federal level, working behind the scenes to make sure that health care reform lives up to its promise,” said Insurance Commissioner Mike Kreidler. “But as we approach Jan.1, 2014, people want to know what the changes will mean to them.”

As early as October, you can start shopping for coverage in Washington state’s new online marketplace, the Healthplanfinder where it will be easy to compare plans, check prices, sign up for coverage and – depending on income – get help paying for it. Individuals earning up to almost $46,000 and a family of four earning up to $94,200 could qualify for subsidies.

“The financial help available through Washington’s new Healthplanfinder will be a lifeline for people who are uninsured or struggling to afford the coverage they have today,” said Kreidler.

To help you get ready for the coming changes, we’ve launched an expanded edition of our health reform website with specific information for individuals and families including:

·    Who has to have health insurance

·    Where you can buy it

·    How much it’ll cost

·    What it’ll cover

Additional resources for small businesses, large businesses and seniors will be added soon so check back often.  We expect to receive rate requests from health insurers for their individual and small employer plans starting in May on our health insurance rate transparency site. At that time, you’ll also see which insurers want to have health plans in the Healthplanfinder.

Sign up today to be notified by email if your health insurer requests a rate or benefit change.

The following reforms are already in place:

·      No out-of-pocket costs for preventive services,

·      Sick children can no longer be denied health insurance,

·      No lifetime caps on the amount an insurer will pay for covered benefits,

·      Young adults can stay on their parents’ health coverage until age 26,

·      And your health plan can’t be canceled, except if you lie on your application.

Other major reforms starting Jan. 1, 2014 include:

·      No one can be denied health insurance if they’re sick.

·      All individual and small employer health plans must cover essential health benefits, such as prescription drugs, hospitalization, maternity care and emergency services.

“The Affordable Care Act won’t fix everything that’s wrong with our health care system today,” said Kreidler. “I’m certain that just as we did with Medicare, we’ll need to make improvements. But the reforms in place now and those coming next year are a huge first step, and not a moment too soon.”

Olympia here we come!

As the previous post demonstrates, there are hundreds of bills under consideration - most won't get out of committee, but so many will. This year Healthcare bills are front and center as the State continues to implement the Patient Protection and Affordable Care Act that should be fully implemented in 2014.

Please come out for a few hours on February 19th to join your fellow activists in a concentrated effort to visit our legislators and educate them about how their votes affect our community. Our legislators WANT to hear from us - so few constituants take the time to share our stories and ask for what we want. How else do our representatives know what their district needs?

http://main.nationalmssociety.org/site/Calendar?id=302056&view=Detail

Get registered for the event and join the educational conference call on February 12th to learn about the legislative agenda for this session.

See you there! - Holly Hawker
Chair - Activism Committee

Interested in how the federal health care law will affect women?

"Health Reform Has Washington Women Covered" Workshops

There's a new health reform law that will give women better access to the health care you need at a price you can afford. You can learn more at an upcoming workshop in your community. You'll learn how the health reform law is already working in our state, the benefits & protectons on the way, and how a recent Supreme Court decision impacts the law. 

Seattle/Tacoma - Tuesday, July 10th, 6:30- 8:00 PM
Highline Community College, Building 8, Mt. Olympus Conference Room
South 240th Street & Pacific Highway South, Des Moines

RSVP: Maha Jahshan (maha@weareoneamerica.org, 206-452-8408)

Everett - Thursday, July 19th, 6:30- 8:00 PM 
Everett Community College, Gray Wolf Hall
2000 Tower Street, Everett
RSVP: Courtney Normand (courtney.normand@ppvotesnw.org, 425.870.9688 )

Yakima - Thursday, July 19th, 6:30- 8:00 PM
Planned Parenthood Health Center
1117 N. Tieton, Yakima

RSVP: Jen Ham (jen.ham@ppvotesnw.org, 509.834.3990) 

Please RSVP to join us, or to let us know you'll need a language interpreter, childcare, or disability accommodation.  Don't see your community on the list? Let us know and we may bring a future workshop to you.  

Looking forward to seeing you at a workshop soon! 

Emily at Northwest Health Law Advocates

The National MS Society's position on the Supreme Court ruling

Holly's post yesterday is a great reminder of the importance of the Affordable Care Act for the MS community. Here's the Society's official position on the ruling:

The National Multiple Sclerosis Society supports the decision of the United States Supreme Court regarding the Patient Protection and Affordable Care Act. This ruling will have a significant, positive impact on many, including the millions of Americans affected by multiple sclerosis.

