Now in Effect: ACA Pre-existing Conditions, Small Business Health Insurance Tax Credit

Establishing the Health Insurance Marketplace

Effective January 1, 2014

Starting in 2014 if your employer doesn’t offer insurance, you will be able to buy it directly in the Health Insurance Marketplace. Individuals and small businesses can buy affordable and qualified health benefit plans in this new transparent and competitive insurance marketplace. The Marketplace will offer you a choice of health plans that meet certain benefits and cost standards. Starting in 2014, Members of Congress will be getting their health care insurance through the Marketplace, and you will be able buy your insurance through Marketplace too.

Learn more about the Health Insurance Marketplace.

Promoting Individual Responsibility

Effective January 1, 2014

Under the new law, most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee to help offset the costs of caring for uninsured Americans.  If affordable coverage is not available to an individual, he or she will be eligible for an exemption.

Learn more about individual responsibility and the law

Increasing Access to Medicaid

Effective January 1, 2014

Americans who earn less than 133% of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid. States will receive 100% federal funding for the first three years to support this expanded coverage, phasing to 90% federal funding in subsequent years.

Learn more about Medicaid

Makes Care More Affordable

Effective January 1, 2014

Tax credits to help the middle class afford insurance will become available for those with income between 100% and 400% of the poverty line who are not eligible for other affordable coverage. (In 2010, 400% of the poverty line comes out to about $43,000 for an individual or $88,000 for a family of four.) The tax credit is advanceable, so it can lower your premium payments each month, rather than making you wait for tax time. It’s also refundable, so even moderate income families can receive the full benefit of the credit.  These individuals may also qualify for reduced cost-sharing (copayments, co-insurance, and deductibles).

Learn how the law will make care more affordable in 2014

Ensuring Coverage for Individuals Participating in Clinical Trials

Effective January 1, 2014

Insurers will be prohibited from dropping or limiting coverage because an individual chooses to participate in a clinical trial. This applies to all clinical trials that treat cancer or other life-threatening diseases. 

Eliminating Annual Limits on Insurance Coverage

Effective January 1, 2014

The law prohibits new plans and existing group plans from imposing annual dollar limits on the amount of coverage an individual may receive.

Learn how the law will phase out annual limits by 2014

No Discrimination Due to Pre-Existing Conditions or Gender

Effective January 1, 2014

The law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also, in the individual and small group market, it eliminates the ability of insurance companies to charge higher rates due to gender or health status.

Learn more about protecting Americans with pre-existing conditions

Increasing Small Business Health Insurance Tax Credit

Effective January 1, 2014   

The law implements the second phase of the small business tax credit for qualified small businesses and small non-profit organizations. In this phase, the credit is up to 50% of the employer’s contribution to provide health insurance for employees.  There is also up to a 35% credit for small non-profit organizations.

Learn more about the small business tax credit

 

Healthcare.gov Marketplace Fact Sheets

If you’re a professional learning about the Marketplace and helping people apply, or if you’re a consumer ready to learn about and buy health insurance, below are links to quick Fact Sheets that may help you:

• What to know about seeing your doctor -http://marketplace.cms.gov/getofficialresources/publications-and-articles/seeing-your-doctor.pdf
• What to know about getting your prescription medications - http://marketplace.cms.gov/getofficialresources/publications-and-articles/getting-your-prescription-medications.pdf
• Appealing your insurers' decision not to pay - http://marketplace.cms.gov/getofficialresources/publications-and-articles/appealing-your-insurers-decision-not-to-pay.PDF
• I signed up, but don't have health coverage. What should I do? - http://marketplace.cms.gov/getofficialresources/publications-and-articles/signed-up-but-no-coverage.pdf
• Getting emergency care - http://marketplace.cms.gov/getofficialresources/publications-and-articles/getting-emergency-care.pdf
• What you should know about early renewal of health coverage - http://marketplace.cms.gov/getofficialresources/publications-and-articles/early-renewal-of-coverage.pdf
• What you should know about provider networks - http://marketplace.cms.gov/getofficialresources/publications-and-articles/what-you-should-know-provider-networks.pdf
• IRS factsheet: http://www.irs.gov/pub/irs-pdf/p5120.pdf

Go to the Health Insurance Marketplace website for more information and to enroll. 

Health Insurance Literacy Low Among Medicaid and Exchange Populations

Public Understanding of Basic Health Insurance Concepts on the Eve of Health Reform

Linda J. Blumberg, Sharon K. Long, Genevieve M. Kenney, and Dana Goin

A central objective of the Affordable Care Act (ACA) is to reduce the number of Americans without health insurance. Providing the opportunity to purchase private insurance through the new health insurance Marketplaces (also called Exchanges) is one of the major ways in which this goal is to be achieved.

