Insurance Update - Staying Covered: Health Insurance Trends 2020 / HealthChoice

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okay miriam i think we'll start well i'll tell you what i'm gonna um i'd like to introduce myself briefly for anyone who doesn't know me uh although i hopefully uh all your registrants do my name is eric iglooski i'm the social worker and the vice president of clinical services here at the mary goolie center here in rochester new york and i appreciate folks joining us today for this very important session that is hosted by the mary goolie center but sponsored and provided by the hemophilia federation of america so without further ado i'd like to

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introduce our our special guest expert speaker miriam goldstein i'd like to think as an old friend of mine at this point in the community and uh someone i'm proud to have seen shine brightly in many different capacities in different different areas for the bleeding disorders community nationally maryam lives in arlington virginia and she's a mother of two adult sons with hemophilia miriam is the policy director and principal legal counsel at the hemophilia federation of america where her work includes monitoring and

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analyzing federal legislation and regulations impacting patient access to care insurance medicaid and medicare issues blood safety and more before joining hfa miriam worked as a lawyer with the federal government and volunteered for many years with her local hemophilia association and the committee of ten thousand i'm very grateful that miriam would choose to spend a little bit of a saturday afternoon with us and uh i'm gonna let miriam uh now speak about this complicated uh insurance landscape that we all deal with in this

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day and age thank you so much eric and thank you so much for those very kind words it's it's a great pleasure to be here with you i wish i could be in rochester in person um as i've gotten to do in other years um but uh this is the next best thing and this is what we do in 2020. um so i wanted to talk about staying covered and about health insurance trends in 2020 and i i would love it eric if you would shine in

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as appropriate because we're a small group and you know especially on new york specific issues you will have so much more expertise than i have but i will present kind of the national overview um both where we are today in terms of insurance what people can be thinking about as we enter the open enrollment period for the coming year and then trends on the horizon so

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just a quick word about hfa hfa's hemophilia federation of america we celebrated our 25th anniversary last year we are a national non-profit organization that assists educates and advocates for individuals and families with bleeding disorders we are grassroots only um we we have a dedicated staff we have wonderful publications and programs but the thing to know about hfa is that

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advocacy is at our heart and at the heart of everything we do so like i said we today we'll talk about trends in private insurance because those overall national trends affect you know trickle down and affect each of us um and obviously one of the the big curves that 2020 has thrown at us is open 19 so we'll talk a little bit about how how the pandemic is affecting

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um insurance and and options for people who may be facing coverage loss because of the pandemic and its economic fallout we'll talk about some insur health insurance basics because health insurance is really complicated it is dry um it is convoluted and yet it is so important and so having that refresher might be a helpful just um pressure on the basic concepts basic vocabulary

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because that will help set you up for success as you're looking towards making your choices for the coming year we'll talk about some insurance company practices of concern that act as barriers to care and what hfa is doing about it how that informs our advocacy agenda and we'll talk about some big picture changes on the horizon so as an overview the 2020 coverage landscape i as everyone knows there is so much economic upheaval and

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financial hardship due to coped right now and unfortunately that is causing widespread losses of jobs and when people lose jobs often they also lose insurance or they face difficulty in paying for care um it means that medicaid enrollment is increasing around the country which is wonderful that's what the medicaid program is supposed to do it's supposed to be there to to provide coverage in these times of hardship but it means that states

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are facing budgetary crunches as their medicaid enrollment grows private payers and that means insurance companies or it means employers who offer insurance to their employees are trying to control costs because the costs of healthcare are going up and up and unfortunately they often try to control costs by putting obstacles in the way of consumers to access services and care that they need and for a community like ours that is so reliant

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on access to good health care that's a really big problem it's almost putting the burden on the least appropriate place um less of a problem in new york state which is nice for you guys than it is in in other states where i give this presentation there is a proliferation of cheaper but skimpier health plan options that are sometimes misleadingly marketed and do not provide the coverage that people with bleeding disorders need

