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An advocate’s guide to King v Burwell

suprme court

On Wednesday, the Supreme Court heard oral arguments for the much anticipated King v. Burwell case, a case that threatens to eliminate tax credits to buy health insurance through the Affordable Care Act (ACA) marketplaces in approximately three dozen states, including Georgia.

Here at GHF, we are happy that the ACA is working and that more than 536,000 Georgians were able to access affordable health care coverage through the Health Insurance Marketplace during the most recent open enrollment period. We look forward to the Supreme Court’s decision in King v. Burwell and hope that it will be a positive outcome for the 461,000 Georgians who currently receive tax credits through the ACA. For now, health care coverage and tax subsidies for Georgia’s consumers remain unchanged.

There has been a lot of news coverage of the case this week and there are many resources available to help advocates communicate about the case to their supporters and stakeholders.

  • The Commonwealth Fund has a series of issue briefs about how subsidy shutdowns could affect consumers, health insurers, health care providers, and states. Each comes with a summary infographic.
  • The Commonwealth Fund also has an interactive map of the potential impact of a subsidy shutdown on each state.
  • Community Catalyst mapped the potential impact by congressional district.
  • The Urban Institute has put together a report about the implications of King v. Burwell on uninsured rates, changes in types of coverage, and costs of insurance.

 


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Questions about tax time and health insurance?

 

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If you are a consumer who enrolled in health insurance through the Marketplace with a tax credit, you likely received a 1095-A form in the mail. You may also have some questions about how to complete the health insurance information on your tax filing form. If your organization works directly with consumers, either providing enrollment assistance or helping them with tax preparation, you may also be hearing about the 1095-A and may have some questions about how health insurance and tax filings intersect. Below is a primer, replete with flow chart, which breaks it all down for you.

Where consumers get their coverage—Marketplace, employer, Medicaid—will determine the impact coverage has on their taxes.  Consumers who have health insurance through their jobs will likely see no changes when they file their taxes – they just check the box on their tax forms indicating they had coverage throughout the year.  The same thing applies to consumers who are covered by Medicaid, Medicare, or their parent’s health plan.  Pretty simple!

During this year’s open enrollment period, 536,929 Georgians purchased health insurance through Healthcare.gov and about 90% received financial assistance to help lower the cost of their premiums.  To keep that tax credit, they’ll have to fill out Form 8962, which asks questions about their health insurance and their income. To help complete that form, all consumers that received a tax credit should have received Form 1095-A in the mail from the Marketplace. Consumers can also find this form on their Healthcare.gov account.

The health insurance tax credit is based on income and household size. When consumers applied for coverage, they estimated their income for the coming year and that amount was used to determine their tax credit. If a consumer misestimated their income, the credit they received may be too high or too low. During the tax filing process, the difference between estimated and actual income is reconciled, and the corresponding tax credit may be adjusted up or down.  This means some consumers may get a refund and some consumers may have to pay back part of their tax credit. If a consumer did not apply for a tax credit previously, they can apply for a credit to be included in their tax refund.

If a consumer went without health care coverage at any point in the year, they may need to fill out an additional Form 8965 to determine whether or not they will need to pay a fine. This year the maximum fee per family will be $285, but fines will increase each year, up to 2% of a person’s annual income.  If a person falls into Georgia’s coverage gap, they will not have to pay the fine, but will need to file the appropriate documents to prove they do not have access to affordable coverage

Household, family, and income changes should be reported throughout the year to Healthcare.gov in order to avoid surprises at tax time.

If you have questions about how your health coverage may affect your taxes, consult a tax professional.  Our partners at Georgia Watch can connect you with free tax preparation help—just click here.

 

 


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So you have coverage…now what?

If you have recently gained health insurance through the Health Insurance Marketplace, it may seem like you need to learn a whole new language to understand your coverage. Health insurance can be confusing, especially if you have never had it before or haven’t had it in a while. Just understanding a few key terms, such as premium, deductible and co-pay, will go a long way in helping you use your health insurance effectively. Click here for a simple guide to help you understand your new coverage. Additionally, if you are having trouble using your health insurance you can contact Whitney Griggs, GHF’s Consumer Education Specialist, at wgriggs@healthyfuturega.org or at (404) 567-5016, extension 5.


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Miss open enrollment? You still may be able to get coverage!

Open Enrollment has officially ended but some Georgians that missed signing up during the three month period may be able to still get coverage. Those “in line” during this last three days of Open Enrollment who were unable to select a plan due to long call center wait times or technical issues have until Sunday, February 22 to enroll. In this circumstance, coverage will begin March 1st.  Otherwise, consumers who have a “qualifying event” may be able to get coverage through a Special Enrollment Period. Special Enrollment Periods can occur at any time during the year and are usually triggered by specific events. These events include life changes such as a marriage, birth, change in eligible immigration status and a permanent move. Another type of event that could qualify consumers is a loss of other health coverage. These types of events could include an involuntary loss of employer coverage, loss of Medicaid coverage, and a death or divorce that results in a loss of coverage. In most cases, the Special Enrollment Period lasts for 60 days after the qualifying event occurs. To learn more about what types of events could trigger a Special Enrollment period, click here. If you think you may qualify, visit https://www.healthcare.gov/get-coverage or https://localhelp.healthcare.gov/ to find in-person assistance in your area.

