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This post is part of a weekly “Did You Know” blog series that highlights important, but not well known features of the health reform law about prevention, wellness, and personal responsibility for our health. 

Did you know that switching the focus from treating chronic illnesses to preventing the diseases will not only improve the health of individuals and families all over the country, but will also rein in health care costs and strengthen the economy?

The Affordable Care Act (ACA) is applying this logic in its fight to lower the rate of preventable chronic illnesses, produce real savings in the health care sector, and recover lost economic activity at the local, state, and national levels. And it’s doing it in the name of prevention through effective public health initiatives.

The prevalence of chronic health conditions in the United States is taking a huge toll on our citizens, our nation’s health care spending, and our workforce. More than half of the people living in the United States have at least one chronic health condition, such as heart disease, stroke, diabetes, obesity, and cancer. Chronic health conditions account for 7 out of 10 deaths in America and rack up 75% of our nation’s health care spending. The cost for treating people with type 2 diabetes, heart disease, hypertension, and stroke, alone, amounts to $238 billion each year. In 2010, the United States spent almost $2.6 trillion on health care, meaning we spent around $1.9 trillion just last year on treating and managing chronic illnesses, most of which are largely preventable. Here in Illinois, more than 6.7 million people have reported being diagnosed with a chronic health condition, costing the state $12.5 billion in annual health care expenses.

What’s more is that the cost of chronic health conditions goes beyond the money spent on health care services. The toll these illnesses take on our workforce productivity is telling. According to the Gallup Poll, 7 out of 8, or 83 percent of American workers either have a chronic health condition or are obese. The poll estimates that this prevalence of chronic illness and obesity in our workers could be costing our economy $153 billion a year in lost productivity due to increased sick days. Other reports that take into account other chronic conditions and factors like lost productivity from workers who show up on the job while sick estimate that chronic health conditions are costing the United States more than $1 trillion each year in lost economic activity. To bring these statistics home, chronic disease plaguing Illinois’s workforce cost the state $14.3 billion in lost productivity. And the commonality of chronic disease is rapidly increasing. It is estimated that the number of Americans living with a chronic health condition will increase by 36%, or 46 million people by the year 2030, and that we could be spending $685 billion a year on medical treatment for chronic disease by 2020. Other sources estimate the total economic toll of chronic health conditions to reach $6 trillion a year by the middle of the century.

But it doesn’t have to be this way. As the CDC states, “Access to high-quality and affordable prevention measures (including screening and appropriate follow-up) are essential steps in saving lives, reducing disability and lowering costs for medical care.” And research has proven that for every dollar invested in effective prevention and public health initiatives, $5.60 is saved. The same study reveals that, if we invest $10 per person every year in effective community-based public health programs, we could save the United States more than $16 billion in just five years. 

Fortunately, the Affordable Care Act recognizes the benefits to be had from investing in smart and effective preventive and public health efforts. The ACA established the National Prevention, Health Promotion and Public Health Council within the Department of Health and Human Services (HHS), made up of secretaries from various federal departments and chaired by the Surgeon General. The Council is responsible for developing our first ever National Prevention and Health Promotion Strategy, which was released in June of 2011 and identifies four strategic directions for preventing disease and improving health nationwide. The four strategic directions are: creating healthy and safe community environments; expanding access to quality clinical and community preventive health service; empowering people to make healthy choices; and eliminating health disparities. The Council is charged with providing leadership moving forward with the National Prevention and Health Promotion Strategy.

The ACA also established a Prevention and Public Health Fund, which is administered by the Secretary of HHS, Kathleen Sebelius, and provides financial support for state and community-wide efforts to prevent disease and promote healthy lifestyles. The Fund is a 10-year, $15 billion commitment to support prevention and public health programs across the country, like the Community Transformation Grants, which fund community-level programs geared towards reducing the prevalence of chronic disease and promoting healthy lifestyles.   Already, $103 million in grant money has been issued to 61 different state and community programs across the country, reaching 120 million people.

So what does all of this mean for chronic disease in Illinois? Already, the State of Illinois has received $17.14 million out of the Prevention and Public Health Fund to support community- and state-level wellness and prevention programs aimed at preventing chronic disease and raising awareness about healthy living. For a breakdown of what programs received funding and for how much, visit HealthCare.gov online.

The Secretary of HHS will continue to issue funds for prevention and public health programs across the country to reverse the trend of chronic disease, so stay tuned as health reform continues to make a positive impact in our communities. To find out what other kinds of initiatives the Affordable Care Act has taken to increase access to preventive health measures and decrease illness in America, visit the Shriver Brief online.

Interested in an in-person presentation on how health reform is rolling out in Illinois and what it means for individuals? Are you a direct service provider or advocate for vulnerable populations and interested in how the Affordable Care Act will impact the population you serve? Rachel Gielau, health policy expert at the Shriver Center, is giving free in-person presentations to Illinois audiences on how health reform is affecting individual and families in Illinois. Contact Rachel Gielau at 312-368-1154 to set up a presentation for your organization!

