Enroll America is a new nonpartisan, nonprofit organization whose mission is to ensure that all Americans are enrolled in and retain health coverage. It will work at the state and federal levels to push for streamlined enrollment procedures and will also raise awareness of enrollment options among the uninsured.

If you are uninsured, learn about your options at the Enroll America website.

The bill provides that the first $2,000 per year received by an individual for participation in a clinical trial shall not be counted as income for the purpose of calculating Social Security benefits.  This provision was included in the House-passed health care reform bill last November, but was not included in the final bill the President signed into law in March.

The Senate already passed this bill on August 5.  House passage later today will clear the bill for review and signature by the President.

The provisions taking effect today that impact the colorectal cancer community are:

Coverage of Preventive Services: New plans must provide dozens of preventive services – including colonoscopies – without charging a copayment (any preventive service with an A or B rating from the Unites States Preventive Services Task Force must be covered).
Why This Is Important: Eliminating cost sharing requirements for preventive colorectal cancer screening will lower the cost of screening services for individuals which will help to increase population-based screening rates thereby helping to lower the incidence and mortality rates from this disease that is preventable and treatable if caught early.
Loophole: The law waives the deductible when a screen turns diagnostic, but not the co-pay. The Colorectal Cancer Coalition believes a fix needs to be enacted so that the co-pay is waived for a screening colonoscopy when it turns therapeutic.

Elimination of Lifetime Limits: No lifetime limits on benefit payouts.
Why This Is Important: Many colorectal cancer patients face a lifetime of cancer treatment. Caps on insurance result in very difficult decisions about the care they will receive and how they are going to pay for it.
Loophole: Lifetime limits are still generally permitted to the extent that the benefits are not “essential health benefits.” Future regulations will define the term “essential health benefits.” For now, the term includes at least the following categories of service: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services; prescription drugs; rehabilitative services and devices; laboratory services; preventive and wellness services and chronic care management; and pediatric services.

Elimination of Annual Limits: Begins to phase out annual limits on benefit payouts, starting by making the limit no less than $750,000. While the lifetime prohibition is immediate, the prohibition against annual dollar limits is phased in through 2014 for “essential health benefits.”
Why This Is Important: See above – same reason that the elimination of lifetime limits is important.
Loophole: May be limited in some cases. Employers whose plans don’t meet requirement can apply each year for a waiver. Individual plans that are grandfathered are also exempt.

Prohibition Against Recissions: The Affordable Care Act prohibits health insurance plans from dropping you or reducing your benefits if you become sick. Applies to both grandfathered and non-grandfathered plans.
Why This Is Important: Newly diagnosed patients will no longer have to worry that they might lose their health insurance coverage because of their cancer diagnosis.

A lot of attention has focused on the elimination of pre-existing condition exclusions. Eliminating pre-existing conditions exclusions is very important for cancer patients. Pre-existing condition exclusions lock the millions of Americans with at least one chronic illness (nearly one third of the population) into existing plans and employment. While this provision takes effect for children today, it is phased in and it is not until 2014 that all group health plans will be prohibited from imposing any pre-existing condition exclusions on children and adults.

Read more about the provisions taking effect today in a special guest blog from Jay Angoff, Director of the Office of Consumer Information and Insurance Oversight “Six Months of the Affordable Care Act: Rights and Protections for Cancer Patients.”

And to learn more about provisions that have already taken effect, and about the provisions that are still to come and will be phased in until the Affordable Care Act fully takes effect in 2018 take a look at our Health Reform and You Webpage.

And remember there is still work to be done! Even after all the provisions of the Affordable Care Act take effect in 2018, many Americans may be newly insured but will still fail to receive the right treatment at the right time. The Colorectal Cancer Coalition continues to support research to help develop new treatments and to support efforts to increase awareness about the importance of early detection and screening.

Jay Angoff (image courtesy of the U.S. Department of Health & Human Services)

If you or a loved one has lived with cancer – you probably know more about the American health insurance system than you ever wanted. While most Americans have health insurance, few really know much about how their insurance works until the worst possible moment, when they are sick and need potentially life-saving care.

During the health reform debate, President Obama talked about the devastation of watching his mother battle both ovarian cancer and her insurance company. Unfortunately, such stories are all too common.

Thanks to the Affordable Care Act, fewer cancer patients are going to have to fight that two-front war. And many of the new patient rights and protections that will help cancer patients are beginning to take effect NOW, starting September 23rd. For example:

