Save the Date
The Second Annual Team McCready Global Fundraiser to benefit Advocacy for Patients with Chronic Illness will be held on March 26, 2011. Venues are being chosen now, all over the globe. Please save the date.
And if you want to participate by organizing a party in your home town, just let us know and we'll set you up!
|
| Know Your Rights Handbook |  |
Want to be your own advocate? Learn how by ordering the Know Your Rights Handbook today.
Learn about health and disability insurance, Social Security disability, employment discrimination, family and medical leave, school-based accommodations, resource location, and much more.
Click here for more information.
|
Look What I Just Found!
The National Organization for Rare Disorders (NORD) has teamed up with the Pew Research Center in an important program to raise awareness of rare diseases and the toll they take on patients and their families. The project involves a short, informal survey. The survey results will be released in conjunction with Rare Disease Day in February.
To take the survey, go here and follow the directions. When they ask for your username, use '9000', which lets them know that you heard about the survey from Advocacy for Patients.
If you, a friend or family member have a rare disease, you know how critical it is to raise awareness. So please take a few minutes to participate in this brief survey. Thanks.
And by the way, Families USA gave me a great holiday gift, naming me a modern health care hero. Pretty exciting!
Jennifer
|
Get Your Guts In Gear
Advocacy for Patients is a beneficiary of Get Your Guts in Gear's 2010 Rides. To learn more about the 2010 Rides in New York, Seattle, and the Midwest, and how you can participate as a rider or volunteer crew member, see their website for details or call 866-9IGOTGUTS (866-944-6848). |
Advocacy for Patients on the Move!
October 23, 2011: CCFA Long Island
Can we do a webinar for your organization? Contact Jennifer and we'll be happy to accommodate your request.!
|
It's Too Hard to Be Sick in America
Our book, It's Too Hard to be Sick in America, is available FREE for your reading pleasure on our website. In it, we tell the stories of some of the patients with whom we've worked in order to show policymakers what chronic illness really looks like. Go have a read -- and the next time you talk to someone who clearly doesn't "get it," give them a copy of It's Too Hard to be Sick in America.
|
Advocacy for Patients
with Chronic Illness We provide FREE information, advice and advocacy services to patients with chronic illnesses in areas including health and disability insurance, Social Security disability, employment discrimination, Family & Medical Leave Act, school-based discrimination, and resource location.
Need help?
Call (860) 674-1370
or email us.
Advocacy for Patients Needs Your Help!
To keep providing these services for FREE, we need your help.
WE DO NOT SOLICIT DONATIONS OUTSIDE OF THE FOLLOWING STATES:
CT, MA, WA, MN, CA, IL, NY, TX, VT, MT, ID, WY, NV, SD, NE, IA, IN.
Advocacy for Patients is committed to using its funds to support the work we do on behalf of patients. Accordingly, due to the cost of registering to solicit donations in other states, we do not solicit donations outside of the states listed above. Nevertheless, generous donors from many states make unsolicited donations for which we are very grateful.
THANK YOU!
|
|
|
|
Health Reform in the New Year
A lot's going on with health reform. First and foremost, back in September when we explained the provisions that kicked at the six-month anniversary of reform, we said that these provisions would take effect on September 23, 2010 or at the beginning of the next plan year after that date. Well, for many of you, the next plan year starts on January 1, 2011. You should start to see changes to your plans now. (NOTE: Remember that some of the changes do not apply to grandfathered plans, i.e., plans that were in effect on March 23, 2010 and have not changed substantially since then in terms of increased copays, deductible, coinsurance, the employer's contribution, or complete elimination of all treatment for a particular disease). These changes include, but are not limited to, the following:
- Young adults can stay on their parents' health plans to age 26. This DOES apply to grandfathered plans, but if the young adult become eligible for group insurance through a job, he or she becomes ineligible to stay on his or her parents' plan.
- There are no more pre-existing condition exclusions for children under 19 years of age. This DOES apply to grandfathered group plans, but it does NOT apply to grandfathered individual plans.
- Preventive services are covered for free. There are no copays or coinsurance for preventive services. This only works if your doctor bills the preventive care under a separate code or if you go to the doctor visit only for preventive care. This does NOT apply to grandfathered plans.
- Annual limits are only allowed if they are reasonable. Reasonable annual limits are: $750,000 for the plan year beginning on or after September 23, 2010 but before September 23, 2011; $1.25 million for the plan year beginning on or after September 23, 2011 but before September 23, 2012; and $2 million for the plan year beginning on or after September 23, 2012 but before January 1, 2014, at which point annual limits will not be allowed at all. This DOES apply to grandfathered group plans but does NOT apply to grandfathered individual plans.