This blog post was coauthored by Rachel Gielau.

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This post is part of a weekly “Did You Know” blog series that highlights important, but not well known features of the health reform law about prevention, wellness, and personal responsibility for our health.   

Did you know that, in an HHS ruling last week, the Obama administration reaffirmed the Affordable Care Act’s commitment to improving the health and well-being of America’s women?

If you’ve been tuning in to our weekly “Did You Know” blog series on preventive health and the Affordable Care Act, you might remember that last summer the U.S. Department of Health and Human Services (HHS) required health insurance companies to cover a set of women’s preventive health services without charging a co-payment (effective August 2012). The comprehensive set of free women’s preventive health services recommended by the Institute of Medicine includes, among many other necessary services, Food and Drug Administration-approved contraceptives, or birth control. This issue affects millions of Americans. There are approximately 43 million sexually active women who do not want to become pregnant in the United States; 89% of them use contraception. 

Last summer’s interim rule allowed certain nonprofit religious employers offering health insurance to their employees to qualify for a religious exemption and therefore be able to decide for themselves whether or not to cover contraceptive services in their employer-sponsored coverage. This religious exemption was narrowly defined, pertaining only to those religious institutions that employ and serve people of the same religious beliefs, like churches or synagogues. The exemption did not include religiously affiliated institutions, like hospitals and schools. When HHS asked for public comment on this part of the rule, it received an outpouring of input from groups supporting the narrow exception and groups wanting it expanded.

On Friday of last week, HHS announced its final ruling on this issue, concluding that the narrow definition of the religious exemption will stand. Religious places of worship like churches will be exempt from the rule, but institutions with religious affiliations like hospitals and schools will not. This means, for example, that churches will not have to cover contraceptive health for their employees, but religiously affiliated hospitals will have to offer that coverage to their doctors, nurses, and other employees. The only change to the rule from last August is the decision to give employers who don’t currently offer contraceptives in their employer-sponsored health coverage because of a religious belief an extra year (until 2013) to comply with the mandate. The Secretary of HHS, Kathleen Sebelius, said that she believes this proposal “strikes the appropriate balance between respecting religious freedom and increasing access to important preventive services.”

This blog post was coauthored by Rachel Gielau.

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The Affordable Care Act (ACA) has friends in high places, and they are letting the world know it. “Amicus Curiae” means “friend of the court” and is the name for a person or group who is not officially the plaintiff or defendant in a lawsuit, but who has good reason to be concerned about the case and offers an opinion based on special experience or expertise to the court regarding the case. Now pending in the Supreme Court is a case challenging the validity of portions of the ACA. Friends of the court are now submitting “amicus curia” briefs to the Supreme Court defending the ACA.

One important friend on the ACA’s side is Illinois Attorney General Lisa Madigan. Recently, she and twelve other attorneys general filed briefs before the Supreme Court arguing that the individual mandate is constitutional as a valid exercise of the constitution’s Commerce Clause. The opponents have argued that the ACA’s “individual mandate” (imposing a tax penalty on anyone who remains uninsured after the ACA is implemented) is beyond the scope of Congress’s power to act under the Commerce Clause. As one of the amici notes, "The healthcare industry takes up at least one-sixth of our economy. If anything is interstate commerce, it's healthcare.”

We say “thanks” to these Attorneys General, including our own Lisa Madigan, for supporting this monumental legislation—they are truly looking out for all of their constituents.

However, it’s not just lawyers who are lining up to support the ACA. Many friends of the law have significant medical expertise, including the American Academy of Pediatrics, the American Nurses Association, the American Cancer Association, and the American Diabetes Association. Other amici are familiar with the intricacies of running health systems, including the American Hospital Association and the Catholic Health Association of the United States, as well as the National Association of Children’s Hospitals. Other friends include Nobel Prize winning economists, the AARP, small business groups and numerous academics. The Shriver Center has joined as “amicus curiae” in two briefs in support of the ACA: one led by the National Women’s Law Center pointing out the tremendous positive impact of the law on women’s health; and the other led by the National Health Law Program that defends the Act’s Medicaid expansion as a valid exercise of congressional authority.

Having experts support the ACA in the Supreme Court is important, but it is also important that everyone who will be affected by this law take a stand in support of it. This law will affect all Americans—whether it is by providing affordable coverage, allowing young adults to stay on their parents insurance, or any of the myriad other benefits the law offers. Share this information with people—research shows many people don’t know how the ACA can help them. Let your friends, neighbors and co-workers in on the good news.  .
 

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This post is part of a weekly "Did You Know?" blog series that highlights important, but not well known, features of the health reform law about prevention, wellness, and personal responsibility for our health.

Did you know that the Affordable Care Act is upping the ante on breast cancer awareness and prevention efforts?

