Supreme Court upholds Obamacare's tax subsidies

See the Oregonian for the full article,

WASHINGTON — The Supreme Court on Thursday upheld the nationwide tax subsidies under President Barack Obama's health care overhaul, in a ruling that preserves health insurance for millions of Americans.

The justices said in a 6-3 ruling that the subsidies that 8.7 million people currently receive to make insurance affordable do not depend on where they live, under the 2010 health care law.

 

Oregon stood on sidelines of Obamacare case

Oregon had less at stake than most states in the U.S. Supreme Court's ruling in King v. Burwell.
The suit targeted subsidies issued by the federal health insurance exchange. Oregon used the federal exchange website to enroll Oregonians in health coverage this year after state officials shelved the homegrown Cover Oregon technology project.
Still, because Oregon had passed a law, insurance tax and regulations to set up a state-based exchange, state officials argued that it should not be considered a federal exchange state. Legal briefs filed by both sides in the case agreed, considering Oregon one of 16 state-based exchanges in addition to that of Washington, D.C..
The Supreme Court majority agreed as well, writing that "At this point, 16 States and the District of Colum­bia have established their own Exchanges; the other 34 States have elected to have (the federal government) do so."
Oregon stood on sidelines of Obamacare caseOregon had less at stake than most states in the U.S. Supreme Court's ruling in King v. Burwell.
The suit targeted subsidies issued by the federal health insurance exchange. Oregon used the federal exchange website to enroll Oregonians in health coverage this year after state officials shelved the homegrown Cover Oregon technology project.
Still, because Oregon had passed a law, insurance tax and regulations to set up a state-based exchange, state officials argued that it should not be considered a federal exchange state. Legal briefs filed by both sides in the case agreed, considering Oregon one of 16 state-based exchanges in addition to that of Washington, D.C..
The Supreme Court majority agreed as well, writing that "At this point, 16 States and the District of Colum­bia have established their own Exchanges; the other 34 States have elected to have (the federal government) do so."

--Nick Budnick

As we breath a sigh of relief for all the people who are able to keep their insurance as a result of this ruling, let's also work to update the ACA so that we have true universal, publicly funded health care!

You can help MVHCA as we work for single payer health care by donatinghosting a house party, signing up for the newsletter, and attending our monthly meetings. You can also Like us on Facebook, and Follow us on Twitter. Thank you.

March 2015 Cover Oregon Consumer Advisory Committee Report

Cover Oregon and the current Oregon Healthcare Exchange under the Affordable Care Act