- Lifetime limits are not allowed -- period. This DOES apply to all grandfathered plans.
- Health plans are not allowed to rescind (essentially, cancel) your insurance retroactively because you got sick, unless you committed fraud on your application. This DOES apply to all grandfathered plans.
- Women have direct access to ob/gyns without a referral; pediatricians can be classified as primary care providers; enrollees have a choice of primary care provider. This does NOT apply to grandfathered plans.
- No prior authorization requirement for emergency care, and no higher cost-sharing for out-of-network emergency care. This does NOT apply to grandfathered plans. It's also somewhat illusory; you can be balance billed by an out-of-network emergency room/doctor, so if your insurance pays less than the billed amount, you may be responsible for the rest of the bill.
- There are new rules governing insurance appeals. Primarily, if you are in a self-funded (large employer) plan, you will now have an external review of your plan's decisions by an independent review organization that can overturn your insurer. These do NOT apply to grandfathered plans.
If these changes did not kick in for you in September, it's highly likely that they will begin to apply this month.
There's more to come in 2011, as well. The Medicare doughnut hole will be cut in half for many seniors, and insurers will have to spend 80 or 85 percent of your premium dollars on health-related costs rather than administration and profits -- or they'll owe you a rebate! And states will begin to establish the Exchanges that will allow us to purchase insurance in a centralized marketplace in 2014. I suspect we'll see some real changes in healthcare this year.
Meanwhile, as you've also read or heard, a judge in Virginia struck down part of the health reform law. This decision differs from those issued by a different judge in Virginia and by a judge in Michigan. The controversy -- to put it simply -- is over whether the Constitution allows the federal government to require individuals to purchase insurance. The judges who believe the government does have this power reasoned that health care involves economic activity; when a person decides not to buy insurance, but ends up in an emergency room, that has an economic effect on commerce in that the taxpayers are expected to pay that bill. The judge who believes the government does not have this power looked just at the decision not to purchase health insurance, and reasoned that this inaction -- not buying insurance -- has no effect on commerce. The judge who invalidated the individual mandate took a very narrow view of the activity regulated by the law -- just the non-purchase of health insurance -- whereas the other judges took a broad view, looking at health care as a whole. That shift in perspective led these judges to reach different results.
The two Virginia cases will now go to the United States Court of Appeals for the Fourth Circuit, whereas the Michigan case is in the United States Court of Appeals for the Sixth Circuit. There also is a case pending in Florida, where the judge is expected to find against the law based on comments the judge made in oral argument. That case, no matter how it turns out, will go to the United States Court of Appeals for the Eleventh Circuit. It is anticipated that all of these cases will end up at the United States Supreme Court.
It is important to note that the judge who struck down part of the law said that he was striking down only that part of the law, and that the rest of the law can continue to be implemented. While this may be true in the short term, it is highly likely that, if the Supreme Court finds that it is unconstitutional to require people to buy insurance, the entire legal scheme will have to be reconsidered. If a disproportionate number of people with pre-existing conditions buy insurance and healthy people don't, the pool of people in insurance plans will be very expensive to insure. Meaningful subsidies might be unaffordable in that event. Thus, many pundits believe that, if you are going to require insurers to cover people with pre-existing conditions, you have to also require everybody to purchase insurance so healthy people are part of the pool to balance out those with high health costs. Thus, while theoretically the law does not have to include a mandate that individuals buy insurance, in reality, I question whether the system works without it. If that's the case -- if removing the individual mandate undermines the entire statutory scheme -- then we may be back to the drawing board. While many Americans are still concerned about the health law, and will be until more of its provisions take effect, I think we must be equally concerned about a return to the status quo that existed before the law passed.
So at least for me -- who has helped so many of you obtain the benefits of the new law -- I have to hope that, when all is said and done, the Supreme Court will share the view that what's being regulated here is the entire health care and insurance market, and not just the requirement that people purchase insurance.
Finally, the House GOP has scheduled a repeal vote for next week. Expect it to pass the House, but not the Senate, and the President would veto it if he had to. I anticipate lots of votes to repeal or change parts of the law. Some will be an improvement. Some will just try to gut it. It's going to be a free-for-all in Washington for the next two years. I'll do my best to keep you up to date on a monthly basis through these newsletters, but remember that you can always check my blog for the newest info.
