Health Reform Frequently Asked Questions
The Supreme Court Decision
Q. What did the court decide?
A.The Supreme Court upheld the law, finding Congress’ taxing power allows it to tax an activity that it otherwise cannot regulate, including the requirement to purchase health insurance. The court found the Medicaid expansion constitutional, but that the federal government cannot withhold all Medicaid funds from states for noncompliance. While this decision ends the legal debate, the health reform law remains an issue in the presidential election campaigns.
Q. What does this mean for implementing the Affordable Care Act (ACA)?
A. Amerigroup will continue to move forward with the same implementation activities as it has done prior to the court’s ruling. Amerigroup looks forward to helping states find quality and cost-effective means for meeting the health care needs of an expanding Medicaid population, the low- to moderate-income population insured through the exchanges and dual eligibles participating in the new state demonstration projects.
Q. What steps should states take now that the ACA has been found constitutional?
A. States should continue to move forward with preparing their infrastructure to successfully position themselves for 2014. Amerigroup will continue to support our state partners in their preparations and looks forward to providing innovative solutions for today’s health care challenges.
Despite the court’s limitation of the federal government’s ability to compel state compliance with the expansion, we encourage states to take advantage of the opportunity to expand coverage, with increased federal funding, for low-income individuals and families.
Q. Does Amerigroup support health care reform?
A. As Amerigroup has remained at the forefront in the national discussion on health care policy, we foresee our Company as one poised to help through the transition from policy to action. There are tremendous opportunities under health reform to offer new ways to provide coverage to the underserved. Health reform heightens our nation’s focus on quality care and accountability, all in an effort to boost outcomes, provide efficient care and improve health status.
Q. What effect will the court’s decision have on Amerigroup?
A. Amerigroup is a leader in solutions for high-cost, high-need populations. We will continue to provide innovative, cost-effective solutions for our government partners. States will be looking for solutions and will turn to private sector plans, like Amerigroup, to provide innovative care delivery while reducing taxpayer costs.
Q. How will the court’s decision impact Medicare-Medicaid dual eligibles and the new state demonstration projects under development as a result of the ACA?
A. Any state demonstration projects and Medicare-Medicaid dual eligible initiatives through the ACA will continue with implementation as they were prior to the court’s ruling. Amerigroup will stand ready to work with the federal government and the states in designing effective programs to best meet the health care needs of dual eligibles.
Q. How is Amerigroup prepared for the upcoming expansion of the Medicaid program?
A. For more than 18 years, Amerigroup has been a valued partner for states, helping identify opportunities to strengthen Medicaid through private sector innovation. We look forward to the opportunity to deliver high-quality health care to the 16 to 20 million Americans newly eligible for Medicaid. We encourage states to take advantage of the cost-effective solutions offered by managed care as they expand their Medicaid programs.
Q. How is Amerigroup preparing to participate in the new health insurance exchanges?
A. Amerigroup’s history and background blends well with the unique needs of low- to moderate-income individuals and families eligible for subsidized coverage in the new health insurance exchanges. We look forward to exploring opportunities to partner with states to maintain continuity of coverage, encourage choice and help the health care dollar go further.
Q. Does Amerigroup think the court made the right decision?
A. We support the decision made by the Supreme Court.
Q. What would Amerigroup change about the ACA?
A. While we do not think the Affordable Care Act is perfect, it is a good place to start. Just as with Medicare and Medicaid, the health reform law will undoubtedly go through many changes in the years and decades ahead. In particular, we believe that in order to ensure a sustainable program providing high-quality, cost-effective coverage for millions of beneficiaries, Medicaid should be exempted from the ACA’s health industry tax.
General Health Reform Questions
Q. What is the Office of Health Reform Integration?
A. The Office of Health Reform Integration was formed in June 2010 to be thought leaders for information, education and communication on the changes and opportunities health reform presents to our stakeholders and partners. We work to make sure our members and providers, investors and analysts, policymakers and government leaders, employees and community partners have access to simple and meaningful tools to help understand and integrate health reform. The Office of Health Reform Integration continues the Amerigroup tradition of providing real, community-focused and innovative solutions to modern health care challenges.
Q: From your understanding of heath care reform, what impact do you foresee this having on Amerigroup? How does this impact compare to our competitors?
A: As Amerigroup has remained at the forefront in the national discussion on health care policy, we foresee our Company as one poised to help through the upcoming transition in health care reform. A key part of the new federal law calls for expanding eligibility and federal funding for Medicaid. The new law also calls for simplifying the enrollment process for Medicaid applicants.
