SPECIAL FULL EDITION UPDATE NEWSLETTER

A new HealthWatch Wisconsin membership year is upon us! Access to the FULL EDITION of the Update newsletter is one of many useful benefits of membership. We have made this June 15 edition of our popular newsletter COMPLETELY FREE to you in order to offer a preview of what HealthWatch members receive twice a month with paid membership.

In this edition, as in every full version of the HealthWatch Update, you will find original analysis on news and events centered on health care and coverage. We also bring you links to training webcasts, useful case tips and practice strategies, connection to local resources, and much more!

Your 2013-2014 HealthWatch Wisconsin membership ensures you are regularly able to access the full version of the Update. To register, or for more information, contact Zach via email or at 1-800-585-4222 ext. 206.

Thanks to all of the current members, subscribers, and supporters--you make the HealthWatch Update possible!

REGISTER TODAY! 
A NEW HEALTHWATCH MEMBERSHIP YEAR STARTS JULY 1!

The start of a new HealthWatch membership year is almost here! For your convenience, we have provided several different ways to register. You may:

• Register online and pay via PayPal at our registration page;
• Fill out our PDF registration form and return it via fax or email; or
• Call us at 1-800-261-6939 x 206 and register over the phone.

A HealthWatch membership provides valuable benefits such as a voice in statewide advocacy that works toward quality and accessible health care for people across Wisconsin, electronic publications, on-demand training videos and other resources through the HealthWatch Training Portal, and substantial discounts on registration for trainings, workshops, and conferences on health care hot topics in 2013 and 2014. In order to keep enjoying the wonderful benefits provided through HealthWatch, members will need to renew their current memberships for the 2013-2014 HealthWatch year. We also encourage you to identify non-members who may benefit from joining us in our efforts.

Registering now ensures the ability to enjoy these member benefits for the full HealthWatch year. With healthcare exchanges unrolling this fall, as well as the variety of other changes taking effect due to the Affordable Care Act, there could not be a better time to join. HealthWatch is here to help keep members up to date and informed ahead of these changes.

Special Gifts for Early Registration + Extended Packer Ticket Deadline!

You may register via PayPal online at our registration page, or you may register via check or invoice by filling out our PDF registration form and returning it via fax or email. For any questions on your HealthWatch membership, please contact Zach via email or at 1-608-261-6939 x 206.

Joint Finance Committee Supports Governor's Medicaid Plan - State Assembly Set to Debate

Last week, people from across Wisconsin packed into overflow rooms (the majority of the chamber was reserved for lobbyists, staffers and the media) as the Joint Finance Committee deliberated Governor Walker’s 2013-14 budget proposal. Among the topics on tap for Tuesday, June 4 was Governor Walker’s proposed alternative to the federally funded expansion of Medicaid and other proposed cuts to the BadgerCare Plus program. Wisconsinites fluctuated between exuberant and despondent as debate raged over two health services omnibus motions that offered drastically different visions for the future of Wisconsin healthcare coverage. 

Joint Finance Democrats Introduce 133/133 Motion

Democrats on the committee introduced a motion (sponsored by Representatives Jon Richards and Cory Mason and Senators Jennifer Schilling and Robert Wirth), that would allow Wisconsin to accept the federal Medicaid money, while modestly expanding eligibility in Medicaid to 133% of the Federal Poverty Level. This motion supported Medicaid expansion, an action that would have continued to cover nearly 85,000 Medicaid eligible Wisconsinites at no additional expense to Wisconsin taxpayers.  ABC for Health’s Bobby Peterson stated, “Even a modest expansion to the 133/133 option saves $119 million with more savings over time and could ultimately cover 84,700 more people, according to the Legislative Fiscal Bureau.” This motion was voted down along party lines

Joint Finance Republicans Support Governor’s Plan

Joint Finance Republicans then introduced an omnibus motion, (sponsored by committee co-chairs Senator Alberta Darling and Representative John Nygren), opposing a Medicaid expansion to 133%, claiming that “uncertainty” surrounding the provision of federal funds through the Affordable Care Act (ACA) was too great. Due to this “uncertainty” the Republican proposal chose to budget $73,520,700 ($30,000,000 State and $43,530,700 Federal) over two years to fund “disproportionate share hospital payments.” These payments will go towards paying providers for services incurred by the uninsured in emergency room visits, rather than providing coverage for the uninsured. The Republican motion “fixed” language that would have cut thousands of pregnant women from BadgerCare Plus, something the Department acknowledged early on as an “unintended consequence of the budget.” However, the motion failed to eliminate a “zombie” clause in Governor Walker’s budget, that while having no immediate effect, could be triggered in the future, resulting in the loss of Medicaid coverage for approximately 30,000 low income children in the state.

Referring to the Walker Administration’s Medicaid Plan, Peterson noted, “We’re looking at pretzel logic, and not good policy for the people of Wisconsin.” Peterson continues, “As people are cut from Medicaid, they delay treatment and fall into worse health, medical debt, and for many, deeper in poverty. It’s bad for people’s health, bad for our hospitals, our economy, and the health of our state.”

