Issues: Health Care (LWVUS)
LWVUS Position in Brief
The League of Women Voters of the United States believes that a basic level of quality health care at an affordable cost should be available to all U.S. residents. Other U.S. health care policy goals should include the equitable distribution of services, efficient and economical delivery of care, advancement of medical research and technology, and a reasonable total national expenditure level for health care.
The complete position is available on the LWVUS website.
ACA CO-OPS (Consumer Operated and Oriented Plans) and Land of Lincoln Health.
The Affordable Care Act (ACA) formed 23 CO-OPs, start up insurance companies backed by federal loans. Land of Lincoln, the Illinois CO-OP, is generating headlines following its shutdown. Some 49,000 subscribers are looking for new coverage by November 1. An additional headache, the new companies require deductible payments to start from scratch in order to provide insurance for the two remaining months. Insurers in some states with failed CO-OPs are waiving this provision. So far, this is not the case in Illinois.
By the end of last year, all but two of the 23 CO-OPs were struggling according to a Commonwealth Report. Currently 7 remain.
Other IL ACA Marketplace Developments
In May United Healthcare dropped ACA plans and Aetna, in early August, pulled out of most ACA exchanges. Effects of this and the Lincoln Land closure remain to be seen, especially in rural communities and areas of the state where services are more fragmented.
Voter AttitudesA July 15 Kaiser Family Foundation survey found that Health Care isn’t high on the list of voter concerns this year. Terrorism scored #1, Candidates’ Personal Characteristics #2. Health Care came in around 37%, close to Gun Control, and Education.
On July 11th President Obama wrote an editorial in the Journal of the American Medical Association on his assessment of the Affordable Care Act.
Relevant health care bills from current legislative session being followed by LWVIL:
HB5576 Contraceptive Coverage Act Ensures access to full range of contraception in all insurance plans, and if patient's care provider prescribes a specific medication or method insurance must provide a 12 month supply without cost sharing.
SB1564 Healthcare Right of Conscience Act Amends the Illinois Health Care Right of Conscience Act to ensure a patient’s right to medically accurate and complete information, even though a provider has religious or moral objections.
These 2 bills have passed both Houses and await the Governor’s signature. LWVIL has sent him 2 separate letters one regarding HB5576 and one for SB1564 requesting his signature. A TFA has been sent asking members to contact the Governor about SB1564.
Current cases before the Supreme Court of the United States:
Zubik et al. v. Burwell. A group of religious non-profits is challenging the HHS accommodation to exempt them from providing contraception in employee health insurance benefits. On May 16th Supreme Court issued an unsigned order asking the courts of appeals to attempt to have the parties work it out.
Whole Women's Health v. Hellerstedt (Formerly Cole) challenges a Texas law imposing new medical regulations on abortion clinics, potentially closing 75% of facilities. The case is one of the most consequential in decades on the future of access to abortion. On June 27th the Court ruled 5-3 that Texas cannot place restrictions on the delivery of abortion services that create an undue burden for women seeking an abortion. The decision may impact similar restrictions on abortion access in other states.
Recently United Healthcare has announced that does not expect to participate in the ACA next year, and some other insurance companies have expressed concern. They are finding participation is not profitable. There had been risk corridors set up to limit insurer gains and losses. Insurers receive a payment from HHS if losses exceed a certain threshold, insurers pay HHS if their gains exceed a certain threshold. However last year Congress (an effort led largely by Senator Marco Rubio) passed legislation that prevented any money beyond collections be paid by HHS.
On May 12th District Court Judge Rosemary Collyer ruled, in a lawsuit by US House Republicans, that the Obama administration illegally spent money that Congress never appropriated for the ACA's cost sharing provisions. Collyer stayed her decision pending an appeal.
Supreme Court of US Current Cases
Zubik et al. v. Burwell. On May 16th the Supreme Court issued an unsigned order asking the court of appeals to attempt to have the parties work out their differences and come to a compromise.
Whole Women's Health v. Hellerstedt (formerly Cole), awaits decision this spring. This case is consequential in the future of access to abortion. Because of Justice Scalia's death the result may be a 4 to 4 split.
