May 21, 2013

Over the past three years, we have heard references to the Health Insurance Exchange, Health Benefits Exchange, State Health Exchange, Federally Facilitated Exchange and now—drum roll, please—the Health Insurance Marketplace.  All of these terms refer to the same thing—an online portal for individuals currently without health insurance to find an insurance plan that is right for them and their families. I recently participated in a conference call hosted by Health and Human Services that provided more details on this new tool.

Beginning October 1, 2013, uninsured individuals and families will be able to use the Health Insurance Marketplace to shop for health coverage plans that will begin on January 1, 2014. Consumers will be able to fill out an online application (about 3 pages in length) and see a range of health insurance policy options. Paper applications also will be available for those without access to computers or who need additional help completing the application.

Based on an initial preview of the application, it seems streamlined and straightforward, although it has not yet been tested.  In most cases, consumers should need only a Social Security Number and a pay stub or a W-2 to complete the process. You can view the sample Individual Short Form here: 

http://cciio.cms.gov/resources/other/files/AttachmentB_042913.pdf

As is the case with any introduction of a new technology, there are likely to be glitches at the start. Even so, with the online marketplace, consumers will finally have the opportunity to shop for health insurance—something everyone needs but most rarely understand—packaged in an electronic form much like the online tools consumers already use to shop for household appliances, cars, and other products and services. 

The marketplace will present coverage plans that meet federal requirements and are approved by the respective states. The number of health plans offered will vary by state. Consumers will see side-by-side comparisons of the available coverage plans, with their benefits, deductibles, out-of-pocket costs and provider networks. The marketplace will be able to screen consumers to determine if they are eligible for their states’ Medicaid and Children’s Health Insurance Plan. Tax credits that can help pay for premiums (which may translate into tax refunds for some low-income consumers) also will be automatically determined.

It is hard to predict how smoothly the launch of this new system will go. And with the launch of the marketplace just a few months away, there remains a lot of confusion about this tool and how it will work. Therefore, our health and human service organization partners will play a critical role in educating their staffs, volunteers and clients so that eligible individuals and families can sign up for coverage. 

Read full text of President and CEO message

Additional Reading:

The Center for Consumer Information and Insurance Oversight (CCIIO) is charged with helping implement many provisions of the Affordable Care Act. In late April, CCIIO released answers to some of the most Frequently Asked Questions (FAQs) related to exchanges, as well as some of the new market wide reforms, including the modified community rating standard, the status of state high risk pools, and the definition of association health plans. 

Fact Sheet:  Navigators: Guiding People Through the Exchange, Community Catalyst

State Exchange Profiles: Kansas

http://kff.org/health-reform/state-profile/state-exchange-profiles-kansas/

State Exchange Profiles: Missouri

http://kff.org/health-reform/state-profile/state-exchange-profiles-missouri/

Kansas City Star columnist Dave Helling wrote (May 7, 2013) about findings of a New England Journal of Medicine study of a Medicaid expansion experiment in Oregon that are being called out by health reform opponents as proof that Medicaid doesn’t work. The debate that has flared up highlights the difficulties of distilling scientific studies into sound bites – they paint a partial picture based on selected results.  

In 2008, the state of Oregon had enough money to expand Medicaid to about 10,000 additional people. However, more than 90,000 applied. The state held a lottery (only in America!) and created an unprecedented randomized controlled experiment in which researchers could compare the health, use of services, financial status, and other characteristics of those who received Medicaid with a group that remained uninsured.

After two years, those who gained access to Medicaid had much lower incidence of depression and higher use of physician services, prescription drugs and preventive care.  More people were diagnosed with diabetes and received medication to control it.  In addition, those covered by Medicaid had much lower out-of-pocket costs, and were less likely to experience catastrophic health costs. The findings also showed, however, that those with high blood pressure, high cholesterol, and diabetes did not show significant improvement. 

The study results were not as positive as Medicaid expansion proponents would have liked. However, the study didn’t prove that Medicaid is a failed program, as opponents would like for the public to believe.

Medicaid, like other health insurance programs, buys access to services, and while our country’s health care system isn’t always effective at producing good outcomes, insurance coverage is an essential element in obtaining health care. In that respect, the Oregon study showed that Medicaid does work.  And we know from decades of research from organizations like the Institute of Medicine that having no coverage at all is linked to dire health consequences, most notably, premature death.

It is likely that those enrolling for the first time in Oregon’s expanded Medicaid program were probably sicker to begin with, having gone without access to preventative care and treatment for years.  Two years may not be long enough to see significant improvements in cholesterol, blood pressure, and diabetes—chronic conditions that take years to develop and a lifetime to manage.  Just ask anyone battling those diseases, insured or otherwise.