Ultimately, Joint Finance adopted the Republican motion along party lines, agreeing to spend nearly $120,000,000 in state taxpayer money rather than accept $120,000,000 from a pool of federal tax dollars. Representative Richards said this plan was spending way too much money, and that he should “cut up [their] credit cards.” As Senator Wirch pointed out, “for every dollar that [Wisconsin Taxpayers] send to Washington, Wisconsin Taxpayers get $0.80 back. We turned down money for the high speed rail, and now we’re turning down money for Medicaid.” Representative Mason further expounded on this inconsistency, asserting that “[the Committee] wrangled our hands over motions that save [state taxpayers] $20,000…This is over $120,000,000 that we’re turning down.”

A “False Choice”

The full legislature has yet to vote on the budget, but as it stands, 85,000 low income Wisconsinites face losing their Medicaid coverage in the very near future. Republican lawmakers such as Representative Klemke, however, say not to worry. According to Rep. Klemke, many of the newly uninsured will be eligible for ACA marketplace exchanges, and that a single person or couple making between 100-133% FPL facing $2,000 or $4,000 a year in out of pocket expenses “won’t have to worry” as “that won’t happen, at least not much. [Individuals between 100-133% FPL] would be looking at hospital visits totaling $20,000 to $25,000 per year per family to get co-payments that high.” Representative Jon Richards said, “People who work full time, for low pay…they can’t get insurance…these people do everything we ask, and they just can’t get insurance…we should be responsible for these taxpayers…we should be fiscally responsible for the state.” He continued, “If you’re an individual making $14,000 a year, how are you going to pay $2,000 in copayments? It’s not going to happen.” Rep. Cory Mason agreed, saying, “It is a false choice to say that there is a choice between MA and private health insurance.”

HealthWatch WatchDog, “A Time to Fish or Cut Bait”

In case you missed it, on the eve of the Joint Finance vote, HealthWatch Wisconsin produced an episode of its popular web show, the HealthWatch WatchDog titled, "A Time to Fish or Cut Bait," to discuss the proposed budget provisions that reject federal Medicaid expansion money and instead remove parents from BadgerCare Plus to the new Marketplace, in addition to other Medicaid program changes. 

The state budget next moves to the Assembly and Senate for debate. The Assembly is scheduled to take up the budget Tuesday, June 18 and the Senate could take up the budget as soon as June 20, according to Republican leaders.

Republican-led Arizona Approves Medicaid Expansion

Arizona Governor Jan Brewer’s campaign to expand the state’s Medicaid proved successful this week, as a group of moderate Republicans and Democrats presented the Conservative Republican Governor with a bill accepting $1.6 billion federal dollars and expanding Medicaid coverage from 100% of the Federal Poverty Level to 133%. This expansion is expected to cover an estimated 300,000 low income Arizonans who were previously uninsured.

Governor Brewer, formerly vocally opposed to ObamaCare, became a source of controversy within the Republican Party when she became one of the first GOP governors to support, much less enthusiastically promote and campaign for, expansion. Drawing support from a diverse mix of organizations, including hospitals, labor unions, religious organizations, public health advocates, and doctors, Governor Brewer’s actions led to bi-partisan cooperation supporting a bill designed to protect Arizona’s uninsured taxpayers. The Governor, in her own defense, frequently cites past Medicaid expansions as justification for participating in this one. Recall, Arizona expanded Medicaid to cover all adults below the poverty line based on a ballot initiative approved by voters in 2000.

Governor Brewer used unorthodox, but ultimately effective measures to get what she wanted. Most notably, the Governor followed through on threats to veto any legislation not related to the Expansion, and also called a special legislative session in order to complete the bill this legislative cycle. These actions have placed Governor Brewer in a unique position among GOP Governors. Not only did she choose to support Expansion, but she fought against her own party’s conservative ideology in order to do what Arizona voters have supported in two previous ballot initiatives.

CMS Releases Proposed Rule Regarding Insurance Marketplace Integrity, More

Today, June 5, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that lays the framework for program integrity of the Health Insurance Marketplace. These regulations are meant to provide oversight to the Marketplace, protecting consumers who will be using this method to purchase their private health insurance.

In addition to guidelines on Marketplace integrity, the proposed rule also covers oversight of Qualified Health Plan Issuers in Federally-facilitated Marketplaces, such as is planned for Wisconsin, consumer protection for enrollment assistance—namely building on existing standards for agents and brokers, program integrity for advance payments of the premium tax credit and cost-sharing reductions, and more.

The public is welcome and invited to submit comments electronically by following the “submit a comment” instructions at www.regulations.gov, or by other methods as described in the Notice of Proposed Rulemaking.

MTM Replaces LogistiCare on August 1: Hearings Scheduled

In preparation for August 1, 2013, when MTM, Inc. will begin managing Wisconsin’s Medicaid and BadgerCare Plus Non-Emergency Medical Transportation (NEMT) services, the Department of Health Services and MTM, Inc. will be hosting six regional town hall meetings. 

The town hall meetings will provide information on upcoming changes to NEMT, an introduction to MTM, Inc. trip scheduling processes, and other general topics. We encourage any community partner, health care provider, or anyone who has interest in learning more about NEMT and MTM, Inc. to attend one of the meetings. Please RSVP if you plan on attending a town hall meeting! Please note that there will be two session per date and location.

