This year my engagement in tax season did not start and end, as it typically does, with the latest Turbo Tax software and single W-2 form. Instead the season for me, and probably for some of you, began a lot earlier and revolved around a trio of brand new Affordable Care Act (ACA) tax forms.

In January, EverThrive Illinois began receiving inquiries from Illinois Navigators who were encountering consumers with questions about how health coverage, or the lack thereof, would affect their 2014 federal taxes. In an effort to help Navigators make sense of the 1095-A form and differentiate a 8965 from a 8962, we worked with our partners at The Sargent Shriver National Center on Poverty Law, Center for Economic Progress, Community Catalyst and Spitfire Strategies to put together a webinar and a flowchart Navigators could reference to help guide concerned consumers.

In helping to prepare these resources, I gained valuable knowledge about the requirements for consumers under the Affordable Care Act. But I also was learning that ACA-related tax provisions were just a few of many variables in a long and confounding tax equation a family needs to navigate in order to file their taxes. To better understand and address consumer questions related to these ACA tax provisions, and also advocate for improved implementation of these policies in the future, I would need to dive deeper into the tax world.

Just as I had encouraged consumers with complicated tax questions to consult tax preparers, I pursued a similar approach with my tax inquiry. Volunteer Income Tax Assistance (VITA) sites provide free tax preparation for individuals with incomes below $25,000 and families with incomes below $55,000 filing federal and state taxes. Directed by the IRS and managed by local non-profits (such as the Chicago-based Center for Economic Progress), VITA sites are located across the country and are staffed primarily by unpaid volunteers. After participating in a two-hour in-person training and completing an online IRS code of conduct exam, I became a VITA volunteer in February.

On Monday and Thursday evenings for several weeks, I traveled to a community college in downtown Chicago where a VITA site sets up shop every year from January to April. My role entailed helping consumers understand and complete the VITA-required paperwork that my colleagues, the tax preparing volunteers, would then use to actually file taxes. I checked to make sure clients had their W-2’s, helped to determine who was included in their household for tax filing purposes, and asked the all-important question, “Did you have health insurance coverage last year?”

Of the 60 or more questions I was required to ask a client, I always spent the most amount of time on this question. Many VITA clients were enrolled in expanded Medicaid coverage, but I also came across a fair number of individuals who were uninsured and had incomes just above the Medicaid threshold. I discussed the individual shared responsibility requirement with them, and rarely came across clients who were surprised by the penalty.

However, most did not know the specific costs associated with the penalty and very few were aware of the opportunity to enroll in health coverage for 2015 under the Special Enrollment Period (SEP). While I always provided the contact information for our state Marketplace so the client could call and make an appointment with a Navigator to explore this opportunity for coverage, I’m not sure how many clients actually ended up enrolling in coverage. Had a Navigator been present at the VITA site to provide immediate assistance and help the consumer learn more about the SEP I am sure that more consumers would have pursued accessing health insurance.

My VITA tax preparing colleagues also shared the questions they often encountered related to the individual mandate and the challenges they faced explaining the requirement to enroll in coverage or reconcile any Advanced Premium Tax Credits (APTC) to clients. Perhaps unsurprising, given that this was the first year implementing these ACA tax provisions, knowledge of the shared responsibility provision and APTC reconciliation varied among VITA volunteers. Uneven understanding of the individual mandate appears to be true of other paid tax preparers as well, as evidenced by reports of some preparers incorrectly subjecting DACA residents to the individual mandate. Just as EverThrive IL and other health advocacy organizations work with health care and social service providers to help them better understand ACA policies and how they affect clients, I think there remains great opportunity to partner with VITA sites—and possibly other tax preparers—to further educate staff and volunteers about the policies, penalties, and opportunities related to health coverage for their clients under the ACA.

