Health insurance coverage is critical to keeping up with preventive care, addressing physical and mental health conditions, and being protected from unexpected medical costs. During this time of year, individuals and families who do not have health insurance through their employer, Medicare, Medicaid, or other plan, can go to healthcare.gov or CuidadodeSalud.gov to find coverage options on the health insurance marketplace that was established through the Affordable Care Act. All plans available on the marketplace provide coverage for the Essential Health Benefits.

For 2023, consumers have more choices and affordable options. The passage of the Inflation Reduction Act allowed the extension of premium tax credits that lower or eliminate out-of-pocket premiums. The Biden-Harris administration recently finalized a rule on the “family glitch” that extends coverage and financial assistance to families that have unaffordable health care coverage with employer-sponsored plans– unaffordable is considered more than 9.5 percent of household income. The administration estimates that this situation affects about 5 million people, and now they will be able to gain affordable coverage on the marketplace because the “family glitch” has been fixed.

The Biden-Harris administration has provided more funding than ever before for Navigator programs that help individuals sign up for coverage through in-person and telephonic assistance. Grant funding of $98.9 million dollars is allowing organizations across the country to support more than 1500 Navigators to provide consumer assistance. Social workers are important liaisons to connect individuals and families with Navigators in their community to provide personalized assistance. Many Navigator programs have expertise in assisting underserved populations including specific racial and ethnic communities, rural communities, LGBTQIA+ individuals, refugee and immigrant communities, low-income families, pregnant women and new mothers, veterans, and small business owners.

Outreach efforts and strategies to keep coverage costs affordable are important tools that are advancing health equity in the United States. A new report shows that since 2020, Black, Latino, American Indian, and Alaska Native consumers saw significant enrollment increases on the marketplace. Social workers should know that their efforts to enroll people in health care coverage help to reduce health disparities.

Social workers can inform clients about available resources to learn more about health insurance coverage options and understand the process to enroll:

• Plan Year 2023 Marketplace Open Enrollment Fact Sheet for more information
• To Find Local Assistance 
• CMS From Coverage to Care Enrollment Toolkit
• CMS From Coverage to Care Roadmap to Better Care
• CMS From Coverage to Care My Health Coverage at a Glance
• CMS From Coverage to Care Resources Available in 9 languages
• Georgetown University Center on Health Insurance Reform’s Navigator Resource Guide
• The Value of Health Insurance
• Find Out if Your Income Qualifies You for Savings

The Centers for Medicare and Medicaid Services (CMS)  is seeking feedback from clinical social workers and other providers about how they should provide estimates for costs of services for patients who use their insurance to pay for health and mental health services.  Your feedback would be helpful in providing information to CMS who may create a proposed rule for preparing national standards in this area.

The request for feedback is related to the No Surprise Act (NSA), which protects patients from large, surprise healthcare bills. Clinical social workers (CSWs) are currently required to give Good Faith Estimates (GFEs) to patients who are uninsured and patients who have insurance but do not plan to use it.

Read “No Surprises Act Regulations 2022”

A future rule may add to the Good Faith Estimate requirements for patients who intend to use their insurance to cover their care.  CMS is proposing that the CSW will need to notify the patient’s health plan of their estimated charges.

The health plan would then send the patient an Advanced Explanation of Benefits based on the CSW’s estimate.

The request for information will help CMS propose detailed steps for sending GFEs from CSWs and other providers to the patient’s health plan.  There are a series of questions available for response.  You may respond to one or more of the questions.  Examples include:

• What privacy concerns does the transfer of AEOB and GFE data raise?
• What burdens or barriers would be encountered by small, rural, or other providers, facilities, plans, insurers, and carriers in complying with industry-wide standards for the exchange of information?
• Would it alleviate burden to allow CSWs and other providers, for purposes of verifying coverage, to rely on a patient’s representation regarding whether the patient is enrolled in a health plan?