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um it's a real situation of buyer beware and as i said in new york state you were lucky because your state government provides some extra layers of protection consumer protection that some other states don't provide and finally in terms of those big picture on the horizon events there is litigation over the affordable care act whether it will survive and there are upcoming national elections and that all of that creates some substantial

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uncertainty about what will happen in health insurance and health care over the coming year so let's talk briefly about trends in private insurance and there's some some charts and graphs in here that i will not go into detail i'm going to go whizzing right by them but i'm happy to share this presentation if anyone wants to look at them more closely so health spending is rising i think we all know that this just shows exactly how sharp land is rising

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premiums for job-based coverage are increasing so this is people who are fortunate enough to have coverage through their jobs and you can't see the years but it was basically covered as a 20-year period with the farther past at the top the present at the bottom the dark blue shows the share that employers pay and the light blue shows the shares that might be deducted from your your paycheck for your share of the premium and the premiums for a family policy in

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2019 the combined employer and employee share thousand dollars last year a growing number of people are underinsured and that means that when you take what they have to pay in premiums and then what they have to pay in cost sharing to actually use their insurance they have to spend more than 10 of their income and so that's a hefty financial burden on families and underinsurance is a problem in the um

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for people who buy aca plans to buy individual plans on the marketplace that's the orange line but that's also a problem for people who get insurance through their jobs and the share of americans with job-based health insurance is decreasing this is before covered and it is a concern because um the american health insurance system is kind of premised on the idea that you will get health insurance from your job and increasingly that is not the situation

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for very many people so as i said that erosion of job-based health insurance has only accelerated due to covert this was a headline from the new york times this summer saying 5.4 million americans lost health insurance because of the coveted economic fallout and that number has only increased since the summer and different analysts expected to go as high as 10 or

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20 million people impacted so i did want to let you know if you are in that situation if you are facing the loss of coverage because you have lost your job we have resources for you um this is just an infographic to present it sort of as as in as punchy a form as possible but you know medicaid might be the one place you look subsidized coverage

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in the aca individual market or cobra coverage which is where you pay to take or you take over paying the entire premium for your job-based health plan and continue on the health plan you own before you lost your job hfa and nhf worked to create some resources as covid hid to to provide a little more detail around that that infographic and so

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you can find this guide on the hfa website and you can also find it on the nhf website i'm just not as familiar with their website is with ours but it it provides kind of a road map you know how to think about your options where to look first and um and you can always contact hfa and i know you can also always contact my colleagues at nhf [Music] we will be very happy to talk to you over the phone and maybe

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provide a little more tailored advice so he said that we would do a bit of a refresher we're changing here is here on health insurance 101 just um because this is convoluted it is um it doesn't come naturally to anyone and so just going over the basics can be helpful so i mentioned that job-based coverage is kind of the foundation of the american system but even

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in job-based coverage there's different kinds there's fully insured versus self-insured plans fully insured is where an insurance company pays the claims and your premium covers all the risks and costs and administration of the plan it can be very hard to tell whether you're in a fully insured or a self-insured plan because in both cases you in your wallet probably have a card that says blue cross or aetna or united health healthcare

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the difference is with a self-insured plan that that insurance company is administering the plan on behalf of your employer and in the end your employer is on the hook for all the costs of your care and this is typically the system that is used by large employers so if you work for home depot or wells fargo or ibm you know or safeway any big company like that you are most

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likely in a self-insured plan um it self-insured whether you're in a fully insured or self-insured plan also determines who is where you take a complaint if you are if if you're not getting coverage for something so do you go to the health insurance company um with a fully insured plan or do you go to your hr department for a self-insured plan there are basic types of private plans

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and that is true whether you're in a fully insured or a self-insured um they range from health maintenance organizations to to preferred provider organizations the the difference there is really how much choice you have and how broad of the network do you have to go for care and how easy is it to go outside of care high deductible health plans linked to a health savings account are a specific kind of plan

