Good News for Young Adults

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

Just because you become an adult does not mean that you have to be uninsured.  In the past, young adults between 18 and 26 years of age might not have had the option of staying insured.  Dropped from their parent’s insurance at 19 (sometimes older if they go to college), being employed in jobs without health insurance or being unemployed are some of the reasons they did not stay insured.  In addition, individual insurance is expensive if available to those with pre-existing conditions.  

The ACA has required since September 2010 that health insurers provide the option for young adults to stay on their parent’s plan until they are 26.  The adult child does not have to be in college, can be married, can live away from their parents, and does not have to be listed as a dependent on a parent’s income tax returns.  If the plan is not grandfathered, the adult child can join or remain on your patient’s plan even if you are eligible to enroll in your employer’s plan.  (Until 2014, grandfathered group plans do not have to offer dependent coverage up to age 26 if a young adult is eligible for group coverage outside their parent’s plan.  Health plans that existed before the health care law are considered “grandfathered” into the new system.) 

According to the most recent survey estimate, as of December 2011, over 3 million additional young adults have already taken advantage of this provision of the ACA and gained health insurance.  (This includes 125,000 young adults in Illinois.) 

Prior to the ACA young adults were much more likely to be uninsured and privately-insured young adults were about twice as likely as older adults to lose private insurance.  According to U.S. census data, in 2009, nearly 15 million young adults ages 19 to 29 were uninsured.  This represented about 1/3 of the young people in this age group.  An overall 45% of young adults reported delaying needed care because of costs and 58% of uninsured young adults had difficulty paying medical bills according to a 2010 Commonwealth Fund study.

Prior to the enactment of the ACA, 37 states already had laws requiring the continuation of dependent coverage for young adults, but the upper age limits and definition of dependent varied.  Since June 2009, Illinois had a law giving parents with insurance policies that cover dependents the right to elect coverage for qualifying dependents up to age 26 and up to age 30 for military veteran dependents.

The below links provide further information:

http://www.healthcare.gov/news/factsheets/2012/06/young-adults06192012a.html

http://aspe.hhs.gov/health/reports/2012/UninsuredYoungAdults/rb.pdf

A survey by the National Center for Health Statistics updates the previous estimate of 2.5 million young adults to 3.1 million young adults.

http://lahealthaction.org/library/rb.pdf

http://insurance.illinois.gov/HealthInsurance/ya_dependent.asp

http://nahic.ucsf.edu/wp-content/uploads/2012/03/CAHL-UCSF-ACA-Young-Adult-Issue-Brief-_Final_Mar22_2012.pdf

Are You Healthy?

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

When is the last time you were screened for blood pressure and cholesterol?  Or have you ever been screened for them?  If you’re a woman, have you had a mammogram on a regular basis?  If you are pregnant, have you been screened for gestational diabetes?

Now you have an opportunity to receive important preventive covered services, including screenings , for all types of illnesses without extra cost.   Your Medicare or private insurance plan is required to cover these services without copayment.  That has already happened, and it’s thanks to the Affordable Care Act.

There are 16 covered preventive services for adults, including screening for blood pressure, cholesterol, colorectal cancer, obesity and depression.  There are screening services particular to women like mammograms as well as screening services for high-risk and pregnant women.  Screening services for pregnant women include gestational diabetes and anemia.  Currently, gestational diabetes range from 2% to 10% of pregnancies in the United States.  Screenings for women at high risk, include screening for gonorrhea, syphilis, and osteoporosis.

As of August 1, 2012, even more provisions for preventive covered services for women went into effect. (These are for new plans starting on or after August 1. Health plans that existed before the health care law are considered “grandfathered” into the new system.  Grandfathered plans don’t have to follow the new preventive services coverage rules.  This means the plan can continue to operate just as it has until it makes significant changes to the plan.  However, a survey found that 90% of all large companies expect that their health plans will lose their grandfathered status by 2014.)

About 47 million women, including an estimated 2 million in Illinois, have guaranteed access to additional preventive services without paying more at the doctor’s office.  These include breastfeeding support and counseling, screening for domestic and interpersonal violence, well women visits. These services have been identified by the Institute of Medicine and endorsed by the Health Resources and Services Administration.

FDA approved contraceptive methods and patient education and counseling are included in the prevention services.  There has been much controversy about how these provisions affect religious institutions.  According to the law, a segment of religious employers such as churches and other houses of worship are exempt from this contraceptive coverage requirement.

The Check's in the Mail

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

This past month, you may have received an unexpected check in the mail.  This check – a rebate from your health insurance company – is a direct result of the health reform law, the Affordable Care Act. 

Before health reform, over 20% of consumers who purchased coverage in the individual market were in plans that spent more than 30 cents of every premium dollar on administrative costs. Health insurers could spend as much money of your premium as they wanted on what they wanted. Now they must be accountable.  

Depending on the size of the insurance plan, insurers must spend at least eighty or eighty-five percent of your premium on health care and activities that improve your health, not on administrative expenses or profits. This is known as the medical loss ratio rule (MLR) rule. If your insurer doesn’t meet those standards, it must send you--or your employer if you have employer-based insurance--a rebate check. 

Even if the check goes to the employer, it will ultimately benefit you, for example through a lump-sum reimbursement or reduction in future premiums.  It can be complicated, but the good thing is most of the money you pay for health insurance will be used for health care or improving the quality of health care, rather than administrative costs and profits. 

