We have also moved our blog to http://everthriveil.org/news/branching-out. Feel free to visit and join in on the conversations.
We have also moved our blog to http://everthriveil.org/news/branching-out. Feel free to visit and join in on the conversations.
“This is a straightforward case…”
So began the oral arguments of attorney Michael Carvin on behalf of the plaintiffs’ of King v. Burwell at the United States Supreme Court on Wednesday, March 4. However, if you’ve been following coverage of this most recent legal challenge to the Affordable Care Act (ACA), you may find this case and its potential consequences to be anything but straightforward. We have you covered with a breakdown of how King v. Burwell challenges the availability of financial assistance under the Affordable Care Act, and what this could mean for you.
Photo credit: Planned Parenthood
Who is King, who is Burwell, and what’s the problem?
Although there are dozens of provisions aimed at improving health insurance quality and lowering health care costs included in the ACA, the 2010 law is perhaps best known for creating new pathways to lower-cost health insurance for millions of Americans. In order to achieve this goal, the Affordable Care Act expands Medicaid eligibility so more people, including nearly 600,000 Illinoisans to date, can enroll in Medicaid coverage.
Additionally, the Affordable Care Act offers low-and middle-income individuals tax credits to help pay for their health insurance coverage if purchased through an ACA-created online Marketplace (referred to in the statute as “Exchange”). Some states, like New York and Minnesota, established their own marketplaces, which operate as one-stop-shops for comparing and purchasing health insurance. Most states, including Illinois, rely on the marketplace created by the federal government, which is Healthcare.gov.
Chances are, you may know someone who has benefited from the tax credits (sometimes referred to as ‘subsidies’ or ‘financial assistance’) offered through Healthcare.gov. In fact, over 270,000 Illinoisans and 6.5 million Americans to date have qualified for tax credits, which can be used to automatically reduce the amount of monthly premiums. Tax credits reduce health insurance costs for an eligible Illinoisan by an average of $210 per month.
Map:How Many Americans Could Lose Subsidies If the Supreme Court Rules for the Plaintiffs in King vs. Burwell?
Provided by: Kaiser Family Foundation
Virginia native David King, the lead plaintiff in King v. Burwell, is one such individual who currently qualifies for tax credits under the ACA to help him purchase health insurance. However, he and his co-plaintiffs contend that they should not be eligible for these tax credits because Virginia did not establish its own marketplace and instead relies on the federal marketplace. Citing a five word snippet of the 400,000 word law, Kings’ lawyer, Michael Carvin, argued before the court that the text of the ACA did not the authorize the federal government to offer tax credits to residents living in the 37 states that did not establish their own marketplace.
As the chief federal official responsible for the implementation of the ACA, Sylvia Burwell, Secretary of the U.S. Department of Health and Human Services (HHS), represents the Obama administration as the defendant in this case. The administration’s lawyer, Department of Justice Solicitor General Donald Verilli, countered the challenges to the ACA by arguing that allowing residents of every state —regardless if the state established its own marketplace—access to tax credits is consistent with congressional intent, the language of the law, and legal precedent.
What’s at stake?
Although the lawyers presented their arguments to the justices in just seventy minutes, the decision of this case could have long lasting and far reaching effects on health coverage for most Americans. Should the Supreme Court rule in favor of King, an estimated 9.4 million low-to-moderate income Americans residing in more than 30 states could lose the financial assistance that they currently rely on to help pay for their health coverage.
Photo credit: Families USA
Without the availability of tax credits to reduce the cost of health insurance premiums on the marketplace, premiums would skyrocket becoming unaffordable for most seeking coverage, including an estimated 4.1 million women. Additionally, without the offer of affordable coverage, the Affordable Care Act’s individual and employer mandates would be significantly weakened, further destabilizing marketplaces. Health policy experts and insurance industry executives agree that an adverse Supreme Court decision could undermine the insurance market and cause a “death spiral.” In plain terms, the non-partisan Urban Institute estimated 8.2 million Americans could lose health insurance coverage. The effects would also be felt beyond those purchasing health care through a marketplace due to an estimated 35% premium increase throughout the health insurance industry.