Below are some of the provisions of the law that the National MS Society believes will have the biggest impact on people with MS and their families:

• Prohibition of coverage denials based on pre-existing conditions: Too many people living with MS had been routinely denied insurance after receiving their diagnosis, preventing them from getting the care they need.
• Prohibition of lifetime limits: Routine, often costly care is needed to manage MS. This may cause those living with severe forms of the disease to reach their lifetime limit early in life. Elimination of that limit was critically important for continued care.
• Elimination of annual limits: Similar to ―lifetime limits, many patients reach their annual limit of coverage because of the cost of care for MS. These arbitrary limits should not prevent those in need from receiving care.
• Extension of parent’s insurance to 26: Many people with MS are diagnosed in their 20s and may still be in school or lacking a full time job to help pay for their care. This provision ensures that they can continue coverage under their parent’s policy.
• Closing the Medicare Part D Coverage Gap: Disease Modifying Therapies for someone with MS can cost as much as $4,000 per month, which is out of reach for the average American; therefore, gradually closing the coverage gap has provided financial relief for those who depend on Medicare for prescription coverage.
• Pathway for Biosimilars: The law provides a pathway for biosimilars which provides some hope of lower cost therapies in the future. The FDA had recently indicated it would not have pursued this pathway without the legislative mandate therefore, it will continue to be developed--which is good news for anyone who uses biologic therapies.

Background

Although many people with MS have health care coverage, 70% of those with health insurance still struggle with the cost of health care and 30% are forced to spend less on food, heat, utilities and other necessities in order to afford their health care. Those without access to private insurance and who do not qualify for public programs are often priced out of the market, as individual plans can be prohibitively expensive.

On average, the financial impact of living with MS is $69,000 per year, and more than half of this amount consists of direct health care costs. Unlike some other diseases, MS is a lifelong illness—typically diagnosed between the ages of 20 and 30s - prime career and family building years. Because of the high cost and complications that can be associated with the disease, the National MS Society has long supported many of the policies that were included in the law just upheld by the Supreme Court.

With guidance of people living with MS, the Society adopted a set of National Health Care Reform Principles several years ago and, as an organization. Our approach is to support legislation that is in line with those principles. We intend to continue to work with Congress and the Administration in pursuit of public policies that address the needs of those impacted by MS.

The Supreme Court got it right this time!

Thank you Supreme Court! The Affordable Care Act is safe.

I don't know about you, but this morning was very emotional for me. I was somewhat prepared for the terrible news that the mandate was overturned (and the law gutted), but the shock and excitement that (almost) the entire law was upheld completely overwhelmed me. As activists we have supported Congress and our President in their effort to enact this monumental bill and desperately hoped for this outcome.

Although the States may opt out of the Medicaid requirement, Governor Gregoire has committed to continuing the process to help insure 500,000 Washingtonians through the expanded Medicaid   program. Jay Inslee has been an outspoken supporter of this law. Even Attorney General McKenna (who joined the lawsuit that got us to this point) expressed support for most aspects of the law in an interview with Robert Mak (KING5) today - although his support of the Medicaid expansion is questionable "....as long as the State can afford it". Governor Gregoire said that for the first few years, the federal government pays 100% of the Medicaid expansion, then 95%, then 90% going forward. I think we can come up with 10% of the cost of insuring an additional 500,000 citizens in our state.

Congratulations to our entire community!

Enjoy what this day means...

Cheers - Holly Hawker

Who benefits from health care reform in Washington?

Washiington's Office of the Insurance Commissioner (OIC) asked this question and they have a pretty good analysis that describes the number of people, county-by-county, who will benefit from the Affordable Care Act.

The OIC report shows that people in every corner of the state will benefit. Take a look at the report to see how many of your neighbors will have access to health insurance in 2014.

Legislative Update - Dodged the bullet this time...and had some wins!

As you know, the Legislature finished up a few weeks ago, and the results were a bit surprising given the place we started in December.  Amazingly, after some creative accounting, almost all of our priority programs were saved! This is partly due to the improved economy, decreased caseloads, and accounting maneuvers (whatever that means).  

We also saw great success with the passage of the Health Exchange bill (HB 2319)!  This is one more step in the implementation of the Affordable Care Act.  A very exciting development is the inclusion of a trigger that will allow the Insurance Commissioner’s office to address the specialty tier issue if it causes adverse selection in the exchanges. Listing critical drugs in the “specialty” tier frequently puts these necessary medications out of reach of many people living with MS. If you have a story about your experience with “specialty” tiers, please contact the chapter to share your story so that we can show our representatives that their constituents are suffering due to this unfair practice.

http://www.nationalmssociety.org/chapters/was/advocacy/tell-us-your-story/index.aspx

The Greater NW Chapter has been included in a task force contributing to establishing the minimum standards for the state Health Exchange network. This is a significant place at the table for the MS Community, as we are communicating the needs of the chronic disease community and establishing a consumer centric Health Exchange that will serve the needs of the consumers who truly need this service.

Over the last several months, we have joined forces with coalitions, such as Healthy Washington and the Long Term Care group/Aging Caucus, to help get our message across to our legislature. The passage of the Health Exchange bill proves we are definitely more effective when we join forces with other groups.  

We are thankful that our programs were “saved”, but after all of the cuts over the last several sessions, there isn’t much left to save. Now we need to focus on improving our safety net programs so that the needs of our community are served. Keep up the pressure on your state Legislators (http://apps.leg.wa.gov/DistrictFinder/Default.aspx ) to protect and improve Basic Health, Disability Lifeline, and Medicaid so that that people living with MS will have access to the services so desperately needed.

