UPDATE ON THE AFFORDABLE
CARE ACT: IMPACTS ON
COLLEGE STUDENT HEALTH
COVERAGE
MACHA Annual Meeting
Philadelphia, Pa
October 2013
Focus of Advocacy Efforts
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Forecasting impacts of the Marketplace on SHPs
Recognition of SHPs as an option in Marketplace
and other communications
Defining the relationship between international
students and the access to the Marketplace and
subsidy
Providing support for members engaged in state
advocacy on Medicaid and patient privacy
Determining if there is a path to tax subsidy for
students purchasing SHPs
Impacts: Marketplace Opening
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Many schools do not offer plans or do not offer
robust plans
Hard waiver processes – Can SHPs survive without
one?
Unlikely SHPs will ever be a Marketplace option
How competitive are we? What about subsidy?
Premium Expectations
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Average of 53 qualified plans
 Categorized
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as “platinum,” “gold,” “silver,” or “bronze”
Young adults – average of 57 when catastrophic
plans are factored in
 Preventive care
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+ 3 primary care visits/yr
Lower than expected premiums
Rules of Engagement
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Beginning on January 1, 2014
 Annual
limits for “essential health benefits” are
prohibited
 Must cover all essential health benefits
 No pre-existing condition exclusions
ACA Essential Benefits
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Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn
Mental health and substance use services
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory
Preventive and wellness services and chronic disease
management
Pediatric services, including oral and vision
Covered Preventive
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One time screening for abdominal aortic aneurysm – male smokers of specified age
Alcohol misuse screening and counseling
Aspirin use for men and women of certain ages
Blood pressure screening for all adults
Cholesterol screening for adults of certain age
Colorectal Cancer screening over 50 yr
Depression screening – adults
Type 2 Diabetes screening for adults with HBP
Diet Counseling for adults at higher risk for chronic disease
HIV screening for all adults at higher risk
Immunization vaccines – according to vaccine schedule
Obesity screening and counseling – all adults
STI prevention counseling
Tobacco use screening for all adults and cessation interventions for users
Syphilis screening for all adults at higher risk
Marketing
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List as an option on HHS communication
List as an option in marketing by Young Invincibles –
digital media toolkit
HHS efforts to engage college campuses
“Opt Out” campaign
http://news.yahoo.com/obamacare-battle-moves-tocollege-campuses-200027191.html
International Student Issues
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Eligibility to participate in the Exchange
 Definition
of “lawfully present”
US citizen/nationals
Aliens – lawfully present
Immigrants – green card holder
 Not
Non-immigrants – F1,J1, H1, etc.
subject to a residency requirement if they are
legally present
International Student Issues
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Taxes and the international student
 All
pay income tax unless they are exempt based on a
tax treaty agreement with their country
 You can be a non-immigrant but a resident for tax
purposes. City, State and Federal govs have different
definitions of residents for tax purposes.
 International students are ineligible for many forms of
tax relief/subsidy
International Student Issues
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Access to tax subsidy for insurance purchased in
the Marketplace
 Eligibility
for tax subsidy for insurance it would be a
departure from norm
 It appears that they are eligible for premium subsidies
if they self-attest for having income for 2014 of
$15,900 or more as an individual.
 it
does not appear that international students will be
qualifying for premium subsidies, except in rare instances
where there is income from a spouse
Medicaid Advocacy
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Primer is on ACHA website
Medicaid issues will probably become even more
confusing with some states opting for expansion
and some not (29 currently expanding)
BasicHealthPlan regulation just posted to the
Federal Register to fill the gap for low income
persons in states that did not accept expansion
Movement in some states toward consideration for
use of Medicaid dollars to purchase SHPs
EOBs and Patient Confidentiality
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Primary purpose of the EOB - increase transparency
and decrease fraud by providing subscribers with
information about services applied to the policy
Providing EOBs varies by state
Has historically created a barrier to care for
adolescents under parents plans
ACA expansion of access to insurance under parents
for young adults to age 26 has exacerbated the issue
May become more problematic as student health
services move to third party billing
Ensuring Confidentiality:
A State Advocacy Issue
•
“On the issue of disclosing minors’ protected health
information to parents, HIPAA defers to “state or other
applicable law,” and if the relevant law is silent on this
issue, the regulation gives discretion to health care
providers to determine whether to disclose such
information to the parent.”

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English, A., Gold, R.B., Nash, E., & Levine, J. (2012). Confidentiality for individuals insured as dependents: A review of state laws
and policies. Guttmacher Institute and Public Health Solutions. doi:http://www.guttmacher.org/pubs/confidentiality-review.pdf
What is the rule in your state?
Protection Afforded by States*
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EOB not sent when no balance is due
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EOB may be sent to patient
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New York, Wisconsin
Confidential STI treatment for minors, including in billing process
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New York, Wisconsin
Connecticut, Delaware, Florida
General confidentiality provisions
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Health care provider must inform insurer when “minors without support” request
confidentiality
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Minor may refuse parents’ request for EOB or claim denial
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Hawaii
Maine
Insurer may not disclose private health information, including by mailing an EOB, without
authorization of minor or adult patient
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Washington
*English, A., Gold, R.B., Nash, E., & Levine, J. (2012). Confidentiality for individuals insured as
dependents: A review of state laws and policies. Guttmacher Institute and Public Health Solutions.
doi:http://www.guttmacher.org/pubs/confidentiality-review.pdf
Options for Ensuring Patient
Confidentiality
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Suppress the EOB if there are no out-of-pocket
costs for care
Send the EOB only to the person receiving the care
even if they are not the principle policy holder
Allow covered individuals to access their payment
from additional means (i.e. electronic)
Allow covered individuals to request suppression
of summary of payment forms
Decrease the detailed content of EOBs
Resources
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www.HealthCare.gov
http://younginvincibles.org/issues/health-care/
http://www.advisory.com/DailyBriefing/Resources/Primers/MedicaidMap