Please note:

• Until July 31, 2013, LogistiCare will be coordinating transportation for members.
• More information about MTM, Inc. for transportation providers
• More information about MTM, Inc. for health care providers   
• Additional information about NEMT
• ForwardHealth has issued Update 2013-32 “New Non-Emergency Medical Transportation Manager for Wisconsin Medicaid and BadgerCare Plus Members” to health care providers. A paper copy will be mailed to all Medicaid enrolled providers at the end of June 2013.
• In early July, Wisconsin Medicaid and BadgerCare Plus members will receive a copy of the Member Update in the mail. See Attachment 1 (page 9) of the Provider Update for a copy of the Member Update.
  

All of the dates, times, and locations of the Town Hall meetings are noted below and at this RSVP link.

MEETING DETAILS:

Consumer Savings from Health Reform's "Medical Loss Ratio"

The Kaiser Family Foundation released a study on June 6 detailing the impact of the medical loss ratio (MLR) rules implemented with health reform. The MLR rule requires insurers to spend a certain portion of premium dollars on health care and quality improvement expenses. If they fall short, they must issue consumers a rebate. The law envisions consumers and businesses paying lower premiums than they would have been charged otherwise (as a result of lower administrative costs and profits), or saving money by receiving rebates after the fact. (Note that in 2012 alone, insurers paid out $1.1 billion in rebates.)

While the rebate amounts issued to consumers are well documented, this study released by Kaiser looked specifically into the actual up-front premium savings from MLR. While many plans sold to small and large businesses were already in compliance with respective medical loss ratio thresholds, savings was realized in the individual market. As the study reports, “In the individual market, by contrast, fewer than half of plans were in compliance with the ACA’s MLR thresholds in 2010, and the average traditional MLRs in this market have been steadily increasing since the requirement went into effect. This means that individual market insurers are devoting a greater portion of premium dollars to health care claims and less to administrative costs and profits compared to before the ACA’s MLR rule went into effect.”

Background on Wisconsin’s Battle to Opt Out of MLR

Recall, in Wisconsin in 2012, leading up to Wisconsin’s adoption of federal rate review standards, Wisconsin’s Insurance Commissioner Ted Nickel wanted a waiver from the rule that says the insurance companies in this state must follow the federal MLR standards as set in the Affordable Care Act. Commissioner Nickel’s request sought an exemption from the federal law that requires health insurers to spend at least 80 cents of every dollar collected in customers' premiums on medical care. Commissioner Nickel said he would rather see a gradual "phasing in" of the medical loss ratio requirement. Under the health reform law establishing this "medical loss ratio," the rule is that insurers who fail to meet the 80% minimum would have to provide rebates to their customers. Commissioner Nickel said he would prefer the money, estimated to be about $14 million in rebates to Wisconsin consumers under the law, was instead retained by the insurance companies. HealthWatch Wisconsin covered the story. On January 9, 2012, the feds sent a letter back to Commissioner Nickel with several questions, namely asking him to provide support on the numerous claims he made in his request. They asked Nickel in more than one instance to explain his math as the feds could not derive the same numbers as Nickel. In what will most likely be construed as a mighty blow, they very kindly thanked Nickel for “Wisconsin’s cooperation in working together to implement the Affordable Care Act.” ABC for Health wrote to CMS, asking Sec. Sebelius to reject Nickel’s request. In a letter dated June 1, the Feds replied to Commissioner Nickel, denying his request. Therefore, the 10% rate review threshold applies to Wisconsin.

Still not completely sure what “MLR” is or means? ABC for Health drafted a “Reporter” devoted entirely to this topic. You can read it online.

May BadgerCare Enrollment Data Now Available

BadgerCare enrollment data for May has now been published to the ForwardHealth Portal. Those who have been following enrollment numbers will see no surprises with the newest data. The Core Plan continues to drop childless adults even as the wait list keeps growing, BadgerCare Plus Basic and SeniorCare both see declines as well. Overall BadgerCare Plus enrollment climbed back over 740,000 individuals, but is still far below the 751,167 mark seen in May of just last year. The trends in overall BadgerCare Plus enrollment as well as the Core Plan can be seen plotted below.

HealthWatch Member News

New HealthWatch Year Begins July 1

Don't forget to complete the membership renewal form on our website or via PDF to ensure that you will still be able to access the benefits of HealthWatch once the new membership year begins on July 1. If you have any questions regarding your membership please contact Zach via email or at 1-800-585-4222 ext. 206.

Case Tip: Social Security "Totalization" Agreements

Workers who have divided their careers between two countries--the United States and another country--benefit from international Social Security Agreements, often called "Totalization agreements." While the there are many purposese to these agreements, one common purpose is Social Security coverage for active workers. Consider a consumer applying for Social Security Disability Insurance (SSDI), and trying to count "work credits" to determine eligiblity, but this individual has just moved to the United States and has only worked in the US a short time. (To qualify for benefits under the US Social Security program, a worker must have earned enough work credits, called quarters of coverage, to meet specified "insured status requirements.")

