The people caring for our children in preschools and child care centers are among the Texans most likely to go without insurance. Most earn low wages and would qualify for Medicaid if our state accepts federal dollars to cover them. Fewer than 1 in 5 child care workers get offered health coverage through their jobs, and at least 27% remain uninsured. That’s why people like Bettina Cox, a Houstonite and former child care provider, traveled to Austin this week to advocate for Medicaid expansion.
Though it was her first time at the Capitol, Bettina got down to business! She spoke at a Texas Organizing Project press conference that Texas Well and Healthy supported, and she met with her elected official. Her message throughout the day was poignant, and it was clear: many hard-working Texans cannot afford health coverage, and when they delay getting regular check-ups or seeking medical treatment, their illnesses unnecessarily worsen.
In November of 2011, Bettina’s health began to decline, and she had to stop working as a childcare provider. Without a job or health insurance, Bettina was consumed with fear and uncertainty. She explained, “I never knew it would be so hard to receive help for a medical condition I had no control over…cancer. My family and I were fearful, frustrated, and worried that I may lose my leg, or worse, my life, for it seemed there was no hope of finding the help I needed.”
Bettina was finally able to see a doctor through the program Gateway to Care and was diagnosed with Stage 1b Cervical Cancer. While waiting to meet with a specialist, her tumor had grown as largeas a grapefruit and was pressing against a nerve in her leg and hip. Without surgery, her leg would have to be amputated. Fortunately, Bettina qualified for the Medicaid Breast and Cervical Program and was able to receive the care she needed. The program, however, provides health coverage only after you’ve been diagnosed.
Today, Bettina is cancer-free. Though she endured a terrifying and painful ordeal, she feels like one of the lucky ones. She knows there are many people who share her story but didn’t receive the treatment they needed in time. About 60 uninsured Texans each week lose their lives because not having health insurance caused them to miss a life-saving screening or treatment. Millions of hard-working, uninsured Texans are still waiting for an affordable health care solution. Motivated by her experience and her faith, Bettina now advocates for herself and the 1.5 million Texans who could receive health coverage if Texas expanded Medicaid. She is an advocate in the truest sense of the word.
Written by: Liz Moskowitz, Texans Care for Children
As back-to-school time approaches, life can get pretty busy. Keeping up with the news becomes not the highest priority for some. We’re here to help. Below are some current-event tidbits to know about, all of it good news from the past couple of weeks.
- Your birth control may now be free.
As of August 1, family planning is part of preventive care, and your health insurer has to pick up 100% of the cost for it, thanks to the nation’s health law. Some people’s health plans are exempt, so it’s not a guarantee, but over 3 million Texas women do qualify as of this month, so be sure to check with your insurer. - Health insurers trying to rip you off had to pay back the difference.
Were you one of the people to get a check or rebate notice from your health insurance company last month? Over $167 million in health care rebates went to Texans whose insurance companies spent too much last year on overhead and profits, instead of actual health care. (This, too, is because of the health law: thanks, Obamacare!) - Texas no longer has the highest rate of uninsured children.
Every summer, a report called “Kids Count” looks at how children in different states are doing. Although Texas kids always lag behind, this time they are doing better in a couple of ways. For over a decade, Texas was the state with the most kids unable to see a doctor in a doctor’s office when they need to. Then some state leaders started to get more serious about covering kids, and now 200,000 formerly uninsured children have health care, so we no longer have that terrible distinction. There’s still a long way to go, but progress is progress, and the health law is making sure Texas holds on to those gains. - Women can get annual medical care without paying out of pocket.
Just as birth control is now covered, other free preventive care for women as of this month includes all your well-woman basics: mammograms, annual pap smears, gestational diabetes screenings, tests for HIV, counseling about domestic violence, etc. (Kids already got free preventive care and well child visits under the health law.) - Supports for nursing mothers, like those costly breast pumps, are now covered.
This, too, is related to the preventive care covered for women, as of August. Many new parents have sticker shock at the price of a breast pump, or renting one from a hospital. Now insurance companies will cover those costs, as well as other services for new nursing moms, under the health law. - We have an opportunity to save 10,000 lives a year.
Governor Perry acts like he single-handedly gets to decide whether Texans get benefits from the nation’s health law, but actually important decisions will be made later by the legislature. That’s especially good news when it comes to Medicaid, which would provide security and better health to more families if the state acts on the nation’s health law. Studies that just came out from Harvard University found that Medicaid not only makes people’s lives better—it has life-or-death importance for many of them. In Texas, we still have a chance to make a huge difference, saving as many as 10,000 lives a year.
What do these good-news items have in common? They all have to do with one very important law, the Affordable Care Act. If the health law still doesn’t make sense to you, check out this cartoon from the Kaiser Family Foundation to get an idea of what it means for so many people:
Now you’re all caught up. Hope it helps. We now return you to your regularly scheduled, hectic summer.
