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Health Insurance Marketplace – Day 2 (CFSAC Spring 2013)

Health Insurance Marketplace – Day 2 (CFSAC Spring 2013)


>>THE NEXT EVENT IS ACTUALLY ONE
THAT WHEN I FIRST HEARD ABOUT THIS I WONDERED WHAT ITS VALUE
WAS AND THE MORE I LEARNED ABOUT IT THE MORE EXCITED I BECAME
BECAUSE IT’S GOING TO ADDRESS ISSUES RELATED TO THE
MARKETPLACE GOING FORWARD WHERE 42 HEALTH INSURANCE IS CONCERNED
AND HOW IT AFFECTS THE PATIENTS THAT WE SERVE AND FOR THAT
MATTER THE REST OF US. DR. LEE WENT TO THE THE EFFORT
TO DO THIS SO I ASK HER TO INTRODUCE HER SPEAKER AND GIVE
BACKGROUND.>>THANK YOU VERY MUCH.
I THINK THIS IS GOING TO BE A DIFFERENT — THE PURPOSE OF THIS
IS A LITTLE BIT DIFFERENT. WE WANTED TO TAKE ADVANTAGE OF
THE AUDIENCE THAT WE HAD TODAY BOTH HERE IN THIS ROOM AND
AROUND THE COUNTRY TO LET PEOPLE KNOW ABOUT THE HEALTH INSURANCE
MARKETPLACE WHICH IS THE NEW NAME FOR FEDERAL HE CAN CHANGE
OR STATE EXCHANGE AND OPPORTUNITIES THAT PATIENTS WITH
CHRONIC FATIGUE SYNDROME AND THEIR FAMILIES ARE GOING TO HAVE
TO HAVE A NEW OPPORTUNITY TO GET HEALTH INSURANCE COVERAGE OFF
TIMES WITH HELP WITH PAYMENT FOR THE — FOR THAT INSURANCE.
THESE — THERE’S A LOT OF INFORMATION OUT THERE THAT MOST
AMERICANS DOPE KNOW MUCH ABOUT THIS.
IT’S BEEN HARD TO GET IT ALL OUT BECAUSE OF THE RAPID WAY THIS IS
GOING SO I’M HERE TO TELL YOU THE PEOPLE LISTENING TODAY ARE
GOING TO BE ON THE CUTTING EDGE OF LEARNING ABOUT THE NEW
OPPORTUNITIES FOR GETTING HEALTH INSURANCE WITHOUT WORRYING ABOUT
PRE-EXISTING CONDITIONS ET CETERA THAT BEGIN IN THE FALL.
SO DR. ANNA PAREK IS DEPUTY ASSISTANT SECRETARY FOR HEALTH
FOR SCIENCE AND MEDICINE IN THE OFFICE OF THE ASSISTANT
SECRETARY OF HEALTH. I THINK DR. PAREK WAS A CFSAC
CFO SOME YEARS AGO SO THOSE AROUND KNOW HIM AND HE HAS DONE 43
A LOT OF WORK IN THIS AREA, HE WORKED CLOSELY WITH CMS, CENTER
FOR MEDICAID AND MEDICARE SERVICES.
SO HE’S GOING TO TELL US TODAY. THIS AGAIN IS NOT PARTICULARLY
TOWARDS THE GOAL HERE ISN’T TOWARDS DEVELOPING
RECOMMENDATIONS TO THE SECRETARY.
IT’S REALLY AN OPPORTUNITY TO LET PEOPLE WHO HAD ISSUE AROUND
AFFORDABLE HEALTHCARE TO HAVE THAT OPPORTUNITY TO LEARN ABOUT
IT.>>THANK YOU, DR. LEE.
LET ME START BY THANKING NANCY FOR HER TREMENDOUS LEADERSHIP ON
THIS ISSUE. I WANT TO THANKS DR. MARSHALL AS
WELL AS CHAIR OF THE COMMITTEE. MARTY BOND.
I WAS HONORED BEING EXECUTIVE SECRETARY OF CFSAC IN 2007, 2008
SO I WANT TO START BY THANKING ALL OF YOU FOR YOUR SERVICE AS
COMMITTEE MEMBERS I SEE FAMILIAR FACES HERE, DR. KEN FRIEDMAN AND
KIM MCCLARY, DR. FILLINGER, SO NICE TO SEE FAMILIAR FACES.
WE’RE JOINED BY MANY, MANY ADVOCATES AND I WANT TO
RECOGNIZE THEM. PARTICULARLY OBVIOUSLY RECOGNIZE
THOSE WHO JOINED US TODAY IN THE ROOM AND ELSEWHERE.
WITH CFS AND FAMILY MEMBERS CARING FOR INDIVIDUALS WITH CMS
CFS AND ME/CFS. AND WANT TO RECOGNIZE THE
COURAGE THEY ARE EXHIBITING EVERY DAY MANAGING ME/CFS.
SO THANKS FOR THE INVITATION TO BE HERE WITH YOU UNDERSTAND
WHEN. AS ALL OF YOU KNOW AND SHOULD
KNOW IMPROVING CARE FOR INDIVIDUALS WITH ME/CFS AND
ADDRESSING THEIR NEEDS. 44 TODAY’S PRESENTATION ON THE
HEALTH INSURANCE MARKETPLACE IS ONE EXAMPLE OF AN OPPORTUNITY TO
ENSURE THAT INDIVIDUALS WITH ME/CFS MIGHT BE UNINSURED MIGHT
BE UNDERINSURED OR AT RISK FOR LOSING HEALTH INSURANCE KNOW
ABOUT OPTIONS THAT WILL BE COMING DOWN THE WAY VERY SOON TO
HELP INCREASE CHANCES THAT THEY HAVE HEALTH INSURANCE AND ACCESS
HEALTHCARE TO BETTER MANAGE SYMPTOMS AND CONDITIONS.
SO I THINK IN THAT SPIRIT, THIS IS VERY EXCITING.
AND I THINK IT’S ALL OF OUR JOBS TO MAKE SURE WE GET THE WORD OUT
AND LET PEOPLE KNOW WITH ME/CFS WHO MIGHT BENEFIT FROM THIS THAT
THERE ARE OPTIONS COMING DOWN THE WAY.
THE OBJECTIVES OF THIS PRESENTATION IF I CAN GET THE
CLICKER TO WORK CORRECTLY HERE. WHAT WE’LL TALK ABOUT TODAY IS
HEALTH INSURANCE MARKETPLACES. CALLED HEALTH INSURANCE
EXCHANGES. AS MANY OF YOU WHO HAVE BEEN
TRACKING THE AFFORDABLE CARE ACT KNOW HEALTH INSURANCE
MARKETPLACES ARE ONE LEG OF THE THREE LEGGED STOOL OF UNIVERSEAL
COVERAGE ENVISIONED BY THE AFFORDABLE CARE ACT.
SO THE FIRST LEG IS ROBUST EMPLOYER, SPONSORED COVERAGE.