According to breastcancer.org, about one in eight U.S. women (just under 12%) will develop invasive breast cancer over the course of their lifetimes. In 2011 alone, it was estimated that nearly 230,000 women were diagnosed with some form of the disease, and tens of thousands of women lost their lives to it. Breast cancer is the second most common type of cancer in women and one of the most deadly cancers among our mothers, sisters, and grandmothers. But it doesn’t have to be. Raising awareness about breast cancer, educating women about effective preventive health practices and increasing access to doctors and routine mammograms can reduce the cost, hardship, and lives lost to this all-too-common form of cancer. And this is precisely what the Affordable Care Act is doing for women all across the country.

The Affordable Care Act (ACA) authorizes the Centers for Disease Control and Prevention (CDC) to award grants to fund breast cancer education and awareness campaigns across the country. The Act also directs the Secretary of Health and Human Services, along with the CDC, to establish an advisory committee on breast cancer and to launch a breast cancer awareness and education campaign, targeting young women with information about prevention and early detection. The law also authorizes the CDC to conduct research to better understand the disease, as well as the most effective prevention and awareness-raising efforts.

The CDC states that mammograms can detect breast cancer up to three years before it can be felt. And according to Health and Human Services, 3,700 lives would be saved every year if 90 percent of women 40 years old and up received routine breast cancer screenings. It is no secret that educating women about the importance and effectiveness of early detection is crucial to reducing the prevalence and mortality rates of breast cancer. 

However, this isn’t just an awareness issue. Especially in today’s economy, the financial cost of a routine mammogram—let alone making a visit to the doctor—is high enough to deter women from getting their necessary check-ups. The Affordable Care Act works to solve this problem for many American women. The health reform law is making women’s preventive health care affordable by requiring health insurance companies to cover certain preventive health services, like routine mammograms, free of co-pay for individuals with new or “non-grandfathered” plans. This means that any woman with a health insurance plan that is new or has changed significantly since March 23, 2010, can receive necessary routine mammograms without having to pay any money out of pocket for the procedure. Yearly well-woman check-ups will soon be free, too, giving women a chance to speak to their doctors about their health without worrying about their bank accounts.

The Affordable Care Act, referred to in the media by “Obamacare”, is also making strides for women who currently battling breast cancer and those who are survivors. Thanks to “Obamacare’s” many new consumer protections, insurance companies are no longer able to place lifetime limits on insurance policies, and in 2014, they will no longer be able to place annual limits on coverage, meaning people everywhere can rest easy knowing that the health insurance they pay for will be there for them when they need it most. Also in 2014, insurance companies will no longer be able to discriminate against anybody for having a pre-existing condition, like breast cancer, which means that women will no longer be denied coverage or charged a higher rate because they’ve fallen victim to cancer.

Breast cancer affects women and men of all races and ethnicities, but did you know that African American women are at a greater risk than any other race of dying from breast cancer in America? Find information on how the Affordable Care Act is working to reduce health disparities like this one across the country online.

For information on what you can do to stay ahead of breast cancer and on top of your health, visit the American Cancer Society online. For more in-depth information about breast cancer, like risks, treatments, and support, visit the National Breast Cancer Foundation website.

This post was coauthored by Rachel Gielau.

Interested in an in-person presentation on how health reform is rolling out in Illinois and what it means for individuals? Are you a direct service provider or advocate for vulnerable populations and interested in how the Affordable Care Act will impact the population you serve? Rachel Gielau, health policy expert at the Shriver Center, is giving free in-person presentations to Illinois audiences on how health reform is affecting individual and families in Illinois. Contact Rachel Gielau at 312-368-1154 to set up a presentation for your organization!

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This is the second post in a weekly “Did You Know” blog series that will highlight important, but not well known features of the health reform law about prevention, wellness, and personal responsibility for our health. 

Did you know that insurance companies will soon be required to cover women’s preventive health services like birth control and annual gynecological visits free of co-pay?

The Department of Health and Human Services (HHS), under the guidelines of the Affordable Care Act, announced this summer that starting in August, 2012 (for new or “non-grandfathered” plans), insurance companies will have to cover a set of women’s preventive health services free of cost-sharing (i.e., co-payments, deductibles, or the use of co-insurance). These services are in addition to the set of preventive benefits for all adults that health insurance companies are already required to cover without cost-sharing in the private market (at least those with “non-grandfathered” plans), all thanks to the Affordable Care Act.

The women’s preventive health services included in the rule are:

• Well-woman visits
• Screening for gestational diabetes
• HPV DNA testing for women 30 years and older
• STI counseling
• HIV screening and counseling
• FDA-approved contraceptives and contraceptive counseling
• Breastfeeding support, supplies, and counseling
• Domestic violence screening and counseling

There are a couple of important exemptions that come with this new rule. Insurance plans with “grandfathered” status will not be required to cover these benefits free of co-pay in 2012. The rule only applies to new plans, or those that have lost their “grandfathered” status. If you are unsure whether or not your plan is new or grandfathered, ask your insurer or your employer if you have coverage through work. You can find more information on grandfathered vs. non-grandfathered plans online.

