Spread the Word: PCN is opening the enrollment window on June 2!

If you know anyone who still lacks health insurance and earns up to 100 percent of the Federal Poverty Level ($11,6700 for a single adult), please let them know that Utah’s Primary Care Network (PCN) has just announced a rare open enrollment beginning on June 2. PCN insurance is practically free (some minor co-pays), and covers primary care, prescriptions, dental work, emergency room visits, and more. (It does not cover hospital stays, scans, or specialists).

Here are the income guidelines for eligibility. Applicants also need to be 19 to 64 years of age, a U.S. citizen or legal resident, and lacking in health insurance.

PCN Guidelines
This will be for stop-gap health and dental coverage until Dec. 31, 2014, when it will expire unless the Feds approve an extension (which they probably will if Utah’s Medicaid expansion is still mired in politics). 

This is probably the last chance to get health insurance coverage for 2014, given that the open enrollment window has closed on Obamacare (except for those with qualifying “life events), and Medicaid expansion has been delayed. Currently 12,000 slots are filled; they will be able to accept about 8,000 applicants. SO SPREAD THE WORD: Anyone in need of health insurance and who fall under the maximum income guidelines, be sure to apply on June 2, which is next MONDAY!

Applicants can apply at online at https://jobs.utah.gov/mycase/ or download and print and application here: http://health.utah.gov/pcn/pdf/BOAapplicationEng.pdf


Politicians Take Notice: 76% of Utahns Want Medicaid Expansion!

While the state legislature continues to posture when it comes to the politics of Medicaid expansion, a recent poll shows 76 percent of Utah voters support a full Medicaid expansion, which would cover 111,000 currently uninsured people in the state. In the face of such unified support for expansion, you’d think the politicians would take notice — especially of the paltry 13 percent that supported House Speaker Becky Lockhart’s fantasy of using only state dollars rather than federal funs. Of those who support the expansion, 43 percent favored Gov. Herbert’s “Healthy Utah” plan, in which federal funds would be essentially block-granted and used for the purchase of private insurance plans, while 33 percent said they would prefer the typical Medicaid expansion, in which Medicaid dollars would go directly to the providers. Meanwhile, we await word on the latest news.

Utah’s Medicaid Expansion

Thanks to our friends at Utah Health Policy Project, here is a synopsis on what our future Medicaid Expansion is going to look like:

In late February Governor Herbert unveiled his Healthy Utah Plan to close Utah’s 57,000-person coverage gap. These are the Utahns who earn under 100% of the federal poverty level (FPL): Too little to purchase subsidized insurance on healthcare.gov, but too much to receive Medicaid. His proposal would give over 111,000 Utahns earning less than $15,521 (133% FPL) per year access to subsidized health insurance. The governor’s plan follows similar “private option” solutions currently operating in Arkansas and Iowa.

The Healthy Utah Plan is the governor’s alternative to Medicaid expansion. In mid-April he returned from meetings in Washington D.C. to report that the feds saw no deal breaker in the Healthy Utah proposal. There are three key elements in the governor’s plan that differentiate it from traditional Medicaid expansion.

Proposed Work Requirement: Similar to employment and training requirements to receive TANF benefits in Utah—the governor’s plan would require that those who are able to work do work, or at least look for work. The governor has acknowledged that there would be some who would not be able to work, and they would be excluded from this requirement.

Proposed Higher Copays: The plans proposes higher copays for medical services like office visits and prescription drugs. According to the governor, the purpose of additional copays is for beneficiaries to have some “skin-in-the-game.”

Proposed Higher Premium Payments: Recipients earning under 100% FPL would not be subject to higher premium payments. However, those earning from 101-133% FPL would face a sliding-scale premium model based on income. Similar approaches have been approved by the feds in 2 states: Iowa and Michigan.

All of these changes are still proposals.  Exact details are being worked out as the governor and the federal Department of Health and Human Services (HHS) continue their negotiations this spring. Any changes will also have to undergo a public hearing process. If the plan is “green-lighted” by HHS, the governor has indicated he may call a special session of the Utah legislature this summer or fall to approve it.