THE SECOND LEG OF A STOOL IS MEDICAID EXPANSION.
THE THIRD LEG IS THE HEALTH INSURANCE MARKETPLACE.
SO WE’LL TALK ABOUT WHAT MARKETPLACES ARE, WHO BENEFITS,
WHO IS ELIGIBLE AND EXPLAIN THE ENROLLMENT PROCESS.
SO ESSENTIALLY THE HEALTH INSURANCE MARKETPLACE IS NEW WAY
FOR AMERICANS TO BUY HEALTH INSURANCE STARTING IN OCTOBER,
SO THIS IS LITERALLY FOUR MONTHS 45 AWAY WHEN OPEN ENROLLMENT IN
EVERY STATE IN THE COUNTRY STARTS.
AND COVERAGE FROM HEALTH INSURANCE PLANS, QUALIFIED
HEALTH PLANS FROM THESE MARKETPLACES WILL BEGIN
JANUARY 2014. SO SOON.
THIS IS NOT SOMETHING IN THE DISTANCE OR FUTURE THAT’S WHY I
THINK THIS TOPIC IS TIMELY FOR DISCUSSION.
HOW DOES MARKETPLACE WORK? ALL OF THESE POINT IN MORE
DETAIL SENTLY FOR INDIVIDUALS COVERAGE IS PROVIDED TO FIT
INDIVIDUAL NEEDS. MANY INDIVIDUALS GET A BREAK ON
COST THROUGH NEW PREMIUM TAX CREDIT.
THROUGH THE MARKETPLACE, THERE IS UNBIASED HELP AND CUSTOMER
SUPPORT. ACCESS TO QUALITY HEALTH
COVERAGE THAT MEETS MINIMUM STANDARDS.
IT WILL BE EASY TO USE, HOPEFULLY USER FRIENDLY.
THERE WILL BE ONE PROCESS TO DETERMINE ELIGIBILITY FOR
INDIVIDUALS ARE QUALIFIED FOR THE MARKETPLACE, WHETHER THEY’RE
ELIGIBLE FOR TAX CREDITS, REDUCE COST SHARING, WHETHER ELIGIBLE
FOR MEDICAID AS WELL AS MARKETPLACE WILL OFFER A CHOICE
OF PLANS AND LEVELS OF COVERAGE AND ESSENTIALLY INSURANCE
COMPANIES THE WHOLE IDEA HERE, COMPETE FOR BUSINESS BASED ON
QUALITY, BENEFITS, COST AND THAT COMPETITION SHOULD DRIVE DOWN
COSTS AND WE’RE ALREADY SEEING SOME EXAMPLES TO HAVE SIT OF
OREGON AND HOW THIS PROCESS MIGHT GET BACK, PLAY OUT.
SO LET’S TALK ABOUT MARKETPLACE BASIC RULES.
ALL PLANS IN THE MARKETPLACE 46 WILL BE CALLED QUALIFIED HEALTH
PLANS, BASIC CONSUMER PROTECTIONS.
THEY MUST ENSURE HIGH QUALITY, THEY MUST PROVIDE INFORMATION ON
IMPORTANT ATTRIBUTES SUCH AS PREMIUMS DEDUCTIBLES AND OUT OF
POCKET COSTS, BEFORE AN INDIVIDUAL DECIDES TO ENROLL THE
MARKETPLACE ALLOWS INDIVIDUALS TO MAKE WHAT WE CALL APPLES TO
APPLES COMPARISONS OF COSTS AND COVERAGE.
SO THIS IS COMPARISON SHOPPING, IT IS TRANSPARENT SO THAT’S
CRITICAL. THE TERM WE USE, QUALIFY HEALTH
PLANS SO WHAT IS A QUALIFY HEALTH PLAN, HOW DOES A HEALTH
PLAN GET THIS, PARTICIPATE IN A STATE MARKETPLACE?
QUALIFIED HEALTH PLAN MUST COVER TEN ESSENTIAL HEALTH BENEFITS,
WE’LL GET TO THAT IN JUST A SECOND.
ALSO MUST BE OFFERED BY INSURER THAT’S LICENSED IN THE STATE AND
IN GOOD STANDING. THE INSURER MUST OFFER AT LEAST
ONE PLAN AT DIFFERENT LEVELS, WE’LL TALK ABOUT A SILVER LEVEL
GOLD LEVEL COST SHARING. AND ENSURED HAS TO CHARGE THE
SAME PREMIUM RATE OR PLAN WHETHER THROUGH MARKETPLACE OR
OUTSIDE THE MARKETPLACE. SO THIS IS A LITTLE BACKGROUND
ON THE QUALIFIED HEALTH PLANS. KEY POINT IS THEY COVER TEN
ESSENTIAL HEALTH BENEFITS. SO THESE ARE TEN ESSENTIAL
HEALTH BENEFITS IN THE AFFORDABLE CARE ACT THAT ALL
HEALTH PLANS MUST COVER. MANY CATEGORIES OBVIOUSLY NEED
— YOU HAVE SEEN BEFORE HEALTH INSURANCE PLAN TODAY COVER THEM
AND PATIENT SERVICES EMERGENCY SERVICES HOSPITALIZATIONS, BUT
THERE ARE OTHER IMPORTANT 47 CATEGORIES THAT ARE CODED BY IN
THE AFFORDABLE CARE ACT. KEY CATEGORIES.
MENTAL HEALTH AND SUBSTANCE USE DISORDERS.
JUST A FEW. THE LAW DICTATES THAT ESSENTIAL
HEALTH BENEFITS BE EQUAL IN SCOPE TO BENEFIT THAT ARE
OVERRED BY TYPICAL EMPLOYER PLAN.
SO THESE ARE THE KEY SEMIHEALTH BENEFITS THAT ALL QUALIFIED
HEALTH PLANS PARTICIPATE IN A MARKETPLACE.
TO INDIVIDUALS. THERE ARE — I ALLUDED TO THIS,
VARIOUS LEVELS OF COVERAGE. A PLAN PARTICIPATING IN A
MARKETPLACE PROVIDE VARIOUS TIERS OF COVERAGE.
THEY’RE CALLED BRONZE SILVER GOLD PLATINUM AND ESSENTIALLY
THIS TIERING IS BASED ON HOW GENEROUS THE PLAN IS.
SO PLANS MAY PAY ON AVERAGE 60, 70, 80, 90% OF TOTAL HEALTHCARE
COSTS. AS YOU CAN IMAGINE THE MORE THE
PLAN PAYS, THE MORE GENEROUS THE PLAN IS, THE HIGHER IN GENERAL
ON AVERAGE THE PREMIUM IS FOR AN INDIVIDUAL.
THIS IS ALL PART OF THE CHOICE ELEMENT.
