This is the space in our newsletter where we talk about health care policy affecting the chronically ill.

 

The legislative sessions in both Connecticut and Washington, DC began this month.  Here are some highlights of things we think (hope?) will be on the horizon:

 

 

President-Elect Obama's stimulus package could include SCHIP reauthorization, and extension of COBRA benefits, possibly with some sort of subsidy. 

 

SCHIP is the State Children's Health Insurance Program.  Funding of SCHIP is shared by the states and the federal government.  It is set to expire in the Fall.  In many states, SCHIP has been extended beyond 150% of the federal poverty level (FPL), and it has covered parents as well as children.  The Bush Administration was adamantly opposed to extending SCHIP to adults who were as much as 300% of FPL and vetoed legislation that would have allowed this sort of expansion.  However, in our view, SCHIP expansion is an important piece of the health care reform puzzle.  For people who are uninsured, this is one way that the state and federal governments could share the cost of providing them with health insurance.  Whole families could be covered, and their income could go higher than 300% of FPL.  We strongly agree that SCHIP must be both reauthorized and expanded to include as many of the uninsured as possible.  Reauthorization comes first, and we support its inclusion in the stimulus bill.

 

The extension of COBRA benefits is better than nothing, but it won't be the fix that the Obama Administration intends unless there are subsidies that make COBRA affordable.  As you probably know, when you leave a job for almost any reason, you are entitled to continue on your group health insurance for 18 months, although you have to pay the premiums.  We get many calls from patients who have been laid off and have the right to COBRA, but can't afford health insurance premiums that cost as much as $900 per month.  If you worked for a large employer and got laid off, your premium may well be reasonable, and an extension of COBRA would be a huge help to you if you are unable to find a new job right away.  However, if you worked for a smaller employer and the premium is much higher, you may not be able to afford COBRA premiums.  We would favor an extension of COBRA that included a sliding scale premium subsidy for people who are unemployed, have no other income, and have no other way to obtain health insurance coverage.  It appears that some sort of subsidy to employers who continue health insurance coverage is under discussion, as well.  We would support that sort of plan.  Some press accounts speculate that there may even be Medicaid eligibility for unemployed individuals who did not have insurance through their jobs, which we would support, as well.

 

These are two good first steps, as is the move towards electronic medical records and an increase of the federal share of Medicaid payments (which are split between the state and federal governments), which the Obama team also is talking about.  But we hope to see more before the end of 2009.  People say we can't fix health care in a bad economy, but if people spend less on health care, they will spend more on other things.  If people are insured, they will not go bankrupt due to medical debt.  So we hope that President Obama will make great strides towards affordable, portable, universal health care in 2009.

 

 

There are likely to be many health care reform proposals introduced in the Connecticut legislature, and in state legislatures nationwide.  The Connecticut HealthFirst Authority already has announced its proposed framework, which would expand publicly funded programs while also opening the state employee pool to others who can't get insurance.  There would not be a mandate requiring everyone to be insured, but everyone who wanted insurance could get it.  The Universal Health Care Foundation has begun to roll out a similar proposal. 

 

Advocacy for Patients supports any program to cover the uninsured, in Connecticut and elsewhere, but we caution you to read the fine print.  Will there be pre-existing condition limitations and waiting periods?  Who will decide whether a treatment you need is covered or not?  Coverage without access is meaningless.  If someone other than your doctor is going to decide what treatment is appropriate, then you may not get your money's worth.  Speak up and speak out about plans that would not adequately serve your needs.  Chances are you are not alone.

 

We also continue to be very concerned about our HUSKY program, which comprises both our Medicaid and SCHIP programs.  In 2008, the state asked for bids from HMOs to run these programs and two of the three successful bidders are entirely new to the state: AmeriChoice (a UnitedHealthcare subsidiary) and Aetna.  These two companies have had great difficulty enrolling a sufficient number of doctors and hospitals to care for all of the needs of the HUSKY enrollees.  We will continue to monitor this situation and to speak out if we find that the provider networks continue to be insufficient to meet the needs of our most vulnerable citizens.

 

 

We are located in Connecticut, and so we follow the Connecticut legislature fairly closely, and often testify before legislative committees.  You can do the same in your state by reading your local newspapers and being in touch with your state legislators.  One excellent way to monitor what is happening in your state is to subscribe to the Kaiser Family Foundation Daily Health Policy Report.  But don't just read: ACT.  Go to hearings and testify.  Tell your story.  Put a real face on the healthcare crisis.  You also can tell your story to the Obama Administration at www.change.gov.

 

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