 It’s Time for Action! Washington

Cheers! – Holly Hawker

Chair, Activism Committee
Greater NW Chapter, National MS Society

The high cost of MS on the national stage

Check out this recent article on the Huffington Post about Mitt Romney's wife, who lives with MS. It's true that health insurance coverage varies widely in this country and it's incredibly difficult to get health insurance once someone is diagnosed with a disease like MS. For those who can afford it, health care is available. For everybody else, good luck! Luckily, the Affordable Care Act will change that, if it's upheld by the Supreme Court.

Celebrate The Affordable Care Act!

As we enjoy the anniversary of the Affordable Care Act and everything it is doing for all Americans, we need to keep in mind that the Law is being challenged from all directions, and most importantly – in the Supreme Court!  As this hallowed body deliberates the legality of various components of the bill, the rest of us stand to lose so much.

It is my naïve, hopeful, and somewhat educated belief that the Affordable Care Act will be upheld by the Supreme Court. However, that will not protect the Law from members of Congress and State government (including Washington’s own Attorney General and candidate for Governor) who want to see the accomplishments of the Affordable Care Act repealed.

 Among all of the wonderful aspects of this law, the special significance to the MS community is the protection of people with pre-existing conditions, which will fully take effect in 2014. This tenant of the Affordable Care Act alone makes this legislation the most significant legislation for people with chronic disease that we have ever experienced.

So next time someone criticizes “Obamacare”, remind yourself and them, what this law means to the MS Community. We DO Care!

 Remember – It’s Time for Action! Washington

Cheers – Holly

What a day in Olympia!

For those of you who missed it, the Day of Activism on January 30th was incredibly informative and motivating! Between the excellent guest speakers, the education we received on the legislative agenda, and the surprising dry weather, the group of about sixty activists were ready to tackle the issues with our legislatures.

As you have seen in previous posts from last week, SB6241/HB2435, the bills aimed at Capping Out of Pocket Expenses are gaining traction! The testimony at the public hearing was attended by a coalition of consumers (including representatives of the Greater Northwest Chapter of the National MS Society) sharing their stories and the impact that the costs of chronic illnesses have on their lives. Please share your story with your representatives and let them know that you support these bills.

The National MS Society has also thrown its support (along with Healthy Washington Coalition) behind consumer driven development of the Health Insurance Exchange required by the Affordable Care Act in 2014. It is crucial that the exchanges are developed to serve the consumer and patients’ interests and not hi-jacked by the insurance companies.

As we have for the past few years, we were again begging our legislatures to STOP the CUTS to the state’s safety net programs. With Basic Health, Disability Lifeline, and aspects of Medicaid on the line, NOW is the time to take a stand. Did you know the state is considering ending the prescription benefits for Medicaid? That alone will devastate the MS Community.

Right now is when your legislators need to hear from you! Call 800-562-6000, visit, or email http://www.leg.wa.gov/pages/home.aspx (click here to find your legislators) and let them know that they MUST protect the state safety net programs!

Stay tuned for updates on the current legislative session and what to follow for the upcoming election in November. It’s Time for Action! Washington.

Cheers - Holly

The Affordable Care Act – Do you know what it is doing for you already?

Not much has been said about the Affordable Care Act since its passage which baffles and saddens me. In my opinion, every member of Congress and the President should mention all of these benefits in every speech. There is much to be proud of in this piece of legislation. The Affordable Care Act is not perfect, but it’s a place to start in protecting Americans who do not have access to health insurance and those who are underinsured. So much has been implemented already and there is much more to come in 2014!

As of Sept 2010, these benefits have been implemented.

- Pre-Existing Insurance Plans (PCIP) offering coverage for previously uninsurable
- Lifetime caps eliminated
- A policyholder cannot be dropped from coverage because he/she becomes ill
- Annual out-of-pocket limits
- No co-pays for preventative services (vaccinations, mammogram, annual exams, etc…)
- No denials based on pre-existing conditions for children
- Adult children can maintain coverage on the parent’s plan until age 26
- 35% tax credit for small business to encourage employers to provide health insurance
- $250 rebate for Medicare recipients in the ‘donut hole’

What will the Affordable Care Act do for you in 2014?

- Eliminate discrimination due to pre-existing conditions
- Competitive health Insurance exchanges making health insurance available to all Americans
- Premium subsidies making health insurance affordable to individuals and families
- Expanded tax credits for small business to encourage employers to provide health insurance
- Medicare ‘donut hole’ eliminated

It’s now up to states to implement the center piece of the Affordable Care Act – health insurances exchanges - and the National MS Society is watching the creation of these exchanges closely to make sure they work for people with MS. The exchanges may be challenged by some legislators and candidates running for election in November. It is up to us to keep the pressure on our state and federal representatives so they know that this bill HELPS PEOPLE WITH MS. And we VOTE!

Have any of you directly benefited from the Affordable Care Act already? I know I have!

Please join us at the Day of Activism on January 30th in Olympia. Register at http://wasmain.nationalmssociety.org/site/Calendar?id=270894&view=Detail

Remember – It’s Time for Action! Washington