EMPOWERING INDIVIDUALS WITH CHOICE TO SELECT WHAT’S BEST TO
THEM AS WELL AS FAMILIES. SO EVERY STATE IN THIS COUNTRY
WILL HAVE A MARKETPLACE IN SOME CASES STATES HAVE CHOSEN TO RUN
THEIR MARKETPLACE AND NUMBERS VACILLATE BETWEEN 16 STATES IN
THE COUNTRY INCLUDING THE DIFFERENT OF COLUMBIA, SEVEN
STATES THUS FAR DECIDED TO PARTNER WITH THE FEDERAL
GOVERNMENT SO THERE’S A PARTNERSHIP MARKETPLACE BETWEEN
FEDERAL GOVERNMENT AND THE STATE 48 FOR NOW THE REST OF THE STATE
THE FEDERAL GOVERNMENT ESTABLISHES AN OPERATES A
MARKETPLACE. SO THERE’S 50 HEALTH INSURANCE
MARKETPLACES THAT WILL BE LIVE FOR OPEN ENROLLMENT ON
OCTOBER 1st, 2013. AND COVERAGE STARTS TO BE
PROVIDED BY QUALIFIED HEALTH PLANS STARTING JANUARY 12014.
CONTINUE TO HAVE TREMENDOUS FLEXIBILITY HOW THEY GO ABOUT
THIS. BUT THERE ARE THREE WAYS STATES
ARE DEALING WITH THIS CURRENTLY. MOVING TO ELIGIBILITY
ENROLLMENT. WHO IS ELIGIBLE TO ENROLL?
THESE HEALTH INSURANCE MARKETPLACES THAT OPEN UP IN ALL
50 STATES? AS YOU CAN IMAGINE, ELIGIBILITY
REQUIRES AN INDIVIDUAL TO LIVE IN THE SERVICE AREA AS DEFINED,
THEY MUST BE A U.S. CITIZEN OR A NON-CITIZEN LAWFULLY PRESENT
HERE. THEY CAN’T BE INCARCERATE.
SO THERE’S CERTAIN ELIGIBILITY REQUIREMENTS FOR INDIVIDUALS TO
PARTICIPATE THE INITIAL OPEN ENROLLMENT STARTS SEVERAL MONTHS
FROM NOW. THE FIRST OPEN ENROLLMENT IS SIX
MONTHS. SO THERE’S TREMENDOUS EDUCATION
OUTREACH CAMPAIGN AND A LONGER TIME FOR OPEN ENROLLMENT.
BUT SUBSEQUENT YEARS, OPEN ENROLLMENT WILL BE LIKE OTHER
HEALTH INSURANCE PLANS, OPEN ENROLLMENT LATE IN THE YEAR,
OCTOBER 15th TO AROUND DECEMBER 7TH.
FOR THE NEXT CALENDAR YEAR STARTING JANUARY 1st.
THAT IS HOW ENROLLMENT CURRENTLY IS BEING PLANNED.
THE ENROLLMENT PROCESS, AGAIN, 49 THIS IS ALL ABOUT ONE STOP
SHOPPING. HOW DO WE MAKE THINGS SIMPLE FOR
INDIVIDUALS. WHAT SEN VISIONED IS ONE
STREAMLINED APPLICATION WHERE INDIVIDUAL CAN DETERMINE WHETHER
THEY’RE ELIGIBLE. TO PARTICIPATE WHETHER ELIGIBLE
FOR PREMIUM TAX CREDITS AN REDUCE COST SHARING.
WE’LL TALK ABOUT THIS. BUT ALSO WHETHER THEY MAY NOT BE
ELIGIBLE FOR THE HEALTH INSURANCE MARKETPLACE BUT MIGHT
BE ELIGIBLE FOR MEDICAID OR THEIR CHILDREN MIGHT BE ELIGIBLE
FOR CHIP SO THIS IS ONE STOP SHOPPING A WAY TO INTEGRATE ALL
THESE OPTIONS SO INDIVIDUALS, WHEREVER THEY ARE, ON THE INCOME
SCALE OR IN THEIR LIVES WILL BE DIRECTED TOWARDS THE OPTION THAT
THEY’RE ELIGIBLE FOR. AGAIN, THESE APPLICATIONS WILL
BE — SUBMITTED, THEY CAN BE SUBMITTED ONLINE, BY PHONE, BY
EMAIL OR IN PERSON SO TRYING TO MAXIMIZE FLEXIBILITY FOR THE
ENROLLMENT PROCESS. HERE ARE A COUPLE OF EXAMPLE,
REAL LIFE EXAMPLES, THE GENTLEMAN ON THE LEFT.
HERE IS AN INDIVIDUAL WHO MIGHT BE ONE YOUNG INVINCIBLE WE TALK
ABOUT OVERALL HEALTH BUT — WELL TO DO, THEY DON’T HAVE ACCESS TO
EMPLOYER SPONSORED HEALTH COVERAGE.
AND THEY ARE ABLE TO GO TO THESE MARKETPLACE, PURCHASE INSURANCE.
THE SECOND INDIVIDUAL WITH HER DAUGHTER ABLE TO GO INTO THIS —
INTO THE MARKETPLACE, FINE OUT SHE AND FAMILY ARE ELIGIBLE FOR
MEDICAID AND OBTAIN MEDICAID THROUGH THERE.
FINALLY ANOTHER REAL LIFE EXAMPLE, AN INDIVIDUAL UNINSURED
GOING TO THE MARKETPLACE BECAUSE 50 THAT INDIVIDUAL BEING LOW
INCOME, BEING ELIGIBLE FOR TAX CREDITS.
ONE APPLICATION, THREE PEOPLE WITH THREE CIRCUMSTANCES
TRIAGEED TO THE RIGHT OPTION, FOR THEM.
LET’S TALK ABOUT AFFORDABILITY BECAUSE THAT’S OBVIOUSLY
CRITICAL, ONE THING TO HAVE ACCESS TO HEALTH INSURANCE BUT
IF YOU CAN’T AFFORD IT, IT DEFEATS THE PURPOSE.
THROUGH HEALTH INSURANCE MARKETPLACES THERE’S FINANCIAL
HELP AVAILABLE FOR WORKING FAMILIES.
ONE WAY, ONE METHOD ARE TAX CREDITS THAT WILL GO DIRECTLY TO
HEALTH PLANS TO LOWER THE MONTHLY PREMIUMS QUALIFIED
INDIVIDUALS PAY. SO MOST TAX CREDITS YOU THINK OF
FILLING OUT TAXES AND THEN YOU LEARN YOU’RE ELIGIBLE FOR TAX
CREDITS AND GET SOMETHING BACK LATER ON CH THESE ARE ADVANCED
PAYMENT TAX CREDITS. SO ESSENTIALLY SO ESSENTIALLY
ADVANCED PAYMENT WHEN YOU ENROLL THE PAYMENT FOR THE TAX CREDIT
GOES DIRECTLY TO THE INSURANCE COMPANY MONTHLY PREMIUM WILL BE
REDUCED. SO IT’S CRITICAL NOT THAT PEOPLE
ARE WAITING AROUND A CALENDAR YEAR, THEY AUTOMATICALLY SEE
THAT THEIR PREMIUMS ARE REDUCED. THE SECOND FINANCIAL METHOD OF
FINANCIAL HELP IS RETUESDAYED COST SHARINGING.