 

Additionally, the Centers for Medicaid and Medicare Services just announced a Special Enrollment Period for tax season for consumers who were penalized for not having coverage in 2014 and are not currently enrolled in health insurance. To qualify for this Special Enrollment Period consumers must also attest that they were not aware of the penalty for not having health insurance until after the end of Open Enrollment (February 15th , 2015) because they filed their 2014 tax return after that date. This Special Enrollment Period will begin March 15th and end April 30th, 2015. Click here to learn more about the announcement.

 


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More than half a millions enrolled in Marketplace coverage!

Open Enrollment for the Health Insurance Marketplace ended Sunday and more than half a million Georgians enrolled in plans through the Marketplace! Georgia’s enrollment was the fourth highest of states using the Federally Facilitated Marketplace, trailing only behind Texas, Florida, and North Carolina. The state’s enrollment numbers passed the 500,000 mark in large part due to a last minute surge in sign-ups. This year’s enrollment numbers greatly exceed last year’s enrollments of 316, 543. Nationally, 11.4 million Americans selected plans or were automatically re-enrolled through the Marketplace. Click here to learn more about Georgia’s enrollment numbers. For Georgians who begun the enrollment process prior to the deadline but, due to issues with either healthcare.gov or call centers, were unable to complete their enrollment, CMS has extended a Special Enrollment Period (SEP).  These people are “in line” and still eligible to enroll this year.  This SEP will end February 22nd.  If you or someone you know thinks they qualify for this extended enrollment period visit HealthCare.gov or call the Marketplace Call Center at 1-800-318-2596


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King v Burwell: what’s at stake for Georgia?

King Burwell Potential ResultOn March 4th, the United States Supreme Court will hear oral arguments in King v. Burwell, a lawsuit challenging the tax credits that consumers utilizing the federal Health Insurance Marketplace receive to help make health insurance affordable. Consumers in thirty-four states, including Georgia, use the federal Marketplace to find and enroll in coverage. Nearly nine out of 10 people who enrolled in coverage through healthcare.gov received financial help and paid 75 percent less than the full monthly premium. This has helped bring the nation’s uninsured rate to an historic low.

 

A study by the Robert Wood Johnson Foundation and the Urban Institute found that the majority of health care consumers who would be impacted and who would likely become uninsured if the tax credits were struck down live in the South. Here in Georgia, hundreds of thousands of people are at risk for becoming uninsured.

 

We believe there is no legal basis for this challenge and that in June, when a decision comes down, we’ll all breathe a sigh of relief. If the court does, however, strike down the tax credits, such a decision would disproportionately impact the South and would put states like Georgia at a competitive disadvantage by exacerbating existing regional health disparities. If this comes to pass, Georgians for a Healthy Future will advocate for a contingency plan to ensure that Georgians have the same access to tax credits that their counterparts in states like New York, California, Colorado, and Kentucky (states that set up their own health insurance exchanges) have.

 

Our friends at Families USA have put together a resource page for advocates interested in learning more about King v. Burwell.


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Network Adequacy: Action Alert

If you’ve been following the Peach Pulse you know that network adequacy is a hot topic in health care right now. (And if you missed it, check here and here to get caught up!) Decision-makers are weighing policy choices that will have implications for health care consumers in Georgia and across the nation. We know that they are hearing from health industry stakeholders; now they need to hear from you!

 

1) The US Department of Health and Human Services (HHS) Proposed Rule on the 2016 Notice of Benefit and Payment Parameters is open for comment until December 22, 2014.  To submit a comment, click here.

 

2) The National Association of Insurance Commissioners (NAIC) is currently updating its model act on network adequacy. This model provides an example that states can use to enact their own legal protections to guarantee private insurance consumers an adequate provider network once they are enrolled in coverage. Advocates can email jmatthews@naic.org until January 12, 2015 with input.

 

Consumer advocates are asking these two entities to put in place 1) specific network adequacy standards such as time and distance standards and appointment wait time standards and 2) rules that provide consumers the right to go out-of-network at no extra cost if their plan cannot provide them timely, geographically accessible, and appropriate in-network care. Please take a few moments to submit your comments to HHS and to the NAIC with this important request. If your organization is interested in engaging more deeply on this issue, please contact Laura Colbert at lcobert@healthyfuturega.org to let us know you’re interested in collaborating.

 

 

 


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GHF welcomes new health insurance navigator!