by CAC member Roberta Hall

On Friday, Feb. 27, Cover Oregon’s Consumer Advisory Committee (CAC) met for the last time. The place was the Durham headquarters of Cover Oregon, soon to be dissolved, though the space will be used for several more months. The exchange is not by any means abolished, however, as its activities will continue under the Department of Consumer and Business Services, the state’s largest regulatory agency. (This transfer occurred about a week later.) The important points that the public should know appear to be these:
1. Cover Oregon costs have been reduced significantly. In 2014 the budget was 90 million dollars, of which 80 million were spent, whereas this year the budget is 15 million. Last year, the average cost per enrollee was $48, and this year it is $10. Last year, enrollment was done with both paper and online techniques developed under contract to the state of Oregon, whereas 2015 enrollees used technology developed by the federal government (HealthCare.gov).
2. The King v. Burwell case, heard in the Supreme Court on Wed., March 4, is a legal challenge to federal tax credits offered in the 2010 Affordable Care Act (ACA). It applies to states that did not set up their own exchange; however, Oregon is one of 16 that did. Oregon continues to run its own exchange, albeit using technology developed by the federal government. Still, if the plaintiffs win, and tax credits are not provided in the other states, it would change the ACA’s impacts dramatically.  Regardless of the outcome (expected in June of this year), the extension of Medicaid to persons with incomes less than 138% of the federal poverty level is not affected by the suit. Oregon’s Medicaid system, OHP, is now administered by the Oregon Health Authority (OHA).
3. Once again, at the 11th hour, the OHA extended the deadline for OHP fast-track enrollees to renew their coverage; “fast-track” refers to automatic enrollment because of prior income-certification through the food-stamp program. The previous deadline was 2/28, but that has been extended to March 31. It was estimated that the remaining fast-track population who need to act before the 3/31 deadline is about 32,000. There has been a backlog, but the OHA has announced that it is hiring more call center staff to address that serious problem.
4. One of the obligations Cover Oregon staff are working on, in addition to clearing up problems that the technology collapse caused earlier, is getting the small business healthcare insurance program (SHOP) online. Right now, there is a manual process in place until a permanent solution is found.  You can find out more here. Employers with 1-50 employees face no penalty for not providing insurance, but it is my understanding that they can use the program if they wish, and some have been using it.  Starting in 2016, employers with 51-99 employees will be required to provide insurance.  Employers with 100+ employees are supposed to offer coverage to 70% of their employees this year, 2015.
Ten members of Cover Oregon’s CAC attended the Feb. 27 meeting, seven in person, and three online. Much of the meeting was given to a report and Q and A with Director Aaron Patnode.  Alicia Blevins discussed income tax forms pertaining to the individual insurance obligation and Qualified Health Plans (1095-A); next year a tax form (1095-B) will also be sent to people enrolled in a government-sponsored plan like OHP.  Joel Melton and D’Anne Gilmore from the Department of Consumer and Business Services, together with Director Patnode gave an update on the apparently amicable transition process. Cover Oregon staff members Rachael Oh, Kelly Harms, and Cherie Miller ran the meeting and performed recording and online activities. CAC members thanked them and Director Patnode for their work, and expressed regret that these employees had in effect been held accountable for problems that they had no control over.
Please note that Cover Oregon employees are not state employees, so they will not be transferred to other state jobs, nor do they have PERS. The director of the agency where the exchange is now housed did not keep director Patnode on staff after the take-over, and the agency is laying off about 50 more in March; several current Cover Oregon staff will continue, perhaps through June. I, for one, appreciate their service and believe that the successes the exchange has had in extending healthcare coverage to many more Oregonians – perhaps approaching half a million – are due to their efforts and dedication.
Advocacy groups such as Mid-Valley Health Care Advocates need to follow these changes as they unfold in order to advise people correctly as well as to learn more about the complexities of making changes in the structure of the state’s healthcare-related programs.


Roberta Hall, member, Cover Oregon CAC, March, 2015



MVHCA's Bobbi Hall reporting on the Cover Oregon Consumers Advisory Committee meeting in Portland

June 6 --I attended the statewide Cover Oregon Consumers  Advisory Committee meetings in Portland. I'm a member, and about 12 or  so of us show up once a month and hear from administrators about changes that are going on, and get updates;  we also ask a lot of  questions and give advice to the Cover Oregon administrators based on  what people in our home areas tell us.Yesterday was special because Clyde Hamstreet (the interim CEO) and  Tina Edlund  (the transitions director) spent an hour and a half with  us. They gave us the report they had given to the Oregon Legislative committee on May 28, and we had lots of questions for them. They have  made many structural changes. Re-structuring means that Oregon will complete the year on a secure  financial base. Many of the working parts of the Cover Oregon website  will be kept. In the future, OHA will be responsible for OHP enrollment, rather than Cover Oregon. Though the Federal website will  be used in November for commercial insurance plans, Oregon will retain  control of how they both are managed, and Oregon's insurance rates  will remain lower than those of most other states. Also, commercial rates in November will NOT be the same as they are now so people interested in changing their commercial plans need to check the Cover Oregon site in the fall.


The Cover Oregon board will meet  Thursday and possibly make some more decisions. Everyone at the meeting spoke very highly about the Community Partners and Navigators,  and the agents, who have helped people to enroll successfully. We also observed that many new enrollees need help in understanding how to use the system. Overall, we on the committee felt good about the meeting and the attitudes of the new managers, who very much want the programs to succeed. My own feeling is that the public attitude toward Cover Oregon is improving and will continue to, once the public learns how many people have been enrolled (more than 400,000 now). 