Between January 1 and August 1, nearly 12.8 million Americans were provided with more than $1.1 billion in rebates this year due to this MLR rule.  The largest rebates have been given to consumers in Texas ($167 million) and Florida ($124 million). The average rebate per family in the U.S. is $151. The average rebate per family in Illinois is about $380. Nearly 230,000 Illinoisans will receive $62 million in rebates; about $380 per family.

However the rebate is done, health reform forces insurers to devote the lion’s share of their premiums to patient care. That’s a basic change to the business model of private insurance. And it’s happening now, because of health reform.

Imminent Immorality: States Opting out of Medicaid Are Opting Out of Caring

by Nancy H. Brandt, a Board Member of Protestants for the Common Good.

There is no other way to say it.  If some 30 states opt out of the Medicaid expansion that was enacted as part of health care reform, as they currently threaten to do, that will be 30 immoral acts. Some governors have given as their reason that they can’t afford it, but the facts around the funding show they almost can’t afford not to participate. And so, one must ask why they would turn down a deal that the Congressional Budget Office estimates will be 93% paid for over the first nine years, a deal that hospitals everywhere favor as it will cover presently uncompensated costs.

The obvious and first conclusion is that ideology trumps everything else. They hate the new healthcare law and its mandate so much that it takes precedence over any other concern. But a deeper and more troubling conclusion is that perhaps half of us in America no longer care a jot about the poor, or the lingering and damaging effects of growing up poor and without healthcare. Is caring simply no longer important?

The Congressional Budget Office predicts that when it actually comes to acting, states opting out of the expansion will result in three million fewer people insured than planned.  This coverage gap will be composed of families below the poverty line, not reachable by the insurance exchanges that will be set up to cover people from 100% to 400% of the poverty line. This would be a bizarre outcome, indeed.

What are the likely outcomes for the uninsured poor?  Clearly it will make it more difficult to address racial disparities in healthcare: 22% of African-Americans, 32% of Hispanics are uninsured, compared with 14% of whites. Opponents of the law seize upon the administration’s behind-the-scenes efforts to explain the advantages of the law to black and Hispanic audiences as a negative, as proof that the health care law is race-based after all and not about the middle class. When did it become not only unimportant but wrong to address racial disparities?

There are real consequences to being poor and uninsured. Researchers from the Harvard School of Public Health conclude that states with more generous Medicaid coverage have lower mortality rates by at least 6%. Do we care how long poor people live? 

Research also points to healthcare improving school outcomes. A study by Teachers College at Columbia University found students with chronic illnesses at greater risk of absenteeism and poor school performance. No surprises there. A recent evaluation of the State Children’s Health Insurance Program found that school absenteeism rates dropped as children’s health insurance rates rose under the program. This is not rocket science.  But will policy makers make the connection?

A long-term answer, as suggested by both Timothy Noah of The New Republic and more conservative economist Robert Samuelson, is to federalize the entire Medicaid program, just like Medicare, if it is no longer feasible to maintain a federal-state partnership. 

But even that solution requires that a majority of the Congress and perhaps a majority of the electorate believe that our nation should care about all its citizens, and especially about the poor.  It comes down to what kind of a country we want to live in.

Adding in Advocacy

Maggie Potthoff is a dual degree master's student in Divinity and Public Policy at the University of Chicago and a PCG summer intern. 

Many of us who are part of faith communities have spent time after worship with our fellow congregants putting our faith into action --- heading to a soup kitchen to serve people living in the streets, packing lunches for struggling families in the neighborhood, or organizing a job-training fair for those out of work.

We are called to this work – this service – through Scripture. “Go and do likewise,” Jesus tells the inquiring lawyer after recounting the story of the Good Samaritan – show mercy and “love your neighbor” (Luke 10:25 – 37). For Jesus and his followers, loving means taking action, particularly on behalf of the “least of these.”

Yet "taking action" includes more than just service. Our faith must be put into words. Indeed, we are called to call ---- to advocate (ad+ vocate). Advocacy is the work of calling for assistance – of speaking out or promoting a particular issue: in the faith context, the advancement of justice.  Jesus said, “God has sent me to proclaim release to the captives and recovery of sight to the blind, to let the oppressed go free, to proclaim the year of the Lord’s favor” (Luke 4:18-19).

So advocacy in the Christian tradition assumes that God through Jesus Christ has something to say about the way society should be structured and, thus, the way government should relate to individuals and communities. In seeking to join God’s work in this world, then, we can live our faith too by not only doing charity, but by calling for justice. In our country, we can do this by advocating for public policy which embraces the healing of society and God’s creation. In our country, we must do this now. Too many lives are at stake in budgetary decisions and other legislative concerns every day, and the common good hangs in the balance.

We are hosting an Advocacy Workshop in a little less than two weeks which will explore this work more deeply. We’ll rely on Scripture some, but also on your fellowship --- learning from each other about our faith and its relationship to justice.

If this is the first time you’ve thought about it terms of “advocacy,” or engaging in discussions about Springfield and the legislative process sounds daunting – not to fear! We’ll hear from long-time advocates about best practices and discover how critical one person’s voice is toward building the common good. Also on the agenda is a discussion of PCG’s current policy priorities which will include Illinois-specific legislation on environmental, criminal, and economic justice.

So sign up now! At our last session, participants enjoyed sharing their “passion for advocacy with similar-minded folks,” learning about pending legislation, and participating in a group activity that makes clear how advocates can engage the process of a bill becoming a law (we'll get more specific than this video, but it's a start!). We'd love you to join us for another opportunity to learn and share about advocacy together!