IMG_9114Georgians for a Healthy Future is excited to welcome Nykita Howell, our new Health Insurance Navigator, who joined us this week! In this role, Nykita provides Marketplace enrollment assistance to Georgia health care consumers. Prior to joining Georgians for a Healthy Future, Nykita worked in the fields of clinical and community based research and as a navigator for the first open enrollment period of the Health Insurance Marketplace. Her research efforts have been on studies focused on retention strategies for an NIH-funded cohort based at Umass Medical School, and a church-based diabetes project housed at Mercer University. Her work as a navigator prior to joining Georgians for a Healthy Future included building community partnerships and educating consumers over a seven county area. She holds an MPH from Mercer University School of Medicine and is a Certified Health Education Specialist. Prior to her graduate studies, Nykita received her B.S. in Biology from Clark Atlanta University, in Atlanta, GA. If you or anyone you know needs assistance navigating the health care system, please contact Nykita at nhowell@healthyfuturega.org or 404-567-5016. Remember, open enrollment begins Nov. 15th—just one month away!


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Network Adequacy Explained

When consumers enroll in a health insurance plan, they gain access to a network of medical providers. Insurance companies contract with a range of providers, including both primary care and specialty physicians, to deliver health care services included within the plan’s benefit package. This network of providers must be adequate to ensure that consumers enrolled in the plan have reasonable access to all covered benefits. This is what is meant by network adequacy. More specifically, to be considered adequate, a network must provide adequate numbers, types, and geographic distribution of providers; must ensure that access to care is timely; and must include essential community providers that serve predominantly low-income, medically underserved individuals. Additionally, accurate information about providers must be made available to consumers.

 

Network adequacy has become a hot topic over the past several months because many consumers who enrolled in new health plans through the Health Insurance Marketplace found that their plan came with a narrow network of providers. Provider directories weren’t always accurate or up-to-date, and consumers expressed a fair amount of confusion over which providers were in their plan’s network.

 

At the same time, the National Association of Insurance Commissioners (NAIC), which develops model laws and rules that states often adopt, has been working to update its network adequacy model law. Stakeholders ranging from insurers to medical providers to patient and consumer advocates are weighing in on this process, making network adequacy a hot topic in the policy arena too. Georgians for a Healthy Future has been monitoring this process through the participation of our executive director as one of the consumer representatives to the NAIC. Earlier this summer, the consumer representatives submitted comments to the NAIC focusing on developing a stronger standard and better oversight of network adequacy, an end to “balance billing” by out-of-network providers in in-network facilities, and greater transparency of provider networks.

 

Georgians for a Healthy Future will continue to monitor this process and will advocate at all levels, in conjunction with state and national partners, to ensure consumers have meaningful access to care.

 

If you are an individual consumer enrolled in a commercial health plan and the provider directory you were given was incorrect or if you have concerns about your ability to access covered services under your plan, please contact the Georgia Office of Insurance & Fire Safety, Consumer Services Division by calling (800) 656-2298 or use the Consumer Complaint Portal at www.oci.ga.gov/ConsumerService. Please also consider sharing your story with Georgians for a Healthy Future so we can get a better picture of what is happening in our state.

 

For more information on network adequacy, please see the following reports and resources:

From Georgetown Center on Health Insurance Reforms: Reforming State Regulation of Provider Networks: Efforts at the NAIC to Re-Draft a Model State Law

 

From Robert Wood Johnson Foundation and Georgetown University Health Policy Institute: ACA Implications for State Network Adequacy Standards

 

From Families USA: Network Adequacy and Health Equity: Improving Private Health Insurance Networks for Communities of Color

 


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Covering Kids & Parents

healthy kids logoCovering Kids & Parents: Health Insurance for the Whole Family 

New from GHF!

 

All kids need reliable access to quality health care.  Children need to see the doctor even when they are healthy:  shots for school, well-child visits, and dental care are all important for kids to grow up healthy and strong.  Their parents need coverage too to stay on track with regular screenings and preventive care, to access the health care system if they become sick, and to experience the financial peace of mind that comes with being covered.

 

Thanks to new health insurance options available through the Marketplace, the uninsured rate among parents is dropping. Still, too many of Georgia’s low-income parents fall into what has become known as the “coverage gap,” meaning they don’t earn enough to qualify for subsidized private insurance and they earn too much to qualify for Medicaid because Georgia has so far declined to join the 27 states (and counting!) who have expanded Medicaid.

 

In an effort to provide accurate information to parents about the coverage options for themselves and their children, GHF has created a set of fact sheets about health insurance coverage for kids and parents in Georgia.  These fact sheets are intended to be a resource for individual consumers and for organizations who represent or provide services for Georgia families.

 

Affordable Health Care for Your Children and For Uninsured Parents help parents understand the coverage options for themselves and their children. If you work with low- to moderate-income families through a charity care clinic, at a school or church, or in a community-based organization, you may want to provide these resources to the families you serve.

 

Covering Kids paints a picture for policy makers and the media who want to better understand children’s health care coverage in Georgia.  If you work with policy makers or want to talk to your legislators about health care coverage for kids, this fact sheet will be a helpful resource.

 

fourth fact sheet serves as a reference for those who need to know the income limits for the Medicaid and PeachCare programs.

 

You can view and download these new fact sheets on the GHF website. If you would like hard copies to distribute to your members, clients, or community partners, please contact Laura Colbert, GHF’s Community Outreach Manager.

 


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