REDUCED TAX CREDIT. BASED ON HOUSEHOLD INCOME
BETWEEN 100 AND 400% OF THE FEDERAL POVERTY LINE, BASED ON
SLIDE SCALE SO THE HIGHER THE INCOME THE LESS THE TAX CREDIT
AMOUNT YOU’LL HAVE VICE VERSA. ALL GETS AT THIS POINT OF MAKING
HIGH QUALITY ACCESSIBLE HEALTH 51 INSURANCE AFFORDABLE.
SO THIS IS A SEGMENT OF THOSE WHO WILL BE ELIGIBLE PREMIUM TAX
CREDITS ALSO WILL BE ELIGIBLE FOR REDUCE COST SHARING, SO
SPECIFICALLY THOSE INDIVIDUALS WITH INCOMES AT OR BELOW 250% OF
THE FEDERAL POVERTY LINE, MEMBERS FEDERALLY RECOGNIZE 300%
FEDERAL POVERTY LINE BUT ADDITIONAL BENEFITS TO REDUCING
COST SHARING, BARRIERS, TO CARE THAT ARE CRITICALLY IMPORTANT
FOR MANY, MANY AMERICANS. FINALLY WE TALK A LITTLE BIT
ABOUT THIS, BUT JANUARY 21, 14, PART OF THE UNIVERSEAL COVERAGE
LAG ALSO COMMENCES SO THERE WILL BE MEDICAID ENHANCED MEDICAID
ELIGIBILITY. THIS IS AN OPTION.
AS FAR AS WE KNOW RIGHT NO, THE MAJORITY OF STATES ARE MOVING
FORWARD TO EXPANDING MEDICAID AND THIS IS STILL PLAYING OUT IN
STATE LEGISLATURES AND MOST RECENT STATE TO INDICATE THEY
WILL EXPAND — YESTERDAY IOWA GOVERNOR WHO INDICATED THAT IOWA
HOPES TO PROCEED WITH MEDICAID EXPANSION.
SO THIS IS APPROXIMATE OPTION FOR STATES BUT ESSENTIALLY WHAT
IT MEANS IS ALL ADULTS 19 TO 65 WITH INCOME 130% OF THE POVERTY
LINE ARE ELIGIBLE FOR MEDICAID. ALL UP TO 133% OF THE —
FAMILIES ELIGIBLE FOR MEDICAID AS WELL.
AND AGAIN, ANYONE GOING THROUGH THIS PORTAL OF HEALTH INSURANCE
MARKETPLACES MIGHT FIND OUT THEY’RE NOT ELIGIBLE FOR HEALTH
INSURANCE THROUGH THE QUALIFIED HEALTH PLAN THROUGH THE
MARKETPLACE BUT MIGHT FIND OUT THEY’RE ELIGIBLE FOR MEDICAID SO
THAT’S THE ONE STOP SHOPPING THAT WE HAVE BEEN TALKING ABOUT.
52>>
>>THERE WILL BE A LOT OF ENROLLMENT ASSISTANCE WHICH AS
YOU CAN IMAGINE WILL BE CRITICAL.
TO HELP EDUCATE INDIVIDUALS ABOUT THEIR OPTIONS, WHAT IS
BEING ENVISIONED RIGHT NOW, EVERYTHING FROM TOLL FREECAL
CENTERS, WEBSITES, TALK ABOUT THAT, NAVIGATOR PROGRAMS, HEALTH
NAVIGATOR, INDIVIDUALS OR IMMUNITY ORGANIZATIONS PROVIDING
UNBIASED IMPARTIAL INFORMATION TO HELP INDIVIDUALS UNDERSTAND
THEIR CHOICES, NOT MAKE THE CHOICES FOR THEM SO NAVIGATORS
WOULDN’T BE ENROLLING PEOPLE ON THEIR OWN.
THEY WOULDN’T BE COMPENSATED BY ANY HEALTH INSURANCE PLAN OR
PROGRAM. THERE WILL BE ALSO OTHER SOURCES
OF HELP AVAILABLE COMMUNITY BASED ORGANIZATIONS IN SOME
STATES INSURANCE AGENTS AS WELL AS — AND ESSENTIALLY ALL THESE
INDIVIDUALS AND ENTITIES WILL BE SUPPORTING INDIVIDUALS IN
CHOOSING OPTIONS BEST FOR THEM, FIND A LAB THAT MEETS THEIR
NEEDS BASED ON QUALITY, BASED ON COST, BASED ON BENEFITS AND ALL
OF THE ATTRIBUTES THAT PEOPLE CARE ABOUT.
WHAT ARE RESOURCES AVAILABLE NOW?
WHERE CAN PEOPLE FIND MORE INFORMATION?
THERE’S ONE WEBSITE TRYING TO DRIVE EVERYONE TO,
HEALTHCARE.GOV. RIGHT NOW INDIVIDUALS BEFORE
OCTOBER 1 CAN GO ON HEALTHCARE.GOV AND FIND
DIFFERENT PLANS, DIFFERENT OPTIONS THERE IS A TREMENDOUS
AMOUNT OF INFORMATION THERE. BUT STARTING AGAIN OCTOBER 1
THESE MARKETPLACES WILL OPEN FOR 53 OPEN ENROLLMENT AND INDIVIDUALS
WILL BE ABLE TO GO ON TO WEBSITES SUCH AS THIS TO
DIRECTLY FIND OUT WHAT ARE THE SPECIFIC OPTIONS AVAILABLE TO
THEM, WHAT ARE THEY ELIGIBLE FOR.
SO COUPLE OF KEY POINTS. JUST TO REMEMBER, I KNOW IT’S
QUITE A BIT OF INFORMATION, MARKETPLACE IS A NEW WAY DEFINED
BY HEALTH INSURANCE FOR INDIVIDUALS, SMALL BUSINESS SHOP
FOR HEALTH INSURANCE THAT FITS THEIR BUDGET.
A LOT OF INDIVIDUALS AN SMALL BUSINESSES PREVIOUSLY LOCKED OUT
OF THE MARKET, THEY HAVE BEEN DENIED HEALTH INSURANCE,
PRE-EXISTING CONDITIONS. THERE’S BEEN GENDER
DISCRIMINATION. ANNUAL LIMITS OR LIFETIME
LIMITS. ALL THOSE ARE REFORMS NOW THE
INSURANCE OF THE INSURANCE MARKET THAT WILL GO LIVE
STARTING 2014. STATES HAVE ELIGIBILITY TO
ESTABLISH THEIR OWN MARKETPLACE. WE HAVE SEEN VARIATIONS IN THAT.