Workers who have divided their careers between the US and a foreign country sometimes fail to qualify for retirement, survivors or disability insurance benefits (pensions) from one or both countries because they have not worked long enough or recently enough to meet minimum eligibility requirements. Under an agreement, these workers may qualify for partial US or foreign benefits based on combined, or "totalized," coverage credits from both countries. Totalalization agreements help assure continuity of benefit protection for people who have acquired Social Security credits under the system of the US and another country.

If the combined credits in the two countries enable the worker to meet the eligibility requirements, a partial benefit can then be paid, which is based on the proportion of the worker's total career completed in the paying country.

For more information on international Social Security agreements and procedures, you can visit the following website or call to inquire on Coverage Rules: (410)965-7306.

Health Care Segregation in Wisconsin

The Core Plan Wait List Surpasses 157,000 In Latest Tally

As of May 23, 2013. The Core Plan Wait List is on the rise! Have a newer Wait List number? Let us know!

HealthWatch maintains that the Department of Health Services should properly screen applicants and help identify coverage options for these people, including, but not limited to, Elderly, Blind and Disabled Medicaid, Medicaid Assistance Purchase Plan, HIRSP, or SSI/SSDI.

Share Your BadgerCare or Medicaid Story!

• Are you one of the more than 157,000 childless adults stuck on the Core Plan Wait List?
• Are you a mother or father just making ends meet who's concerned about the new changes to BadgerCare coverage?
• Do you worry about the possibility of losing access to Family Planning Only Services?
• Do you have another health care issue that needs to be brought to the attention of DHS officials and policymakers?
• CLICK HERE to complete a story form and email it to ABC for Health or call and talk to one of our advocates (608) 261-6939 ext. 229 and let them know you are calling to tell your BadgerCare story!

At the Intersection of Public Health & Public Interest Law

By Kellan McLemore, UW Madison Law School, Legal Intern at ABC for Health

I have always known that I wanted to pursue a career focused on helping the less fortunate, but it wasn’t until I took a “Law of the Civil Rights Era” class during my junior year of college that I actually gave thought to a legal career.  Once I got past the stigma of a lawyer being some greedy, low-life, I was able to see that a legal career possessed ample opportunity to do some good. From day one of law school I knew that I was pursuing a law degree for the sole purpose of using it to benefit those who need my help the most.

The American legal system is a complex institution that can be quite difficult to navigate, especially for those individuals who are unable to afford legal services. It was clear that there were huge populations of underrepresented individuals and families who were being adversely affected by the legal system because of their inability to afford adequate legal representation, and many more that were being discriminated against because of their race. It seemed to me that a career in the public interest sector would afford me the opportunity to help level the playing field a bit for those underrepresented individuals.

As a rising second-year law student interested in public interest law, I leaped at the opportunity to work at a nonprofit, public interest law firm. As a Biology major, who spent the majority of my undergraduate career working either nonprofit or public health jobs/internships, I saw ABC for Health as the perfect opportunity for me to continue my interest in public health while also furthering my passion for providing legal services to the people who need them the most. I have no doubt that this internship will prove to be a useful stepping stone into my budding career in the public interest sector.

Coalition Roundup

CLICK HERE to see details for upcoming coalition meetings on the HealthWatch Wisconsin calendar!

SPECIAL EVENTS:

Will you be in or around Madison on June 27? If so, JOIN US! The Dane County HealthWatch Coalition is hosting it's "Second Annual Pontoon Boat Picnic!" RSVP to reserve your seat on the pontoon. We'll launch from Olin Park at 4pm and be back at the dock by 6pm. Cost will be around $20 (it is dependent on the number of boaters!) Email Anna to reserve your seat.

3 C's for CYSHCN!
"Competency, Capacity, & Coordination" 

Ask a Good Question...

My son Charlie needs surgery, but every time we talk to the insurance company, they give another reason why they can’t cover the cost. It feels like they keep changing their reason for denying these claims. Can they do that?

...Get a Good Answer:

No, it’s called “bad faith behavior” for your insurance company to act in this manner. In your case, more of the detailed facts help us answer this question. The first time Charlie’s surgery was denied, the insurance company said the surgery and therapy services Charlie needed were not “medically necessary.” After providing documentation from his physician that the services were needed by your son, the insurance company indicated that they were not “covered services.” After identifying the section of the insurance plan that permitted coverage of these services, the insurance company claimed the services were “experimental,” given Charlie’s diagnosis. Finally, after gathering documentation to show that use of these services for a person with Charlie’s diagnosis was not experimental, using a variety of medical journal articles as evidence, the insurance company still refused to pay the claim.

Save the Date: The Next LIVE CYSHCN Collaborators Training is June 27!

June 27, 2013, 10:30am-11:30am via LIVE webcast!

Training Topic: "Public Health Coverage: An Update on the Status of BadgerCare Plus Eligibility & Coverage."

If you are part of the Collaborators Network, you will receive login information via email in advance of the webcast. If not, please contact HealthWatch.

Thank you to everyone who completed the "Knowledge Assessment Tool" survey! Your answers helped inform the selection of our 2013 training topics! You indicated you wanted to learn more about health reform topics, private insurance, and advocacy strategies. Our fourth webcast for 2013 will begin with an overview of BadgerCare Plus elements, and any proposed changes that could be implemented in Wisconsin by 2014.