The other exemption to this new rule, which is still being considered by HHS, involves religiously affiliated places of work and the mandate to provide coverage for birth control. Controversial in nature, the proposed religious exemption has recently become the center of debate. The exemption would allow religiously affiliated institutions that oppose birth control and offer employer coverage to refrain from providing contraceptive benefits. This means that millions of women working for religiously affiliated institutions, including places of work like hospitals and schools, may face barriers to accessing affordable FDA-approved family planning methods, which is a concern for women’s rights advocates across the country.  

Quick Fact: Speaking of women’s preventive health, did you know that health reform is already working to increase women’s access to ob-gyns?  Thanks to the Affordable Care Act, women no longer have to get a referral from their doctor before seeing a gynecologist no matter what kind of insurance they have! This consumer protection applies to all women and has been in effect since September 23, 2010.

This blog post was coauthored by Rachel Gielau.                                      

Interested in an in-person presentation on how health reform is rolling out in Illinois and what it means for individuals?  Are you a direct service provider or advocate for vulnerable populations and interested in how the Affordable Care Act will impact the population you serve?  Rachel Gielau, health policy expert at the Shriver Center, is giving free in-person presentations to Illinois audiences on how health reform is affecting individual and families in Illinois. Contact Rachel Gielau at 312-368-1154 to set up a presentation for your organization!

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Family holiday dinners can be wonderful, warm times to bond, or they can devolve into intense full-contact debates. We’ve all been at the table when Uncle Steve wants to debate politics or Cousin Liz is in the mood to talk about religion. A little friendly debate over crescent rolls can bring a family closer together and enlighten people, or it can make for a really uncomfortable holiday. 

This year, I’m predicting the federal Affordable Care Act (ACA) to be a hot-button topic as relatives spar over the universal mandate, death panels, and whether or not Grandma’s Medicare will be rationed. (Hint: it won’t be.) Research shows that about half of uninsured people who will benefit from the ACA are really in the dark about healthcare reform; some of them are probably going to be sitting around the table with you. We would like to remind our readers to take advantage of this great opportunity to enlighten (in a positive, respectful way) family and friends on the many ways the ACA is helping Americans get affordable healthcare. Once people know about the many benefits of the ACA, they are far more likely to support it.  

Here are a few tips to make sure this holiday season doesn’t end in frustration for anyone.

1.     Most importantly, take ownership of the ACA. You like this legislation—tell people why!

I know I’ll be telling my own family how thrilled I was that my young adult sisters and I could remain on my parents’ very good insurance (along with 2.5 million other young Americans) rather than purchase overpriced, low-quality plans on our own before being eligible for employer-provided insurance.  

Or maybe you have diabetes and are looking forward to the day (January 1, 2014) you won’t be denied the ability to purchase insurance for your preexisting condition, or you would like to provide health insurance to maintain your best employees and are excited about the tax credits you will receive. Whatever part of the ACA you are excited about, share it with your family over dinner. Positive stories create positive impressions of the law.

2.     Know what you’re talking about. Have reliable information ready to refute your dad’s claim that small businesses will be going under in droves or your sister’s statement that sick people won’t be readmitted to the hospital. We suggest using the official website, The Kaiser Family Foundation, and the new interactive game “Thanks Obamacare!”  for helpful facts. Misinformation absolutely will not help the cause of broadening public support for the ACA. 

3.     Mention the most popular provisions of the ACA, like closing the Medicare donut hole and requiring health insurance companies to sell policies to all people (even people with preexisting conditions); research shows that most Americans feel “very favorable” about these provisions.

4.     Don’t be insulting. Your aunt’s unwavering stance on death panels may make you twitch with anger, but don’t ever attack her personally. She’s still your family and you still have to finish the evening with her. Address her misinformation calmly and with facts rather than focusing on her propensity for exaggeration or gullibility.      

5.     Call a truce if the discussion gets intense. Don’t make discussing the ACA a battle during your dinner. Agree to continue the discussion via an email chain, where you can include citations to reliable information, and then everyone can focus on enjoying dessert and family. 

Of course, this advice doesn’t just apply to holiday dinners—everyone who supports the ACA has an important job to do in confronting misinformation that they hear about the law and in spreading the word about its positive aspects. As you do this, keep a mental note of the most outrageous or most prevalent misinformation you hear and share it with us via blog comments or email. We would love to know more about what we are up against!

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We have good news and some bad news. The good news is that, in 2010, the number of uninsured children in the United States was one of the lowest in over a decade—about 7.3 million children were uninsured. Of course, Illinois’s rates of child uninsurance are even lower, thanks to the All Kids program. The Affordable Care Act has the potential to cut the number of uninsured children even further to 4.2 million (still too many uninsured children, but improving!). The expected decreases in uninsured children depend significantly on the states’ continuation of Medicaid and Children’s Health Insurance Programs (CHIP) coverage. 

The bad news is that some lawmakers are proposing legislation that will eliminate or greatly reduce Medicaid and CHIP. Without this coverage,  the level of uninsured children might actually rise—the exact opposite of what the Affordable Care Act is intended to accomplish. Eliminating Medicaid and CHIP for families above 138% of the federal poverty level would gut the Affordable Care Act’s goal of insuring our nation’s children—these programs must continue in full force in order to offer affordable insurance to young Americans. 