THERE’S FINANCIAL HEALTH, TAX CREDITS AS WELL AS REDUCE COST
SHARING FOR FAMILIES AND SIGNIFICANT ASSISTANCE AVAILABLE
TO INDIVIDUALS TO FIND THE COVERAGE THAT BEST MEETS THEIR
NEEDS. AGAIN, INDIVIDUALS WILL HAVE
CHOICES, EMPLOY BASED COVERAGE, ONE PART OF THAT THREE LEGGED
STOOL WILL CONTINUE. INSURANCE WILL CONTINUE TO BE
SOLD OUTSIDE THE MARKETPLACE, THERE’S NOTHING MANDATORY,
VOLUNTARY BUT OBVIOUSLY MANY PEOPLE BELIEVE THIS IS THE WAY
PURCHASE AFFORDABLE HEALTH INSURANCE.
THE MARKETPLACE, THE ONLY PLACE 54 POINT I’M JUST MAKING TO GET
SOME OF THE METHODS OF FINANCIAL ASSISTANCE.
FINALLY, THE TAKE AWAY POINT FROM US IS FOR ALL OF US TO SIGN
UP TO GET EMAIL AND TEXT ALERTS ON HEALTHCARE ANALYSIS.
ALL OF US LISTENING IN WE ALL KNOW SOMEONE WHO UNINSURED OR AT
RISK FOR LOSING HEALTH INSURANCE OR UNDERINSURED.
I THINK IT BEHOOVES US TO KNOW THE UPDATED INFORMATION SO WE
CAN COMMUNICATE THIS TO OTHERS, WE WANT TO DRIVE PEOPLE WHO ARE
UNINSURED OBVIOUSLY SO THEY KNOW THEIR OPTIONS COMING
OCTOBER 2014 BUT WE WANT TO DRIVE PEOPLE WHO HAVE HEALTH
INSURANCE TO HEALTHCARE.GOV. EVERYBODY KNOWS SOMEBODY AT RISK
FOR LOSING HEALTH INSURANCE OR WHO IS UNINSURED FOR PARTNER
ORGANIZATION THERE’S ADDITIONAL WEBSITE MARKETPLACE.CMS.GOV
WHERE INDIVIDUALS GET MORE RESOURCES.
I WANT THE TO STOP THERE. MY CONCLUDING COMMENT WILL BE
BRINGING BACK TO THE POPULATIONS HERE TO CARE FOR.
THERE ARE THOUSANDS OF AMERICANS WITH ME/CFS TODAY WHO EITHER
HAVE NO HEALTH INSURANCE OR AT RISK FOR LOSING HEALTH INSURANCE
OR UNDERINSURED. THERE IS NO DOUBT THESE OPTIONS
WILL HELP THOSE INDIVIDUALS BE ABLE TO ACCESS HEALTH AND
HEALTHCARE TO HELP THEM MANAGE THEIR SYMPTOMS AND THEIR
CONDITION. WE ALL KNOW THAT EARLY
MANAGEMENT IS CRITICAL SO WE CAN REDUCE EXACERBATION AN HELP,
KEEP PEOPLE HEALTHY AND FUNCTIONING AND HAVE THE OPTIMUM
QUALITY OF LIFE. SO AGAIN, I THINK GETTING THE
WORD OUT, MAKING SURE PEOPLE 55 UNDERSTAND THE OPTIONS, THE
CHOICES, MAKING SURE THEY’RE UP TO SPEED, AGAIN, OCTOBER 1 IS
JUST FOUR MONTHS AWAY. BUT I THINK THOSE ARE SOME OF
THE OPPORTUNITIES HERE. I’M SURE SOMEONE HAS DONE
EPIDEMIOLOGICAL RESEARCH TO MAP OUT WHERE POPULATIONS OF HIGH
CONCENTRATION OF ME/CFS AND WHERE ARE INDIVIDUALS WHO MIGHT
BE UNINSURED. AND TARGETED EFFORTS THROUGH
THIS COMMITTEE, THAT ORGANIZATION AND OTHERS.
TO FIND INDIVIDUALS, MAKE SURE THEY UNDERSTAND THE NEW OPTIONS
WILL GO A LONG WAY. SO AGAIN, THANKS FOR THIS
OPPORTUNITY TO GIVE YOU AN UPDATE AND HOPE THIS IS HELPFUL
AND HAPPY TO TAKE QUESTIONS. SFROM [APPLAUSE]>>THAT WAS A WONDERFUL
PRESENTATION, EXPLANATION OF SOMETHING THAT SEEMS DIFFICULT
TO GRASP. WITH REGARD TO MEDICINE
PRACTICED ACROSS STATE LINES DO YOU SEE DIFFICULTY, FOR EXAMPLE
PEOPLE GEOGRAPHICALLY HAVE TO CROSS THE STATE LINE OR
TELEMEDICINE OR — BECAUSE SPECIFIC EXPERTISE EXISTS
ELSEWHERE, DO YOU SEE ANY DIFFICULTY WITH THIS SYSTEM WITH
WITH REGARD TO THAT?>>I DON’T KNOW.
NOTHING COMES ACROSS MY MIND THAT THIS IS GOING TO BE A
PROBLEM. OBVIOUSLY MANY QUALIFIED HEALTH
PLANS COVER INDIVIDUALS ACROSS STATE LINES SO IT MAY BE AN
ISSUE FOR CERTAIN INDIVIDUALS BUT I DON’T THINK THERE’S 56
ANYTHING PROHIBITIVE FOR INDIVIDUALS WHO MIGHT LIVE IN
ONE STATE AND ACCESS CARE IN ANOTHER STATE.
BUT I THINK THAT LEVEL OF DETAIL PROBABLY DEPENDS ON WHICH
QUALIFIED HEALTH PLAN FOR EXAMPLE, THEY CHOOSE.>>LET ME ASK YOU A QUESTION
THAT INTERESTS ME. THE TERM IN HERE THAT’S USED IS
BASIC. BASIC COVERAGE IN TERMS OF
HEALTHCARE. YOU MAKE A POINT IN ONE SLIDE
THAT ALLOWS AN APPLES TO APPLES COMPARISON BECAUSE IT TALKS
ABOUT WHAT IS COVERED AND WHAT IS NOT.
I THINK IN SOME CLEAR DISTINCTION WE HER A
PRESENTATION ABOUT MEDICARE YESTERDAY FROM DR. JACK WHO
SHOWED US AN EXAMPLE BY STATUTE, EYE GLASSES ARE NOT COVERED
UNDER MEDICARE PERIOD YET MANY AS CLINICS MADE THE POINT WE AT
TIMES WILL SEE THINGS DENIED AND WE GO BACK TO THE PAYER WHETHER
THIRD PARTY PAYER, WHETHER MEDICARE TO APPEAL THAT DENIAL
DECISION. IT’S A MECHANISM OF THIS IN
THESE MARKETPLACES THAT THEY WILL BE MEDICAL OFFICERS IN
PLACE OR SOME MECHANISM WHERE WHEN IT’S IN THAT BIG HUGE GRAY
ZONE OF IS IT REALLY COVERED, IS IT ‘ALLY NOT, IT HAS TO BE
APPEALED, HAS THAT BEEN WORKED OUT IN TERMS OF HOW THAT WILL
WORK IN THE MARKETPLACE?>>I ASSUME EVERY HEALTH PLAN
WILL HAVE A MECHANISM FOR THAT. WHAT YOU’RE ASKING, WHETHER L
THERE BE BROADER UMBRELLA MECHANISM THAT IS OUTSIDE THE
PLAN. 57 I DON’T KNOW THE ANSWER TO THAT
QUESTION, MAYBE DR. LEE.>>EVERY STATE — MOST STATES
ARE SETTING UP SOMETHING CALLED CONSUMER ASSISTANCE PROGRAM.