Brenda R. Sharpe, President and CEO

Read other views of the Oregon Medicaid study results:

“What Oregon Really Told Us about Medicaid,” New Republic, May 13, 2013

“Oregon’s Medicaid Experiment:  Coverage is the First Step,” Health Affairs, May 2, 2013

“Study:  Medicaid Reduces Financial Hardship; Doesn’t Quickly Improve Physical Health,” The Washington Post, May 1, 2013

The Kansas Health Institute (KHI) has released a new report on the insurance status of Kansans in 2012. KHI’s Annual Insurance Update draws upon data from the Current Population Survey (CPS) showing that approximately 365,000 Kansans, or 13.1 percent of the population, were uninsured in 2010-2011, slightly less than the 12.7 percent who were uninsured in 2009-2010.

The CPS says that approximately 67,000 Kansas children ages birth to 18 (8.8 percent) were uninsured in 2010-2011, up slightly from the 7.7 percent who were uninsured in 2009-2010.

More than half (51.8 percent) of all Kansans are covered by employer-based health insurance. Nearly a third (29.6 percent) are covered by public health insurance, such as Medicare or Medicaid. The report notes that Kansans who don’t have employment-based health care coverage or public coverage may have other private coverage, but are more likely to be uninsured.

Read the full report.

It’s been three years since passage of the Affordable Care Act (ACA). Yet, many people still do not understand the law. On Friday, April 19, 11:30 a.m.-1:30 p.m., Nonprofit Connect will host “The
Affordable Care Act & Nonprofits” to help nonprofit organizations understand what’s in the law (and what’s not), and how it may affect your organization and employees.

Representatives from three policy organizations (representing both Missouri and Kansas) will present information and answer questions. Topics to be covered will include health care, health insurance, and why health reform is an important policy issue; how the ACA may (or may not) address problems in the health care system; and the impact of the law on consumers, health providers and businesses; and more. 

The workshop is open to members and non-members of Nonprofit Connect. Find information and register at Nonprofit Connect.

This workshop is sponsored by the REACH Healthcare Foundation.

Merriam, Kansas — The REACH Healthcare Foundation Board of Directors elected five members to the Board at its March 28 meeting. Four members were incumbents elected to a second, three-year term; one is a new member to the REACH Foundation Board. The following individuals will begin their terms on June 1:

Harold Johnson, Jr., Senior Pastor and CEO of Faith Deliverance Family Workshop Center, Kansas City, Kansas. Resident of Wyandotte County, KS.

Syrtiller Kabat, Ph.D., licensed professional counselor and marriage and family therapist. Resident of Jackson County, MO.

Randy Lopez, Director of Migrant Education Program and Community Liaison, Shawnee Mission School District. Resident of Wyandotte County, KS.

Brad Stratton, Owner/First Vice President-Wealth Management, CONCERT Wealth Management, Overland Park, KS. Resident of Johnson County, KS.

Judy Works, clinical nurse specialist, The Family Physicians family practice clinic, Iola, KS.  Resident of Allen County, KS.

Dr. Kabat was elected to a first term. All other members were elected to second terms. The deadline to apply to be considered for 2014 is December 18, 2013.

Read the press release.

In our work, we come across a number of news items and reports related to the REACH Foundation’s funding priorities and strategic goals. “What we’re reading at REACH” is a collection of links to noteworthy articles that have caught our attention.

The Patient Protection and Affordable Care Act Turns Three 

Three years ago, on March 23, 2010, the Affordable Care Act (ACA) was signed into law. The target date for full implementation of the provisions of the law is January 1, 2014, but many provisions have already been put into place or are in process, increasing access to health care and advancing better care delivery models for people. Although the ACA remains controversial and continues to be debated at the national and state level, implementation has moved forward.

Following are briefs and articles that explain the status of key provisions and highlight benefits to our region:

National

The Affordable Care Act Three Years Post-Enactment, Focus on Health Reform, produced by The Henry J. Kaiser Family Foundation, March 2013.

Obamacare’s Five Biggest Challenges, by Sarah Kliff, The Washington Post, March 23, 2013.

Kansas

Kansas on track for October 1, 2013, Medicaid/insurance exchange connection, KHI News, March 18, 2013.

Affordable Care Act Will Increase Coverage, Demand for Mental Health Services, Kansas Health Institute Brief, March 21, 2013.

Kansas Providers Paid $46.6 Million in First Year of Federal HIT Incentives, KHI News, March 22, 2013.

