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The ACA – What’s at Stake

The Affordable Care Act (ACA) has been under fire from its inception. Currently the future of the landmark decision and healthcare reform legislation is uncertain. California vs Texas (known as Texas vs U.S. in lower courts) is scheduled to begin oral arguments on Tuesday, Nov.10, 2020. This was sparked by a group of 20 states led by Texas to sue the federal government in February 2018. This case challenges the ACA’s individual mandate which was reduced to zero dollars on Jan.1, 2019 by way of the 2017 Tax Cuts and Jobs Act. The U.S. Court of Appeals for the 5th Circuit affirmed the decision that the individual mandate was no longer constitutional because the individual mandate would no longer produce revenue for the federal government. Instead of striking down the entire ACA, the case was sent back to trial court for additional analysis. The implications for Pennsylvanians and Americans could be disastrous should the law be struck down. Consider:

  • Over 760,000 Pennsylvania Medicaid eligibles would lose coverage
  • Over 307,000 Pennsylvania Health Insurance Marketplace consumers would lose coverage, 87% of those accessing Advance Premium Tax Credits and 44% with cost-saving reductions
  • More than 2.3 million young adults under age 26 nationwide would lose access to coverage through their parents’ group coverage
  • Over 2,105,000 Pennsylvanians with a prevalence of pre-existing conditions could be eliminated from purchasing health insurance
  • 87% of covered workers with employer-sponsored insurance (approximately 133 million people) were enrolled in plans that must provide free preventive services as of 2019
  • Prior to the ACA, 75% of non-group health plans did not cover maternity care, 45% did not cover substance use disorder (SUD) treatment and 38% did not cover mental health services
  • Prior to the ACA, 59% of covered workers’ employer-sponsored health plans had a lifetime limit
  • Prior to the ACA, only 19% of covered workers had no limit on out-of-pocket expenses
  • Reinstating the Medicare coverage gap would increase costs incurred by Part D enrollees who have relatively high drug spending
  • Employers with 50 or more employees must now provide adequate break time for breastfeeding women and a private space that is not a bathroom for nursing and pumping
  • The ACA prohibits discrimination against individuals on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities, under Section 1557, which builds on long-standing and familiar federal civil rights laws

The ACA is an enormous law and the potential impacts of it being eliminated are monumental.

Pennie Is Open for Business

Pennsylvania’s Insurance Exchange, Pennie, opened on Sunday, Nov. 1. Assisters statewide fielded calls and assisted consumers with enrolling in Qualified Health Plans offered by seven Pennsylvania insurers: Ambetter, Capital Blue Cross, Geisinger, Highmark, Independence Blue Cross, Oscar and UPMC. The Pennie call center experienced issues and was not available to consumers or assisters for part of the day on Monday but resumed operations on Tuesday morning. The call center is open Monday–Friday, 8:00 am – 7:00 pm; Saturdays, 8:00 am – 1:00 pm; and closed Sundays and holidays. Customers needing assistance can call 1-844-844-8040. The dedicated Assister Call Center number for troubleshooting and assisting with enrollment is 1-844-844-4440. Learn more about Pennie.

LIHEAP Application Process Opened in Pennsylvania

The Pennsylvania Department of Human Services (DHS) announced the start of the annual Low-Income Home Energy Assistance Program (LIHEAP) application process for the 2020-21 season. LIHEAP assists with home heating bills so low-income Pennsylvanians can stay warm and safe during the winter months. Assistance is available for renters and homeowners. LIHEAP opened for applications on Nov. 2 and closes April 9, 2021. Pennsylvanians can apply for LIHEAP and other public assistance programs online at www.compass.state.pa.us Those who prefer to submit paper applications can print from the website or request an application by phone at 1-800-692-7462 and mail it to their local County Assistance Office (CAO) or place it in a CAO’s secure drop box, if available. While CAOs remain closed to the public, work processing applications, determining eligibility and issuing benefits continues. Click here for more information on LIHEAP.

Trump Signs Executive Order to Make It Easier to Fire and Replace Career Policy Officials

President Trump has signed an executive order making it easier for federal agencies to fire and replace career federal policy officials by reclassifying them under a new category of employees called Schedule F. The move could impact attorneys, public health experts, regulators, scientists and other officials not normally subject to change during Presidential transitions. Under the order, the U.S. Department of Health and Human Services has seven months to decide which of its 80,000 employees to reclassify. Read More.

It’s Official! Pennsylvania Governor’s Signature Removes FQHC Funding Cap

Pennsylvania Governor Wolf signed SB 273, now known as Act 100 of 2020, into law, amending the Community-Based Health Care Act (CBHC). CBHC established a grant program within the Department of Health for safety-net providers to expand or create new sites. Over the years, this program has been used by many providers to support improvements in access to care. Unfortunately, the legislation imposed an arbitrary statutory cap only on FQHCs to apply for no more than 25% of the grant funding, a restriction that meant the state might not be funding the best applications.

States Turn to Telehealth During the Pandemic

Since March, 36 states, the District of Columbia and Puerto Rico have enacted more than 79 bills changing telehealth policies, either permanently or temporarily, during the pandemic. This article published by the National Conference of State Legislatures discusses the details of that legislation. The article was funded through HRSA’s cooperative agreement with the National Organizations of State and Local Officials.

Read the article.

The Importance of a Comprehensive Approach to Improving Maternal Health

Through HRSA’s cooperative agreement with National Organizations of State and Local Officials, the Association of State and Territorial Health Officials posted a video interview with New Jersey’s Deputy Commissioner for Public Health Services and the Executive Director of the New Jersey Maternal Care Quality Collaborative. The interview explores the Nurture New Jersey initiative that aims to reduce maternal mortality and morbidity by 50% over five years and to eliminate racial disparities in birth outcomes.

Watch the interview.