When you tune in on June 27, be sure to keep the following learning objectives in mind:

• Brief overview of BadgerCare Plus
  
• Learn who will be affected by any new rules or regulations after the state budget
  
• Review your role in assisting families, especially as they navigate BadgerCare Plus and new elements of Health Reform as implemented in Wisconsin
  
• Learn where to keep current on BadgerCare Plus rules and policies
• Discuss how to talk with families about future coverage changes and options
• Keep current on case management strategies that work for families.

Referrals to ABC: CYSHCN Collaborators, download the "Referral Form" to be directed to the printable version of the CYSHCN Client Referral Form! Use this handy tool in directing a family to ABC for Health for services.

Why should you use this Referral Form? It helps to keep YOU in the loop! By using the form, you agree to the language on the form that says you have "Verbal permission from parent/guardian to share information with ABC for Health." This allows us to communicate with YOU!

Mark your calendars! The remaining webcasts will be as follows:

• July 25, 10:30-11:30am
• September 26, 10:30-11:30am

Events of Interest

Milwaukee County Departments Proposed Budget Requests Briefing: Tuesday, July 9 Disability Rights Wisconsin will be holding a briefing on the 2014 Milwaukee County Department budget requests. The budget briefing will be followed by a business meeting of the Milwaukee Mental Health Task Force – all are welcome to attend. For more information, view the PDF flyer.

Opportunity to tell your story to a national audience: Genetic Alliance is partnering with Parent to Parent USA (P2P) and Family Voices (FV) to collect resources that will support individuals who wish to act as advocates on behalf of themselves, their families, or others living with the same condition. To date, they have collected over 240 resources that will help users build leadership, communications, outreach, and advocacy skills. The tools will be part of an accessible online toolkit, with advocacy resources grouped by topic area. If interested, please refer to our .pdf for more information.

2013 Summer Family to Family Course: Put on by the National Alliance on Mental Illness, this free, 6-week, course is for family caregivers of individuals with mental illnesses. The course is taught by two trained family members and has had over 115,000 family members graduate from this national program! Classes will fill up quickly; call Shirley at 414-344-0447 or contact her via email for more information.

Parents in Partnership and Youth in Partnership with Parents for Empowerment Training: Parents and other caregivers meet to share their family stories, challenges, joys, and triumphs of raising their children. The program assists parents in developing: communication skills, leadership skills, positive advocacy skills, collaboration skills, their own Community Action Plan. Youth and their parents will hear from speakers and take part in hands-on activities. To learn more about these free trainings, visit the registration page or contact Martha DeYoung.

The Division of Services for Children with Special Health Needs (DSCSHN) of the Maternal and Child Health Bureau (MCHB) monthly webinar series: This series was started by the Division to promote the work of the National Centers to MCHB’s grantees. These Centers provide resources for comprehensive, community-based, family-centered, culturally competent, coordinated systems of care for children and youth with special health needs and their families. Meeting information can be found on their site.

CLICK HERE to view our online Events of Interest calendar!
CYSHCN Collaborators, please let us know if you have an upcoming event you would like posted to the calendar!

Et Cetera: Bills to Watch, Ops Memos, Provider Updates, Admin Register, Federal Register Updates

Wisconsin Insurance News, Issue 1, Spring 2013, June 6, 2013

The Commissioner of Insurance issued his spring newsletter where he argues, among other things, that by not creating an insurance exchange in WI, he’s “taken the road less traveled.”

Bills to Watch:

SB 206: Relating to: requirements to perform abortions, requiring an ultrasound before informed consent for an abortion, and providing a penalty.

SB 203: Relating to: requiring the payment of health insurance premiums.

AB 233: Relating to: repealing the changes made to the earned income tax credit in 2011 Wisconsin Act 32.

AB 227: Relating to: requirements to perform abortions, requiring an ultrasound before informed consent for an abortion, and providing a penalty.

Operations Memos:

OM 13-17: Spousal Impoverishment Allowance

OM 13-18: Change in Homeless Definition for BC+ Core Plan

OM 13-19: Private Pay Nursing Home Rate

Administrative Register:

AR 690: The June 15 Administrative Register is now available

Provider Memos:

2013-31: Requesting Exemption from Prior Authorization Requirements for Advanced Imaging Services

2013-32: New Non-emergency Medical Transportation Manager for Wisconsin Medicaid and BadgerCare Plus Members

2013-33: ForwardHealth Will Only Accept the Acknowledgement of Receipt of Hysterectomy Information Form

2013-34: New Requirements for Prescribing/Referring/Ordering Providers Due to the Affordable Care Act

Federal Register Updates:

Rules:

- HIPAA Privacy, Security, and Enforcement Rules; Technical Corrections
- Establishment of Exchanges and Qualified Health Plans; Small Business Health Options Program

Proposed Rules:

- National Institute on Minority Health and Health Disparities Research Endowments
- Prime Enrollment Fee Exemption for Survivors of Active Duty Deceased Sponsors, etc.