Written by: Christine Sinatra, Texans Care for Children
FOR IMMEDIATE RELEASE
August 1, 2012 Contact: Christine Sinatra (512) 473-2274
Texas Women and Texans Whose Insurers Charged Too Much for Administrative Costs Last Year Have Milestones Today
AUSTIN - Important improvements in women’s preventive care and a milestone related to controlling health care spending coincided today with a Texas legislative hearing about what the Affordable Care Act means for our state. Even as lawmakers from two state senate committees heard testimony about the nation’s health reform law, 3.4 million Texas women were affected by provisions of ensuring women could receive preventive care, including screenings, check-ups and contraception, without out-of-pocket costs. Additionally, Wednesday is the deadline by which the Texas insurers who spent less than 80 percent of last year’s premiums on actual health care must distribute rebates to small businesses and policy-holders to make up the difference.
“These developments will not only protect Texans’ health, but also save them their hard-earned money,” said Mimi Garcia, Organizing Director with Texas Well and Healthy, a statewide grassroots campaign to improve health care in Texas. “These are big steps forward for women’s healthcare and for better value in health insurance premiums. They help Texans protect their health and their finances.”
Beginning today, all women’s health plans moving forward must include the preventive health care services recommended by the Institute of Medicine without co-payments, co-insurance, deductibles or other out-of-pocket costs. This includes well-woman visits, birth control, breastfeeding supports and screenings and counseling, for things ranging from gestational diabetes to domestic violence.
Today is also the deadline for health insurance companies that have to give rebates to their customers if they spent less than 80 percent of last year’s premium dollars on health care, as opposed to overhead and profits. The Affordable Care Act requires health insurance companies to follow this 80-20 rule, and those that failed to last year in Texas have been reimbursing small businesses and Texans with individual policies for the past several weeks. In 2012, over 1.5 million Texas families will have received a total of $167 million in refunds, averaging $187 per family.
For more on today’s hearing at the Texas legislature, which is being jointly held by the committee on health and human services and the committee on state affairs, visit http://www.senate.state.tx.us/.
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The Texas Well and Healthy campaign is a broad, grassroots coalition working to ensure that every Texan has access to comprehensive and affordable health insurance. It is a collaboration of members of Cover Texas Now and other health care coalitions in the state, and led by the Center for Public Policy Priorities, Children’s Defense Fund- Texas, Engage Texas and Texans Care for Children. More about the campaign is at http://texaswellandhealthy.org
Under the ACA, will the August 1 no-copay rule for contraception apply to EXISTING health plans or just new ones? And do you know if IUDs will be covered?
Sincerely,
Confused About the Contraception Rule
Dear Confused,
What a great question! There has been a lot of chatter about the August 1, 2012 start date at which all insurance plans must provide co-pay-free contraceptive coverage. Before diving in to an answer, Confused, let me give a little background information for those who haven’t heard about this yet.
No co-pay, you say? That’s right.
If you are insured and using contraceptives (and by “contraceptive” I mean every FDA-approved contraceptive, from the pill to the patch, to the ring, to the shots, to IUDs and even tubal ligation) as of August 1st of this year, you will no longer pay any out-of-pocket cost for this coverage. Why? Contraception is classified as preventive care (in this case meaning you are preventing an unintended pregnancy and all the associated medical costs), and under the Affordable Care Act (the health reform law), preventive care must be covered by insurers out of the cost of your premiums. No more co-pays. Click here for a complete list of preventive care offered to women under this new rule.
So, to answer your question. The rules for contraception apply to all health plans EXCEPT those that are grandfathered under the “keep your health care if you like it” provision in the ACA. Click here for a full explanation of how plans are grandfathered, but in sum, it goes like this: the grandfather clause states that any health insurance plan in existence on March 23, 2010 does not have to comply with rules like this one for contraception. UNLESS that plan makes (or has made) “meaningful” changes to its plan (i.e., raising costs or reducing benefits for beneficiaries), in which case it does then have to comply. On the other hand, all new plans, or recently altered plans must comply.
My advice? Call your plan to find out whether they are grandfathered or whether they will comply with the regulation.
As for whether IUDs will be covered, yes. All IUDs (intra-uterine devices), both hormonal and non-hormonal, are FDA-approved contraceptives. They will be covered under this ACA rule. Go forth and save money, my friend!
To a well and healthy Texas,
Cheasty Anderson
With so many pieces to the Affordable Care Act (ACA), it can be difficult to understand exactly how health reform is going to play out. One easy way to resolve this is to ask how it would affect you or a loved one. What if you found out you were infected with a life-threatening disease?
Let’s take HIV and AIDS, for example.
You may not be able to think of anyone you know who is living with HIV or AIDS, but don’t be fooled – more than 1 in 400 Texans are living with HIV, and that number is on the rise.
In Texas, we have a problem with HIV patients going untreated. Only 1 in 3 Texans living with HIV is receiving treatment. Not having health care coverage is a big reason.
Luckily, health reform is on its way, and, by 2014, the ACA is going to help make sure that Texans can access the medical care they need. Here’s how:
- By requiring most insurance plans cover preventive care and screening. Routine HIV testing will be paid for, which will increase our state’s low testing rate (only 21% of us got tested last year). It also means that people living with HIV will have access to the treatments that help them stay healthy and avoid transmission.