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where you have to pay quite a lot out of pocket before your plan starts kicking in anything towards your medical costs but if it's linked to a health savings account your employer might be funding a separate health savings account that will help you while you're in that deductible phase so i've already started using some terms and i haven't defined them yet so now it's time to define them um premium that is the amount that you pay

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just to get the health insurance policy think of it as almost a membership fee it is um what you pay right off the bat to be able to say i have health insurance deductible is an amount that you have to pay out of pocket before the health plan kicks in and the deductible might not apply to all services so in fact for for most people um primary care a

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visit not not a comprehensive care visit with your htc but a primary care visit with your general practitioner it is covered before the deductible co-pay is a fixed dollar amount that you pay out of pocket and again this is in addition to the premium co-pay is something you might pay every time you have a doctor's visit or for prescription drugs coinsurance is similarly a percentage

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amount dollar amount that you pay for using services and here the problem is that it's not a fixed amount it is a percentage now and it is very common with specialty drugs and you know clotting factor and other food disorders medications and because those are costly medications um setting your out-of-pocket amount by a percentage rather than a flat fee can mount up very quickly

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so there are limits by federal law on how much you have to pay in the given year of apocalypse these are really high you levels you might look at them and say how could i possibly pay eighty five hundred and fifty dollars or seventeen thousand dollars from my family on top of my premiums on top of living expenses and that is absolutely right these are very high limits

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the problem is there used to be no limits before the affordable care act so when you think about those call insurance and that's when you think about paying a percentage of say your clotting factor costs um if there's no limits you could be on the hook for even more than this but so so these are the good limits they talk about the affordable care act and they like to talk about the bad caps and the good caps these are the good steps they prevent

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you from unlimited financial exposure but they're still really high now what counts towards that out-of-pocket maximum premiums don't remember that's just your cost of getting in the door but deductibles co-pays coinsurance and qualified health expenses for essential health benefits so if you see an acupuncturist that may not count towards your maximum out-of-pocket it depends on if your plan considers that an essential health

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benefit but um copays and coinsurance for your prescription medications for office visits those will count towards your non-profit vaccine i jumped ahead here these are the things that don't count towards your out-of-pocket maximum your premiums that is your your cost to get in the door if you go out of the network and you um turn out of network provider they can bill you more than an in-network provider we bill you and they

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can bill you actually up to the full rack rate which is a problem that's something called surprise billing or balance billing um and uh unfortunately that does not that's a problem in and of itself and it also doesn't count towards your your the limits on your out-of-pocket spending you may have heard about metal tiers with plans with bronze plans silver plans and gold

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plans and what that means is the percentage of your medical costs taking you as a typical consumer that you can expect your plan to cover and so a gold plan is expected to cover more of your total cost and leave you with less outpocket expenses a bronze plan leaves you more exposed to the out-of-pocket expenses

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and so this just kind of breaks it down for bronze plans but in the marketplace by law have and it's called an actuarial value they're supposed to cover 60 of the costs for medical care for a typical consumer silver 70 gold 80 percent and platinum 90 and you can see that um some of the employer plans so non-marketplace plans um rate at the

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upper end of those ranges marin can i interrupt with that please a lot of the patients and families i work with who are navigating the marketplace or navigating high deductible plans are very much noticing uh you know the the very generous pharmaceutical copay programs that they offer um sometimes that might guide them for better or worse to take a plan with a higher out-of-pocket is there risks involved in that

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or or uh is that strategic or i'm just that's all right that's an issue that comes up a lot it's a great question and it's really hard to give one seismics all advice as i'm sure you have encountered um i'll talk about a little later when we talk about the barriers to care um one of the barriers to care is a practice that some health plans are adopting where they're not allowing that manufacturer co-pay assistance

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to to count towards people's out-of-pocket maximums and so then it is a risk but if you can be confident that and if that you can make full use of that manufacturer assistance then you can be strategic you'd and it makes sense to to go for the lower premiums and knowing that your out-of-pocket costs will be um covered by the manufacturer assistance you have to read the plan and you have to

