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Legal council head talks Obamacare, LGBT community
by Stephen Sonneveld
2013-02-28


Ann Hilton Fisher, executive director of the AIDS Legal Council of Chicago, examined "Obamacare Implementation in Illinois: What Lawyers Know So Far" at the Feb. 20 Chicago Bar Association LGBT Committee meeting, co-sponsored by the Lesbian and Gay Bar Association of Chicago (LAGBAC).

Fisher spoke for an hour about the changes being incrementally instituted as a result of the sweeping Patient Protection and Affordable Care Act (ACA), colloquially known as the Affordable Care Act, the federal health-care law and Obamacare. The measure was signed into law March 23, 2010, and all phases are expected to be fully implemented by 2020.

Topics of the address included general interest items such as there being no health-insurance exchange legislation in Illinois, despite the fact that enrollment opens Oct. 1. Known as the "Health Insurance Marketplace," the exchanges "will allow individuals and small businesses to compare health plans, get answers to questions, find out if they are eligible for tax credits for private insurance or health programs ... and enroll in a health plan that meets their needs," according to HealthCare.gov.

Another portion of the Act will see the demise of the Medicare Part D "donut hole" by 2020, a 2006 provision that created a coverage gap in Medicare prescription payouts, forcing consumers to pay out-of-pocket when their drug costs reached the window of $2,700-$6,154, which greatly impacted the finances of the elderly and those with chronic conditions. The U.S. Department of Health and Human Services (HHS) reported, "Experts estimate that more than a quarter of Part D enrollees hit the donut hole and often stop following their drug regimen as a result of the added cost burden."

Fisher mentioned Medicaid changes that are expected to affect "350,000 people in Illinois." For primary care providers, the Medicaid rate will be raised to Medicare rate.

Also, the Cook County Bureau of Health Services received a federal waiver to begin implementing Medicaid expansion a year early, resulting in County Care, a program enrolling now that will provide health care to U.S. citizens who make less than $15,282 a year. The restricted network of providers includes the Howard Brown Health Center, which was created by and has been serving Chicago's LGBT community since 1974.

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A contentious point of the Act calls for the creation by 2015 of Health Information Exchanges (HIE), which mandates that if providers "want to get Medicare reimbursement [they] have to have electronic medical records," Fisher stated.

With the governor's task force at work to establish the system, Fisher noted, "What we are being told is the technology can't actually sequester mental health or HIV records from your general records," though it may be possible at a later date.

Fisher told Windy City Times that unlimited access to someone's complete medical history is a sensitive issue because HIV patients are still discriminated against by nursing homes and doctors. "One of the things we say about people with HIV is that people need to have trusting relationships with their health care providers, because it's not an easy medication regiment," she said. "They need to have the power to decide for themselves who they're going to trust with this information. And so, we really want to preserve that."

During her presentation, Fisher pointed out, "Your records will go into the HIE unless you opt out. [O]ne of the things the advocates are trying to do is make sure that people know they have that option to opt out."

"The elephant in the room for all of us who are involved with HIV issues is what's going to happen to the Ryan White Care Act (CARE)," Fisher told the attended. "[CARE] was fundamentally passed and funded to make sure that people with HIV had access to medical care. With health care reform, people with HIV, unless they're undocumented, should be able to have access to medical care."

Despite what Fisher called "wonderful, convincing evidence" from Massachusetts for keeping CARE as support services, "The people at HHS have said we don't think after the ACA we're going to need special programs for special diseases."

She added, "In the meantime, places like the AIDS Foundation are talking to all the managed care providers, saying we've got a lot of expertise in case management for this population, don't you want to hire us to do it? And the managed care entities are saying, eh, you're small fish, we really don't have time to think about you right now."

An employee from a law firm said of CARE, "We're trying to figure out what to tell people who call us and want to know what's going to be happening with my health care."

Fisher responded, "If you are currently getting your health care at a [CARE] provider like Howard Brown, you're going to be fine, because Howard Brown is going to be in Medicaid, is going to be in the managed care plans, you're going to be able to choose a managed care plan where your provider at Howard Brown is your primary care provider, and you're going to be fine.

"It's going to be much harder if you're getting your care at say, the Open Door Clinic out in Elgin, which is really just providing medical care to people with HIV, which is not, I think, a federally qualified health center, has not entered into any arrangement with managed care plans, has not become Medicaid certified."

CBA LGBT Committee meetings such as this one are open to the public, said chair and Cook County State's Attorney David Amen. Though the committee does not have a website, information about future speakers if often available from CBA and LAGBAC.

In attendance was Eli Judge—president of the DePaul University College of Law's LGBT student group, the Outlaws—who called the presentation "phenomenal. I think that this is information that anyone should be aware of."

Captions:

Speaker: Ann Hilton Fisher, Executive Director, AIDS Legal Council of Chicago

Fisher speaking with Eli Judge, President of DePaul Outlaws, LGBT student group at the DePaul U. College of Law

David Amen, Chair of the CBA LGBT Committee, and Cook County State's Attorney.

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