• Ending limits on care and benefits. Insurance companies can’t impose lifetime limits. And in most health plans, annual limits will be restricted. This means that your health insurance will be there right with you, covering your treatments, as long as you need it.
• Ending rescissions. If you get sick, your insurance company can’t drop you from coverage just because you made a mistake on your paperwork. If you keep paying your premiums and act in good faith, you won’t face losing your health insurance the moment you need it most.
• Appealing denied claims. If you are in a new plan, and your insurance company denies a claim, you have new rights to a fast and fair appeals process so you can ask them to reconsider that denial. This holds insurance companies accountable for delivering the benefits patients are entitled to.
• Covering kids. Cancer can strike at any age. Now, plans that offer coverage to your kids will have to continue covering them up to age 26, as long as they can’t get coverage through their own job. And most insurance companies can’t deny coverage to kids under age 19 because of a pre-existing condition, so you know you can buy your kids coverage if your employer doesn’t cover them.
• Choosing your own doctors. Now, new health plans have to let patients choose their own doctor from the plan’s network. And if you are in an emergency medical situation, you can’t be charged more to get treatment at a hospital out of your network.
• Keeping you healthy. As the saying goes, an ounce of prevention is worth a pound of cure. Now, new plans have to provide a number of preventive services without cost sharing. These include numerous cancer screenings, so more cancer cases will be detected early, as well as counseling and screenings to help prevent chronic conditions that contribute to poor health like heart disease, diabetes, and obesity.

Fighting cancer is a fight for your life – Americans shouldn’t have to fight their insurance companies at the same time. Now, thanks to the Affordable Care Act, patients have new tools and resources to get the care they need and take back control from insurance companies.

If you were not able to join us for the live webinar, you can access a video of the webinar or download the slides from the presentation.

Still have questions about the Affordable Care Act, and how it changes access to colorectal cancer screening and impacts the cost of cancer care?  Email us at Advocacy@FightCRC.org.

Register for C3′s upcoming webinar to learn more about the new health care reform law including: upcoming implementation deadlines; opportunities for advocates to get involved; and an explanation of how the law will affect the colorectal cancer community.

The new HHS web portal, HealthCare.Gov, includes a yellow-page like listing of health insurance plans.  By October, HHS would like to have more information available on the site for consumers – information about plan costs and coverage benefits as well as data about insurance claims (for example, the percent of claims denied and the percent of claim denials that have been appealed).

The New Pre-Existing Condition Insurance Plan (PCIP) is a stopgap fix for the most vulnerable until 2014, when core provisions of the new health care law take effect.  In order to enroll in the PCIP program an individual must meet the following eligibility requirements:

• Be a U.S. citizen or legal resident.
• Have a pre-existing medical condition.
• Been uninsured for six months or longer.

If the PCIP program in your state is run by HHS, you can apply to participate in the program online.  While individuals can apply for the HHS run Pre-Existing Condition Insurance Plan today, the premium rates won’t be officially available until July 15.

Premiums will vary from state to state.  If you live in a state where HHS provides coverage, the premium for an age 50 year old enrollee may range between $320 and $570.  In California, for example, the cost for a 50-year-old is estimated at $575 a month, with a $1,500 annual deductible and 15 percent co-insurance.  Premiums in states with lower medical costs could be around $400 a month.

If your state is one of the 30 states running its own Pre-Existing Condition Insurance Plan you can get information about eligibility requirements, premiums, and how to apply online.

Millions of Americans are have been denied insurance coverage because of a pre-existing medical condition, and experts estimate that the new PCIP program could enroll as many as 375,000 people this year, but run out of money around the end of 2011.  While Congress has already appropriated $5 billion to fund the PCIP program through 2013, the Congressional Budget Office estimates that another $5 billion to $10 billion will be needed to fully meet the enrollment demand and prevent the program from running out of money before the core provisions of the new health care law take effect in 2014.  It’s unclear what the Administration and Congress will do if the money runs out.

To make matters more confusing, most states already operate their own high risk insurance pools, covering about 200,000 people in total.  However, the state plans tend to charge significantly higher premiums than the new PCIP program, and many offer fewer benefits.  Individuals currently enrolled in a state high risk pool will not be able to switch from state to federal coverage (to switch to receive coverage through the PCIP program an individual would have to risk going six months without health insurance).

Register for C3′s upcoming webinar to learn more about the new health care reform law including: upcoming implementation deadlines; opportunities for advocates to get involved; and an explanation of how the law will affect the colorectal cancer community.

Some headlines from this issue:

• Palliative Care: Not Just for End of Life
• Listening to the Little Voice
• Patient to Patient Advice for Caregivers
• Health Care Reform & Cancer: Your Implementation Guide

You’ll also read testimonials from advocates who attended the C3 Call-on Congress in March and learn about the young, innovative researcher who is looking into new treatments for late stage colorectal cancer, thanks to a grant from C3.

To receive Momentum free at home, sign up at the C3 Action Center.

In a letter to governors, Secretary Sebelius laid out several options states will have to use $5 billion in the Patient Protection and Affordable Care Act to bridge the time from July 1, 2010 until January 1, 2014 when the insurance exchanges will be available.

Coverage will need to include at least a floor set of benefits established by the federal government.  Out-of-pocket costs are limited to $5,950 for an individual, and premiums cannot be set at more than the existing standard non-group rates.  There can be no exclusion for pre-existing conditions.

Governors were asked to respond with a letter of intent by April 30, 2010.  If a state does not want to participate in the program, the Department of Health and Human Services will provide the high risk pool services to needy individuals in that state.