The Supreme Court is expected to issue its decision on this case in June, and until then, we won’t know much more. That does not mean, however, that we can’t be prepared. Now is the time to reiterate to our legislators the critical role these tax credits play in making health coverage more affordable for Illinois residents. Are you one of the 270,000 Illinois residents who pays less for their health coverage as a result of these tax credits? Do you know someone who is? If so, we’d love to hear from you! Your stories and advocacy are the best assets we have to making the case for maintaining and expanding access to affordable health coverage.
-Alicia Siani, Health Reform Coordinator
By Divya Mohan Little, Director – Child and Adolescent Health Initiative
In early November, 2014, I joined a team of Illinois school-based health care experts, advocates, and funders at an in-person learning summit in Washington, DC. The summit was convened by the School-Based Health Alliance as part of their multistate policy learning collaborative. Team Illinois couldn’t be more excited to participate in this first cohort, and the timing couldn’t be better as the state rolls out major changes to the health care system.
Every member of the Illinois team benefited greatly from the summit. We learned from experts who challenged our thinking about school-based health center (SBHC) finance, and networked with peers from Oregon, New York, and Connecticut who share our commitment to finding innovative policy solutions for sustainable funding. We were proud (and surprised) to discover that our state is already leading in several different areas, including how SBHCs are allowed to bill for services.
The Illinois team is comprised of representatives from two SBHCs (one downstate and one in Chicago), the Illinois Department of Public Health, and the Polk Bros Foundation. A huge benefit of the summit for me was getting the uninterrupted attention and focus of my partners who participated so intentionally and meaningfully over the two days. Every member of the team left invigorated and energized, albeit slightly overwhelmed with our subsequent task lists!
Currently, Illinois is in the third year of its managed care rollout. We accepted Medicaid expansion dollars, and will have no issues meeting the demands of increased enrollment. However, recent changes in the governor’s office will assuredly affect budget allocations for all human services. We will work to educate the new governor’s staff about the SBHC model and its integration in the wider health care landscape.
We will explore opportunities to maximize federal matching funds from Medicaid and work with our state Medicaid agency to enforce SBHC billing and reimbursement. We will continue to press for managed care representatives to meet with the SBHC field to fully leverage the resources health plans can bring to our mission.
Much of the work being done through this policy collaborative had to happen in Illinois. I’m so thrilled to have the infrastructure and resources that the School-Based Health Alliance provides to guide and standardize this work.
This post originally appeared on the School-Based Health Alliance Blog.
By, Alicia Siani, Health Reform Coordinator, EverThrive Illinois
Contraceptive coverage is an essential component of a woman’s health and family life. According to the Guttmacher Institute, the average American woman envisions having only two children. In order to realize that intention, a woman would likely need access to consistent, effective, and affordable contraceptive coverage for 30 years—or longer!
Although contraceptives have long been clinically proven to reduce unintended pregnancies, help women plan for and space pregnancies resulting in optimal fetal health, and remedy non-pregnancy related health issues, reliable access to affordable contraceptives remains out of reach for too many Illinoisans. The Affordable Care Act (ACA) took a meaningful step toward contraceptive affordability through the elimination of co-payments for those who do have health insurance, however, a comprehensive implementation of this provision has proven difficult to achieve.
Last month, EverThrive Illinois collaborated with the University of Chicago’s Section of Family Planning and Contraceptive Research to host the Illinois Contraception Equity Summit. The summit brought together more than 90 health care and social service providers, clinic administrators, health advocates, and government program professionals to identify the barriers to care that a woman or man may experience while seeking contraceptives and discuss action steps to overcome these barriers.
Action Step 1: Comment on the Illinois Family Action Plan
Julie Hamos, Director of the Illinois Department of Healthcare and Family Services (HFS), unveiled the Illinois Family Planning Action Plan (IFPAP) and requested comments from summit attendees and the community at-large, providing them with clear and timely opportunity to influence access to contraceptive coverage. IFPAP is a two-part strategy designed to improve access to family planning and long acting contraceptives for Medicaid beneficiaries. Medicaid is responsible for providing health coverage, including reproductive health services, for approximately one million girls and women of childbearing age, and is the single largest payer for all pregnancies in our state.
In an effort to increase the number of providers offering Medicaid patients the full range of FDA-approved contraceptive care, the Action Plan proposes to double the provider reimbursement rate for vasectomies and intrauterine devices (IUDs). IUDs are a form of long-acting reversible contraception (LARC) that are clinically proven to be more effective at preventing pregnancy than other types of birth control, including the pill. In addition to increasing reimbursement rates for the most effective of contraception methods, IFPAP also reaffirms HFS’s expectation that health plans and participating providers will practice evidence-based counseling and provide patient education on all FDA-approved contraceptives.
