Navigators play a vital role in helping consumers prepare applications to establish eligibility and enroll in coverage through the Marketplaces and potentially qualify for an insurance affordability programs. They also provide outreach and education to raise awareness about the Marketplace, and refer consumers to health insurance ombudsman and consumer assistance programs when necessary. Navigators are funded through federal grant funds and must complete comprehensive federal Navigator training, criminal background checks, and state training and registration (when applicable), prior to assisting consumers.
Back in April, in the midst of the earlier stages of the COVID-19 pandemic sweeping through much of the nation, there was a loud outcry for the various ACA health insurance exchanges, including the federal exchange at HealthCare.Gov which hosts enrollment for over 3 dozen states, to re-open enrollment to anyone who missed the official Open Enrollment Period which had ended several months earlier.
I've been making a LOT of fuss lately about how important it is for CMS Administrator Seema Verma to give the green light to an official "Open" COVID-19 Special Enrollment Period (SEP) via the federal ACA exchange (HealthCare.Gov). Last week I projected that if every state were to offer a full 60-day "open" SEP ("open" means that any uninsured U.S. citizen or eligible documented resident could sign up without requiring a Qualifying Life Event), somewhere between 2.5 - 3.3 million Americans would likely enroll during that 2-month period.
Of that number, I projected that around 1.8 - 2.3 million additional people would likely reside in the 38 states hosted by HealthCare.Gov, with the remainder living in the 12 states which are offering COVID-specific SEPs (although the deadlines in those states vary, and some do require enrollees to jump through at least minimal hoops to enroll).
For over a month now, I (and many, many others) have been pleading with HHS Secretary Alex Azar, CMS Administrator Seema Verma and CMS itself to launch a formal, "open" COVID-19 specific Special Enrollment Period for the millions of people living in the 38 states hosted by HealthCare.Gov who are uninsured but who don't qualify for Medicaid, CHIP or other "year-round enrollment" programs such as the Essential Plan in New York, MinnesotaCare in Minnesota or ConnectorCare in Massachusetts. Even the insurance industry--which normally hates letting people enroll at any time outside of the official Open Enrollment Period--has been calling for them to do so.
Yesterday I ran an exclusive analysis based on existing COVID-19 Special Enrollment Period (SEP) data to figure out a) roughly how many Americans are likely to enroll in ACA exchange coverage using this SEP in the twelve states offering one, and b) how many additional Americans would likely #GetCovered via ACA exchange policies in the other 39 states which don't currently have a CV19 SEP in place.
As I've explained before, while pretty much anyone who loses their employer-based health insurance is automatically eligible for a normal 60-day Special Enrollment Period regardless of what state they live in, under the current pandemic/mass layoff situation, the standard "loss of coverage" SEP is a red tape nightmare under Trump Administration regulations since you have to provide hard-to-get documentation of your status and have it verified by CMS, which can take weeks.
With all the anger at CMS Administrator Seema Verma, HHS Secretary Alex Azar and of course Donald Trump himself over CMS's refusal (to date) to open up a COVID-19 specific Special Enrollment Period on the federal ACA exchange (HealthCare.Gov), last week I decided to try and figure out just how many people are enrolling across the 12 state-based exchanges which are offering CV19 SEPs...and just as importantly, how many people would likely take advantage of a CV19-specific SEP on the federal exchange if and when they ever decide to go ahead and launch one.
Host: "Before I let you go, I want to ask you one more time: Are there gonna be people in this country who don't get a ventilator if they need one? Are you concerned that the actual physical equipment that is needed to serve the people who will get sick is out there...can you reassure everyone that there is not a shortage of ventilators or ICO units?"
Verma: "And that's why the President has taken such a bold and decisive action, right? We're not waiting for this to get worse, we're not waiting for this to be a crisis in our healthcare systems, and that's why the mitigation strategies that he announced last night, limiting travel from Europe, not allowing that, umm...you know, we've given travel advisories on cruise ships. That's why we're taking all of this action, because we don't want to put stress on the healthcare system."
Host: (pause) "...OK...that's not a...direct answer to the question..."
Medicare chief asked taxpayers to cover stolen jewelry
A top Trump health appointee sought to have taxpayers reimburse her for the costs of jewelry, clothing and other possessions, including a $5,900 Ivanka Trump-brand pendant, that were stolen while in her luggage during a work-related trip, according to documents obtained by POLITICO.
