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Wednesday, September 6, 2017

Efforts to repeal and replace the Affordable Care Act (ACA or “Obamacare) have been unsuccessful thus far. Although the House passed the “American Health Care Act” in May, the Senate did not pass their companion bill, the “Better Care Reconciliation Act.” However, efforts to repeal and replace the ACA are far from over, and CSC is concerned that several mechanisms may undermine the ability of individuals to access comprehensive, high-quality, timely, and affordable health care coverage.

Public Awareness of Health Care Options

The health care marketplace, where individuals can purchase health insurance coverage, is the foundation of the ACA. The marketplace will be open for new enrollees to purchase insurance, or current enrollees to make changes to their coverage, beginning November 1, 2017 and ending December 15, 2017. However, the Centers for Medicare and Medicaid Services (CMS) recently announced significant cuts to enrollment assistance, outreach, and education funding. This includes navigation assistance as well as funding for advertising. This means that people who aren’t paying close attention to health care policy details, or individuals in hard-to-reach populations, won’t have access to vital information that will help them to enroll or update their health care coverage. Further, with the ongoing debate about health care, there is also public confusion about the status of the ACA, making this outreach even more critical.

Funding for ACA Cost Sharing Reductions

The ACA offers plans with reduced costs to some patients based on their incomes. These lower cost plans are critical to cover at-risk populations and reduce health care disparities. In turn, insurance companies receive funding from the federal government to help cover their costs as a result of these reductions. A major issue in the health care debate has been whether the government should continue funding cost sharing reductions (CSRs). The Congressional Budget Office estimated that the termination of CSRs would initially lead many insurers to withdraw from the marketplace because they could not predict the health care costs for people purchasing plans. This could lead to geographic areas with few or no options for health insurance coverage and more uninsured individuals. It would also lead to higher premiums (up to a 25% increase) for patients, in order for insurers to cover costs.

State Medicaid Waivers

State Medicaid waivers are optional mechanisms available to state Governors who want to create pilot programs intended to improve health care access. These waivers can be used in a range of ways. Maine has created a waiver that would create a 20-hour a week work requirement, impose co-pays and premiums, and a $5,000 asset cap on Medicaid beneficiaries. Kentucky, Indiana, and Wisconsin also have proposed similar state waivers that include work requirements and increased cost-sharing for patients. The waivers are being used to create more restrictive environments for Medicaid patients, not improving health care access. This means that a patient’s geographic location has the potential to threaten their access to health care.

There are ways to improve the ACA, and help patients in need. However, we are concerned that the issues raised in this blog have the potential to negatively impact patients, particularly those who cannot afford insurance coverage without assistance and those with chronic illnesses such as cancer who simply cannot risk losing insurance coverage.

What Can You Do?

Make sure you are a Cancer Support Community Grassroots Advocate to receive up-to-date policy information and opportunities to take action on issues like these.

Talk to your friends and family to ensure that they understand the current status of health care reform and how these issues might impact access to care. Make sure they understand that open enrollment starts November 1, 2017 and ends December 15, 2017.

Pay attention to state health care policy, particularly if your state might apply for a Medicaid waiver. Understand what that waiver could mean to patients and contact your state lawmakers to express your opinion.

Engage with CSC on social media and speak out on policies that will impact cancer patients and their loved ones: