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Granite State Rumblings: The Dire Consequences Of ACA Repeal In NH

Last week we took a broad look at what repeal of the Affordable Care Act could mean for Medicaid and CHIP. This week let’s dig a little further into what the repeal would mean to children.

Repeal of the ACA would have particularly dire consequences for the 4.4 million children who would become uninsured. Health insurance for children has long-term positive outcomes, such as reductions in infant mortality and childhood deaths, improved health, and reduced disability. But there are subtler effects, too: expanding health coverage for low-income children improves high school and postsecondary success, and also employment over the long haul. Plus, children’s life chances are improved when parents are able to get the care they need, like treatment for depression (which is widespread among low-income mothers of young children). In states that have expanded Medicaid under the ACA, many more parents have health insurance, making access to treatment for behavioral health or substance use disorders more available, which helps parents’ own health and improves outcomes for their children.  ~ Source: CLASP ~

10 Reasons Why Repealing the ACA Would Harm Kids

  1. If health reform were repealed, insurers would go back to denying coverage for children with pre-existing conditions. Parents of children with cancer, children born with a birth defect, children with asthma, special-needs kids, among others, would once again be unable to get coverage for their kids without the Affordable Care Act.
  2. Insurers would return to the practice of placing lifetime limits on coverage so that if a child is fortunate enough to beat leukemia when they are 8 they would be uninsurable if they face another serious illness later in life.
  3. Dependent children through age 26 would not be guaranteed access to coverage on their parents’ policy, leaving scores of young adults, including recent high school and college grads, back among the ranks of the uninsured.
  4. Insurers would not have to cover vision care services or eyeglasses for children even if it is impossible for a child to be successful in school if they can’t see
  5. Insurers also would not be required to cover dental care, a horrible return to the days when lack of coverage could cause a child to die from an infected tooth that could have been addressed for about 100.
  6. Repealing health reform would jeopardize the future of the successful Children’s Health Insurance Program (CHIP), a federal-state program that offers low or no-cost coverage for families who earn too much to qualify for Medicaid but not enough to buy their own coverage. CHIP and Medicaid were crucial for families during the recession, ensuring that coverage for kids remained stable despite the downturn in the economy.
  7. Children with terminal illnesses would be returned to the days when they would not be able to get compassionate end-of-life hospice care unless they agreed to forgo looking for a cure for their illness.
  8. Insurers would be allowed to resume the practice of charging co-payments for preventive health services, including essential well-baby and well-child visits, and vaccinations, creating financial disincentives for parents to get care for their children that keeps them healthy.
  9. Children in foster care would no longer qualify for Medicaid beyond age 18. This provision parallels the one enabling young adults to remain on their parents’ health plans until they turn 26.
  10. Efforts to eliminate bureaucratic red tape and streamline enrollment processes for children who are already eligible but not enrolled in public health coverage would suffer if health reform was repealed. Nearly two-thirds of children who are uninsured actually qualify for coverage but face significant barriers that make it difficult for them to sign-up or re-enroll for coverage.

As we explained last week, through the Affordable Care Act, Medicaid and the Children’s Health Insurance Program (CHIP) have worked in unison to dramatically cut the ranks of the uninsured across the country. CHIP has provided coverage to the almost eight million children whose families currently or once lived in the coverage gap. 

Because of the options available under the ACA the percentage of uninsured children has dropped from 14.9 percent in 1997 to just 4.8 percent in 2015 — a 68 percent reduction. That is impressive! 

Medicaid and CHIP have also been an option for many parents who can participate in a health insurance option through their employers, but because of costs associated with employer based coverage have turned instead to these programs.

Michelle Andrews with Kaiser Health News, a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation wrote about this in a recent article.