Seema Verma, who runs the Centers for Medicare and Medicaid Services, filed a $47,000 claim for lost property on Aug. 20, 2018, after her bags were stolen while she was giving a speech in San Francisco the prior month. The property was not insured, Verma wrote in her filing to the Health and Human Services department.
The federal health department ultimately reimbursed Verma $2,852.40 for her claim, a CMS spokesperson said.
Earlier this year, a top Republican communications operative delivered a plan to boost the profile of Seema Verma, President Trump’s appointee overseeing health insurance for the elderly and poor. The “Executive Visibility Proposal” was a month-by-month blueprint to have her grant interviews to Women’s Day and other magazines, speak at prominent conferences and appear at Washington’s most prestigious social events.
Marked “privileged, pre-decisional, deliberative,” the eight-page proposal, emailed to Verma’s deputy chief of staff, was part of an unusual campaign carried out by high-paid contractors Verma brought on at a cost to taxpayers of more than $3 million.
HEARING ON "SABOTAGE: THE TRUMP ADMINISTRATION'S ATTACK ON HEALTH CARE"
Date: Wednesday, October 23, 2019 - 10:00am
Location: 2123 Rayburn House Office Building
Subcommittees: 116th Congress, Energy and Commerce (116th Congress), Oversight and Investigations (116th Congress)
The Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce will hold a hearing on Wednesday, October 23, 2019, at 10 a.m. in the John D. Dingell Room, 2123 of the Rayburn House Office Building.
One of the great strengths and dangers of the ACA is that it includes tools for individual states to modify the law to some degree by improving how it works at the local level. The main way this can be done is something called a "Section 1332 State Innovation Waiver":
Section 1332 of the Affordable Care Act (ACA) permits a state to apply for a State Innovation Waiver to pursue innovative strategies for providing their residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA.
The Trump appointee who oversees Medicare, Medicaid and Obamacare quietly directed millions of taxpayer dollars in contracts to Republican communications consultants during her tenure atop the agency — including hiring one well-connected GOP media adviser to bolster her public profile.
Last fall, I reported that thanks to the one-two punch of a) reinstating the ACA's individual mandate penalty at the state level and b) using the revenue generated from the mandate penalty to help fund a robust reinsurance program, the state of New Jersey had successfully lowered average unsubsidized premiums for 2019 individual market policies by a net swing of nearly 22 percentage points.
“But the plans were on display…”
“On display? I eventually had to go down to the cellar to find them.”
“That’s the display department.”
“With a flashlight.”
“Ah, well, the lights had probably gone.”
“So had the stairs.”
“But look, you found the notice, didn’t you?”
“Yes,” said Arthur, “yes I did. It was on display in the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying ‘Beware of the Leopard.”
--Douglas Adams, The Hitchhiker's Guide to the Galaxy
Yesterday CMS Administrator Seema Verma posted this on Twitter...
I’m excited by the partnerships that Arkansas has fostered to connect Medicaid beneficiaries to work and educational opportunities, and I look forward to our continued collaboration as we thoroughly evaluate the results of their innovative reforms. #TransformingMedicaid
Note: Much of this entry is a repeat of yesterday's, but I felt it was worth a separate entry.
This metaphor will take a bit, but bear with me.
On March 16, 1981, CBS aired the 17th episode of Season 9 of M*A*S*H. For those of you too young to remember, M*A*S*H, set at a U.S. Army medical camp in Korea during the Korean War, was one of the most successful TV shows in history, running 11 seasons. I believe the series finale remains the most highly-viewed broadcast in history. While M*A*S*H started out primarily as a sitcom, it evolved over the years into more of a drama with comedic moments.
Anyway, in S9 Ep17, "Bless You, Hawkeye", the main character, Dr. Benjamin Franklin "Hawkeye" Pierce (played by Alan Alda) finds himself stricken with a sudden, unexplained and violent allergic reaction to something. He spends much of the episode trying standard medical solutions, but his fits of sneezing and coughing become so bad that eventually a recurring character, psychiatrist Dr. Sydney Freedman, is brought in to see if there might be a psychological cause.
The Trump administration has drawn a red line on Medicaid cuts. There are some proposals that the Centers for Medicare and Medicaid Services won’t approve.
In a letter on Monday, CMS Administrator Seema Verma told Kansas officials that her agency would not approve the state’s request to impose lifetime limits, which would have capped a person’s eligibility at three years, after which they could no longer be covered by the program.
Verma noted that the administration had approved proposals by other states to cut off benefits for Medicaid enrollees only if they fail to meet certain work requirements.