Under the Affordable Care Act, children and families with incomes under 138% of the federal poverty level will be covered under expanded Medicaid eligibility provisions. dults over the Medicaid threshold will be expected to obtain coverage for themselves through either the benefits exchanges or traditional employer-provided coverage and will be provided tax credits to make coverage more affordable. 

However, as the law currently stands, children in families between 138% and 400% of federal poverty level will continue to be eligible for Medicaid and CHIP due to congressionally mandated “maintenance-of-effort” (MOE) requirements. These requirements dictate that states maintain their existing eligibility, application, and renewal procedures requirements for children until October 1, 2019. his means that states cannot scale back coverage in order to save money, nor can they enact more onerous enrollment procedures.

Unfortunately, some lawmakers are calling on Congress to roll back those MOE requirements. If they are successful, states looking to balance their budgets will surely be tempted to make cuts in this area and force vulnerable children off Medicaid and CHIP. This would be a disaster for the health of our nation’s children. If states are allowed to discontinue their MOE requirements, an estimated 7.9 to 9.1 million children would be uninsured.      

If this happens, some families without employer-provided coverage will be eligible for tax credits and purchase coverage for the children on the benefits exchanges. Others will be able to obtain affordable employer-provided coverage.

However, not all families will be able to take advantage of these options. Children of all ages and races will experience higher rates of uninsurance without CHIP and Medicaid, despite the availability of exchange or employer-based coverage intended to replace those programs. For various reasons, the exchanges may be too expensive or unavailable to these families, leaving children without options for insurance.

The Affordable Care Act is a vital piece of legislation that has the potential to cut the number of uninsured parents and children by millions if it is implemented properly. We cannot skimp on providing coverage for children. Although the government could save some money by eliminating Medicaid and CHIP coverage for families over 138% of the federal poverty level, a decision to do so could leave millions of our most vulnerable uninsured. Medicaid and CHIP must continue at full strength, since these are vital lifelines for millions of uninsured children and high-quality and affordable coverage for our nation’s youth.

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Editor's Note: This is the first of a weekly “Did You Know” blog series that will highlight important, but not well known features of the health reform law about prevention, wellness, and personal responsibility for our health. 

Did you know that you can receive preventive health services at your doctor’s office free of co-pay?

That’s right! The Affordable Care Act is serious about changing the culture of our health care system from treating disease after we get sick to preventing disease so that we don’t fall ill in the first place. From free preventive medical services and personalized wellness plans to community transformation grants and nationwide health education campaigns, the Affordable Care Act can help Americans raise a healthy generation of kids, build a healthier workforce, and reduce the overall cost of health care. 

One of the many ways the Affordable Care Act is working already to help individuals stay ahead of chronic illnesses is by requiring health insurers, including Medicare, to offer certain preventive health services free of co-pays. This new rule has been in effect since September 23, 2010, so you may already be reaping the benefits! For private insurance, the rule applies only to new plans, or those that have lost their “grandfathered” status, meaning, if you enrolled in a new plan at work or your employer significantly changed its health plan since March 23, 2010, you can receive the following preventive services without paying a deductible or co-payment:

• Blood pressure screening
• Cholesterol screening for certain aged and high-risk adults
• Colorectal cancer screening for adults over 50
• Type 2 diabetes screening for adults with high blood pressure
• HIV screenings for people at high risk
• Depression screening
• Alcohol abuse screening and counseling
• Aspirin use for men and women of certain ages
• Immunization for adults and children (see full lists here)
• Abdominal aortic aneurysm screening for men who have smoked
• Diet counseling for adults at higher risk for chronic disease
• Obesity screening and counseling
• Sexually transmitted infection prevention counseling and screening for people at high risk
• Tobacco use screening and cessation interventions for tobacco users
• Syphilis screening for adults with high risk

There are additional preventive health services available specifically for women and for children that are also free of co-pays. Comprehensive lists of available services can be found online. Information about each of these preventive services, along with tips and resources to help you and your loved ones stay healthy, is also available.

Unsure whether or not your plan is grandfathered or if you will be able to get these services at no cost to you? Ask your insurer! They will know. You can also learn more about grandfathered plans online.

This post was coauthored by Rachel Gielau.

Interested in an in-person presentation on how health reform is rolling out in Illinois and what it means for individuals? Are you a direct service provider or advocate for vulnerable populations and interested in how the Affordable Care Act will impact the population you serve? Rachel Gielau, health policy expert at the Shriver Center, is giving free in-person presentations to Illinois audiences on how health reform is affecting individual and families in Illinois. Contact Rachel at 312-368-1154 to set up a presentation for your organization.

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The Affordable Care Act (ACA) is the name of the national health reform law, which has also become known as “Obamacare.” The ACA creates a set of tools that can significantly address the health coverage crisis now and especially over the next few years as the law phases in. 