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read it carefully and boy are those things long and dull and convoluted and then you have to make phone calls because you can't just rely on reading a plan you have to talk to your great and expert htc staff like you um where where the htc social worker may have experience with the plans in your area and know you know have specific experience with those clans and

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know where the pitfalls are it is labor intensive it involves a lot of phone calls it involves you know please take notes and keep records for yourself as you make these phone calls um so so the answer is all of the above that it might be strategic to do that you just have to put in a lot of homework as long as i look and thank you that's a very

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thoughtful um response and one that i i mirror with my my consumers as well because i you know there are certainly risks involved and it's a buyer beware situation before we go any further another question that's popped up along this process is that that you talked about fully insured and self-insured um are there any differences uh it was asked um between the aca protections between those two or or do both do both buckets get equally

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protected with those they both get equally protected under the aca um so the aca required that both types of plans have an internal review process if you have a difference of opinion or you're unhappy that something isn't being covered and they both have to have an external review process it's just you'll go different places for those appeals depending on what kind of plan you are in there is also a shrinking

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number of grandfathered plans and i do not know off the off the top of my head if there are any in new york um those plans you know we just marked the 10th anniversary 10th birthday of the aca those plans should have gone a way by now but they've sort of been grandfathered along and they do not have to meet aca standards i think it's very unlikely that someone with a bleeding disorder is in

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one of those because they do not offer the protections that people in this community as a social worker i appreciate referencing that because you're right it's great that we're celebrating that 10-year birthday because uh you're right in hindsight it was quite a bear for me to help people navigate because there seemed to be these these potholes through these uh these grandfathered plants that hasn't come up as much recently yeah no it was that we actually had a bunch of patient advocacy groups had an

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aca 10 year birthday party in washington dc in march i think it may have been the last and personal thing i went to um you know just to remind our friends in congress of the important games that the aca achieved for for anyone with a pre-existing condition anyone relying on medicaid and we'll talk about that at the end here sorry for interruption keep going no no thank you you know i love it it makes it more conversational it's much more

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interesting than hearing me drawn on so you're doing a fantastic job we appreciate your gifts so thank you so we'll talk about because it is the fall and fall is typically when open enrollment is this is a great time to talk about getting coverage sort of when now how and what to consider so open enrollment for employer plans is typically once a year and it's often in the fall away from you know you can't you know they can make their own

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rules for aca marketplace plans it is november 1 to december 15th in most states some states that run their own marketplaces like new york can can adopt a longer open enrollment period um for medicare plans um october 15th so that is coming up really soon to december 7th and those dates are the same every year there is also something called special enrollment periods and um and that those are triggered by

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major life events um so if you have lost your job if you have been undergone a divorce and the health insurance policy was uh in the name of your divorced spouse death of the policyholder uh birth of a child adoption of a childhood moving out of state things like that um new york state because of covid has actually um held a i don't know whether to call it a special enrollment period or an open

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moment period but they have made it available i think now through the end of the year they kept extending it which is appropriate because people are still experiencing those economic impacts so you really have to make your insurance choices during open enrollment because otherwise you are locked out unless you experience one of these major life events and here they are then

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so eric and i started talking about this what do you do how do you evaluate your insurance choices if you are fortunate enough to be presented with choices one thing i have to emphasize and i that you do this eric with your patients is um don't just automatically renew for the coming year make sure you you review your policy and look for any major changes because there could be

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changes that make it not work for you ask for help your your htc has phenomenal stuff um as i said your your national organizations are are stand willing to help we'd love to hear from you but your local htc is going to move at a much more granular level the ins and outs of the plans that are available in your area um don't wait till the last minute and i think i already said this

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call and and with bleeding disorders are the products that are so essential to to our care the first person you get on the phone is not going to know the answer this is where you have to make yourself a pest and it is hard at work um you know and and no one likes to be that person but it's saying i think i may need to talk to someone else i think you may not have enhancers so asking for someone who deals with