Many Parents With Job-Based Coverage Still Turn To Medicaid, CHIP To Insure Kids

By Michelle Andrews, December 9, 2016

Lower income parents who have health insurance through their employers are increasingly likely to forgo family coverage and enroll their kids in Medicaid or the Children’s Health Insurance Program (CHIP) instead, a new study found. Working families’ growing reliance on these programs is something lawmakers should keep in mind when they consider whether to renew financing for the CHIP program in 2017, the study’s lead author said.

“These aren’t just safety net programs for uninsured families,” said Douglas Strane, a clinical research associate at PolicyLab at the Children’s Hospital of Philadelphia and the lead author of the study, which appeared in the December issue of Health Affairs. “If CHIP isn’t renewed, we could place substantial pressure on working families.”

Medicaid is the state-federal program that provides health coverage for low-income adults and children. CHIP provides health insurance for children in families whose incomes are modest but too high to qualify for Medicaid. In 2016, only three states — Arizona, Idaho and North Dakota — limited Medicaid/CHIP coverage to children whose families have incomes less than 200 percent of the federal poverty level ($40,320 for a family of three). In contrast, 19 states offered coverage to children with family incomes greater than 300 percent of the federal poverty level ($60,480 for a three-person family), according to the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

Medicaid/CHIP out-of-pocket costs vary by state, but coverage is generally significantly less expensive than employer coverage.

Health Affairs study analyzed data from the Medical Expenditure Panel Survey between 2008 and 2013 for families with incomes between 100 and 400 percent of the federal poverty level in which at least one parent had employer-sponsored coverage. The study predated the opening of the health law’s marketplaces, but the researchers said that because these families had employer-based coverage options, they would likely not qualify for less expensive coverage on the exchanges.

Over the course of the study, nearly all the families in which a parent was offered coverage accepted it for the parent, and about three-quarters of children in the sample were covered by their parents’ employer-sponsored plan, on average.

But the proportion of kids who lacked employer-sponsored coverage even though at least one parent had it grew from 22.5 percent in 2008 to 25 percent in 2013, the study found. Likewise, the percentage of children who were on Medicaid or CHIP even though at least one parent had coverage through an employer increased 3.1 percentage points, to 15.2 percent, over the course of the study.

Premium increases for employer-sponsored coverage may put a family plan out of reach for low- and moderate-income families, said Strane. Between 2006 and 2016 premiums rose 58 percent for family coverage, according to the Kaiser Family Foundation’s 2016 annual survey of employer-sponsored coverage. This year, families pay $5,277 for coverage on average, 29 percent of the total cost of the plan. Workers’ share of the premium grew 78 percent over the past decade, outpacing the growth in premiums, according to the KFF study.

“They did the math and likely figured CHIP was going to save them money,” said Strane.

There is a lot at stake for children and families as the plan to repeal the Affordable Care Act moves forward. And we need your help!

Personal stories are the most powerful tools we have in our fight to protect access to affordable, high-quality healthcare for all children and their families. By telling your story in support of CHIP, Medicaid and the consumer protections gained under the Affordable Care Act, you help put a face to how kids and families will be impacted by the threat to repeal the Affordable Care Act and dismantle Medicaid and CHIP.

Every Child Matters in NH and Maine are collecting stories from those who have benefitted from Medicaid and CHIP.

Please share this link and help us collect real life stories that we will share with our members of Congress and the new Administration in Washington. We have the data; now we need your story!

Impact of the Affordable Care Act in New Hampshire

Thousands of Granite Staters have gained coverage, and hundreds of thousands more have had their coverage substantially improved.

The U.S. Department of Health and Human Services released an extensive compilation of state-level data illustrating the substantial improvements in health care for all Americans over the last six years. The data show that the uninsured rate in New Hampshire has fallen by 43 percent since the Affordable Care Act (ACA) was enacted in 2010, translating into 63,000 Granite Staters gaining coverage. And, in addition to residents who would otherwise be uninsured, hundreds of thousands more Granite Staters with employer, Medicaid, individual market, or Medicare coverage have also benefited from new protections as a result of the law.

