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Jul 27, 2017

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Bethany Pray currently serves as CCLP's Interim Executive Director. Her areas of expertise include regulatory analysis and advocacy for Medicaid and commercial coverage, access to behavioral health benefits, Medicaid eligibility and much more.Staff page ›

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The ‘skinny’ on the latest ACA repeal effort

by | Jul 27, 2017

Health

When teenagers want to get away with something, they sneak out in the dark – to the football field after hours, the basement, the unlit corners. In that, they have something in common with Congressional leadership, though teenagers are more likely to have a few beers in mind than a plan to strip health coverage from millions of Americans who – being human – may have a baby on the way or blood pressure that needs controlling, who rely on insulin, who need a strep test, a flu shot, a colonoscopy, radiation treatment, or a few weeks of physical therapy so they can get back to work.

After a brief interlude in the open, Congress is heading back down to the basement. Unable to pass a straight repeal bill or the Better Care Reconciliation Act, the Senate version of repeal-and-replace, the Senate is on the verge of voting for a place-keeper bill – a so-called skinny repeal – that will allow them to return to a secret negotiation process where they can avoid the scrutiny of colleagues and, more importantly, avoid us, the public.

Today, the skinny repeal is a clear and present danger for those who need health coverage. If the Senate’s skinny repeal were to be adopted by the House without changes, it would immediately destabilize the individual health market. Pennsylvania carriers, for example, said they would impose an additional 15 percent hike in 2018 premiums to account for the end of the individual mandate to purchase insurance. By 2026, the skinny repeal would leave 16 million more people uninsured and increase premiums on insurance policies on the exchange by 20 percent, according to an analysis from the Congressional Budget Office.

However, a skinny repeal in the Senate is very likely to undergo big changes in the conference committee that would convene following a Senate vote. And despite what may look like more modest terms, there is every indication that the bill to finally emerge from that committee would retain the elements we’re familiar with: the end of the Medicaid expansion, cuts to the overall Medicaid program that grow harsher over time, skimpier plans on the exchanges and smaller subsidies for most.

Based on state analyses,the original repeal plan would decimate Colorado’s people and Colorado’s budget. As for Colorado’s Senators, Sen. Bennet spoke of devastating consequences and urged a more transparent process.  In March, Sen. Gardner urged caution in a letter to Senate Majority Leader Mitch McConnell, arguing against the draft House repeal and replace bill, and warned that Medicaid restructuring could cause individuals to lose access to “life-saving health care services.”  A Yuma native, Gardner may know that rural counties have particularly high percentages of residents enrolled in Medicaid, and would suffer disproportionately.  After a series of non-statements regarding replace and/or repeal, Gardner showed his allegiance to party over his constituents by voting for the straight repeal along with a Medicaid-slashing replacement plan. Fortunately, neither bill passed.

It should be obvious that all Coloradans sometimes get sick and will continue to do so in the future, whether or not our Senators’ votes allow them to keep their Medicaid coverage or their insurance subsidies. Coloradans age, and will continue to age. People with cerebral palsy will still have cerebral palsy. Nothing in the House or Senate replacement plans tells us how the at least half-million people slated to lose Medicaid in Colorado would get appropriate medical care, let alone the tens of thousands who will find private coverage either unaffordable or too meager to be usable. Nothing in those plans would help change what is now driving up the cost of health care, whether that is pharmaceutical prices or too much medical testing or provider reimbursement systems.

By all means, let’s fix health care. Because health care is not just complicated but positively labyrinthine, a fix will take time and will have to include the best ideas of lots of people. No more backrooms and basements, please. It’s time to let the light in.

Tell Senators Gardner and Bennet to vote NO on any form of repeal that doesn’t include a comprehensive replacement. Tell Senators Gardner (202-224-5941) and Bennet (202-224-5852) that Colorado needs innovative, bipartisan, effective legislation. Let’s make it happen!

– Bethany Pray

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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.