But here’s what we do know: Utahns are paying the cost to cover our uninsured. We pay through our state and federal taxes. We pay by subsidizing emergency room care. We pay by making charitable donations. The Governor’s Healthy Utah Plan closes the coverage gap, and extends insurance to low-income, working families.    Courtesy of Utah Health Policy Project

Healthcare.gov’s Back-end Blues

While the healthcare.gov website appears to be running smoothly, this belies the fact that the website’s back-end, which is responsible for pushing billions of dollars around between the government and the insurers, is still “under construction.” Government officials now state they hope to have everything running smoothly by the end of summer. Meanwhile, insurers will continue to be paid through what is being called an “interim” accounting process at least until September. Upside: This “interim” process doesn’t impact your access to advance premium tax credits or cost-sharing reductions. Downside: When the permanent system comes online, it could lead to a massive corruption exposing taxpayers to more costs or puts pressure on insurance companies to raise prices on premiums.

Another Doomed Attempt to Derail the ACA. Or Is It?

The U.S. House of Representatives has just passed a measure to delay the implementation of the tax penalty ($95 or 1% of your income) for one year, which marks the 50th time the House has voted to derail Obamacare. This measure has no possibility of passage by the Senate, and even if that were to happen, would certainly invite the president’s veto. Or would it? With so much waffling concerning implementation of the ACA — delay of the employer mandate, of the open enrollment period, and the extension of non-ACA-compliant policies into 2017 — one has to wonder. The mid-term elections seem to be taking their toll on the successful rollout of the ACA.

Junk Insurance Still Offered

Those junky older health insurance policies out of compliance with ACA reforms will still be allowed another two years (until 2017), no thanks to a recent ruling from the Obama administration. The cancellation of up to 4.7 million of these individual policies caused considerable political damage last year, just as the Health Insurance Marketplace was suffering from a disastrous rollout. Since then, the administration gave these older policies, most of them with far less financial protection and fewer benefits that what is allowed under the Affordable Care Act, a year’s reprieve, though the final decision as to their fate still relies on each state’s approval. (About half of all states continue to allow these plans in order to smooth the transition into ACA compliant policies.) This reprieve will affect up to 1.5 million people, who will now be able to hang onto these less-expensive plans until 2017.

New Timeline for 2014/15 Open Enrollment

The open enrollment window for sign-ups for 2015 plans has been delayed. Originally scheduled to begin October 15th, 2014, it will now start on Nov. 15th, 2014, and will run to Jan. 15th, 2015. In other words, we now have another option for putting a present under the Christmas Tree. This date change will also extend the enrollment period by a full week. Reason? By extending the deadline, this will allow insurance companies more time to accurately set their premium prices.

Medicaid Expansion on the Ropes

Everyone seems to be asking the same question: “Is Utah going to expand Medicaid.” The short answer seems to be: “Yes…maybe.” Gov. Gary Herbert has gone on record that “doing nothing is not an option.” Unfortunately, House Speaker Becky Lockhart (R-Provo) is rejecting any expansion plan that depends on federal funding, a position lampooned in a Salt Lake Tribune editorial as “drivel.” At this point, the State Senate appears more amenable to the idea of Medicaid expansion, while the House of Representatives is digging in its collective heels against the whole idea. Jim Dunnigan (R-Taylorsville), an insurance agency owner in private life, heads the legislative task force on Medicaid expansion, and appears to favor an option to privatize Medicaid dollars, using the money as grants to purchase private insurance on either the federal health exchange or possibly through Avenue H, the state small business exchange. The buzz is that there will be some expansion to cover those with incomes under the poverty level, who currently are locked out of receiving subsidies on the federal health exchange. But any expansion plan that does not include people up to 138 percent of the federal poverty level will have a hard time getting federal support. And if the Medicaid expansion only goes up to 100 percent of the Federal Poverty Level, the federal government’s share of the cost for that expansion drops from 100 percent to 70 percent. This has led some Utah representatives to suggest we forgo federal funds in favor of a state-funded approach that would allow much more flexibility in designing an expansion that may or may not include those below the Federal Poverty Level. The governor has said that the Medicaid predicament may not be solved by the time this 45-day session ends, and that it might take a special session of the Legislature later this year come up with a final solution. Bottomline: While we are optimistic that Medicaid expansion will take place in Utah, what at first looked like a slam dunk appears to be going into overtime. We had hoped that Medicaid expansion might happen as early as July 1st, but a Jan. 1st start date is looking more likely.