Here are some of myths spread by opponents of the law, and the facts that refute them:

Myth: The ACA is a government takeover of health care. 

Fact: The ACA keeps the private insurance system, but strengthens the watchdog role of government to ensure that consumers get choice, control, and peace of mind. Health care itself is still private, and most individuals under 65 will continue to get insurance from their employers and private insurance companies. 

Myth: The ACA replaces Medicare or cuts basic Medicare benefits. 

Fact: False. In fact, 18.9 million Medicare recipients have received free annual checkups and preventative services, and 4 million have received Medicare prescription discounts. The ACA will eliminate the notorious Part D “donut hole” entirely.

Myth: The ACA hurts small businesses. 

Fact: Small businesses do very well under the ACA. Employers will be able to purchase insurance with large-pool savings and bargaining power. They will also receive tax credits to offset the cost of their employee premiums. Only larger companies will be fined for failure to offer coverage.

Myth: The ACA adds to the federal deficit. 

Fact: The nonpartisan Congressional Budget Office has scored the ACA to reduce the deficit. 

Myth: The ACA does not actually insure anyone.

Fact: Already a million young Americans are covered under their parents’ plans because the ACA raised the age limit to 26 for dependent coverage. After the phase-in period, well over 30 million Americans now uninsured will be covered by affordable, comprehensive private insurance or (for lowest income people) a Medicaid expansion.

The ACA contains strategies to improve the health insurance worries that afflict every American household, regardless of income. It is also a smart and crucial strategy to fight poverty, by improving lives and upward mobility.      

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Some people are spinning hard about the outcome of the recent mid-term elections. They are trying to say that the changes in Congress were a “mandate” to repeal health care reform. As usual, most of those spinners have little to say about how to resolve health care issues--for them health care is an ideological or political issue, not an issue of importance in everyday lives. It is a tactical issue in the beltway game, a ploy in the never-ending struggle for power and for special interest money.

But out here, when the issue is reduced to kitchen-table reality, people don’t think ideologically or politically. They think about their own health care, their families’ health care, and their own financial circumstances. 

Here are some numbers about health coverage and the election. 

Even on the ideological level on which they choose to operate, the spinners are wrong. The election result was driven by concern about the economy and jobs, not health care. According to a CNN exit poll, only 19% of voters named health care reform as their top concern--a distant second to the 61% of voters most concerned with the economy.

On the big abstract ideological question about support for the health reform law, the voters split down the middle: 48% say they support repeal and 47% say they want the reform law to stay the same or be expanded. Some mandate. 

Polls consistently confirm that, when the public hears truthful facts (as opposed to the other kind of “facts”) about the health reform law, they want the benefits and support health reform. The specifics of health care reform already help people in ways that matter deeply to them. Undoing health care reform would mean:

• People would continue to be denied coverage or charged more for it due to pre-existing conditions.
• People diagnosed with the particular pre-existing condition of being female would continue to be discriminated against in the cost of their coverage. The spinners would continue that outrageous discrimination. 
• People would continue to have coverage dropped when they get sick.
• People would continue to have lifetime caps on their insurance coverage.
• Small businesses would continue to have to pay higher rates for health insurance than big corporations.
• There will be no smart investment in prevention as the focus of our healthcare system--clearly the way to get both lower cost and better patient outcomes.
• People would lose the comfort of knowing that, no matter what happens to their job, their health, or their family, there will always be access to affordable, decent coverage.  
• Entrepreneurs would continue to experience the drag on their creativity and chances for success caused by the health coverage problems. And health coverage issues would continue to prevent would-be entrepreneurs from even getting started, stuck in their current jobs in order to retain insurance.

The post-election spinners stay far away from these real problems. The new law leaves the private insurance sector in place (a single-payer system would have ended it), but imposes fair boundaries on it. The spinners, scrupulously avoiding anything specific about how to address health coverage issues, instead simply call the new law names: “takeover,” “socialism.” But calling something a name is not the same as talking about it honestly--indeed, it’s a time-honored way to stifle full discussion. The health reform law is in fact a very promising public-private effort to address a problem that plagues American households everywhere. The spinners are wrong about the importance to real people of health care reform. When the focus is on the actual health coverage problems that plague American households, most Americans want their federal and state officials to get on with implementation--and do a good job of it.

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Women are the most likely to have the greatest contact with the health care system, as they often coordinate health care for themselves and their families. Yet women face unique barriers to obtaining and paying for health care. Nearly half of all low-income women are uninsured, and those who are insured are less likely to visit the doctor because of unaffordable out-of-pocket costs. However, things are changing for the better. Thanks to health care reform, low-income women now will face dramatically fewer cost barriers to access health care. The newly passed health care reform law, the Patient Protection and Affordable Care Act of 2010, will make health care more affordable, easier to obtain and provide more comprehensive services, ensuring women receive the care they need. 

