'Tis the season...

‘Tis the season ….
    To light candles and sing carols, to give gifts and greet strangers.

Protestants for the Common Good (PCG) wishes you joy and fulfillment in this holy time of year as we anticipate the coming of Christ and the indwelling of hope in all our lives. 

Please support PCG with a year-end gift to grow our education and advocacy work.

Your gift matters.  Imagine what it means to work in a low-wage job without an increase in three years.  Think about a loved one who needs relief for chronic, debilitating pain.  Consider what it’s like to worry that your drinking water might be contaminated due to nearby natural gas extraction.  Think about the barriers that persons with felony records encounter as they look for a decent job or adequate housing.  

‘Tis also the season ….
    To face tragedy and mourn losses, to show mercy and confront injustice.

Your support and involvement has made it possible for us to impact the lives of thousands of Illinoisans in 2012.  Thanks to you, our Advocacy Network trained lay and clergy members in grassroots lobbying and worked faithfully in coalitions for positive legislative solutions to significant state-wide problems. 

Together we achieved important results:  expanding charity care for uninsured persons, protecting victims of sex trafficking, and closing two Chicago coal-powered plants. 

But, we still have more work to do. 

With your gift, we will faithfully advocate for raising the minimum wage, passing medical marijuana, creating regulations for hydraulic fracturing, i.e., “fracking,” and sealing felony records of persons who no longer have involvement with the criminal justice system.

‘Tis the season ….
    To renew spirits and lift hearts, to advance justice and proclaim hope.

Make a difference.  Help support our advocacy for the common good in 2013.  We are ever grateful for your generosity and support.

Thank you for your many gifts to PCG – invitations to your church, advocacy for good policy, participation in our events, and financial contributions to support our work.  We also value your prayers.  If you have already made a year-end gift to PCG, thank you.  If you have not, please give now.

May you have a season of blessing and joy this Christmas.

Good News: Medicaid Eligibility Expands in Cook County

Healthcare Policy Expert, Robin Scott, is a contributing blogger for Protestants for the Common Good.

Starting in 2013, tens of thousands of currently uninsured and low-income single adult patients may be able to get Medicaid in Cook County.  This expansion is a result of a federal waiver granted to Illinois to expand Medicaid in Cook County through the Affordable Care Act one year early. The waiver approval allows Cook County Health and Hospital System to enroll more than 115,000 eligible individuals into a Cook County Medicaid network in 2013 rather than wait until 2014.

The new Medicaid program is called CountyCare.  Only doctors that are part of the CountyCare network may accept CountyCare patients.  The network will include Cook County Health and Hospital sites and some community health providers, such as community health centers. Each patient will have a medical home which would coordinate the person’s care.  Routine and preventive care, hospital inpatient and ambulatory services, emergency services, laboratory services, prescription drugs, medical supplies and equipment, and mental health services are some of services covered by CountyCare.

To qualify for CountyCare, individuals must:

• Live in Cook County
• Be 19-64 years of age
• Have income at or below 133% FPL ($14,856 individual, $20,123 couple annually)
• Not be already eligible for Medicaid (parent, pregnant, blind, aged, or disabled)
• Not be eligible for Medicare
• Be a U.S. citizen or a legal immigrant for five years or more
• Have a Social Security number or have applied for one

Beginning the week of December 1, 2012, individuals can call 312-864-8200 or 855-671-8883 (toll-free) to apply by phone.  In the future, individuals will be able to apply in person with application-assistance staff located throughout the county health system.

http://www.cookcountyhhs.org/announcements/john-h-stroger-jr/countycare-begins-health-system/

The Prevention and Public Health Fund

Healthcare Policy Expert, Robin Scott, is a contributing blogger for Protestants for the Common Good. 

America spends more on health than other nations – almost $2.5 trillion in 2009 – and yet scores less than other wealthy nations on life expectancy, infant mortality and other indicators of population health.  The bulk of U.S. health expenditures (75 percent) are spent treating chronic diseases, many of which are preventable. (Chronic diseases include obesity, diabetes, high-blood pressure, heart disease, and cancer.)  A mere fraction of U.S. health expenditures (3.1 percent) is spent on prevention.  An Institute of Medicine report released in 2012 concluded that the federal government’s public health investment ($11.6 billion in 2009) should be doubled to begin to fund public health efforts at a level that would address current needs.

The Affordable Care Act makes public health and the prevention of chronic disease a United States priority for the first time by establishing mandatory funding for the Prevention and Public Health Fund.  Fifteen billion dollars over 10 years was set aside for the Fund.  The Fund already has provided $1.25 billion for prevention and public health activities: $500 million in FY 2010 and $750 million in FY 2011.  Another $1 billion has been allocated in FY 2012 and is in the process of being distributed.  