- By expanding Medicaid to cover most low-income Americans. Americans with HIV who meet the financial qualifications for Medicaid will be covered, increasing the likelihood that they will receive life-saving medical treatment.
- By ensuring that Americans living with diseases can get insurance. Starting in 2014, insurance companies won’t be able to deny or drop us based on pre-existing conditions. Until then, the government is subsidizing “Pre-Existing Condition Plans” for Americans who have been denied health insurance coverage due to pre-existing conditions like HIV or AIDS.
- By counting AIDS Drug Assistance Program payments as “true out of pocket” costs for Medicare recipients. The donut hole for people living with HIV/AIDS can be very large, and the health law will close it faster.
These measures are designed to make sure that all people, including those with HIV, have access to affordable care. Why? Because untreated HIV is everybody’s problem. By ensuring that people already living with HIV receive treatment, we can reduce the risk of transmission by about 96% and prevent new cases. We don’t want Americans with HIV - or any other disease - to go without treatment for any reason, including public health. When they do, we lose the battle against these diseases in our communities and we also lose lives.
Whether we talk about it or not, the AIDS epidemic is real. Luckily, we’ve got a health care law in place that is trying to solve some of the problem. So, let’s talk about it!
Contributed by: Katherine C. Kornman
Dear Cheasty,
I’m confused about the contraception regulation controversy that exploded in the news last week. I was under the impression that women already have access to birth control through their insurers. Is anything going to change with the compromise they reached on Friday?
Thanks,
Confused about Contraception
Dear Confused,
Creative Commons License photo credit: brains the head
Well, the air is still clearing, and even health policy experts still have some unanswered questions, but I can at least clarify the basic facts and circumstances for you. Let’s start by addressing your first point.
You are mostly correct in your belief that women already are guaranteed access to contraception coverage through their insurer. Just like the Obamacare mandate, for a number of years now the state of Texas has had a law in place that requires any insurance plan that offers prescription drug coverage to also cover contraception. That includes all FDA-approved methods, from the birth control pill to diaphragms, to IUDs. (Not condoms, which are sold over the counter, but you get my drift.) Texas is one of 28 states that have such regulations, but even in states without the laws, this was fairly standard practice. The innovation here is that Obamacare promises women access to contraception with no additional co-pay – in other words, free.
But what was the big deal? Hasn’t this “no co-pay contraception” part of Obamacare been in the news for a while? Why, all of the sudden, were Catholic bishops on tv and radio complaining about government interference in their right to religious freedom?
In short, that’s a great question. First of all, the Obama administration did not, as it might appear from the dust-up, just release a regulation solely about contraception coverage. What we’re talking about here are the ACA’s regulations about preventive care. Preventive care includes everything from annual exams to mammograms, blood work, colonoscopies, and yes, contraception.
Anybody who is paying attention has known about these regulations for months. But early last week, The Department of Health and Human Services released their final version of the regulations, and the Catholic bishops were ready for battle.
The original (pre-kerfuffle) regulations contained an exception for religious organizations. So if an organization’s primary purpose is the practice of religion (i.e., a church or diocese), then it doesn’t have to cover contraception through its insurance plan. However, if an organization is affiliated with a religion, but its primary purpose is not the practice of religion, (i.e., Seton Hospital or charities), then those institutions were not exempt.
The Catholic bishops were furious because, in essence, they felt the regulation was forcing Catholics to condone and pay for something that violated their religious beliefs. In an election year where conservatives seem to be grasping at straws, this generated a lot of political momentum.
Friday’s compromise quelled the hubbub by retaining the original exemption for churches, and by setting up a system that will work as follows. If Jane Doe works for XYZ Catholic University and XYZ doesn’t cover contraception, Jane Doe will call XYZ’s insurance company and say, “Hey insurance company, I need coverage for contraception.” The insurance company will then adjust Jane Doe’s policy to cover contraception. XYZ’s insurance plan will pay for it, but the cost will not come out of the plan’s premiums. This way, the employer need not know, nor must they pay.
Wait a second, you say. The insurance company will just eat the cost of contraception?
Essentially, yes. Obama wagered that insurance companies would be okay with this deal because it’s cost effective for them (birth control is way cheaper than an unintended pregnancy), and pretty much, he was right. They’ve issued a statement belly-aching about “setting a bad precedent,” but so far, so good. Churches and diocese and the like will still have the exemption they started with, but all the rest of us will have access to contraception at no additional co-pay, as originally promised in the law.
Disaster averted, it seems, for the time being. While the U.S. Bishops are still not satisfied, it appears most catholic voters support the policy.
Well, Confused about Contraception, I hope this helped clarify things for you about contraception. In short, you can rest easy. No matter where you work, or what your employer’s position on birth control is (unless you work for a Catholic church), your guaranteed access to contraception coverage is secure. It took some fancy footwork, but by Friday evening all seemed to have calmed down. What a roller coaster!
To a well and healthy Texas,
Cheasty Anderson
Center for Public Policy Priorities