LWVIL Bills Current Session:
HB5576 Contraceptive Coverage Act Passed the House on 4/21/16. Sent to the Senate, placed on Calendar order of 3rd Reading on May 18th.
SB1564 Healthcare Right of Conscience Act Passed by Senate 4/22/15, and sent to House 4/22/15. On 4/12/16, had second reading and 4/28 sent to rules committee.
HB5576 Contraceptive Coverage Act - Time for Action sent 4/4/16. Ensures access to full range of contraception in all insurance plans without cost sharing.
SB1564 Healthcare Right of Conscience Act amends Illinois Health Care Right of Conscience Act to ensure a patient’s right to medically accurate and complete information, including a referral, even though a provider has religious or moral objections. Passed by Senate 4/22/15, to House 4/22. Final deadline: 4/28/16
Supreme Court of US Current Cases
A divided Supreme Court issued an order March 30 directing both sides in Zubik et al. v. Burwell to file new briefs to determine the minimum plaintiffs must do in order to pay for contraception. A group of religious non-profits is challenging the HHS accommodation to exempt them from providing contraception in employee health insurance benefits. The court asked both sides to discuss a compromise where contraception could be provided without the groups having to formally object. The court pointed out ways this could occur. Deadline for response is April 20. This unusual order would avoid a 4-4 tie vote, leaving different rules in place across the country since lower courts have issued conflicting rulings.
Whole Women's Health v. Hellerstedt (Formerly Cole) heard March 2, challenges a Texas law imposing new medical regulations on abortion clinics, potentially closing 75% of facilities. The case is one of the most consequential in decades on the future of access to abortion. Currently 13 states have similar restrictions in place.
In Illinois, LWVIL opposed bills filed with restrictions on abortion for the past six years; none came to a vote. Medical professional associations in Texas and nationally, dispute Hellerstedt’s contention that the regulations would ensure the health and safety of women. Rather, the law would be harmful by putting unnecessary barriers to care, pushing an abortion into the second trimester.
Bills followed by LWVIL in IL Legislature:
SB1564 Healthcare Right of Conscience Act amends Illinois Health Care Right of Conscience Act to ensure a patient’s right to medically accurate and complete information, including a referral, even though a provider has religious or moral objections. Passed by Senate 4/22/15, to House 4/22. Final deadline: 4/28/16.
HB5576 IL Contraceptive Coverage Act amends the Illinois Insurance Code, changing section on coverage for contraceptives. Provides individual or group health policy provide coverage for all contraceptive drugs, devices, and other products approved by the USFDA, If the patients care provider recommends a particular service or item, the insurance must provide it without cost sharing. Bill was introduced 2/9/16, LWVIL sent Witness slip 2/24 when it was in Human Services Committee. Placed on Calendar Second Reading. Anticipate TFA, but House not in session again until April 4th.
Public support for the Affordable Care Act remains divided, primarily along partisan lines.
According to a recent survey, health care is not the top voting issue this fall.
ACA enrollment begins on Nov. 15, 2014 and ends on Feb. 15, 2015. Changes since last year will bring “... improvement but not perfection,” according to an HHS official.
GetCoveredIllinois enrolled 217,492 individuals eligible for private insurance through healthcare.gov and 405,000 in expanded Medicaid.
Illinois State-Based Health Insurance Exchange
Expanded Community Health Center Funding
On July 22 a pair of circuit courts issued opposite opinions in similar cases on whether income tax subsidies under the Affordable Care Act for people who sign up under federally run insurance exchanges law are legal. A three-member DC Circuit Court said the law was written in such a way to grant these subsidies only to those who enrolled through a state-based exchange. The Richmond Virginia 4th District Court stated that the intent of the law was clear, even if poorly written: to provide subsidies to everyone. This looks like another thorny health care decision that will rest with the Supreme Court.
The Illinois Department of Healthcare and Family services announced they are increasing reimbursement for family planning services starting October 1. The goal is to provide the most appropriate method for the patient. Payments for vasectomies and intrauterine devices would be doubled.