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specialty pharmacy or specialty pharmacy reimbursement those are the types of words that are likely to get you to the person who will have the answers when you make these phone calls so what are your major sources from your employer if you are fortunate enough to have insurance offered through your job from the individual market the marketplace healthcare.gov in new york it's got another name but

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anywhere you are if you enter healthcare.gov it will redirect you to the right place in new york it will redirect you to the new york state marketplace um i can say that staring keeping offspring on the parents plan until age 26 has been just a key key thing for my family there's medicaid there's chip or for families with uh who earn too much for medicaid but need coverage for their children

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the new york state basic health plan which is they're something created by the aca there are only two states that have adopted the basic health plan and it is it's available to people who earn too much for medicaid but for whom paying the prices in the marketplace would be a new burden and eric i'd love to toss it to you to talk about anything more about the basic health plan or the essential health plan is the name

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in new york exactly it's the essential health plan it's very easy to apply for on the new york state of health.gov website that's our marketplace here in new york and and again it's a it's it's a social worker's best friend is what it is because it really has helped it's been helped so helpful to our our our consumers who uh like you just said so eloquently mary who sort of fall between the cracks who we just could never afford even a silver plan for the marketplace but uh but make a little too much for medicaids that's these

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typically are our young men who maybe aged out of their parents insurance maybe aren't making quite enough to pay for the marketplace plans otherwise and what's great about it is it covers things beautifully almost as comprehensively as medicaid but with a very little out of pocket costs and like the example i just gave of maybe the young man who may be aged out who doesn't have a lot of dependents taking about 25 000 a year to qualify or less and uh

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and have very little premium and it's just a great program yeah and i think the other category of people so as you said i think it's available to people making up to 200 of the federal poverty level or about 25 000 for an individual it's also available to immigrants with legal status who may not have the residency requirement years yet to qualify for medicaid i believe that's the case in new york

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and so that's another really important source so and uh so then just rounding this off you cover which is that program to continue your employer-based coverage um if you have lost your job coverage is very expensive because you take over the employer's share of the premium as well as your own share of the premium the the thing is for people in our community at this point in the year if you have lost your job you are you

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don't qualify for medicaid you need to continue coverage cobra may actually make sense despite the high price tag because you have probably already met your out-of-pocket requirements and it allows you and if you went to the marketplace you would have to start all over again with a new deductible and new out-of-pocket requirements and you know then the whole issue of whether you can keep your existing network of providers um including

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specialty pharmacy and doctors and all that so so covert is a pricey option but oddly enough for some people in our community it may sometimes be the right option ma'am that's an exceptional point i have to admit my the last several years i i thought maybe cobra was going out of style because most of my my patients and families in those situations have shifted to the marketplace but that's an interesting point you just made about maybe it might be worth the cost to stay

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the course because of uh those out of pocket maxwell's being met and whatnot that's part of the equation i hadn't thought of yeah you know math is required it was not my favorite subject in the in the high school and uh did not take much of it in college and so um so this stuff is not easy but there are resources there are people who can help with figuring this out so marketplace plans um

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most people who find plans on the marketplace get assistance with their premiums that is key please do not be put off if you go to healthcare.gov if you go to new york state i'm sorry it's along whatever the new york state marketplace is and you you put in your area and you'll it will generate a list of plans and you'll look at the premiums and your eyes might come but if your income is under 400 of the federal property level

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which is now so i'm trying to remember so fifty thousand roughly fifty thousand dollars for an individual a hundred thousand for a family for you are eligible for tax prep credits to help pay those premiums and so um so you can't go by your first gut reaction to those premiums you have to keep kind of plugging in the numbers then if your income is between

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100 and 250 percent of the federal poverty level you may be eligible for assistance with your pockets as well now because of the basic the essential health plan in new york this is less um less of an issue in new york than in other states because if you're under that 200 you're going to go to the essential health fund and have very little out of pocket expenditures so don't automatically assume that the

