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Mar 7, 2017

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Making health care inaccessible again

by | Mar 7, 2017

Health

Piggybank with medical cross

On Monday, House Republicans released their long-anticipated ACA repeal-and-replace bill. Though the title is the American Health Care Act, a better name might have been “Repeal Access to Care.”

Among other measures, this bill would make insurance unaffordable for 450,000 low-income Coloradans by reducing the federal match for the Medicaid expansion after 2020 from 90 percent to 50 percent.

The legislation would eliminate cost-sharing assistance for individuals and families with private insurance who make less than 250 percent of the Federal Poverty Level. It would reduce premium tax credits, designed to make health insurance affordable for people with more middle class incomes. Additionally, the bill would make it harder for low- and moderate-income people to get and keep insurance coverage. Furthermore, it would repeal taxes on the wealthy by reinstating tax exemptions for insurance companies that pay their directors, officers and employees more than $500,000 a year and Medicare taxes for people making over $250,000 a year.

But wait, there’s more!

In addition to making it impossible for TABOR-restricted Colorado to retain the Medicaid expansion after 2020 without gutting funding for education and other expenditures, the bill would make the Medicaid program less accessible to low-income people by reducing children’s eligibility from 133 percent of the Federal Poverty Level to 100 percent FPL. It would eliminate an important pre-ACA Medicaid protection that allows people to get help with medical bills incurred up to three months before they applied for Medicaid. Another core ACA provision, the Medicaid three-month “look-back,” made sure that very low-income people who were uninsured were able to get help with medical bills rather than forgo care and/or fall into bankruptcy.

Most significantly over the long-term, the bill would change the core structure of Medicaid financing by instituting a per-capita cap for program expenditures. The per-capita cap, which would begin in Federal Fiscal Year 2020, would be allocated to states according to a formula based on 2016 expenditures in four Medicaid eligibility categories:  aged blind and disabled, children, non-expansion adults and expansion adults.

Not only would the base funding year be four years out of date by 2020, but states that over-expend their allocation after that would have to pay back any over-expenditure through a reduction in their allotment the following year –thus whittling away the amount of money available to states. While the growth rate in the per capita allocation will be tied to a medical inflation rate, states would inevitably face multiple unexpected circumstances that drive health care expenses, including the availability of expensive new medical technologies and pharmaceuticals (think Hepatitis C treatments) as well as natural disasters and recessions. The per-capita cap is at the core of the federal effort to reduce federal expenditures and shift program costs to the states. In the end, Medicaid will be a very different program under this financing structure, and Colorado would face impossible financing decisions related to care for its most vulnerable citizens, including seniors and the disabled.

With respect to private insurance, the bill includes advanceable, refundable tax credits, but reduces the amount available to families and individuals compared to current ACA premium tax credits. Young people, under age 30 would be eligible for $2,000 a year to help them purchase insurance; older people over age 60-65 would be eligible for $4,000. The credits would be stackable within a family up to a maximum of $14,000. The average cost of employer-based family coverage in Colorado was $16,940 in 2015 with the employee paying almost $5,000 of that. Individual plans range in price, but a typical quote for insurance for a four-person family in Denver is about $1,260 a month ($15,120 per year) for a mid-level silver plan and $1,877 a month ($22,525 per year) in Summit County.

The bill phases out tax credits when on annual incomes reach $75,000 for an individual and $150,000 for a married couple. Also, there is no acknowledgement that families that are struggling to make ends meet are in a very different position with respect to how much help they need in order to afford health insurance than those making six figures, or the skimpier the insurance policy, the more the policy-holder is exposed to high out-of-pocket costs.

Finally, the bill attempts to address shortfalls by expanding access to Health Savings Accounts (HSAs). But HSAs are tax shelters that help families that are middle-income and above. CCLP’s Self Sufficiency Standard demonstrates that low and moderate income families require income of as much as 300 percent of the Federal Poverty Level just to make ends meet without support, and are not in a position to put money away in a restricted savings account.

While there is a lot more to the bill outlined in our fact sheet, this poorly conceived legislation would substantially reduce the number of insured Coloradans and make it far more difficult for low- and moderate-income families to afford care. If approved into law, the burdens will be felt by the most vulnerable and the benefits by the least.

Committee markup on the American Health Care Act is on March 8, at 10 a.m. EST. Please take action by calling your member of Congress now.

– Elisabeth Arenales

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Apr 5, 2024

For the 2024 legislative session, CCLP is keeping its eye on bills focused on expanding access to justice, removing administrative burden, preserving affordable communities, advocating for progressive tax and wage policies, and reducing health care costs.