An Obamacare Alternative? Not.

Our own Sen. Orin Hatch is one of the three sponsors of the Republican alternative to Obamacare, which is called CARE. How does this plan compare to the ACA? Under Obamacare, you are no longer charged more for your insurance due to preexisting conditions. The Republican plan would also limit what you would be charged for preexisting conditions — but only if you are continuously insured. Those without insurance would still have to pay dearly because of any preexisting conditions. Under Obamacare, subsidies are granted for those earning up to 400 percent of the Federal Poverty Level. Under the Republican plan, those subsidies would be scaled back to 300 percent. Under Obamacare, the most an insurance company can charge the oldest enrollees is three times what a 21-year-old would pay. Under the Republican plan, insurance companies would be able to charge five times the same amount. As for Medicaid, the Republican plan would favor block grants, thus limiting expansion to pregnant women and children living below the Federal Poverty Level, and also give states the option of participating or not. Additionally, the Republican plan would repeal all of the taxes that pay for Obamacare and instead place a limit on the current tax exclusion for employer-sponsored insurance. This means that only 65 percent of the price of an average health plan would be tax-free, and the rest would have to be paid for with post-tax dollars. (It is estimated that the federal government could gain over $100 billion in revenue each year by taxing health plans.) Also, the Republican plan would get rid of the essential health benefits, as well as gender rating. Repeal Obamacare? I think not.

Utah Dithers on Medicaid Expansion

Utah is one of the few states still dithering on whether or not to expand Medicaid to cover people making up to 138 percent of the Federal Poverty Level (FPL), despite the Federal Government’s offer of paying 100 percent of the expansion cost until 2017, and 90 percent of all costs after 2020. (The Feds currently pay 70% of Medicaid costs.) What’s the rationale for not expanding Medicaid in Utah? (Apart from the economic boost it will give the state.) As one government insider told me, it boils down to this: “We don’t trust the federal government.” But this isn’t to say that Utah will not be expanding coverage. While Governor Herbert — and it’s his choice to make — is not considering a full expansion, he is still deciding between three options: do nothing; cover up to 100 percent of the FPL, leaving the rest to shop for federal subsidies on the Federal Marketplace; or partially expand Medicaid to 100 percent, and use Medicaid dollars to subsidize private insurance for those between 101 and 138 percent of FPL. This same government insider opined that option three, a privatization of Medicaid dollars, is the likeliest. This is partially due to the Medicaid Expansion task force being led by Chairman Rep. Jim Dunnigan, R-Taylorsville, who happens to be an insurance broker. His argument is that Medicaid restricts a person’s choice of doctors, while putting those at 100 to 138 percent of FPL into private plans on the Healthcare Marketplace with Medicaid-derived subsidies would benefit both patients and providers with more choices and higher reimbursements. This same government insider said this third option — contingent upon the Feds allowing this flexibility with Medicaid dollars — could be implemented by July 1st.

While I’m a firm supporter of Medicaid expansion, I’m willing to admit option three has some merit, as long as the state subsidies on the Health Marketplace are equal to or greater than what the Federal government provides. The important thing is to make sure everyone is covered. And to do this, the public has to keep the pressure on the governor. Most everyone who has weighed in — the AFL/CIO, League of Women’s Voters, even the Utah Hospital Association — support Medicaid expansion. (The LDS church is strangely silent on the issue.) To support Medicaid extension, write an email to Governor Herbert: http://act.betterutah.org/letter/medicaid_expansion/