Missouri

The Missouri Medicaid Expansion: Good for All Missourians, Timothy McBride, Ph.D., Washington University; Sidney Watson, J.D., Saint Louis University School of law; Amy Blouin, Missouri Budget Project, January 2013.

From REACH

Read a “Message from President and CEO Brenda Sharpe,” who published an essay in August 2012 on the Affordable Care Act and the option to expand Medicaid.

The awards are part of a Cultural Competency Initiative introduced in 2009 that aims to reduce health disparities and improve health outcomes by preparing the primary health care, mental health care and human services workforce to meet the health needs of racially, ethnically and culturally diverse populations. To date, 28 organizations have participated in the technical assistance opportunity.

Read the press release.

Health care issues remain at the forefront of discussions in Kansas and Missouri this year.  With the majority of provisions of the Affordable Care Act upheld, and legislatures halfway through their sessions in Kansas and Missouri, it’s a good time to talk about the remaining health policy opportunities before us.

Participation in one of the most significant optional provisions, expansion of state Medicaid programs, is the topic of the moment, and rightly so. I have written before about the REACH Foundation’s support for Medicaid expansion in both states. Our Board of Directors sees this as one of the most important opportunities in our lifetimes to cover hundreds of thousands of low income and uninsured people in the two states we serve. Medicaid eligibility levels in Kansas and Missouri are remarkably low relative to the rest of the nation. It is nearly impossible for very low income, uninsured, childless adults in either state to qualify for Medicaid.

While a number of governors have stated their intentions to expand state Medicaid programs, others haven’t publicly shared their plans. In Missouri, Gov. Jay Nixon has announced his support for expansion of Medicaid, calling it an economic decision. Kansas Gov. Sam Brownback hasn’t communicated his position yet, but his administration continues to study the issue.

In both states, there is a lot of discussion among lawmakers, consumer advocates, business organizations, hospital and medical associations and others. While lawmakers in both states are generally opposed, hospital associations and a number of business chamber groups have voiced their support. We believe the more voices that join this chorus the more our elected officials will begin to understand the very real impact of Medicaid expansion on their own constituents and hometowns. Here’s our view in a nutshell:  Medicaid expansion is a sound investment for our states. Plenty of reports and studies are pointing in this direction.

Read full text of President and CEO message.

2013 REACH Foundation Policy Priorities 

The REACH Foundation will support a new round of clinical and operational assessments and technical assistance for three dental clinics in the Kansas City metropolitan area, expanding an effort started in 2012 to strengthen the clinical capacity and financial viability of the region’s safety net dental operations. 

Cabot Westside Medical and Dental Center, Kansas City CARE Clinic and Hope Dental, a stand-alone dental program in Blue Springs, Mo., will work with a consulting team from Safety Net Solutions, a program of the DentaQuest Institute, to assess all aspects of their dental program operations, from staffing levels and composition, to patient flow, reimbursement, billing and service delivery. Through the assessment process, clinics gain greater understanding of their patient demographics, staff productivity, fee schedules, payor mix, transaction costs and other factors that impact the cost, delivery and sustainability of dental services. The consultants work with clinic managers and providers to develop a work plan, and then provide ongoing support for implementation efforts. 

Safety Net Solutions has worked with more than 200 safety net dental programs in 24 states, including in Kansas and Missouri. In 2012, the REACH Foundation supported technical assistance for the Health Partnership Clinic of Johnson County and Samuel U. Rodgers Health Center, both federally qualified health centers, and Cass County Dental Clinic, a stand-alone dental clinic in Belton, Mo.

The Unified Government-Hollywood Casino Grant Fund announces it will hold a final grant information session on Wednesday, March 6, at 1:00 p.m. at Donnelly College, 608 North 18^th Street, Kansas City, KS. This session was originally scheduled for February 22, 2013. The information session is not mandatory and no RSVP is required. 

The purpose of the recently established grant fund is as follows: 

In keeping with the intent of Healthy Communities Wyandotte, the focus will be to fund programs that increase knowledge and long-term changes that enable our Wyandotte County community members to eat healthy food and be physically active. Applications should demonstrate cultural relevance, address opportunities to increase knowledge and improve the food environment and/or support active living through utilization of Wyandotte County’s environmental infrastructure.

The grant process will be administered through the Greater Kansas City Community Foundation. The deadline to apply is Friday, March 22, 2013.

For more information, contact Mayra Aguirre, maguirre@gkccf.org, 816-627-3426. 

Access grant information and the application:

http://www.gkccf.org/grant/unified-government-hollywood-casino-grant-fund