Contributors: Loyce Pace-Bass, Director of Health Policy and Cameron Krier, Director Government Relations
Some governors steadfast in their decision not to expand Medicaid under healthcare reform are now changing their minds. Why has there been a flip? Because expanding Medicaid makes sense.
Political and economic arguments aside, what matters to LIVESTRONG Foundation is what matters for people living with cancer: access to affordable insurance and care. The majority of survivors that access our navigation services do so because of financial concerns related to their cancer treatment. Some have private insurance, some have insurance through a government-assistance program, and some are uninsured. Regardless of their status, many are not prepared for the toll a cancer diagnosis can have on their finances and life. From out-of-pocket medical costs to reduced hours at work due to illness, cancer can alter an individual’s economic status in a heartbeat. After a major medical event, some people’s only option for insurance and care is through Medicaid.
Medicaid provides an important safety net for low-income individuals that cannot afford or may not have access to private insurance. The healthcare reform law mandated states to expand their Medicaid program so that more low-income individuals would qualify for healthcare insurance. However, last year, the Supreme Court decision made the Medicaid expansion optional, and many states are struggling with what to do.
There are clear financial benefits to states if they expand their Medicaid programs. The federal government covers all costs for the expanded population for three years, and even though the match is reduced in future years, it never falls below 90 percent. At a time when many state budgets are strained, this significant federal funding would provide substantial relief. In addition, many argue that the Medicaid expansion will lead to improved health status and access to preventive care services; reduced uncompensated care borne by healthcare providers; and reduced cost shifting to individual taxpayers, businesses, and the private-insurance market.
Some states embraced the expansion immediately, vowing to implement this aspect of the healthcare law along with its other important tenets. But many states are undecided, leaving millions of people living with cancer now, or in the future, at risk of being uninsured and without access to lifesaving preventive services and treatment. And unlike other aspects of healthcare reform, if a state opposes the expansion, the federal government cannot step in and provide services to that population.
LIVESTRONG Foundation has joined Coverage Counts, a coalition of patient organizations supporting Medicaid expansion and calling on stakeholders to advocate for increased coverage in their states). Over the coming months, we will mobilize our constituents to join the voices of other survivors and caregivers in this nationwide effort.
We want to make sure all protections of the Affordable Care Act are realized by everyone affected by or at risk for cancer, to the fullest extent. Because it matters. And it’s just what makes sense.
Key Provisions of Healthcare Reform:
- Over 30 million uninsured Americans are expected to receive health care coverage once the law has been fully implemented.
- The law currently prohibits private insurance companies from enacting pre-existing condition exclusions for children 18 and younger. By 2014, individual and group plans will be prohibited from enacting pre-existing condition exclusions for adults as well.
- Meanwhile, states and the federal government have offered pre-existing condition insurance plans to more than 100,000 adults nationwide since the new law has been in place. These programs have provided critical care for patients with serious medical conditions and immediate needs, with cancer being the most commonly reimbursed condition among enrollees.
- Health plans are now prohibited from dropping a person from coverage when they become sick.
- Individual and group plans are now prohibited from placing lifetime caps on health insurance benefits. Recent estimates indicate that 105 million individuals no longer face lifetime limits as a result.
- By 2014, the law will end any annual limits on health insurance benefits.
- Increases in healthcare insurance premiums are now subject to review, requiring insurer justification. States will report on trends and exclude plans accordingly.
- Young adults are now able to be covered under their parents’ insurance policy until their 26th birthday. Recent data estimates that 2.5 million individuals aged 19 to 25 years gained insurance in the period between the enactment of the law in September 2010 and June 2011. A recent study indicates that over half of those new young-adult enrollees were made up of racial and ethnic minorities.
- The law now requires Medicare and new private plans to cover preventive services like breast, cervical and colorectal cancer screening with no co-pays and with preventive services exempt from deductibles.
- By 2014, states are required to provide insurance “exchanges,” essentially a one-stop shop of plans with an “essential health benefits package” that includes a comprehensive list of services across 10 major medical categories, as outlined by the legislation. Exchanges are intended to be available for people otherwise ineligible for an employer or other state plan but must nonetheless include plans comparable to those typically provided, based on common provisions and cost-sharing schemes.
- By 2014, the law will prohibit new health plans from dropping coverage because an individual chooses to participate in a clinical trial and from denying coverage for routine care that they would otherwise provide just because an individual is enrolled in a clinical trial. It would apply to all clinical trials that treat cancer or other life-threatening diseases.
- The law also includes a number of consumer–friendly education resources as well as tax credits and other incentives.