In order to be eligible coverage through the high risk pools, individuals must,

• Be a citizen or national of the United States or lawfully present in the United States.
• Not have had credible coverage for the six months before applying for coverage.
• Have a pre-existing condition.  The Secretary will provide guidance as to what determines pre-existing conditions.

States will have the option to,

• Operate a new high risk pool alongside a current state high risk pool.
• In states without high risk pools, establish a new one.
• Build upon other existing programs designed to cover people with pre-existing conditions.
• Contract with a current HIPAA carrier of last resort or other carrier, to provide subsidized coverage for the eligible population, or
• Do nothing, in which case HHS would carry out a coverage program in the state.

Writing to governors, Secretary Sebelius stressed willingness to be flexible in getting the program off the ground.

In reviewing the existing state high risk pools, there is much common ground in the benefits currently provided. Since HHS is considering establishing a floor set of benefits that all the new high risk pool programs must cover, we anticipate that these benefit requirements would take into account benefit lists currently used by existing state high risk pools. Similarly, states would have the option to follow pre-existing condition criteria for determining eligibility established by the Secretary, or propose their own, subject to Secretarial approval. We are committed to working with states to identify other areas where flexibility is appropriate.

Although many of the provisions of the new law are phased in to take effect gradually until the entire law is implemented in 2018, some benefits will be available immediately.

Highlights of the provisions that will benefit individuals people facing cancer treatment include: prohibiting insurance companies from dropping patients who become sick; eliminating lifetime and annual limits on coverage; prohibiting insurance companies from denying coverage because of pre-existing conditions; and limits on on out-of-pocket expenses.

You can review a chart developed by C3 with key issues affecting colorectal cancer prevention and treatment that are part of the health care reform legislation.

While historic, enactment of this new law is just one step in an ongoing process.  Even after all the provisions in the new law take effect in 2018, many Americans may be newly insured but will still fail to receive the right treatment at the right time.  The Colorectal Cancer Coalition continues to support research to help develop new treatments and to support efforts to increase awareness about the importance of early detection and screening.

BENEFITS IF YOU HAVE BEEN DIAGNOSED WITH COLORECTAL CANCER:

• Beginning immediately, health insurance plans cannot drop you or reduce your benefits just because you become sick, a process called rescission.
• After January 1, 2014, insurance plans will not be able to deny coverage or charge higher premiums if you have a pre-existing condition.  Until that time, people with pre-existing conditions will be able to find affordable insurance in special high-risk pools supported with federal funds.  For people with inherited colorectal cancer who worry about testing for a genetic condition, the law specifically includes genetic information among the health conditions for which there cannot be discrimination.
• Six months after the the law is enacted, insurance companies can no longer place lifetime limits on healthcare coverage, nor can they impose restrictive annual limits.  In 2014, all group and individual plans must eliminate annual limits.  Even if you need expensive cancer care, you will no longer need to worry about your insurance refusing to meet those costs.
• Depending on your income, there will be limits on the amount of money you need to pay out-of-pocket for health care for you and for your family each year.
• In 2014, uninsured people will have access to several new options including higher income limits for Medicaid and participation in an American Health Benefit Exchange.  The exchanges will clearly outline costs and benefits of each health care policy so consumers can make  informed choices about care.  Subsidies will be available to keep costs affordable.

BENEFITS IF YOU WANT TO PREVENT COLORECTAL CANCER:

• If you are privately insured through your employer or the insurance exchanges, preventive services are covered fully without your having to meet a deductible or pay a co-pay.
• If you are on Medicare, cost-sharing for preventive screenings will end on January 1, 2011.  In addition, there will be no additional co-payments if a polyp is discovered and has to be removed during the screening exam.  Medicare will also pay for an annual check-up.
• If you are on Medicaid preventive services will be provided at no cost.

OTHER IMPACTS ON COLORECTAL CANCER PREVENTION:

While not specifically addressing colorectal cancer, wellness and prevention of illness are addressed in several new initiatives established and funded by the law including:

• Establishment of a National Prevention, Health Promotion and Public Health Council to coordinate prevention, wellness, and public health strategies.
• Establishment of a Prevention and Public Health Fund to expand and sustain funding for prevention and public health programs, as well as task forces on Preventive Services and Community Preventive Services to develop, update, and disseminate evidenced-based recommendations on the use of clinical and community prevention services.
• Grants to support evidence-based community prevention and wellness programs that strengthen prevention activities, reduce chronic disease rates and address health disparities, especially in rural and frontier areas.  Funding for five years beginning in FY 2010.

If you have questions about how the new law will affect you, the New York Times has an interactive site where you can look at your personal impact whether you are insured or uninsured and whether your current insurance is on your own, through an employer, or via Medicare or Medicaid.

So, what exactly will the pending legislation do?

Take a look at a side-by-side chart comparing some of the provisions in the House-passed, Senate-passed, and pending House reconciliation bills that C3 thinks are important for people living with colorectal cancer.  The chart also includes links to the full text of each of the bills, so that you can read the complete legislation.