A list of additional questions is available at Request for Information: Advanced Explanation of Benefits and Good Faith Estimate for Covered Individuals.  The deadline for submitting feedback to CMS is November 15, 2022.

NASW will be submitting comments and requesting an exemption from the proposed requirement that clinical social workers issue GFEs to insurers, and advocating for less burdens.

NASW members may forward questions to Clinical.Practice@socialworkers.org

Photo courtesy of Centers for Medicare and Medicaid Services.

The open enrollment period for the health insurance marketplace is significantly shorter this year — from November 1 to December 15, 2017.

The Trump administration has also cut funding for advertising and enrollment assistance.

Social workers should share enrollment information with clients, families, friends and communities to bring awareness to the narrow enrollment window.  Each of us can do our part to help distribute this important information!

Get ready to enroll!

https://marketplace.cms.gov/outreach-and-education/about-the-marketplace-english.pdf

Make note of key dates for the Health Insurance Marketplace this year

https://marketplace.cms.gov/outreach-and-education/key-dates-for-marketplace.pdf

Visit www.healthcare.gov or www.cuidadodesalud.gov/es to find out more about your eligibility.

Call 1-800-318-2596 (TTY 1-855-889-4325) to have your questions answered and for support with signing up for health insurance coverage.

Sign up in person by finding assistance near you. Locate help in your area at localhelp.healthcare.gov or at a health center www.hrsa.gov

Health insurance enrollment information is available in the language you need https://www.healthcare.gov/language-resource/

Many organizations are dedicated to connecting you to the right resources to secure health care coverage:
Families USA 
Young Invincibles 
Out 2 Enroll 
UnidosUS (formerly National Council of La Raza)
Asian American Pacific Islander Health Forum
National Women’s Health Network

For more information contact NASW Senior Practice Associate Carrie Dorn, LMSW, MPA at cdorn.nasw@socialworkers.org.

The latest proposal would wipe out subsidies for the purchase of private health coverage, end Medicaid expansion, erode critical consumer protections for pre-existing conditions and essential health benefits, and convert Medicaid to a per-capita block grant financing system.  The bill would target states that have expanded Medicaid and significantly cut their funding.

The cut in funds for insuring low-income single adults through Medicaid will significantly increase to number of uninsured among the country’s most vulnerable citizens. While Leader McConnel will seek to advance the Cassidy- Graham bill without a score from the Congressional Budget Office (CBO), independent experts have already projected that the bill would leave more than 32 million Americans without coverage. That would be a tragic consequence.

This is the home stretch. We need your voice now more than ever!  As your Senators debate health care repeal/replace, NASW urges you to ACT NOW by emailing or calling their offices. We must stand up to preserve access to health care services for millions of Americans.

Sample Email

As a constituent, social worker, and member of the National Association of Social Workers I urge you to VOTE NO on the Graham-Cassidy bill, which seeks to repeal and replace the Affordable Care Act.

As a health care professional, I am particularly concerned about the effect this bill will have on mental health services and low-income individuals. The bill undermines critical consumer protections and its Medicaid cuts would leave millions without coverage. I ask for your commitment to a bipartisan approach to improving Medicaid and the ACA marketplace.

I strongly urge you to oppose the Graham-Cassidy bill. VOTE NO.

After three hours of debate last night, Leader McConnell called for a vote on the Better Care Reconciliation Act (BCRA), highlighted in NASW’s previous alert. The Senate, ultimately, voted down the bill, 43-57. While the vote represents an early setback for Leader McConnell, it marks only the beginning of an intense and lengthy repeal and replace fight that will unfold over the next few days.

In fact, over the next couple of days the Senate Majority will offer a series of comprehensive amendments aimed at repealing the ACA and cutting funding to Medicaid. Leader McConnell continues to work behind closed doors to craft legislation that can garner the votes needed for passage, including talk of a slimmed down health care package – if all other options are exhausted.

Time is of the essence and your voice is needed now more than ever! As your Senators debate health care repeal/replace, NASW urges you to ACT NOW by emailing or calling their offices. In these final hours, we must continue to stand up to preserve access to health care services for millions of Americans.