Notices:

- Disability Benefits Questionnaires
- Requests for Ban or Standard on Adult Portable Bed Rails
- Senior Executive Service Performance Review Board Membership
- Agency Information Collection Activities; Proposals, Submissions, and Approvals
- Request for Employment Information in Connection with Claim for Disability Benefits
- Annual Collection of Three Performance Measures for Low Income Home Energy Assistance Program, etc.

Headlines

Panel Tells Congress Medicare Is Unfairly Penalizing Hospitals Serving The Poor, Kaiser Health News, June 14, 2013

The financial penalties that Medicare imposes on hospitals with high rates of patient readmissions are too harsh for hospitals serving the poor and should be changed, according to a congressional advisory agency.

State-Level Progress in Implementation of Federally Facilitated Exchanges, Robert Wood Johnson Foundation, June 14, 2013

Health insurance exchanges are one cornerstone of the Affordable Care Act, offering structure and organization to the small group and non-group health insurance markets. A new report from the Urban Institute highlights three case studies of states decisions on exchanges and more.

Jan Brewer wins Medicaid expansion in Arizona, Politico, June 13, 2013

Arizona Gov. Jan Brewer muscled her way to victory in her crusade for Medicaid expansion Thursday, outmaneuvering conservative opposition to push through a key piece of President Barack Obama’s agenda.

Expanding Medicaid coverage is not a cure-all, Washington Post, June 13, 2013

The debate over “Obamacare” has focused largely on the number of uninsured Americans and how the regulations will be implemented. Not enough attention is being paid to the difficulties our health-care system imposes on those with Medicaid insurance, which is being extended to millions who lack coverage.

Experts explain looming health care reforms, Stevens Point Journal, June 13, 2013

A public forum on the Affordable Care Act was held in Wausau this week, where about 150 people attended. The forum, titled "Ready or Not: What the Federal Health Insurance Marketplace Means for Wisconsin" featured health policy experts from around the area.

Small-business exchanges draw few insurers, Politico, June 13, 2013

Obamacare’s new insurance marketplaces for small businesses, which have already stumbled before getting out of the gate, are facing another pressing question just months before millions can sign up for benefits: What happens if insurers don’t show up to sell?

Judge Reluctantly Approves Government Plan For Morning-After Pill, NPR, June 13, 2013

An obviously unhappy Judge Edward Korman has approved the Obama administration's proposal to make just one formulation of the morning-after birth control pill available over the counter without age restrictions.

The cost of rejecting Medicaid funds for Wisconsin, The Isthmus, June 13, 2013

The Joint Finance Committee voted 12-4 on party lines to reject federal money to expand health insurance for the poor. As a result Wisconsin lawmakers saddled the state with a bigger price tag in return for less health coverage. That's the assessment of the deal's critics, who include academics and activists, health providers and lawmakers. It's also the conclusion reached in nonpartisan studies.

Surgeon general to step down, Politico, June 13, 2013

Surgeon General Regina Benjamin has announced that she plans to step down from her post, which she has held since 2009. Deputy Surgeon General Boris Lushniak will serve as acting surgeon general while the search takes place to fill the post, said Dori Salcido, spokeswoman for Health and Human Services.

Medicaid Expansion Under the ACA: How States Analyze the Fiscal and Economic Trade-Offs, Robert Wood Johnson Foundation, June 12, 2013

Within the next few months, state leaders must make a decision about whether or not to expand Medicaid to residents who earn 138 percent of the federal poverty level. A new report from the Urban Institute examines issues impacting this decision.

House panel OKs national late-term abortion ban, The Hill, June 12, 2013

The House Judiciary on Wednesday approved a national late-term abortion ban that is due on the floor next week. The bill from Rep. Trent Franks (R-Ariz.) would ban nearly all abortions after 22 weeks of pregnancy, making an exception only for women whose lives are in danger.

Obamacare Shows Hospital Savings as Patients Make Gains, Bloomberg, June 12, 2013

Less than five months before the Affordable Care Act fully kicks in, hospitals are improving care and saving millions of dollars with one of the least touted but potentially most effective provisions of the law.

Analysis: ObamaCare will bring flood of retail health clinics, The Hill, June 11, 2013

Global consulting firm Accenture predicted that the number of walk-in medical facilities located in retail stores will rise to nearly 3,000 by 2015. The clinics are expected to account for 10 percent of non-primary care outpatient visits within three years.

Editorial: Rand study adds to the evidence: Expanding Medicaid makes sense, St. Louis Post-Dispatch, June 11, 2013

If states expand Medicaid, their bottom-line health care costs will be significantly less than if they don’t. That’s not politics. It’s not spin. It’s just math.

Gov. Scott Walker embraces Obamacare, Journal Sentinel, June 11, 2013

We owe a debt of gratitude to Walker and his allies on the Joint Finance Committee for rejecting the conservative path, embracing Obamacare, expanding Medicaid up to 100% of the poverty line and helping non-poor adults to claim a subsidy to buy insurance via the new exchange. 

Administration backs down on Plan B, The Hill, June 11, 2013

Women's health groups celebrated Tuesday after the Obama administration announced it would no longer fight a court order striking down all age limits on the birth control pill known as Plan B. The Justice Department said Monday evening it would withdraw its appeal of the judge's ruling and approve the drug for over-the-counter access without age restrictions.