Starting January 1, 2014, 8.2 million women whose incomes are at or below 133% of the federal poverty level will now be eligible for health coverage through the expansion of the Medicaid program. According to the National Women’s Law Center, up to 154,300 uninsured, low-income women in Illinois will gain health care coverage through the Medicaid expansion.  Another benefit, this coverage will be more comprehensive and include family planning and contraceptive services that are, without a doubt, a plus for women.

Moderate-income women and their families will also reap the benefits from health care reform with the creation of health insurance exchanges. Women with incomes up to 400% of federal poverty level can receive tax-credits that effectively lower out-of-pocket costs and help pay for health insurance coverage. Up to 7 million uninsured women nationwide and 471,000 women in Illinois will benefit from health insurance exchanges and tax-credits.

All women will benefit from the provision that requires all new individual and small business health plans to carry an “essential benefits package”, which provides coverage for essential services such as maternity care, prescription drug coverage, and mental health services.  Because of the difficulty women have finding these services in the individual market, this coverage marks a vital improvement in providing fundamental services women need.

Women stand to gain greatly from health care reform. In fact, women across socioeconomic levels have already started benefiting from health care reform. The National Women’s Law Center and the Commonwealth Fund have done extensive work to make clear what health care reform means for women. For more information on how health care reform benefits all women, read or subscribe to the latest issue of WomanView, entitled “30 Million Women Will Benefit from Health Care Reform.”

Heidy Robertson coauthored this article.

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Throughout the debate on health care reform, the focus on changes for older Americans was largely prescription drugs and closing the drug coverage "doughnut hole." These changes are extremely important for many senior citizens who hit their drug coverage limit and are forced to pay high out-of-pocket costs. In fact, there is a $250 payment to seniors who reach the doughnut hole--a down payment until the eventual full elimination of the doughnut hole that will happen later this year.

However, the new law also includes several other provisions that will greatly assist older Americans, particularly low-income senior citizens, which the National Senior Citizens Law Center details in several recent reports.

• For older Americans who rely on long-term services, the new law will create financial incentives for states to shift Medicaid spending toward community-based services, including a six-percentage point increase in federal Medicaid reimbursement for community-based care initiatives.
• The law establishes several pilot programs to study and improve coordination of care for Americans who receive coverage through both Medicare and Medicaid, otherwise known as "dual eligibles."
• The law strengthens medical assistance programs to ensure beneficiaries promptly receive covered services.
  
• The law eliminated co-payments for prescription drugs for individuals receiving long-term care services in the home and in an institutional setting. Under current law, individuals living in an institutional setting do not have co-payments, while those receiving services in the home do have co-payments.
  
• For Americans who are too young to qualify for Medicare but who retire early, a temporary "reinsurance" program will reduce the cost burden on employers.
  

According to the National Senior Citizen Law Center, the most significant new provision in the new law is the extension of coverage for 32 million Americans, which includes millions of people aged 50-64, through a Medicaid expansion, new state-based Exchanges with subsidies for low- and middle-income Americans, and regulation of the worst practices of insurance companies. Finally, millions of low-income older Americans will have access to the care that they need, and important improvements will be made to programs that contribute to the health and well-being of older Americans.

Check out the NSCLC reports for details on how reform benefits older Americans!

Carrie Gilbert co-authored this post.

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I'm not a health care expert, just a spectator like most of America. It's been said that watching legislation being made is like watching sausage being made. Thanks to the 24-hour news cycle, blogs, etc., we've all just been treated to 14 months of the stomach-turning process of watching legislation being made. This may account for the less-than-jubilant reaction to the enactment of health care reform into law.

Make no mistake, however. This is real, lasting, fundamental, historic social change, on a par with the creation of Social Security in the 1930s and Medicare in the 1960s. It ends the national shame of more than 40 million people without health insurance. It creates a system where everyone must play and everyone has a stake.

Health care reform is not a traditional safety net program. You don't get a card. But we live in a much more complicated world than we did in the 1930s or the 1960s. This reform had to be a accomplished within the confines and constraints of two of the most powerful industries in America--the pharmaceutical industry and the insurance industry. Health care reform succeeded because it builds on the existing health care structure to accomplish at least nine extraordinary goals:

1. First and foremost, it creates a system of subsidies that will allow all people--adults, children, working, not working--to access affordable health insurance.
    
2. It will protect people from financial ruin if they contract a disabling disease.
    
3. It will prevent insurance companies from canceling insurance policies when the policyholder gets sick.
    
4. It will provide workers with job mobility since insurance companies will no longer be permitted to deny coverage based on a preexisting condition.
    
5. It will make insurance affordable for middle-income people through a system of subsidies.
    
6. It will provide very low-income single adults with access to Medicaid.
    
7. It will make it affordable for small businesses to provide health insurance to their workers.
    
8. The doughnut hole will be eliminated and seniors will be able to afford their prescriptions.
    
9. Young adults--an age group that is particularly likely to be uninsured--will be able to remain on their parents' insurance policies until they turn 26.