Action Step 2: Join our Efforts
While we are encouraged by HFS’s efforts to expand access to effective family planning and contraceptive methods, the discourse of the summit reinvigorated us to continue our work in improving access to affordable contraception. As such, EverThrive IL will continue to advocate for funding of the federal family planning program (commonly referred to as Title X). Through Title X funding, women who do not have health insurance are able to access critical reproductive care at Title X supported clinics, including community health centers, local health departments, and Planned Parenthood centers.
We will also continue our work to hold health insurance providers accountable to the ACA requirement that they must provide the full range of FDA-approved contraceptives with no cost-sharing for their plan beneficiaries.
Finally, despite the U.S. Supreme Court’s Hobby Lobby decision and proposed accommodations for companies that object to including contraceptive coverage in their employees’ health plans, we will work to ensure that all Illinoisans have access to reliable and comprehensive health coverage--including contraceptive care with no cost-sharing-- which is still guaranteed by law.
To join our advocacy efforts or participate in future contraceptive equity meetings, please contact Kathy Waligora, Manager of the Health Reform Initiative. You can also access resources shared at the summit on our website.
By, Dr. Julie Morita
As a health care professional, it is important to know that the HPV vaccine prevents several forms of cancer and genital warts, which could greatly improve health outcomes for future generations. The Centers for Disease Control and Prevention (CDC) estimates that 3 in 4 sexually active adults will contract HPV at some point in their lives. So, it is especially distressing that only about 20% of adolescent females in Illinois are completing the 3-series HPV vaccine.
As a nonprofit organization dedicated to the health of women, children, and families, our friends at EverThrive Illinois are asking YOU to be the vaccine’s biggest advocate.
Unlike many other vaccine-preventable diseases, we know that HPV will only be contracted when the patient becomes sexually active, so some parents may not see the necessity of the vaccine for their early adolescents. Allowing patients to wait may lead patients and their parents to believe that the HPV vaccine is less important than others or not necessary at all. Additionally, we’ve seen how challenging it is to get teens in the office for a three-dose series; once they are in your office, it is the perfect opportunity to recommend the HPV vaccine and get started.
With the majority of new HPV infections occurring in teens and young adults, we can’t afford the risk of waiting to immunize. Additional statistics and suggestions are included in this AAP article, HPV vaccine can’t wait.
Tips for Talking with Parents
Even parents who have vaccinated their children on time, every time for the past decade may have questions about the HPV vaccine and will seek your recommendations. The CDC has a tips and time-savers sheet that outlines parents’ common questions. Here are a few of our favorite tips:
If your patients aren’t convinced about the vaccine’s efficacy , you may want to share international information about increased HPV immunizations rates improving health outcomes. Several countries are far ahead of the U.S. in helping to get their young people immunized. Australia has seen resounding success from its HPV vaccination campaign, including a 93 percent decline in genital warts for women under 21 and “a striking decline in high-grade cervical abnormalities in teenage girls, a sign that a decline in cervical cancer cases may be on the horizon.”
In addition to the resources listed above, there are handouts, videos, and tools available at the CDC’s HPV Vaccine Resources for Healthcare Professionals page.
EverThrive Illinois has also created an HPV vaccine blog post that is meant for the general population, including parents and adolescents. Share it with your patients and community members, and help us reduce the prevalence of HPV-related illnesses and cancers for our children’s generation.
Dr. Morita is the Deputy Commissioner, Bureau of Public Health and Disease Control at the Chicago Department of Public Health. EverThrive IL works closely with CDPH on their #UCanStopHPV campagin - aimed at educating Chicago's parents and teens on the importance of the HPV vaccine.
If you live in the city of Chicago, you may have spotted the image below on the side of a bus or on your CTA train featuring the hashtag #UCanStopHPV.
Wondering why it features a young girl when HPV (Human Papillomavirus) is the most common sexually transmitted infection (STI)? Read on to find out. We’ve also included some of the most important facts, stats, and details on HPV and the vaccine so that you can help stop HPV.
A little HPV Background….