The Fund is anticipated to be used for programs at the local, state, and federal level.  Illinois has been awarded more than $31 million in Prevention Fund grants.  Funding is intended for community prevention, clinical prevention, public health workforce and infrastructure, and research and tracking.  Community prevention includes tobacco prevention and obesity prevention and fitness.  Public health workforce and infrastructure includes supporting training of public health providers.

The Prevention and Public Health Fund is intended to supplement not supplant existing federal commitments for public health and prevention.  However, the Affordable Care Act allows Congress to use money from the fund to spend on existing prevention or health promotion programs that met the goals of improving health and restraining growth in costs.  Also, Congress can still pass laws to reduce the amount of money allocated to the Fund.  Congress can even amend the Affordable Care Act to eliminate the Fund.  Funding of the Prevention and Public Health Fund has already been cut by $6.25 billion over nine years to help postpone a cut in Medicare physician payments.  

The Fund remains at risk. Earlier this year, Congress passed the Sequestration Act which would make across-the-board cuts in defense and nondefense discretionary programs in January 2013 if a deficit reduction plan was not passed and signed into law.  So far, a deficit reduction plan has not been enacted.  According to an OMB report released mid –September critical programs that protect the public’s health face an 8.2 percent cut.  (The Prevention and Public Health Fund would be subject to cuts of 7.6 percent.)

Some useful websites for more information:

http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=1326

http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=63

http://www.apha.org/NR/rdonlyres/D1708E46-07E9-43E7-AB99-94A29437E4AF/0/PrevPubHealth2012_web.pdf

http://www.healthcare.gov/news/factsheets/2011/02/prevention/il.html

 

Closing the Dreaded Donut Hole

Healthcare Policy Expert, Robin Scott, is a contributing blogger for Protestants for the Common Good. 

You have probably heard about the dreaded donut hole.  That refers to a problem that affects people receiving Medicare health coverage, even those who have also enrolled in Medicare Part D Prescription Drug Plans.  As everyone knows, prescription medicines are expensive, especially if you have a chronic illness.  I have heard stories of people skipping doses, sharing medicine with spouses, and skipping medicine altogether because of price.  

For Medicare beneficiaries, you have the option of purchasing a Medicare Part D Prescription Drug Plan.  Initially, you may have to pay a deductible of a little more than $300 and an average of 25% of the cost of your medication until you reach the $2,930 drug coverage limit. (The dollar amount to reach the $2,930 coverage limit includes what you pay and what the plan pays.) Then you hit a coverage gap or donut hole where the costs of your co-payments increase until you reach catastrophic coverage.  Then you pay 5% or $2.60 for generics and $6.50 for brand-names whichever is greater. 

 

Before health reform (or the Affordable Care Act), you would have had to pay 100% of out-of-pocket costs before getting out of the donut hole. (The donut hole for 2012 was $2,930 to $6,658.) See illustrations for 2012 and 2013 respectively at: http://familiesusa2.org/assets/pdfs/medicare-part-d/Prescription-Drug-Benefit-Illustration-2012.pdf  and  http://familiesusa2.org/assets/pdfs/medicare-part-d/Prescription-Drug-Benefit-Illustration-2013.pdf.  Not surprisingly, it was difficult for people to pay the costs of medicine during the donut hole so many of them never even reached catastrophic drug coverage.  Some beneficiaries stopped filling their prescriptions and others never reached the dollar amount in drugs to get out of the donut hole.

But thanks to health reform, in 2012, beneficiaries receive an automatic 50% discount on brand-name drugs and 14% discount on generics while in the donut hole. The brand name and generic drug discounts gradually increase every year until 2020 when the donut hole is phased out.  Then you will once again pay an average of 25% of the cost of your medication until you reach catastrophic coverage.

In the first four months of 2012 alone, more than 416,000 people have saved $301.5 million – an average of $724 a person so far this year.   The Affordable Care Act was helping them even before that.  After the Affordable Care Act passed in 2010, those who hit the donut hole received a $250 rebate – with almost 4 million seniors and people with disabilities receiving a collective $1 billion.  In 2011, Medicare beneficiaries received more than $2.1 billion in savings – averaging $604 per person last year – from the 50% discount on brand-name drugs in the donut hole.  http://www.healthcare.gov/blog/2012/05/medicare052412.html (There was also a 7% subsidy for generic drugs purchased in the donut hole in 2011.)

For Medicare beneficiaries, it is the Annual Open Enrollment period for 2013.  It started October 15 and ends on December 7.  If you already have a Part D plan, you should check to make sure that your current plans continues to work for you in 2013 (for example, make sure that all drugs that you take are on the formulary and check premiums and co-payments and co-insurance).  General information about Medicare Part D Prescription Drug Coverage can be found at: http://www.medicare.gov/part-d/index.html

·         (This blog does not refer to people who get “extra help” or the low-income subsidy.)

Wilcox Symposium on Criminal Justice: Photos