AND YOU GO TO HEALTHCARE.GOV. IF YOU’RE HAVING CONCERNS THAT
SOMETHING ISN’T BEING COVEREDDED THAT’S SUPPOSED TO BE, YOU CAN
GO TO THAT SLIDE IN THERE. I HAVE TO GO INTO IT.
I THINK IT’S SOMETHING THAT — SOME STATES DON’T HAVE
SPECIFICALLY THE CONSUMER. IT’S PROBABLY THE STATES THAT
AREN’T EXPANDING MEDICAID OR DOING THEIR OWN MARKET PLACE,
THERE’S POLITICAL RESISTANCE TO SOME — IN SOME OF THE STATES TO
DOING SOME OF THIS WORK. THERE IS CONSUMER ASSISTANCE
PROGRAM FOR EACH STATE AND IF YOU GO TO HEALTHCARE.GOV AND
TYPE THAT IN, YOU’LL GET O THE SPECIFIC STATE INFORMATION.>>THAT’S GERMANE FOR MANY
ME/CFS PATIENTS, THIS COMMITTEE HEARD STORY AFTER STORY AFTER
STORY OF PATIENTS DENIED COVERAGE OR DENIED SPECIFIC
REIMBURSEMENT FOR A TEST THEIR PHYSICIAN FELT WAS CRITICALLY
IMPORTANT IN DIAGNOSIS OR THEIR MANAGEMENT.
WE HAVE HEARD ENOUGH STORIES ABOUT THE INTEREST COMPANIES AN
EVEN MEDICARE DENYING THESE SERVICES SO IT RAISED THE
QUESTION IF THERE WAS A BIGGER APPEAL PROCESS THAN GOING BACK
TO THE INSURANCE COMPANY ITSELF. EILEEN.
— ALAINE, SORRY.>>THIS IS ALAINE WITH WITH CMS.
I WANT TO ADD A LITTLE BIT TO THAT ANSWER.
I DON’T HAVE A LOT OF DETAILS 58 ABOUT THIS BUT THE AFORRABLE
CARE ACT CREATES NEW ROLES AROUND APPEALS PROCESSES THAT
APPLY TO NEW PLANS, THERE ARE SOME COMPLEXITY WHAT’S
CONSIDERED A NEW PLAN, WHAT’S NOT.
SO I’M NOT GOING TO SAY TOO MUCH BECAUSE IT’S A COMPLICATED AREA.
BUT THERE ARE NEW PROCESSES IN PLACE FOR THIRD PARTY APPEALS.>>THIS IS GOOD INFORMATION I
BELIEVE FOR THE PATIENT POPULATION.
AND PROVIDERS TO KNOW THAT THEY DON’T HAVE TO TAKE A NO FOR NO.
THERE’S A NEW SHERIFF IN TOWN. I’M SORRY I’M A TEXAN.>>I HAD A QUESTION WHETHER OR
NOT PROVIDERS FOR THESE PLANS PROVIDERS NETWORK TO SEE
PATIENTS FROM THESE PLANS A FUNCTION LIKE THE HM WHERE THE
PROVIDER PROVIDE FOR THE PATIENTS TO GET THIS TYPE OF
INSURANCE TO BE COVERED. SECONDLY, IN ONE SLIDE YOU HAD A
PLATINUM PLAN AND MORE BASIC PLAN AND WHAT WOULD BE THE
DIFFERENCE IN TERMS OF THOSE TWO PLANS, THOSE TWO TYPES OF PLANS
IN TERMS OF WHAT SERVICES WILL BE COVERED.>>FROM THE PROVIDER
PERSPECTIVE, IT WILL BE JUST LIKE THE CURRENT SYSTEM
FUNCTIONS SO
THEY MAY OR MAY NOT HAVE TO BE PART — THEY PROBABLY
HAVE TO BE PART OF A PLAN TO ACCEPT PATIENTS.
THAT’S HOW THEY’LL GET REIMBURSED.
SO I DON’T THINK THERE WILL BE CHANGES FROM THE PROVIDER
PERSPECTIVE. THE TIERING IS REALLY BASED ON
THE ACTUARIAL VALUE OF EACH OF 59 THESE PLANS.
BRONZE, SILVER, GOLD, PLATINUM IS ESSENTIALLY HOW GENEROUS A
PLAN IN IS TEEING OUT TOTAL COST.
SO IT’S ALL BASED ON HOW MUCH COVERAGE INDIVIDUAL WANTS
PROVIDING THEM THAT CHOICE KNOWING FULL WELL THAT THAT WILL
LIKELY BE HIGHER FOR PLANS MORE GENEROUS.
THAT’S THE THINKING MIND THE TIERING.>>IN OTHER WORDS THE PLATINUM
PLAN MIGHT PAY HIGHER PERCENTAGE THAN WHAT THE DOCTOR CHARGED?
>>THAT’S RIGHT. IT WILL BE MORE GENEROUS IN
TERMS OF BENEFIT, THE OTHER TRADE OFF BEING PREMIUM, THE
AVERAGE PREMIUM MAYBE HIGHER.>>MY UNDERSTANDING IS THE
PLATINUM PLAN HAS A 10% DEDUCTIBLE.
THE BONDSMAN HAS A 40% DEDUCTIBLE.
SO IF YOU ARE A HEALTHY YOUNG PERSON WHO DOESN’T HAVE ANY
KNOWN HEALTH PROBLEMS YOU MIGHT CHOOSE THE 40% DEDUCTIBLE
BECAUSE THAT’S LIKELY. REMEMBERING NO PRE-EXISTING
CONDITION EXCLUSIONS ANY MORE SO THAT IF YOU GET SICK IN THE
MEANTIME THE NEXT TIME — NOT SURE MAYBE ALAINE OR ANNA KNOWS
BUT YOU’LL BE ABLE TO UP AND GO INTO A HIGHER BRONZE — GOLD OR
PLATINUM LATER ON IF YOU START NEEDING IT.
THAT’S HOW IT WILL WORK. RIGHT?>>YEAH.>>YOU MAY HAVE TO WAIT UNTIL
THE NEW ENROLLMENT PERIOD. 60
>>EILEEN.>>HI.
THANK YOU. PATIENTS WITH ME, SOME OF THE
SICKEST PATIENTS AND ALSO SOME OF THE POOREST.
SO THE AFFORDABLE CARE ACT IS SOMETHING THAT IS VERY
IMPORTANT. YOU MENTIONED OUTREACH CAMPAIGN
AND HOW TO TARGET AND FIND THESE PEOPLE.