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On March 21, the House of Representatives passed historic health insurance reform legislation. The House passed the reform bill previously passed by the Senate, which now becomes law upon the President’s signature (expected as early as March 23).  The House also passed a package of changes to the Senate bill that have been negotiated with the Senate, and which the Senate is expected to pass very soon (using the “reconciliation” procedure that requires a simple majority vote).

The package of reforms is a major step forward to provide Americans more security, more choices, and better cost control for their health care.  See the impact in your legislative district.

This is the end of the worst practices of the insurance industry—no more denials due to pre-existing conditions or dropping coverage for people who get sick, or hidden ceilings on your coverage.

We will all get the same insurance choices that Members of Congress have. What is good for them will be good for everyone.

We have kept what is good in our health system and added oversight of insurance practices, control of insurance rate increases, choice of plan and doctor, more competition, and expanded prevention.

Medicare will be strengthened—reform will cut waste and fraud in Medicare, improve solvency and close the gap in prescription drug coverage for seniors.

There will be access to affordable health care for 3.6 million small businesses and 32 million Americans who have been left out – until now.

The first order of business is to thank your House member, if he or she voted “yes”.  Here is the roll call.  This is VERY important – these are leaders who deserve thanks and support.

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Remember the show, Let’s Make a Deal, with Monty Hall? Well, it's back--sort of. For more than a year, Congress has been saying that it’s close to making a deal on legislation to overhaul America’s health care and financial systems. 

The original Let’s Make a Deal show was based on the show’s host, Monty Hall, offering deals to members of the audience. The contestants usually had to weigh the possibility of an offer being for a valuable prize, or an undesirable item. In its simplest format, a contestant was given a prize of medium value (such as a television set), and the host offered the contestant the opportunity to trade for another prize. However, the offered prize was unknown. It might be concealed on the stage behind one of three curtains, or behind "boxes" onstage, or within smaller boxes brought out to the audience.

Congress seems to have brought this classic TV game show back. “We’re close to a deal,” on health care legislation. “We’re close to a deal,” on financial reform legislation. 

Health Care Reform

The need across the country for health insurance reform has not abated. Americans agree that the nation's health insurance system is broken, but Congress still hasn’t sent a bill to President Obama to fix it. The current deal on the table is for the House to pass the Senate’s bill and then for both chambers to pass a budget reconciliation bill that resolves their differences. The proposed deal would ban insurance companies forever from denying coverage to children with preexisting conditions and from dropping coverage when an individual becomes sick. Insurance companies would no longer be able to randomly hike premiums or to impose lifetime or annual limits on the amount of care someone can receive. All new insurance plans would be required to offer free preventive care so that illnesses may be caught early. Young adults will be able to stay on their parents’ insurance policies until they are 26 years old. Uninsured individuals and small business owners would have the same kind of choice of private health insurance that members of Congress get for themselves. And individuals who do not have insurance coverage through a large group could be part of a bargaining pool that negotiates lower rates. Also, if an individual is ineligible for Medicaid but still can’t afford the insurance offered through the pool, she or he would receive a tax credit to assist with this cost. Finally, this deal would provide a new, independent appeals process if a claim has been unfairly denied.

It’s time for Congress to take the deal and make health insurance available and affordable for all.

Financial Regulation Reform

After the catastrophic financial crisis, President Obama called for the creation of an independent Consumer Financial Protection Agency, which would have as its sole mission the protection of consumers. It would create and enforce clear rules to ensure fairness of credit card terms and conditions, overdraft loan programs, payday and car title loans, and mortgages. In the fall, the House of Representatives passed legislation creating such a new Consumer Financial Protection Agency, which would provide the type of consumer protections that should have been in place all along. The Senate, however, has been debating the issue for months.

Specifically, Senate Republicans and the financial-services industry have opposed the creation of such an entity. Instead they would prefer that the Federal Reserve continue to be responsible for consumer protection as part of its regulation of nationally chartered banks. The central bank has always been responsible for the health of the nation's largest banks and the safety of American borrowers; however, its failures in both roles have been well documented. For years, the Federal Reserve primarily focused on monetary policy over bank supervision and often made consumer protection an afterthought. As a result, millions of American families have been left unprotected and financially unstable.

Additionally, the Federal Reserve only regulates banks, which would mean that the so-called shadow banking system of payday lenders, debt collectors, and loan originators and servicers would remain unregulated. The power of these entities has been demonstrated by the huge role they had in the current economic crisis. Allowing them to continue their predatory practices without being regulated would not be a deal on reform but rather a continuation of the status quo. Lawmakers have repeatedly said that they are close to a deal on this very divisive issue. Yet, proposals to let the Federal Reserve remain the primary regulator of consumer protection laws, is not a deal, it’s just the status quo. 

Well Monty, Where’s the Deal?

Congress seems to be weighing the possibility of whether reforming health care and financial systems will ultimately be valuable prizes, or undesirable items. Yet, rather than holding onto its existing undesirable prizes, Congress should choose Door #1, quality, affordable health insurance reform NOW and a dedicated agency to monitor and rein in the reckless behavior of financial institutions. 

Well Congress, where’s the deal?
 

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