HEALTH:
HEALTH FIRST COLORADO (MEDICAID)

To maintain health and well-being, people of all ages need access to quality health care that improves outcomes and reduces costs for the community. Health First Colorado, the state's Medicaid program, is public health insurance for low-income Coloradans who qualify. The program is funded jointly by a federal-state partnership and is administered by the Colorado Department of Health Care Policy & Financing.

Benefits of the program include behavioral health, dental services, emergency care, family planning services, hospitalization, laboratory services, maternity care, newborn care, outpatient care, prescription drugs, preventive and wellness services, primary care and rehabilitative services.

In tandem with the Affordable Care Act, Colorado expanded Medicaid eligibility in 2013 - providing hundreds of thousands of adults with incomes less than 133% FPL with health insurance for the first time increasing the health and economic well-being of these Coloradans. Most of the money for newly eligible Medicaid clients has been covered by the federal government, which will gradually decrease its contribution to 90% by 2020.

Other populations eligible for Medicaid include children, who qualify with income up to 142% FPL, pregnant women with household income under 195% FPL, and adults with dependent children with household income under 68% FPL.

Some analyses indicate that Colorado's investment in Medicaid will pay off in the long run by reducing spending on programs for the uninsured.

FOOD SECURITY:
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)

Hunger, though often invisible, affects everyone. It impacts people's physical, mental and emotional health and can be a culprit of obesity, depression, acute and chronic illnesses and other preventable medical conditions. Hunger also hinders education and productivity, not only stunting a child's overall well-being and academic achievement, but consuming an adult's ability to be a focused, industrious member of society. Even those who have never worried about having enough food experience the ripple effects of hunger, which seeps into our communities and erodes our state's economy.

Community resources like the Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps, exist to ensure that families and individuals can purchase groceries, with the average benefit being about $1.40 per meal, per person.

Funding for SNAP comes from the USDA, but the administrative costs are split between local, state, and federal governments. Yet, the lack of investment in a strong, effective SNAP program impedes Colorado's progress in becoming the healthiest state in the nation and providing a better, brighter future for all. Indeed, Colorado ranks 44th in the nation for access to SNAP and lost out on more than $261 million in grocery sales due to a large access gap in SNAP enrollment.

See the Food Assistance (SNAP) Benefit Calculator to get an estimate of your eligibility for food benefits.

FOOD SECURITY:
SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC)

Every child deserves the nutritional resources needed to get a healthy start on life both inside and outside the mother's womb. In particular, good nutrition and health care is critical for establishing a strong foundation that could affect a child's future physical and mental health, academic achievement and economic productivity. Likewise, the inability to access good nutrition and health care endangers the very integrity of that foundation.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides federal grants to states for supplemental foods, health care referrals, and nutrition information for low-income pregnant, breastfeeding and non-breastfeeding postpartum women and to infants and children up to age five who are found to be at nutritional risk.

Research has shown that WIC has played an important role in improving birth outcomes and containing health care costs, resulting in longer pregnancies, fewer infant deaths, a greater likelihood of receiving prenatal care, improved infant-feeding practices, and immunization rates

Financial Security:
Colorado Works

In building a foundation for self-sufficiency, some Colorado families need some extra tools to ensure they can weather challenging financial circumstances and obtain basic resources to help them and their communities reach their potential.

Colorado Works is Colorado's Temporary Assistance for Needy Families (TANF) program and provides public assistance to families in need. The Colorado Works program is designed to assist participants in becoming self-sufficient by strengthening the economic and social stability of families. The program provides monthly cash assistance and support services to eligible Colorado families.

The program is primarily funded by a federal block grant to the state. Counties also contribute about 20% of the cost.

EARLY LEARNING:
COLORADO CHILD CARE ASSISTANCE PROGRAM (CCCAP)

Child care is a must for working families. Along with ensuring that parents can work or obtain job skills training to improve their families' economic security, studies show that quality child care improves children's academic performance, career development and health outcomes.

Yet despite these proven benefits, low-income families often struggle with the cost of child care. Colorado ranks among the top 10 most expensive states in the country for center-based child care. For families with an infant, full-time enrollment at a child care center cost an average of $15,140 a year-or about three-quarters of the total income of a family of three living at the Federal Poverty Level (FPL).

The Colorado Child Care Assistance Program (CCCAP) provides child care assistance to parents who are working, searching for employment or participating in training, and parents who are enrolled in the Colorado Works Program and need child care services to support their efforts toward self-sufficiency. Most of the money for CCCAP comes from the federal Child Care and Development Fund. Each county can set their own income eligibility limit as long as it is at or above 165% of the federal poverty level and does not exceed 85% of area median income.

Unfortunately, while the need is growing, only an estimated one-quarter of all eligible children in the state are served by CCCAP. Low reimbursement rates have also resulted in fewer providers willing to accept CCCAP subsidies.