Colorado Offers Exchange ‘Assister’ Money To Many Groups, Kaiser Health News, June 11, 2013

One of the 16 states that is setting up its own online insurance marketplace, Colorado on Monday named 58 organizations it’s selected to form its “assistance network” to help residents sign up for health coverage on the exchange.

Study: Brand Name Drugs Drive Up Medicare Spending, Kaiser Health News, June 11, 2013

A new study suggests that cash-strapped Medicare missed an opportunity to save more than $1 billion by not addressing the varying costs and use of prescription drugs.

Enrollment in private Medicare plans hits record high, The Hill, June 10, 2013

Enrollment in Medicare Advantage hit a record 14.4 million this year, challenging predictions that ObamaCare's cuts will kill the private plans. The Kaiser Family Foundation (KFF) reported Monday that enrollment in Medicare Advantage grew by nearly 10 percent in the last year and by 30 percent since 2010.

Food Stamps Poll Finds Most Americans Prefer No Cuts, Huffington Post, June 10, 2013

According to a new Huffington Post/YouGov poll, fewer Americans support cutting food stamps than leaving the program alone or expanding it. According to the new survey, the 40 percent of Americans who want the food stamps budget decreased were outnumbered by the combined 48 percent who said spending on food stamps should either be increased (24 percent) or kept the same (24 percent).

What pediatrics can teach us about addressing adult social determinants of health, The Health Culture, June 9, 2013

Pediatrics continues to evolve clinical practice aimed at addressing social determinants because of children’s exquisite vulnerability to the deleterious effects of the social and physical environment, especially the aggregation of social factors associated with poverty.

Treatments of physical and mental health are coming together, LA Times, June 9, 2013

As the nation seeks to extend healthcare coverage to millions of new and in many cases chronically ill patients, one of the great parallel challenges to controlling costs and improving delivery of care will be managing the mental health problems of people like Hunter.

Prepare for Big Piece of Health Law, Wall Street Journal, June 8, 2013

The biggest part of the health-care law—online exchanges that offer insurance to individuals—kicks in next year. And beginning this October, states will start selling those health-care plans, which adhere to a new set of standards, though online marketplaces.

President Obama takes health pitch to California after rate row, Reuters, June 7, 2013

President Barack Obama insisted on Friday his healthcare overhaul is already proving worthwhile as he promoted the plan in California, where an argument is raging over whether it is living up to its name as the Affordable Care Act.

Wisconsin Department Of Health Services Seeking Proposals for Managed Care Organizations in Several Areas of the State, DHS, June 7, 2013

Wisconsin Department of Health Services Secretary Kitty Rhoades announced that the department is seeking proposals from interested parties to contract as managed care organizations for the delivery of Family Care and Family Care Partnership programs in several areas of Wisconsin.

DHS Secretary Promises Smooth Transition For Former BadgerCare Enrollees, WPR, June 7, 2013

Department of Health Services (DHS) Secretary Kitty Rhoades says the state will help former BadgerCare enrollees transition to the private market. Lawmakers on the budget committee have approved 89 new positions for DHS, mainly to help determine what coverage poor people are eligible for under the Affordable Care Act.

NAMI Wisconsin on JFC Budget: Appreciation for Mental Health Initiative Support and Disappointment with Medicaid Expansion Decision, NAMI Wisconsin, June 7, 2013

NAMI Wisconsin and our 35 local affiliates applaud the Joint Finance Committee for approving Governor Walker’s mental health initiatives. However, we are deeply disappointed with the decision to reject federal funds for Medicaid expansion.

Analysis: Private insurance exchanges on the rise, The Hill, June 7, 2013

Nearly one in five people will purchase health coverage through a privately run insurance exchange within four years, according to new research. Accenture Research predicted that private exchanges will "upend … purchasing for many of the 170 million people who receive benefits through their employer."

Beyond Rebates: How Much Are Consumers Saving from the ACA’s Medical Loss Ratio Provision?, Kaiser Health News, June 6, 2013

This Kaiser Health study looks at how much consumers are saving from the Affordable Care Act’s Medical Loss Ratio (MLR) provision centered on the requirement that insurers issue consumer rebates when they fall short of spending a certain portion of premium dollars on health care and quality improvement expenses.

New healthcare model cut even more costs in year two: insurer, Reuters, June 6, 2013

The nation's largest experiment in delivering medical care in an innovative way has reduced costs and improved the quality of care even more in its second year than in its first, according to the insurance company behind it.

Republican Myth about the ‘Uncertainty’ of Medicaid Expansion Funds Debunked, Office of Rep. Jon Richards, June 6, 2013

Rep. Jon Richards (D-Milwaukee) today released a letter he received from the federal Center for Medicare and Medicaid Services (CMS) that flatly refutes unsubstantiated Republican claims about the "uncertainty" of federal Medicaid expansion funding.

Related: Letter from CMS

Analysis: Subsidies will offset ObamaCare 'rate shock', The Hill, June 6, 2013

Most of the young, healthy people whose premiums will rise under President Obama's healthcare law will be eligible for tax credits to help with the added costs, according to a new analysis.