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plan with the lowest premiums will make the most financial sense for you you have to think about your out-of-pocket spending and this gets back to the question that eric raised you know can you count on the employer i'm sorry the manufacturer copay assistance maybe you can and then you can go for a lower premium a lower premium and higher out of pocket but you have to make sure that you can make take full advantage of those manufacturer

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co-pay assistance programs you have to look for hidden obstacles and that stand in your way of making good use of those programs if you are buying insurance on the individual market again please view and and healthcare.gov and the new york state website will automatically figure figure this in if you are entitled to tax credits to help with the premiums and if you're entitled to assistance

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with your out-of-pocket spending you have to bring a lot of documentation and input a lot of data about yourself but um just understand that the the list price may not be what you are charged in the end there are financial resources for paying insurance costs and eric mentioned one that's really important to this community which is those manufacturer co-pay assistance programs and co-insurance programs

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there's also premium assistance from entity charities like psi and so that is another source of the systems that can help with that getting in the door paying those premiums and then different types of health savings accounts that your employer may or may not contribute to and so we're still talking about considerations i love the homework the the extensive homework that you're going

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to have to do is you sign up for a health plan in open enrollment and obviously one of the things you want to look at is does your plan cover the providers who you want to see and need to see is your htc or your other hematologist of choice in network what about any other specialists that you need to see hospitals that you use well you have a choice of pharmacy provider that's

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that's gotten a lot narrower in recent years and um what happens if you go out of network so it's a lot as i said it's a lot of um information to piece together and figure out what kind of poll what the whole picture looks like when you piece together all of these different factors very key are your products covered um we always ask people to

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to investigate whether their product is covered under the major medical benefit or the pharmacy benefit and that is so hard to find out um part of the reason it's important to find out is that most of these marketplace tools or online marketplace tools will have an online formula area where you can check if your products covered but then only the online tool only covers things that are covered on the pharmacy side so that's

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another reason you have to make these phone calls and you have to make yourself a test you may look in the marketplace plan and say they don't cover any product factor at all how can i sign up for this plan and it might be covered on the major medical side and so you have to call you're i see you nodding eric are there other tips that you found have worked for people i was just nodding emphatically at that particular kind of spider web you just described because i think a lot of folks uh operate an assumption of the pharmacy benefit and that

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that shock value i've had many many call me saying it's not none of the drugs are covered and that's not the case i mean it's the major medical and and and again you've given a couple nice plugs to the friendly neighborhood social worker but i'll jump on that so that you know people don't need to uh do this alone they can certainly uh reach out to their htc social worker and and we can be advocates and i have i've gone to you know for folks who worked with the marketplace i've i have a company within two two meetings with health insurance

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navigators to help them ask the right questions because it can you know it can get overwhelming and and the navigators are a great resource they they are provided by the marketplace itself but you know remember we're a small community and so our concerns are you know really important to us the kind of niche they the navigators may not ever have counseled someone with a bleeding disorder and not even know

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you know sort of where to begin so having that expert assistance is wonderful i can't speak to what my colleagues do in other asgcs but when i have um young men or patients who are navigating the marketplace um i think a lot of the you know sorry i'm aging myself so i'm gonna but i'm still gonna say a lot of the kids today are prone to just go online and and apply that way and that's very fine but um uh it's easy to you know i can't speak of other states but sometimes there's technical difficulties and glitches uh

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maybe i'm just old-fashioned but i really recommend our patients connect with the navigator and bring uh bring me along just as an advocate and as soon as it can help translate like you said with this this really nitchy language that's unique to our very small community to this otherwise great expert who knows a lot about insurance that's wonderful and really valuable service that you're providing so i wanted to just touch on this so

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you know even once you have insurance unfortunately there can be bumps in the road insurance company practices that act as barriers to care um and these are some of them uh you know some of them are our de facto they're you know how on earth do i pay these out of pocket costs some of them are insurance company practices that's um insurance companies creating narrow formularies and saying we're not going to cover