WRITE A LETTER

MAKE A CALL

The outlook for Senate action on BCRA or perhaps just a straight repeal of the Affordable Care Act (ACA) remains uncertain (CBO estimates full repeal would result in 32 million uninsured). The one thing that is clear is that the Senate GOP Leadership does not yet have the 51 votes to complete health care repeal and/or replace efforts. Additionally, the fate of the devastating cuts in Medicaid remain unchanged, with nearly $800 billion of Medicaid supported access to health care designated to be eliminated.

Despite waning support for BCRA, Senate Majority Leader, Mitch McConnell (R-KY), remains committed to holding a vote next week, whether they have the votes needed for passage or not.  The public opposition of Senators, Lisa Murkowski (R-AK), Shelley Moore Capito (R-WV), and Susan Collins (R-ME), combined with the devastating diagnosis of brain cancer for Senator John McCain makes passage next week an uphill climb for Leader McConnell.

Despite these hurdles, however, the Senate GOP is working around the clock to revive health care repeal efforts. President Trump is strongly and publicly urging them to continue negotiations. While the Senate’s strategy is changing by the hour, NASW calls on you to stay vigilant in this fluid environment. We have witnessed the revival of a seemingly dead bill before and we must keep the pressure up. NASW urges you to contact your Senators and ask them to VOTE NO on the latest BCRA discussion draft or any ACA repeal efforts.   We must continue to stand up to preserve access to health care services for millions of Americans.

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The latest version incorporates an amendment by Senator Ted Cruz (R-TX) that would fundamentally undermine critical consumer protections, including pre-existing conditions and essential health benefits. The provision would allow insurers to offer cheap plans that cover few services so long as they offered a single plan in the market that adheres to current law. Experts believe this approach would essentially create an unaffordable and unfunded high-risk pool option for the old and sick and drive the young and healthy into cheap barebones coverage options.

While the newest discussion draft adds an additional $45 billion, over 10 years, for opioid treatment and recovery, it does not go nearly far enough to ensure a strong health care system for the millions of Americans suffering from substance abuse disorders.

Additionally, the latest draft allows health saving accounts (HSAs) to pay for health care premiums, which would largely benefit high-income individuals. While several Republican Senators still have concerns with this latest draft, negotiations are underway to ensure swift passage.

The Congressional Budget Office (CBO) is expected to release its score of the updated BCRA draft today or Tuesday. Because of a surgery and recovery period for Sen. John McCain (R-AZ) the vote will likely be delayed. NASW will provide you with up-to-date information once the CBO releases its score and as the Senate GOP Leadership works to secure the required 50 votes-plus a tie breaking vote from Vice President Pence – to obtain Senate passage.

As you await these updates, remember that your voice is vital! Please use every opportunity to communicate with your Senators to vote no on this new iteration of BCRA.

Write a Letter

Make a Call

A year ago Heidi L. Allen’s sister died.

“She lived in Idaho, which did not expand Medicaid under the ACA” (Affordable Care Act, also called Obamacare), said Allen, an associate professor of social work at Columbia University in New York whose focus is low-income, uninsured adults.

“Here I study health insurance, and I have a 44-year-old sister dying of cancer who doesn’t have health insurance,” she said. “I felt so helpless to be an expert in this particular area and not be able to help my family. It was horrible. I’ve seen firsthand the consequences people have to this financial barrier.”

And, she said, she is not alone.

“This was my personal tragedy,” Allen said. “Four children lost their mother in the United States of America. It is wrong, and it happens every day. Everyone I know has a story like this. I’ve seen tragedy after tragedy.”

“I focus on insurance, and because I study health insurance, it’s my personal passion. I think it’s one of the biggest issues we need to address.”

The American Academy of Social Work and Social Welfare has focused the profession’s attention on the issue by making “Close the Health Gap” one of its 12 Grand Challenges for Social Work.