HPV is the name for a group of more than 100 types of viruses, 40 of which can be passed through sexual contact. It’s estimated that 75% of sexually active adults will have at least one HPV infection over the course of their lives. Most people never show symptoms of HPV because the virus may clear up on its own, but they can still pass HPV onto their sexual partners.
HPV becomes a problem when it does not clear up on its own. HPV can cause genital warts in both men and women and can also cause several types of cancer, including: cervical, vulvar, vaginal, penile, anal, and cancer of the throat, tongue, and tonsils. HPV is the leading cause of cervical cancer in women.
Many HPV-Related Cancers Can Be Prevented by Getting the Vaccine
The vaccine prevents the most common types of HPV that cause cervical cancer and genital warts. You read that right – the vaccine prevents cancer! The HPV vaccine is recommended by the CDC for all boys and girls 11-12 years old. The vaccine is administered in early adolescence to ensure that young people are protected long before they become sexually active.
Sign up here!
Three doses of the shot are needed for its full effectiveness and are given over the course of six months. While the vaccine is recommended for boys and girls as early as 11-12 years old, it’s still recommended for all men and women up to the age of 26. Talk to your doctor today about getting the vaccine.
Looking for additional proof?
Australia has seen resounding success from its HPV vaccination campaign, including a 93 percent decline in genital warts for women under 21 and “a striking decline in high-grade cervical abnormalities in teenage girls, a sign that a decline in cervical cancer cases may be on the horizon.”
If you are a parent/guardian of a preteen or teenager who has not yet received the HPV vaccine or all three doses, talk to your health provider right away. Additional resources can be found through the Chicago Department of Public Health and the CDC.
If you’re a health professional seeking additional information for your patients, you can be the vaccine’s biggest advocate. Utilize these tips for talking to parents and help your patients get protection from HPV-related cancers.
Today, the Supreme Court ruled in favor of Hobby Lobby in the highly-anticipated birth control case, allowing some bosses’ religious beliefs to trump the health needs of their employees. Never before has the Court stated that an employer’s personal views can be utilized to deny their employees’ guaranteed benefits. We are disappointed by the ruling, which interferes with a woman’s health care decisions and may prevent some women, especially those struggling to make ends met through hourly-wage jobs, from getting birth control.
The court issued a 5-4 decision which affirms that "closely-held" corporations, an IRS designation for companies where the majority of stock is held by five people or less, may seek an exemption from the Affordable Care Act (ACA) requirement to provide birth control in employee health plans. In the United States, roughly 90% of companies are designated as closely-held corporations. More than 40 businesses across the country have filed suits similar to Hobby Lobby.
This decision does not strike down the ACA’s contraception coverage mandate; millions of women will continue to have access to birth control without cost sharing in their individual market and employer plans. Instead, it requires companies like Hobby Lobby to file a request for an exemption, shifting the responsibility of covering contraceptive services to insurance companies. The burden of understanding contraceptive coverage and access will fall on women and advocates to ensure that accommodations are implemented correctly and to remove barriers to access.
Additionally, the decision specifically states that the Religious Freedom Restoration Act (RFRA), the law used to challenge the birth control mandate, may not be used as justification to deny coverage for other benefits that may be objectionable to religious groups, such as immunizations or blood transfusions. It also states that this decision does not allow for the use of RFRA as "a shield for employers who might cloak illegal discrimination as a religious practice."
The ACA includes several benefits intended to promote the health and wellness of women including, screenings/counseling for domestic violence, breast cancer screenings, pap smears, support for breastfeeding, and the full range of FDA-approved birth control. Contraceptive coverage enables a woman to take better care of herself and her family by providing financial stability, time to complete education, health benefits, and/or the ability to space pregnancies accordingly.
As part of their argument, Hobby Lobby and others have pegged certain contraceptives as “abortion causing,” which is simply false. Preventive methods such as Plan B, IUDs, and birth control pills prevent fertilization by delaying ovulation and do not induce abortion.
The law utilized to defend Hobby Lobby’s position is the RFRA, which states that the government cannot make laws that will potentially harm a person’s free exercise of religion. The ACA established accommodations specifically for nonprofit organizations and places of worship to express objections to practices such as birth control in accordance with this law. Hobby Lobby and other for-profit corporations were not granted the same religious protections prior to the Supreme Court’s ruling.