Report by Bobbi Hall

Oregon health care reform succeeds despite problems at Cover Oregon (guest opinion)

By Gil Muñoz

There’s no doubt that the Cover Oregon website has been dogged with problems since it launched last October, but the exchange’s IT problems are overshadowing a major policy success. To date, thousands of Oregonians who were previously uninsured have gained access to health care, benefiting all of us.

At the same time that Oregonians are signing up for health insurance through Cover Oregon, Community Health Centers like Virginia Garcia are working with Coordinated Care Organizations (CCOs) to update the way we provide care and implement cost-effective measures that improve patient outcomes. We’re establishing patients with a primary care home and providing them with a team of providers and staff who share knowledge and give patients personal attention. This team-based model of care is working for the benefit of our patients and it’s something we continue to expand and improve.

Virginia Garcia currently serves over 36,000 patients, but there are thousands of people in Washington and Yamhill counties who still don’t have access to care. To meet this growing demand, Virginia Garcia is increasing our capacity to provide services for patients where they live and work.

Full article here.

Cover Oregon Enrollment Deadline Extended

Oregonians have until April 30 to enroll in health insurance plans, an extra month that was announced by Gov. John Kitzhaber announced Wednesday. That will leave insurance agents with more time to help sign up the thousands of uninsured people in the state and give Cover Oregon more time to process new and backlogged applications.

The federal government granted the extension largely because Oregon’s website has failed to work properly.

“I know that for too many Oregonians, the Cover Oregon website and its ongoing technical problems have created delays, confusion, and frustration,” Kitzhaber said in a press release.

In spite of the very public problems with the website, people are signing up for health insurance.

Cover Oregon is recommending people who still need to enroll use an insurance agent, as they are the only people who can use the website.

Full article here.

What Went Wrong With Cover Oregon?

In January, 2014, Governor Kitzhaber asked for an independent, third-party review of the Cover Oregon website project. These are the questions that First Data was tasked with asking:
1.  What was the basic oversight and governance accountability as it relates to the multiple parties and the procurement/administration/finances of vendor services?
2.  Who was in the position to make decisions as it relates to the Website Project?
3.  Why were Oracle products and Oracle services chosen for the Website Project?
4.  Did the State or Cover Oregon consider engaging a system integrator to assist with the Website Project?  If not, why not?  Did the Website Project Team or any of its members believe the State or Cover Oregon had the expertise to undertake the Website Project without the assistance of a system integrator?  If so, why?
5.  How was the original scope of the Website Project determined and by whom?  To what degree did the scope of the Website Project delay the implementation?  How was the scope managed?  After the Website Project Team or any of its members realized that the Website was not going to work, would it have been possible to change the scope?  If so, how?
6.  Did the Website Project Team or any of its members have a plan B for operations developed when the Website Project Team or any of its members realized or began to realize the exchange was not going to work?  If not, why not?
7.  When did the Website Project Team or any of its members realize or begin to realize the Website was not going to be ready?  Who first realized the Website was not going to be ready?

Do you want to know too?  Click here for the executive summary and full report.

Cover Oregon: Apply Now If You Want Health Insurance This Year

Time is running out to apply for private health insurance through Cover Oregon, the state's health insurance exchange. Individuals have one week left to sign up if they want coverage by Apr. 1. The final deadline is March 31.

Those who do not enroll through Cover Oregon and pick a plan will have to wait to sign up until the next open enrollment period starting Nov. 15, 2014.

As of Friday, interim director Bruce Goldberg said 134,400 people were enrolled through Cover Oregon; 42,000 were enrolled in private insurance and the remaining 92,000 were enrolled in the Oregon Health Plan, Oregon's version of medicaid.

Complicating matters, Goldberg learned on Friday that it's looking it's less likely the website will be ready for people to enroll themselves before the deadline.

Full article and video here.