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your product or we're not going to cover your product the product that your doctor thinks is best for you until you try one two or three other products first and fail on them it's a practice called stick therapy um or uh we're we're going to place the product and maybe the one that's best for you on a higher tier with higher cost sharing now again in new york state you have some state level protections

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that um some other some other people would be very envious of which is which is great um but uh unfortunately this is the lay of the land a lot of practices that are aimed at saving money but they do so by making it hard for people to access the care they need so i wanted to to put out some other resources i as eric said there really is no substitute for

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for making that in-person contact and asking the questions but there are some some resources where you can start your self-education on the hfa website and indeed on the nhf website and if you do encounter one of these obstacles you know you have your insurance and yet you cannot access the care you need because of insurance company policies that stand in your way please let us know at hfa we have

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something that is now in its fifth year called project calls where we try to document those insurance company practices we try to collect data and then use that as we talk to lawmakers as we talk to payers to try and make the insurance system work the way it's supposed to be for people who need it so project calls if you encounter one of these problems which we hope you won't

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um you can call us you can fill out the is now survey short survey if you call us you will get a trained social worker on the hfa side and we keep your data very you know uh confidential um [Music] and and just to let you know over the years the project calls has been running um we get twice as many reports of problems that people have encountered in accessing their product

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as we do of problems in accessing their provider um and we consistently over the years in half the cases people report that the insurance company practice that is causing them problems has caused them to delay care and we know in bleeding disorders still need care can be have really serious health consequences so we want to we take that to lawmakers and say look you have to put some constraints on

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insurance companies use of these tactics because it is harming people's health and it's even backfiring if you have delayed terror you have breakthrough bleeding you have an emergency room visit or um you know you're using extra factor that's not saving money for the insurance company in the long run so um please help this make like i said i hope you will not encounter these problems and if you do and you have bandwidth um and willing to share

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your story with us that helps us try and make a case of change so just takeaways for for the the coming year if you do not have insurance through your employer start your search at new york state of health.new york.gov or healthcare.gov it's easier to remember and it will direct you over to to the new york website be an active participant and unfortunately put in all this hard work that you have wonderful resources

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here with your your htc staff being so willing to help out on your behalf make sure you understand if your options change from year to year do not just focus on this price because there are sources of financial assistance um that can help you afford your insurance so that's that's where we stand now and unfortunately there are some

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threats on the horizon and the big one is a lawsuit that is right now in front of the supreme court i i don't know if any of you have heard of it but um it is a lawsuit challenging the constitutionality of the affordable care act um most legal experts and that's regardless of their political persuasion actually think of the merits of the lawsuit is that there is very little merit to the lawsuit that is on

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really shaky grounds and yet two federal courts have have so far ruled against the affordable care act and decided that it is unconstitutional either in a whole or in part and i'm happy to i'm a former lawyer happy to geek out on the arguments with anyone who wants to ask those 15 questions but um two things to know for right now the case is on appeal to the supreme court the supreme court will be hearing oral

48:15

arguments on november 10th one week after the election and while the case is on appeal despite these lower court rulings the aca remains in effect and why is that important i love this graphic which came from kaiser health news it says obviously the aca has affected nearly all americans in some way um we talked about how the aca just turned 10 this year and 10 years is sort of a simultaneously

48:46

the blink of an eye and it feels like forever and so people now think that protections that were put in place by the aca are baked in people assume for granted that even if you have a pre-existing condition you can get coverage and you won't be charged more because of your pre-existing condition and the health plan can't deny you treatment for your pre-existing condition that was not true before the aca the aca provided medicaid expansion

49:19

provided funding so that low-income adults regardless of whether they have a disability regardless of whether they have children can get medicaid coverage that was not true before the aca created these marketplaces the aca also created provided benefits for people in employer-sponsored health insurance so i got i remember i said something about bad caps and boot camps pre-aca there were people who had annual