There is hope that states will still uphold contraceptive equity laws, which are currently in place in 28 states, including Illinois. This is a guarantee that contraceptives will be covered just like all other medications in a health care plan and protects women’s access to birth control. It is uncertain if state-based equity laws will be challenged in the future, but for now they are protecting contraceptive coverage for millions of women.
The ACA is still federal law and will continue to provide preventive health services for both men and women, however, this ruling could jeopardize the health care of many working women. You can sign on to the dissent with Planned Parenthood Action here.
You can also join us and the National Women's Law Center in telling Congress to get bosses out of our business. The NWLC also has a toolkit for what to do if you are charged for a preventive service.
This blog was written by EverThrive IL policy staff. For questions, please contact Annie Boesen.
In 2012, the Illinois Department of Healthcare and Family Services (HFS) leaders and state legislators were faced with a problem: Medicaid was costing the state more than it could afford. The backlog of unpaid Medicaid bills was and still is staggering; officials believed that cutting entire services was the only way to save money. Illinois was also in the middle of strategizing the expansion of Medicaid and implementing the Affordable Care Act (ACA). Two years have passed since the Save Medicaid Access and Resources Together (SMART) Act was implemented, and thankfully, in spring session this year, legislators reconsidered many detrimental components of the Medicaid program.
In public health, prevention is the overarching strategy for improving health outcomes; public health scholars regularly quote Benjamin Franklin, “an ounce of prevention is worth a pound of cure.” But we also calculate the cost effectiveness of interventions because in practice and politics, the cost of providing a service or program can unfortunately trump the known benefits. This was the case with service cuts to Medicaid including adult dental, access to a podiatrist, and limitations on prescription drug benefits. In late May 2014, following significant debate and discussion, many of these services were restored through a large Medicaid Omnibus Bill – SB741.
Representative Greg Harris (D-Chicago) stated, “We are restoring this simply because we have found out from experience that these cuts actually did not save us money. They cost the people of the state of Illinois more money, and they brought suffering and hardship to families. They brought overutilization to our emergency departments and interfered with the delivery of health care to other patients in need.”
We applaud Representative Harris, his legislative allies, and our partners who fought tirelessly for the large Medicaid Omnibus Bill, and we plan to spend the future ensuring that both consumers and providers are aware of changes to the Medicaid Program, which include:
As As these changes are implemented, we are hopeful that more individuals will access preventive care in order to avoid future costlier problems and improve their overall health and well-being. With this approach, healthier families have a better chance of sustaining employment and rising out of poverty, and therefore will decrease their need for safety net programs like Medicaid.
This blog was written by EverThrive IL Policy Director, Annie Boesen.
By Stephanie Altman, Sargent Shriver National Center on Poverty Law
In Illinois, we’ve been busy enrolling more than 260,000 newly eligible adults through Medicaid’s front door. But we’ve also had our eye on Medicaid’s back door to make sure we don’t lose Medicaid-eligible individuals through the annual renewal process.
The state has been working with us at the Shriver Center and other stakeholders on a "Medicaid Redetermination Project" to streamline the process for Medicaid renewals (sometimes called “redeterminations” or “REDEs”). This includes work on the regular annual renewals and new Modified Adjusted Gross Income (MAGI) based renewals. Some key practices that are already helping to facilitate renewals in Illinois include:
We still have work to do to improve the Illinois renewal process both in policy and in practice. We are monitoring the initial mailing of renewal forms to assess whether there is a high percentage of non-response or terminations. We are also trying to collect more information and clarification on the Illinois renewal process through the Medicaid Advisory Committee and working to ensure that at least 30 days are permitted to respond to renewal requests and at least 90 days to reinstate cancelled cases.
It is our hope that other states will also keep their eye on the back door and share strategies and best practices surrounding Medicaid renewals.
This blog originally appeared on “Say Ahhh!” a blog from Georgetown University Health Policy Institute Center for Children and Families on May 6, 2014.
On Saturday, April 26, our Cooking Matters program hosted a grocery store tour in Chicago's Austin neighborhood. We welcomed participants from the community along with Jeannie Boutelle, a sustainable food writer at The Local Beet, Edible Chicago Magazine. Boutelle wrote a blog for Huffington Post Chicago, highlighting her experience as she shopped for a well-balanced meal for four people with only $10 - the amount designated for SNAP participants. You can read her full blog post here.