WE KNOW THAT PROBABLY 80% HAVE NOT BEEN DIAGNOSED.
MANY THAT ARE DIAGNOSE THE NOSED, STUDIES SHOW BETWEEN 50
TO 75% ARE DISABLED, CANNOT WORK.
MOST ARE COLLECTING BENEFITS AND I KNOW MANY SO IN PLAIN NUMBERS
WHAT IS THE AFFORDABLE CARE ACT BECAUSE I LOOKED AT FIGURES, IT
WAS CLOSE TO 300 A MONTH FOR A PREMIUM.
CAN CAN YOU GIVE US A BALLPARK, CAN YOU GIVE US ANSWERS HOW
SOMEONE ON $10,000 A YEAR COULD GET HEALTH INSURANCE THROUGH THE
AFFORDABLE CARE ACT?>>GREAT QUESTION.
‘ALLY IMPORTANT. WE HAVE TO SEE HOW IT PLAYS OUT
IN TERMS OF BIDst THAT COME IN FROM INSURANCE COMPANIES FROM
QUALIFIED HEALTH PLANS. BUT ESSENTIALLY, THE IDEA HERE
IS NO LONGER CAN PEOPLE WITH PREEXISTING CONDITIONS AND IT’S
QUITE POSSIBLE MANY PEOPLE WITH ME/CFS HAVE TRIED TO GET HEALTH
INSURANCE IN THE PAST, TOLD THEY HAVE A PRE-EXISTING CONDITION
AND DENIED COVERAGE OR CHARGED VERY, VERY HIGH PREMIUM AMOUNT.
SO THAT DISCRIMINATION WILL NO LONGER BE THERE.
IN TERMS OF AFFORDABILITY MECHANISMS OF ADVANCED PAYMENT 61
TAX CREDITS AND REDUCE COST SHARINGING, IT IS BASED ON
SLIDING SCALE SO THE LESS INCOME AN INDIVIDUAL HAS THE MORE
GENEROUS. ALL THESE TAX CREDITS AND COST
SHARING WILL BE. BUT WE’LL HAVE TO SEE HOW THIS
PLAYS OUT. THOSE WHO HAVE VERY LOW INCOME
LESS THAN 133% OF FEDERAL POVERTY LINE IN STATES THAT IN
STATES THAT EXPAND MEDICAID WILL HAVE THAT OPTION OF GETTING
HEALTH INSURANCE COVERAGE THROUGH MEDICAID.
THERE WILL BE SOME STATES WHO CONTINUE TO NOT WANT TO EXPAND
MEDICAID. IN THOSE STATES INDIVIDUALS FROM
100 TO 133% FEDERAL POVERTY LINE GET ACCESS FROM HEALTH INSURANCE
MARKETPLACES AND ACCESS TO TAX CREDITS REDUCED SHARING SO
MECHANISMS ARE IN PLACE, SOME OF THIS WE HAVE TO SEE HOW THIS
PLAYS OUT. YOUR CONCERN IS SHARED WIDELY.
THERE IS A LOT OF BUILT IN FEATURES TO THIS TO TRY TO GET
AT THAT EITHER THROUGH MEDICAID OR THROUGH FINANCIAL MECHANISMS
THROUGH THE MARKETPLACES.>>A FOLLOW-UP, MANY PATIENTS
ARE HOME BOUND AND ISOLATED. NOT TO MENTION SOME ARE HOMELESS
BUT ONES THAT HAVE A HOME ARE HOME BOUND AND ISOLATED.
WHAT KIND OF OUTREACH ARE YOU GOING TO DO?
FOR A LOOK TIME THE PCICSP PROGRAM OF THE AFFORDABLE CARE
ACT WHICH WAS VERY IMPORTANT ABOUT PRE-EXISTING CONDITIONS,
JUST WASN’T PUBLICIZED, IT WASN’T GETTING OUT THERE, HOW
ARE YOU GOING TO GET THIS INFORMATION OUT THERE TO THOSE
PATIENTS. 62>>THE TOP PRIORITY OF THIS
DEPARTMENT FEDERAL, NON-FEDERAL PARTNERS THINKING ABOUT
EDUCATION OUTREACH, PLANNING EDUCATION OUTREACH FOR SOME
PEOPLE, THE WEB MAYBE A WAY TO GET INFORMATION, THE OTHERS
COULD BE COMMUNITY SENORS. BUT THERE ARE SOME PEOPLE WHO
ARE HOME BOUND AND RELYING ON FAMILY MEMBERS GETTING THE WORD
OUT. THERE’S PEOPLE GOING PROBABLY
DOOR TO DOOR. SO THERE WILL BE LOTS, PROBABLY
WAYS I THINK THAT WE’LL SEE OVER 6 TO 12 MONTHS AS IT PLAYS OUT,
THERE ARE GOING TO BE ALL SORTS OF APPROACHES TO TRY AND REACH
PEOPLE. I THINK YOU’RE RIGHT.
THERE ARE A LOT OF PEOPLE OUT THERE UNFORTUNATELY WHO THE VERY
PEOPLE WE’RE TRYING TO REACH WHO ARE LEAST INFORMED.
THAT’S THE CHALLENGE. SO IT’S SORT OF ALL HANDS ON
DECK, IN ALL WAYS WHERE WE CAN REACH PEOPLE.
AND PEOPLE ARE IN DIFFERENT PLACES AND DIFFERENT LEVELS IN
TERMS OF KNOWLEDGE, WHAT’S GOING ON SO THAT’S PART OF THE
CHALLENGE.>>THANK YOU.>>KIM MCCLEARLY.>>HELLO, AGAIN.
MY QUESTION IS ABOUT THE TYPES OF COVERAGE THAT WILL BE OFFERED
BY THE DIFFERENT PLANS. AND WE SEE IN THE CURRENT
MARKETPLACE THERE ARE SOME PLANS THAT EXCLUDE DEES CATEGORIES OR
LIMBS ON THE PLAN. AND WILL THAT KIND OF THING BE
TRANSPARENT WHEN PEOPLE GO TO 63 SEARCH FOR WHICH PLAN IS BEST TO
THEM SO THEY DON’T HAVE LIMITATIONS ON THE COVERAGE THEY
SEEK?>>ALL PLANS HAVE TO SPECIFY IN
DETAIL WHAT BENEFITS THEY’RE GOING TO OFFER.
YOU CAN IMAGINE WILL WILL BE LINKS TO THEIR PLANS AND LOTS OF
INFORMATION. BUT THE WHOLE IDEA IS FOR
INDIVIDUALS TO BE TRANSPARENT AND COMPARE THE BENEFITS OFFERED
BY EACH OF THE PLANS AND COST AND QUALITY OF PLANS AS WELL.
BUT THAT’S GOING TO BE IMPORTANT.