Cover Oregon and Other Healthcare Expansions---Update, March, 2014

The March meeting of the Cover Oregon Consumer Advisory Committee (CAC) provided little new information except that enrollments by hand and, to some extent, using agents operating directly through the internet, are continuing, but still are behind schedule. Agents help clients with commercial products and community partners help clients who qualify for the Oregon Health Plan (OHP/Medicaid), and at least as I understand it, no agents have yet been compensated for the time taken out of their business to do this. The hope is there, but in this health care episode, there are many uncompensated players. Beneficiaries are those who have succeeded in getting signed up for Oregon Health Plan  or gotten lower cost and improved insurance coverage, many (about 79%) with federal tax credits covering part of their premium. Some who qualify, however, still lack coverage.

The relationship between Cover Oregon and Oracle continues to be difficult. The Oregonian reported on Mar. 13 that a federal report on Oracle and Cover Oregon is scathing. However, it did corroborate the statements of some Cover Oregon employees that Oracle had repeatedly denied requests for information--that is, Cover Oregon had attempted to manage the contract, but been rebuffed. Clearly, the contract itself had been deficient, based on non-existent trust.

At the April CAC, members will discuss what other things Cover Oregon can do to accomplish its mission of improving the health of the population.

One optional ACA expansion, Basic Health, is being studied. It is a program to extend health services to more low-income people (those under 200% of the poverty line), including legal immigrants with less than 5 years residence who heretofore have been excluded from Medicaid (OHP). A bill to establish this study, HB 4109, passed in March. A discussion I had with the Chair and Vice-chair of the House healthcare committee about what Basic Health is aired Mar. 10 on KBOO and can be heard here.

---Roberta Hall

Cover Oregon (CO) Consumers Advisory Committee meeting Feb. 7, 2014

Because of snow, this meeting was virtual and lasted only an hour and 15 minutes. Director Bruce Goldberg gave a 20-minute update on enrollment: in addition to 123,000 people enrolled fast-track, 67,517 applicants were enrolled in OHP and 35,247 in commercial plans; an additional 35,000 applicants have received information to enroll. Process is “hybrid” – a combination of internet and paper modes (no full internet yet). CO is working with agents and community partners and testing upgrades. CO is restructuring its customer service to improve flow. Also: The cost of hiring additional people is being covered within existing budgets of OHA and CO; it still is possible for CO to be self-funded at the required time; there is an improved online-fillable pdf application; they are looking at contingencies to put into place IF the site is not IT-ready at the end of the open-enrollment period (probably this is Mar. 15—not sure, and they are asking the feds to extend it, but doubt their request will be granted).
Following are answers to a few of the many questions he responded to: MODA has gotten most of the commercial business, and with Kaiser this amounts to more than ¾ of enrollees. After CO determines eligibility for OHP, the files go to OHA, which is supposed to send info to enrollees and OHA has backlogs (he hopes within the next 10 days this will be caught up). An applicant who is determined OHP eligible is covered retroactively to the date of the application, whereas someone enrolling in a commercial plan starts on the first of a month (depending on when the forms come in). Ads for CO have been pulled but a public service campaign will begin toward the end of Feb. to highlight the Mar. 15 enrollment deadline.  –Roberta Hall, CAC member from Corvallis

Dembrow, Thompson Discuss Cover Oregon Rollout, Single Payer

Senator Michael Dembrow says even if the legislature passes a single-payer bill, it's likely to be referred to voters.

Five speakers – including state legislators from both sides of the aisle, as well as political advocates and representatives from the insurance industry – gathered in the banquet room at Kells Irish Pub Tuesday night to talk about what lies ahead for healthcare reform in Oregon.

The Portland City Club-sponsored event, “Health Care Reform After Obamacare: What's Next for Oregon?” attracted about 50 people and was moderated by Dr. Samuel Metz of Physicians for a National Health Program. Each speaker presented for about 10 minutes, and then the floor opened up for questions and comments from the audience.

Read the full Lund Report article here.

Report from the Citizens Advisory Council of COVER OREGON

Cover Oregon Consumer Advisory Committee, Jan. 3, 2014

Application forms: Cover Oregon’s advisory committee met Jan. 3, spending most of its time gathering suggestions for yet another revision of its application form. A new one, now operational and available on the website Jan. 1, made a correction that some members of Mid-Valley Health Care Advocates had sought. The question about income of self-employed people changed to  requesting “net profits” (rather than gross profits). Another tricky issue concerns the definition of “household.” Often this refers to individuals who comprise a single unit for income tax purposes, but not all groups of people living together and sharing resources file taxes. Needless to say, not all issues were resolved, but all parties – Cover Oregon staff and members of its CAC – came to a greater understanding of the complexities of the process of requiring everyone to have health insurance.  Many asked: wouldn’t universal coverage be more manageable?