The people most likely to enroll in Marketplace-based coverage—those the ACA Marketplaces are specifically designed to help—are nonelderly adults with incomes above the national Medicaid-eligibility cutoff (138 percent of the federal poverty level, or FPL) who are currently uninsured or are purchasing individual coverage. Many qualify for Marketplace subsidies because they are not eligible to buy health insurance through an employer or other group coverage or because their available employer-sponsored coverage is unaffordable.

The new Marketplaces will offer a multitude of choices with differing costs and benefits, although all will include coverage within ACA-defined categories of essential health benefits. This brief focuses on how well the target population understands the concepts they will confront as they make their insurance choices.

Plenty of information will be available to them. States and the federal government will be providing a great deal of information on the multiple options available through the Marketplaces. Insurance agents, brokers, navigators, in-person assistors, and call center personnel will also be deeply involved in providing support to potential consumers. But insurance is a complex product, particularly for those without prior experience purchasing coverage. If consumers do not understand basic insurance concepts, they will find it hard to make the choices that best suit themselves and their families.

Go to http://hrms.urban.org/briefs/hrms_literacy.html to read the entire report.

Proven Ideas to Improve Insurance Enrollment

Proven Ideas to Improve Insurance Enrollment A new report released by Maximizing Enrollment, an initiative of the Robert Wood Johnson Foundation, highlights innovative approaches to support streamlining eligibility determinations and boosting enrollment of those eligible in Medicaid and the Children’s Health Insurance Program—meaning that people have faster access to coverage and remain covered. Since 2009, eight states have pursued unique approaches to manage programmatic changes aimed at lowering ‘disenrollment’ by improving communications with partner agencies and programs as well as those enrolled in health coverage; promoting data analysis to make informed decisions; and providing effective and innovative leadership. The lessons learned by these states, all of which participated in the Maximizing Enrollment program, are especially timely as the Affordable Care Act is implemented. Learn how each state is keeping consumers enrolled.

Funding Opportunity: Utah Cancer Control Program (UCCP) Request for Grant Applications (RGA)

The Utah Cancer Control Program (UCCP) is excited to release the attached "Request for Grant Applications" (RGA). Organizations may submit applications to receive $15,000 to $20,000 for projects fitting the "Scope of Work" in the RGA. The UCCP anticipates funding three to six awards. Applications must be submitted by January 21, 2014.

The application packet is available online at http://cancerutah.org/fy15awards/. A recording from the first technical assistance webinar, and a list of Frequently Asked Questions are available on this site. You may also register for the technical assistance webinar coming up on January 7.

Please pass this on to any of your contacts who may be interested. Opportunities are available to address primary prevention (physical activity and nutrition), as well as cancer screening.

Lynne Nilson, MPH, MCHES

Director Utah Cancer Control Program

lpnilson@utah.gov

(801) 538-7049

New National Survey of Pacific Islander Health

Posted by Kiran Ahuja on December 18, 2013 at 10:49 AM EST

Over the last four years at the White House Initiative on Asian Americans and Pacific Islanders (WHIAAPI), we have been working with federal agencies across the board to improve data collection, analysis, and dissemination of findings and reports on Asian Americans and Native Hawaiians and Pacific Islanders (NHPIs).  We have been particularly focused on NHPIs, who, according to the 2010 U.S. Census, comprise just 0.4 percent of the total U.S. population, making it difficult to include them in sufficient numbers in most national population-based health surveys. The lack of reliable health data for this population has made it difficult to assess their health status and health care utilization. However, the available data for this population indicates that Native Hawaiians and Pacific Islanders experience significant health disparities when compared to other groups, such as lower utilization of health care services and higher rates of chronic diseases, such as diabetes and obesity.

That's why we welcome the announcement made today that the U.S. Department of Health and Human Services (HHS) will  launch the first-ever, large-scale national health survey to collect detailed health information on NHPI households<http://www.cdc.gov/media/releases/2013/p1217-pacific-islanders.html> - the Native Hawaiian/Pacific Islander National Health Interview Survey. This information will be collected through HHS' National Health Interview Survey<http://www.cdc.gov/nchs/nhis.htm>, the nation's largest in-person, household health survey. Never before has there been a study of this scale to assess the health needs of NHPIs, and this type of survey has long been called for by the NHPI community. This important effort will help improve our understanding of the health concerns - from access to health care to health insurance coverage to rates of chronic diseases like diabetes or heart disease - faced by this community and to identify areas of opportunity for federal government to better address these concerns.

WHIAAPI encourages advocates and organizations across the country to join us in spreading the word about this landmark survey.  We hope you can continue the conversation with us on Twitter using #NHPI<https://twitter.com/search?q=%23NHPI&src=typd>.

Our hope is that the results of this study will provide researchers, policymakers, and community leaders with the data they need to understand and address disparities in health and health care, and provide lessons for data collection and analysis focused on small populations.

The Native Hawaiian/Pacific Islander National Health Interview Survey will begin early next year, and the results will become available summer 2015.

Kiran Ahuja is the Executive Director of the White House Initiative on Asian Americans and Pacific Islanders.

Holiday Greetings from OHD and the White House