“As our nation debates changes to the health care system, it’s important to take stock of where we are today compared to where we were before the Affordable Care Act,” said Secretary Sylvia M. Burwell. “Whether New Hampshirites get coverage through an employer, Medicaid, the individual market, or Medicare, they have better health coverage and care today as a result of the ACA. Millions of Americans with all types of coverage have a stake in the future of health reform. We need to build on our progress and continue to improve health care access, quality, and affordability, not move our system backward.”

Highlights of the data release include:

Employer Coverage: 853,000 people in New Hampshire are covered through employer-sponsored health plans. Since the ACA was enacted in 2010, this group has seen:

  • An end to annual and lifetime limits: Before the ACA, 545,000 Granite Staters with employer or individual market coverage had a lifetime limit on their insurance policy. That meant their coverage could end exactly when they needed it most. The ACA prohibits annual and lifetime limits on policies, so all New Hampshirites with employer plans now have coverage that’s there when they need it.
  • Young adults covered until age 26: An estimated 9,000 young adults in New Hampshire have benefited from the ACA provision that allows kids to stay on their parents’ health insurance up to age 26.
  • Free preventive care: Under the ACA, health plans must cover preventive services — like flu shots, cancer screenings, contraception, and mammograms – at no extra cost to consumers. This provision benefits 690,524 people in New Hampshire, most of whom have employer coverage.
  • Slower premium growth: The average premium for New Hampshire families with employer coverage grew 4.8 percent per year from 2010-2015, compared with 7.3 percent over the previous decade. Assuming New Hampshire premiums grew in line with the national average in 2016, family premiums in New Hampshire are $3,300 lower today than if growth had matched the pre-ACA decade.
  • Better value through the 80/20 rule: Because of the ACA, health insurance companies must spend at least 80 cents of each premium dollar on health care or care improvements, rather than administrative costs like salaries or marketing, or else give consumers a refund. Granite Staters with employer coverage have received $2,264,293 in insurance refunds since 2012.

Medicaid: 189,429 people in New Hampshire are covered by Medicaid or the Children’s Health Insurance Program, including 94,622 children and 20,839 seniors and people with disabilities covered by both Medicaid and Medicare. The ACA expanded Medicaid eligibility and strengthened the program for those already eligible.

  • 22,000 Granite Staters have gained coverage through Medicaid: An estimated 22,000 New Hampshire residents have health insurance today because New Hampshire expanded Medicaid under the ACA. Coverage improves access to care, financial security, and health, resulting in an estimated 3,000 more Granite Staters getting all needed care, 3,200 fewer Granite Staters struggling to pay medical bills, and 30 avoided deaths each year.
  • Thousands of Granite Staters with a mental illness or substance use disorder are getting care: Thanks to expansion and improved access to treatment, an estimated 2,000 fewer Granite Staters are experiencing symptoms of depression.
  • New Hampshire is saving millions in uncompensated care costs: Instead of spending $20 million on uncompensated care, which increases costs for everyone, New Hampshire is getting $210 million in federal support to provide low-income adults with much needed coverage.
  • Children, people with disabilities, and seniors can more easily access Medicaid coverage: The ACA streamlined Medicaid eligibility processes, eliminating hurdles so that vulnerable Granite Staters could more easily access and maintain coverage.
  • New Hampshire is improving behavioral health: Under the ACA, CMS is helping New Hampshire link payments with improved outcomes for beneficiaries with co-morbid conditions; customize expansions/ enhancements to specific populations; and spread integration efforts to new areas of the state.