WE HAVE TO REMIND PEOPLE AS THEY LOOK AT THEIR OPTIONS, TO DO A
GOOD COMPARISON. BECAUSE THESE TEN ESSENTIAL
HEALTH BENEFIT CATEGORIES, THEY’RE BROUGHT.
AND AGAIN, WHAT WE HAVE SAID IS THAT ALL OF THESE QUALIFIED
HEALTH PLANS HAVE TO COVER THESE BENEFITS AT TYPICAL EMPLOYER
PLANS WOULD. BUT HOW THAT ULTIMATELY GETS
DEFINED IN TERMS OF WHAT OFTEN INDIVIDUAL PLAN COVERS AND
DOESN’T COVER, THAT’S WHERE LOOKING AT THESE OPTIONS
CAREFULLY AND IN IN WAYSES THAT DETAILED FINE PRINT, THAT’S
WHERE THE CHOICE ELEMENT COMES, PEOPLE ARE GOING TO HAVE TO HELP
— WE HAVE TO HELP PEOPLE LOOK AT THESE OPTIONS THAT THEY HAVE
AND SELECT ONES THAT FIT BEST WITH THEIR NEEDS THAT’S PART OF
THIS.>>TIME FOR ONE LAST QUESTION
BRIEFLY. STEVE.>>IF I’M UNDERSTANDING WHAT
YOU’RE SAYING, 64>>I’M ALWAYS ON.
I THOUGHT IT WAS KIND OF INTERESTING THAT I HAS A — I’M
ALSO A GRADUATE OF THE UNIVERSITY OF MICHIGAN SCHOOL OF
PUBLIC HEALTH.>>TERRIFIC.
NICE TO SEE ANOTHER MICHIGAN FACE.
BUT I’M A LAWYER THESE DAYS AND I DO HEALTH INSURANCE CLAIMS.
ONE THING THAT INTERESTS ME IF I’M UNDERSTANDING CORRECTLY, IN
THE ESSENTIAL HEALTH BENEFITS CHRONIC DISEASE MANAGEMENT IS
PART OF IT. WHICH IS WHERE CARE FOR PEOPLE
WITH ME/CFS IS GOING TO BE. AM I CORRECT IN ASSUMING THAT
EACH QUALIFIED PLAN IN EACH STATE IS GOING TO DECIDE HOW
THEY’RE GOING TO MEET THAT?>>SO EACH — WE CAN GET MORE
INFORMATION ON THIS BUT ESSENTIALLY EVERY STATE SELECTED
BENCHMARK PLANS. ALL QUALIFIED HEALTH PLANS IN
THAT STATE HAS TO MEET OR COVER AT THE MINIMUM THOSE SERVICES
COVERED BY THE BENCHMARK PLAN SO EVERY STATE WILL HAVE THAT THE
BENCHMARK PLANS WILL VARY FROM STATE TO STATE SO QUALIFIED
HEALTH PLANS DO HAVE MORE DIRECTION THAN JUST BROAD TEN
CATEGORIES AS THEY DECIDE WHAT TO COVER OR WHAT NOT TO COVER.>>ONE OTHER CONCERN IS THAT
EVEN UNDER THE CURRENT SYSTEM BEFORE WE MOVE TO THIS
IMPROVEMENT I HOPE, IS THAT THERE’S A VERY BIG DIFFICULTY IN
GETTING THE TYPES OF CARE OR EVALUATIONS PAID FOR.
IS THERE A WAY TO LOOK AT WHAT THE STATES ARE DOING TO SEE IF
THIS POPULATION IS GOING TO BE 65 SERVED BETTER THAN THEY
CURRENTLY — THE ME/CFS POPULATION.
THAT’S PROBABLY INCUMBENT UPON ALL, THERE WILL BE EVALUATION
THAT ARE LOOKING AT THE POPULATION BROADLY THESE
CONSUMER ASSISTANCE PROGRAM ALSO HELP TO MAKE SURE THAT THERE’S
NOT ABUSE OF THE SYSTEM. BUT I THINK THAT’S A REALLY
IMPORTANT POINT AS THIS GOES THROUGH, SEEMS LIKE A HUGE
OPPORTUNITY, SOUND LIKE A HUGE OPPORTUNITY, SHOULD BE A HUGE
OPPORTUNITY BUT FOR INDIVIDUALS SPECIFICALLY WITH ME/CFS, ARE WE
GETTING THE EDUCATION OUTREACH TO THAT SO THEY KNOW ABOUT THE
OPTIONS? ARE THEY GETTING IN MAPS THAT
BEST SERVE THEIR NEEDS? THOSE ARE THINGS THAT HAVE TO BE
TRACKED BY FEDERAL AND NON-FEDERAL PARTNERS.
THE PROMISE IS THIS, NOW WE HAVE TO MAKE SURE THE IMPLEMENTATION
GETS TO PEOPLE WITH ME/CFS.>>I REMEMBER WILL BETTER CONE
COMING TO TALK TO US WHEN HE WAS ALIVE HOW WE WILL HAVE NATIONAL
HEALTH INSURANCE IN THE EARLY ’70s.
GLAD TO SEE SOMETHING MOVING FORWARD.>>I WANT TO THANK YOU FOR YOUR
PRESENTATION AND YOUR WILLINGNESS TO ANSWER YOUR —
ONE OF US. YOU REMAIN THAT WAY.
DR. LEE WANTS TO PULL THIS TO A CLOSE WITH A COMMENT AND CALL TO
ACTION.>>JUST BACK TO EILEEN’S COMMENT
ABOUT HOW WE GET THIS WORD OUT, THAT’S WE HERE, GUYS.
THAT’S WHY WE’RE DOING THIS. 66 THIS IS THE — REALLY, ONE OF
THE FIRST PATIENT GROUPS REACHED OUT TO, SO WE REALLY WANT YOU
GUYS, THE ORGANIZATIONS, THE ADVOCATES, TO DO WHAT YOU CAN TO
GET THIS INFORMATION OUT AND EVERYBODY OUT THERE WATCHING ME
TALK RIGHT NOW, PLEASE DO THAT. WE HAVE BLOGGERS, WE HAVE WEB
SITES, WE HAVE ADVOCATES AND PATIENTS AND CLINICAL
ORGANIZATIONS THAT ARE VERY INTERESTED IN ME/CFS AND YOU
GUYS CAN HELP PEEP DOLL THIS. IN A FEW NOT VERY LONG THIS
INFORMATION POWERPOINT PRESENTATION WILL BE ON OUR
WEBSITE. THE INFORMATION THAT ALAINE HAS
GIVEN TODAY HAS BEEN ARCHIVEED AND PEOPLE WITH LEARN ABOUT
THIS. SO THEY CAN REVIEW THEIR
INFORMATION FROM WHAT WE HAVE DONE TO DATE AND HEALTHCARE.GOV.
EVERYBODY THERE. SO THANK YOU VERY MUCH.>>LET’S TAKE A BRIEF BREAK AND
IN ABOUT 15 MINUTES, WE WANT TO BE PROMPTLY BACK HERE AT 11:15
FOR PUBLIC TESTIMONY.

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