Wisconsin Insurance News, Issue 1, Spring 2013, June 6, 2013

The Commissioner of Insurance issued his spring newsletter where he argues, among other things, that by not creating an insurance exchange in WI, he’s “taken the road less traveled.”

Poll: Americans still leery of Obama health care law, USA Today, June 6, 2013

An NBC News/Wall Street Journal survey says 49% of Americans say the health care plan is a bad idea — the highest number on that question since the poll began asking it in 2009.

The Split Between the States, New York Times, June 5, 2013

Wisconsin and Minnesota are neighboring states with long traditions of caring for the least fortunate, but, at the moment, only one of them is concerned about the health of the poor and uninsured.

Advocacy Group Seeks To Force Employers To Give Pregnancy Coverage To Dependents, Kaiser Health News, June 5, 2013

Employer health plans routinely cover pregnancy costs for workers and their spouses—but not necessarily daughters. According to a handful of new complaints filed with the federal government, that's sex discrimination, and the Affordable Care Act doesn't allow it.

Care Bearers, The Daily Show, June 5, 2013

Jessica Williams of "The Daily Show" travels to America's "health belt" to investigate Tennessee's rejection of expanded Medicaid coverage.

Committee rejects expansion of BadgerCare, Sheboygan Press, June 4, 2013

The Republican-controlled budget committee on Tuesday sided with Gov. Scott Walker in voting to reject a federally funded expansion of Wisconsin’s BadgerCare Medicaid program even though accepting the money would lead to more people receiving insurance at a cheaper cost to the state.

Fair Pricing Law Prompts Most California Hospitals To Adopt Policies To Protect Uninsured Patients From High Charges, Robert Wood Johnson Foundation, June 4, 2013

This article summarizes California’s Hospital Fair Pricing Act, which was passed in 2006 with the intent of protecting low-income uninsured patients from having to pay hospitals’ full billed charges.

Part D, Without Paying a Dime, New York Times, June 4, 2013

Most people who qualify automatically are signed up for Extra Help through their enrollment in Medicaid or Supplemental Security Income. But among those who are eligible but must apply on their own — roughly 2.5 million older adults — only an estimated 35 percent to 40 percent receive it.

'Will My Family Be Eligible For Subsidized Coverage?', Kaiser Health News, June 4, 2013

Reader questions about coverage subsidies for families under the Affordable Care Act, filling the gaps in Medicare coverage and laws governing health plans in companies that conduct business in more than one state are answered.

Key Lessons from Medicaid and CHIP for Outreach and Enrollment Under the Affordable Care Act, Kaiser Family Foundation, June 4, 2013

The Affordable Care Act (ACA) will significantly increase coverage options through an expansion of Medicaid and the creation of new health insurance exchange marketplaces. However, effective outreach and enrollment efforts will be key to ensuring that new coverage opportunities translate into increased coverage

Schwartz blasts GOP's permanent 'doc fix' bill, The Hill, June 4, 2013

Democratic Rep. Allyson Schwartz (Pa.) slammed House Republicans' plan to reform the Medicare physician payment system as too weak to ensure the program rewards quality instead of volume. Schwartz is behind an alternative, bipartisan package for repealing the flawed sustainable growth rate (SGR) formula.

The six ways Obamacare changes insurance premiums, Washington Post, June 3, 2013

This Washington Post article discusses the affect that insurance exchanges will have on insurance premiums.

Study highlights cost benefit of expanding Medicaid, Modern Healthcare, June 3, 2013

An independent study released today on the economic impact of Medicaid expansion under healthcare reform found that states' share of the cost of expanding Medicaid under reform would be lower than the cost of providing uncompensated care to their uninsured residents.

Fewer Families in U.S. Say Struggling to Pay Medical Bill, Bloomberg, June 3, 2013

About 20 percent of people under 65 reported being in a family that was having problems paying for medical bills in the first six months of 2012, according to a survey by the National Center for Health Statistics. That’s a decrease from about 22 percent in the same period a year earlier, a drop of about 3.6 million people, the report found.

Time is Ripe to Address End-of-Life Care in Medicare, Some Experts Say, Medicare Newsgroup, June 3, 2013

Many congressional leaders, lobbyists, providers and advocates say now is the time to revive a national discussion about end-of-life care, advance care planning and palliative and hospice care. Not just because they can save Medicare money and improve care for seriously ill and dying patients, but because it’s the right thing to do.

Helping Consumers Understand and Use Health Insurance in 2014, Institute of Medicine, May 29, 2013

This paper presents basic information that can be used to help people understand their health insurance options and guide them through enrollment. It is a resource for those who will be helping consumers make decisions—for patient navigators, community organizations, employers, media, educators, and any individual or organization working to improve understanding of health insurance.

Support Our Efforts with a Tax-Deductible Contribution!

Support ABC for Health as we pursue our mission of helping people in Wisconsin secure access to health care and coverage. Our staff works tirelessly with the thousands of families and individuals who contact our office each year. To continue, we do need your help and support. A tax-deductible financial contribution will support direct legal, advocacy, and education services to families in Wisconsin.