Individual market: 49,114 people in New Hampshire have coverage through the Marketplace. Individual market coverage is dramatically better compared to before the ACA:

  • No discrimination based on pre-existing conditions: Up to 597,050 people in New Hampshire have a pre-existing health condition. Before the ACA, these Granite Staters could have been denied coverage or charged an exorbitant price if they needed individual market coverage. Now, health insurance companies cannot refuse coverage or charge people more because of pre-existing conditions.
  • Tax credits available to help pay for coverage: Before the ACA, only those with employer coverage generally got tax benefits to help pay for health insurance. Now, 31,151 moderate- and middle-income Granite State resudents receive tax credits averaging $261 per month to help them get covered through HealthCare.gov.
  • Women pay the same as men: Before the ACA, women were often charged more than men just because of their gender. That is now illegal thanks to the ACA, protecting roughly half the people of New Hampshire.
  • Greater transparency and choice: Before the ACA, it was virtually impossible for consumers to effectively compare insurance plan prices and shop for the best value. Under the ACA, New Hampshire has received $9 million in federal funding to provide a more transparent marketplace where consumers can easily compare plans, choosing among 32 plans on average.

Medicare: 275,803 people in New Hampshire are covered by Medicare. The ACA strengthened the Medicare Trust Fund, extending its life by over a decade. In addition, Medicare enrollees have benefited from:

  • Lower costs for prescription drugs: Because the ACA is closing the prescription drug donut hole, 21,026 New Hampshire seniors are saving $22 million on drugs in 2015, an average of $1,047 per beneficiary.
  • Free preventive services: The ACA added coverage of an annual wellness visit and eliminated cost-sharing for recommended preventive services such as cancer screenings. In 2015, 176,282 New Hampshire seniors, or 74 percent of all New Hampshire seniors enrolled in Medicare Part B, took advantage of at least one free preventive service.
  • Fewer hospital mistakes: The ACA introduced new incentives for hospitals to avoid preventable patient harms and avoidable readmissions. Hospital readmissions for New Hampshire Medicare beneficiaries dropped 3 percent between 2010 and 2015, which translates into 152 times New Hampshire Medicare beneficiaries avoided an unnecessary return to the hospital in 2015. 
  • More coordinated care: The ACA encouraged groups of doctors, hospitals, and other health care providers to come together to provide coordinated high-quality care to the Medicare patients they serve. 8 Accountable Care Organizations (ACOs) in New Hampshire now offer Medicare beneficiaries the opportunity to receive higher quality, more coordinated care.

Content created by Assistant Secretary for Public Affairs (ASPA)
Content last reviewed on December 13, 2016

From our friends at the Campaign for a Family Friendly Economy: 

The future of our state depends on lawmakers acting now to enact policies that help New Hampshire become the best state to live, work and raise a family.

Join us Thursday, January 26 in Concord to make our voices heard. RSVP today to attend the Family Friendly Economy State House Day.

Together, we will make sure that our lawmakers act this year to establish paid family and medical leave insurance and make investments in child care so working families can make ends meet while caring for their families. 

Our day of activities will include a breakfast training, small group meetings with legislators, and a press conference to get our message out far and wide. Your voice is critical to our success.

Ahead of January 26, we’ll work with you to schedule a meeting in Concord with your legislator so you can share with them why it’s critical to your family’s future that they act to increase investment in quality child care and establish a family and medical leave insurance program in New Hampshire.

Your legislator needs to hear from you. Join us at our Family Friendly Economy State House Day. RSVP now to be a critical part of creating a brighter future for New Hampshire’s workforce!

Our state’s economic prosperity depends on keeping parents in the workforce and providing for the next generation – our children can’t wait. We must speak out. 

Thanks for your support,

Amanda Sears
Director, Campaign for a Family Friendly Economy

There are a few upcoming events in 2017 that I want to be sure are on your radar. 

Family Friendly Economy State House Day: January 26th 9am-1pm, Concord State House (114 N Main Street). You can find more information about it HERE.

The NH Children’s Trust 6th Annual Strengthening Families Summit is set for Tuesday, March 28th. You can find more information about it HERE.

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About MaryLou Beaver

New Hampshire Campaign Director Every Child Matters Education Fund
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