Important OHP information: Cover Oregon has qualified many people for expanded Medicaid, i.e., for the Oregon Health Plan, but some of these have not been notified (as of Jan. 5). We learned that after Cover Oregon makes the eligibility determination, it passes information to the Oregon Health Authority. Rather than sending an immediate notification to the applicant, it appears that the OHA sends information to the relevant CCO, and the CCO sends enrollment information to applicants. Applicants who were certified before the end of December were officially covered beginning Jan. 1, and can expect to (or, should I say, can hope to) hear from their CCO, in January, and it is important that they know they are covered, retroactively if need be, beginning Jan. 1.  Amy Fauver, a Cover Oregon employee, told the CAC that if an individual needs, for instance, to go to Urgent Care before notification happens, s/he should ask the provider to check on his or her coverage with the Oregon Health Authority.

Another meeting is set for the first Friday in February. If questions come up at any time, as an unofficial Mid-Valley representative to CAC, I will seek answers for you.  Click here to contact me.

Roberta Hall

 

Cover Oregon's Roadmap to Plan Selection -- a quick overview of what you need to do to assure coverage in 2014.

Here is Cover Oregon's Roadmap to Plan Selection. If you have questions about your application or eligibility we recommend that you contact Cover Oregon at info@coveroregon.com  or 1-855-268-3767 to check on your application.  If you did not turn in your application by December 4, you should follow the step for people who have not heard from Cover Oregon (and turn in your application for coverage later in 2014).


Report from Bobbi Hall on Cover Oregon

The immediate goal of Cover Oregon (CO), interim director Bruce Goldberg reported to Cover Oregon’s Consumer Advisory Committee (CAC), can be expressed in three words: “enrollment, enrollment and enrollment.” To implement this goal, Goldberg said on Friday, Dec. 6, at the committee’s meeting in Portland, Cover Oregon has hired many people to process the program’s paper applications. Further, CO has contracted with a professional telephone call center to advise applicants what tax credits they are eligible for, assigned staff to make calls to seek answers from those who submitted incomplete applications, and has been training most of its employees how to process paper applications to speedily get coverage for all qualified Oregonians. 

On Monday Dec. 2 several thousand applications were processed, many for enrollment in the Oregon Health Plan (OHP, or expanded-Medicaid). By Dec. 6 about 6000 were enrolled. OHP applications can be processed most quickly because it is a one-step process: fill out the application and if the individual qualifies, the application is sent to the state for enrollment.  Those who apply for tax credits have a two-step process. Their application is examined to determine if, and how many, tax credits are available. This information is provided to the applicant who then must choose a health insurance plan. CO wants people to learn about plans using their website (www.coveroregon.com) before receiving tax credit information so they can immediately make their choice. CO promises that all of those who have sent in a completed application by Dec. 4 will receive the necessary information to choose a plan and send their choice by a Dec. 16 postmark date to assure that coverage can start Jan. 1. Additionally, plans are underway so that those who must have health care coverage by Jan. 1 (such as people in the high risk pool) have it.

About 55,000 paper applications have been sent in but about half had missing data. With the exception of OHP applicants for whom no deadlines apply, applications that come in late will get coverage starting Feb. 1. Questions can be answered by calling: 1-855-268-3767, or by e-mailing: info@coveroregon.com. Some areas such as Benton County have navigators who will answer questions to help people with the process. (Benton County’s navigator Leticia Rodriguez is available, in English and in Spanish, by an e-mail to: leticia.rodriguezgarcia@co.benton.or.us, or by phoning: 541-760-9591).  Roberta Hall, on the outreach committee of Mid-Valley Health Care Advocates, is a member of Cover Oregon’s CAC and can provide other information (rlhall@peak.org).