Stay tuned. Jennifer
|
|
Connecticut Insurance Department Rejects Anthem Blue Cross Rate Increases
In our last newsletter, I told you that we had testified at a hearing on Anthem Blue Cross Blue Shield's proposed rate increases. Well, we won! Or should I say 48,000 Connecticut consumers won.
With great leadership from Vicki Veltri from the Office of the Healthcare Advocate, and Tom Ryan from the Attorney General's Office, the Hearing Officer found Anthem's rate increases to be "excessive." Based on his recommendation, the Acting Commissioner rejected the rates.
Score one for the little guy. And watch for rate hearings in your state. Go. Testify about what the rates mean for consumers. Press your state officials to take a hard look. If you need help, let us know and we'll help you prepare.
If we consumers band together, we may just be able to get some of these rates under control.
|
Disability for All?
On December 9, 2010, former Obama Administration Budget Director Peter Orszag published an op-ed saying that people who otherwise would be working are going on disability due to the economy, and that this is straining the Social Security system badly. He suggested a program of employer-sponsored disability insurance.
I wrote a letter to the editor in response. While I recognized that "Peter Orszag rightly expressly concern about people on disability separating themselves from the workplace for longer than they might if they had other alternatives," people are going to hold onto their disability because it's so difficult to get Social Security disability, often taking longer than a year, during which applicants have no income and no health care. I went on to say:
However, Mr. Orszag's suggested solution - employer-sponsored disability insurance - is never going to happen. Many employers can't afford to provide health insurance; it is unrealistic to think that they could be persuaded to assume additional burdens.
There are solutions, though. We should have short-term Social Security disability - a year or two during which a person could recover from surgery, stabilize a chronic condition or ride out an episodic flare. If accompanied by a streamlined application process, this would be favored by many applicants over permanent disability.
Not only would it provide an incentive to get back to work as soon as one is able, but it also would save money by shifting people from permanent benefits to temporary, short-term payouts. This type of system works well in New York and California, which have state-sponsored temporary disability. It should be tried on a national level.
What do you think? Jennifer
|
|
The Chronicity Project
This is the space in our newsletter where we talk about health care policy affecting the chronically ill.
Here's an update on what's happening in the legislative arenas:
Federal
While health reform implementation proceeds, there is now talk of repeal or, at the very least, amendments. The first repeal vote is scheduled for next week. We will try to keep you up to date on all of this, but it's going to get noisy, as many bills are introduced to eliminate or change many aspects of the reform legislation. Look for attempts to make the prohibition against using federal funding to pay for abortions -- a prohibition that's already in the law -- even stronger (although I don't see any gaps in it now). In addition, we've already seen a proposal that would allow States to opt out of the requirement that individuals purchase insurance as long as they meet a set of criteria that shows that they're dealing with the goal of universal coverage in other ways. I suspect that there will be many other proposals, many of which will be symbolic since the Republicans know they don't have the votes for repeal in the Senate, and the President would veto any bill that attempted to gut the law. If you like any of the benefits of reform -- if your child is now on your policy to age 26, or if your child to age 19 now has coverage of pre-existing conditions, if you are enrolled in the affordable pre-existing condition insurance plan, if you are looking forward to the new appeals rules giving you more muscle as you fight for coverage with your insurer, let your members of Congress know. They're likely to listen to the loudest voices, and right now, that's the opposition. So if you want reform to remain the law -- with tweaks to improve it -- contact your members of Congress today.
To find your Representative, go here; to find your Senator, go here.
Connecticut The Connecticut legislative session will get going soon. We'll continue to focus on SustiNet design and implementation (for more info, go here). The SustiNet Board has come up with several options for the new Governor to consider, from pooling all of the people who already are insured by the State of Connecticut (State employees, retirees, HUSKY members, etc.) to expanding that pool to include small businesses, nonprofits, municipalities, and even large groups. Since the budget deficit is a serious concern, look for incremental implementation. But since even just pooling would save the State many millions of dollars, expect to see some implementation of SustiNet in this legislative session. As always, it's always good to contact your State Senator or Representative and tell them how you feel about things. Your State
Is there something happening in your state's legislature? Shoot me an email and I'll add it to our next newsletter. In the meantime, keep up the fight. First, be aware. Read your local newspapers. Find the website for your state legislature. Read. Write your state legislators about things that concern you. One tool we like is the Kaiser Health News, to which you can subscribe for free. But don't just read: ACT. Go to hearings and testify. Tell your story. Put a real face on the healthcare crisis. |
|
Jennifer C. Jaff, Esq.  Executive Director
|
|
|