Now that group, which Allen is a member of, is proceeding amid the uncertainties of an altered political climate that is pushing potentially dramatic changes for millions of Americans who cannot afford to buy insurance on their own.

Heidi Allen

“We definitely have setbacks with the political climate, but at the same time, the election has banded people together and created a community of people who want to see change,” said challenge co-leader Michael Spencer. “It’s an opportunity for social work to encourage participation with changing structures.”

While he believes a single-payer system “would solve a lot of problems,” he said, “that’s not where we are starting with this grand challenge.”

“Now we have the ACA, a huge step forward for people and for this country,” said Spencer, BA, MSSW, Ph.D. and the Fedele F. Fauri Collegiate Professor of Social Work at the University of Michigan in Ann Arbor. “It needs more funding. It needs to expand and grow. Those states that chose to expand Medicaid are doing well. We can be idealistic — and we are — but we also believe the fight is before us, and where we’re starting now is with the ACA.”

Gains in Care

The Obamacare Facts website cites a 2012 FamiliesUSA study that states between 2005 and 2010, more than 130,000 Americans died because they lacked health insurance.

“The number of deaths due to a lack of coverage averaged three per hour and the issue plagued every state,” it says. “Other studies have shown those statistics to be high or low, but all studies agree: In America the uninsured are more likely to die than those with insurance.”

A September report by the Henry J. Kaiser Family Foundation states: “The ACA’s major coverage provisions went into effect in January 2014 and have led to significant coverage gains. As of the end of 2015, the number of uninsured non-elderly Americans stood at 28.5 million, a decrease of nearly 13 million since 2013.”

In the following year, more people gained health insurance, according to data from the National Center for Health Statistics released in April. It found 18.2 million fewer adults overall lacked insurance in 2016 than in 2010.

Titled “Changes in Characteristics of Chronically Uninsured Adults,” the bulk of information covers changes for the chronically uninsured — those who lacked insurance for more than one year — from 2010 to September 2016. Those highlights include:

Among adults ages 18 to 64, the percent of chronically uninsured decreased from 16.8 percent to 7.6 percent.

In 2010, the percent of chronically uninsured adults who were non-Hispanic white was larger than the percent who were Hispanic. But in the first nine months of 2016, Hispanics comprised the largest group among the chronically uninsured.

The percent of chronically uninsured adults who lived in the South was higher than in any other region, increasing from 44.6 percent in 2010 to 54.7 percent in the first nine months of 2016.

From the June 2017 NASW News. Read the full article here. 

Like the House-passed American Health Care Act (H.R. 1628), the Senate version, being drafted behind closed doors, expects to undermine vital protections for Americans with pre-existing conditions, eliminate essential health benefits, increase premiums, cut Medicaid, and cause as many as 23 million people to lose coverage.

It’s critical that Senators hear from you! Especially if you live in a state with Senator’s who are currently undecided in terms of their votes, such as: Susan Collins (R-ME), Shelly Moore Capito (R-WV), Rob Portman (R-OH), Cory Gardner (R-CO), Bill Cassidy (R-LA), Jeff Flake (R-AZ), Dean Heller (R-NV), Lisa Murkowski (R-AK), Rand Paul (R-KY), Mike Lee (R-UT), and Ted Cruz (R-TX).

As a Social Worker and constituent your voice is powerful. Contact your Senators, today, and urge them to support a new direction that prioritizes the needs of our nation’s most vulnerable populations and promotes health security for all Americans.

Write a Letter

Make a Call

Share on Social Media:

Facebook/LinkedIN:

The Senate is working on legislation that will cause millions of Americans to lose health care. Join NASW in urging lawmakers to #ProtectOurCare! bit.ly/2rz8d0L

Twitter:

Join NASW to #ProtectOurCare and fight Senate bill that could end health care for millions bit.ly/2rz8d0L #SWStandUp

Other Actions You Can Take:
o Visit the office of members of Congress
o Attend state-level town hall and coalition meetings