Because of the changes, approximately 16 million people without health insurance are expected to become eligible for Medicaid and the Children’s Health Insurance Program (CHIP). With much of the enrollment growth projected to occur in states where we already serve members, Amerigroup foresees significant opportunities. Amerigroup operates in four of the five states where the potential for enrollment growth is significant: Texas, Florida, New York and Georgia.
Q. What role do you believe Amerigroup should play as health care reform moves from debate and passage to implementation?
A: Despite the year-long debate over health care reform and the extensive scope of the legislation, its success or failure will rest on the extensive implementation process already underway in Washington, D.C. and state capitols. Much of the new federal law’s impact will be determined through both state and federal government action, as well as regulation and rulemaking.
In states across the country, the people of Amerigroup work to provide innovative solutions to today’s health care challenges. Working closely with state partners, with members in their communities and with distinguished and culturally diverse advocates, experts and academics, our company looks forward to furthering practical approaches to the challenges and opportunities of health care reform. Driving Real Solutions in health care is more than what we do – it is who we are.
Q: Long-term care spending represents a significant and rising cost for states and their Medicaid programs. What role does health care reform have in addressing these trends? Is this a beneficial thing for Amerigroup and for states?
A: Health care reform will dramatically change every aspect of health insurance and health care coverage, including long-term care. Under the Affordable Care Act, states will have the opportunity to expand and improve independent living options for seniors and people with disabilities, which is both more affordable for taxpayers and preferred by Medicaid beneficiaries. Some of the key opportunities for states are the State Balancing Incentive Program; Community First Choice Option; and, the Medicaid Money Follows the Person Program, among others.
Aiming to address the imbalance many states face in the financing of their long-term care programs, the State Balancing Incentive Program offers state Medicaid programs financial incentive to shift their Medicaid long-term care spending from institutions, such as nursing facilities, to home and community-based services (HCBS). Earlier federal emphasis on shifting spending away from institutional settings was demonstrated in the Money Follows the Person Program (MFP). MFP enables public funds to move with the individual needing long-term services and supports and – as their needs and preferences change – to the most appropriate settings. Health care reform extends this program through 2016.
These programs, and others like them in the new federal law, will enable our members to increase their quality of life by receiving care in a preferred setting: their home or in the community. Advancing alternatives to institutional care is an approach we believe in. Amerigroup looks forward to working with our state partners to expand and improve the availability of the HCBS programs for our members.
Q: What are some of the major changes in health care reform?
- Reforms the health insurance market
- No preexisting condition exclusions
- Must accept all applicants for coverage
- Must renew or continue coverage
- Premiums may not vary based on health status, gender, class of business or claims experience
- Premiums may vary only by family structure, community rating area, actuarial value of the health plan benefit and age
- May not establish annual or lifetime limits
- Only minimal cost sharing for certain preventive services
- Dependent coverage extended to age 26
- Establishes individual mandate and employer requirements
- Requires all U.S. citizens to have minimum essential coverage
- Establishes a tax penalty for individuals who do not meet minimum essential coverage in any month
- Provides for religious exemption and other exemptions on the basis of incarceration and lack of lawful presence
- Requires large employers to automatically enroll employees into health insurance plans offered by the employer
- Mandates employers inform employees of coverage options and report cost of coverage benefits of Form W-2s
- Fines large employers $250 per month per employee if an employee receives coverage in the Exchange
- Expands and changes public health programs
- New national floor for Medicaid coverage of 133 percent of the Federal Poverty Level (FPL)
- Includes virtually all persons at or below this level except those covered by Medicare and unauthorized immigrants
- States required to maintain current eligibility levels
- Extends Children’s Health Insurance Program through 2019
- Reauthorizes Medicaid Special Needs Plans through 2014
- For uninsured, childless adults between 133 and 200 percent of FPL, states may create Basic Health Plan
- States must extend Medicaid coverage to persons under age 26 who were in foster care at age 18
- Streamlines eligibility processes
- Creates state-based health insurance purchasing exchanges
- Starting January 1, 2014
- Requires every state establish an American Health Benefit Exchange and a Small Business Health Options Program Exchange to purchase health insurance coverage from Qualified Health Plans
- Individuals and small businesses may purchase coverage in or outside an exchange, but can access federal premium subsidies and tax credits only in an exchange
- Exchanges may be multi-state or regional
- If a State does not create a fully functioning exchange, the Health and Human Service Department will operate an exchange on the State’s behalf; readiness reviews to begin January 1, 2013
- Provides premium assistance and cost-sharing credits to those below 400 percent of the Federal Poverty Level (up to $88,200 for a family of four in 2009)