49:50

or lifetime caps on how how much their insurance would protect them so maybe the insurance company would only pay out a hundred thousand dollars of benefits in a year or a million dollars over a lifetime in our community that doesn't go nearly far enough um and the aca said across the board insurance companies cannot put those kind of caps on benefits the aca allowed their said plants have to cover kids stage 26

50:22

their the aca subplants had to cover essential health benefits so in the in the marketplace so access to maternity benefits to prescription drugs to special specialist can those were not routinely covered by individual health insurance plans before the aca and how they are required using those essential information so if the case goes wrong and this is actually from uh last summer i think so the numbers

50:57

are higher now 21 million people could use their health insurance altogether that's people covered by medicaid expansion and people who get their coverage in the aca market crisis 133 million people across the us have pre-existing medical conditions they're not all as serious as bleeding disorders but smart enough to get people barred from insurance in the past or have to pay more so about 52 million people have conditions serious enough to be

51:30

denied coverage outright then you can bet lead into soldiers following that category 171 million americans can face a return of any modern lifetime caps the bagpipes the um you know you've exhausted your health insurance benefits and have to look elsewhere and uh 2 million adults who are under 26 good health plans to decide to stop covering them so like i said those are our pre-coded numbers

52:02

those those numbers are anything uh more extreme now because um people are migrating to medicaid and to large places with coded and perfect related economic difficulties so that means healthcare is going to be from to the center in the november election and um now even more so with justice with greater guinness from staff last night um and with a pandemic going on so people

52:37

are very concerned about staying healthy and being able to pay for their care so what does that mean it means registering please and they cannot tell you how to vote please make sure you're registered and please do the research and make sure to vote and so with that i am going to end the slideshow and um i don't know if there are questions

53:10

actually um mary we addressed all the questions as we went uh we we got them all all tackled i have to tell you you did a fantastic job covering so much ground and really taking some complicated concepts and breaking them down although know between you and me it sort of bummed me out at the end there it's a it's it's it's it's it's heavy uh to to think about just as a person who's been serving the bleeding disorder community myself for 10 years and to know i i understand that the aca

53:42

is politically charged and maybe provokes people in different directions depending upon where they they may they may be philosophically or politically but uh but as a provider i have to tell you it's made a huge amount of difference in the lives of our patients and i just i dread the thought of going back to our uh having to help patients deal with uh being annual caps uh by march because their medicine's so expensive or not getting their medicine at all because of pre-existing condition so i'm gonna hold my breath and see what's

54:15

uh what comes ahead i think it'll be months ahead before we know right it will be because um fools aaron to try and predict anything about what's happening with the supreme court right now but as i say um the case won't be argued until a week after the election and then it can um the justices typically issue an opinion before their term ends in the

54:43

summer of 2021 unless they were to decide that they needed to have it be argued for some reason um and the end there's an election and who knows what what that will bring um [Music] so it is an unsettled time and um it is unsettling but i guess i i guess to spin it in a hopeful way um i'm incredibly proud to be a part of the bleeding source community as a provider because it's a very empowered community and i think that

55:18

folks with hemophilia and von willebrands and rare bleeding disorders can say there's a feather in their cap and that their stories helped i think help the aca get passed their stories made a difference and new york state has a very empowered uh blindness source coalition hfa and nhf have have wonderful and i think very powerful um advocacy days both in the state and certainly on the national level so we're not done fighting yet

55:48

and uh this community will continue to fight i'm sure of it no whichever way the wind blows so so on that note i see we've come to about an hour here and uh i just want to thank you again mary you're you're extraordinary i appreciate you uh you sharing your time with us and your expertise and um my understanding is this this program uh this this session will be recorded and uh for anyone who missed it uh i i'm thankful that uh that they can catch a later date

56:19

well thank you so much for having me and i've really uh i really enjoyed our back and forth and having this via conversation it's really marvelous let's do it again sometime okay man yes yes well on that note i just want to wish everyone well and uh we'll uh see you next time take care you

Insurance Update - Staying Covered: Health Insurance Trends 2020

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