As tax season came to a close, so did my volunteer experience. I still have a long way to go to understand the ins-and-outs of the tax filing process, but a few short weeks at a VITA site helped me grasp just how confusing and time consuming it can be for consumers to meaningfully engage in the tax and health coverage worlds —especially if forced to navigate both at the same time. Fortunately, there are organizations and hardworking volunteers dedicated to providing consumer assistance in both of these fields. By engaging in formal partnerships and coupling these services when possible, the non-profit enrollment assistance and volunteer tax preparing communities have unprecedented opportunity to help consumers improve their financial stability and also access health coverage.

To learn more about VITA sites and opportunities to volunteer, please visit the IRS VITA website.

- Alicia Siani, EverThrive IL Health Reform Coordinator

EverThrive Illinois, formerly the Illinois Maternal and Child Health Coalition, works to improve the health of Illinois women, children, and families over the lifespan through community engagement, partnerships, policy analysis, education, and advocacy.

Over the past five years, we at Community Catalyst have watched the Affordable Care Act go from a hotly contested piece of legislation to a hotly contested law that, despite non-stop efforts to undermine it, has given millions of American’s access to health care. The ACA is fulfilling its promise to the American people.

Unfortunately, unrelenting attacks on the law, heightened by media coverage, have overshadowed the ACA’s impact on real people. On the heels of a second successful enrollment period that ends today with more than 11 million people signing up for coverage, it’s time to put the attacks against the ACA to rest. Americans are tired of the political posturing that’s resulted in more than 50 votes to repeal the law. Recent polling shows that more Americans support than oppose the law, and that more people would rather see the law improved or kept as is than repealed.

It’s time to turn the focus on what this law is really about – people, not politics. It’s about your friend with diabetes who can now no longer be denied the coverage she needs to stay healthy. It’s about your neighbor who can start a new business without the worry of losing access to affordable health care coverage. It’s about a family member who won’t have to go into debt to pay for a hospital stay. We need to lift up those stories.

That begins with sharing the stories of people like Julie. Julie is an aunt, a wife and a successful musician, who, thanks to the ACA, had coverage when she needed it most. Today, the Community Catalyst Action Fund launched a national ad campaign about Julie’s experience with the ACA. We think Julie’s story and the message in this campaign is one worth sharing.

For more than 20 years, Julie went without health insurance. Thanks to the ACA, Julie was covered when she was diagnosed with breast cancer. Her coverage gave her peace of mind and access to affordable treatment for her cancer. Everyone should be able to have the quality, affordable health coverage they need—just like Julie has. While the ad is only 30 seconds long, it is a powerful example of what the ACA means to people who have gotten covered.

We hope you can help share Julie’s story and the powerful impact of the ACA.

Medicaid and CHIP work together to provide robust coverage for low- and middle-income children. We already know they have increased health insurance coverage rates for children, now at a remarkable 92 percent. These important public coverage programs have shielded families from the risk of high out-of pocket costs, they’ve increased access and they’re important tools for reducing health disparities for children of color. Finally, we know that CHIP has led to higher rates of entrepreneurship, and past expansions of Medicaid eligibility for children has been linked to higher earnings later in life. This month, the Institute for Research on Poverty released a new study that provides further confirmation that Medicaid and CHIP contribute to the long-term health and success of children.

The Institute for Research on Poverty at the University of Wisconsin-Madison found that expansions in Medicaid eligibility for low-income pregnant women in the 1980s and 1990s increased the likelihood that their children experienced upward mobility into adulthood. Their findings not only confirm the importance of Medicaid and CHIP for children and families, but also their importance for the country as a whole. When children succeed, everyone benefits, and robust, affordable health coverage is a key component of that success.

We must consider this new data in the context of the populations that these public programs serve. According to a report from the Kaiser Commission on Medicaid and the Uninsured, Medicaid and CHIP cover more than half of Hispanic children and Black children, compared to a little over a quarter of white and Asian children. We already know that economic security is deeply intertwined with health, and that health care coverage is a vital tool in keeping kids and parents healthy. Considering that Medicaid and CHIP play roles in increasing health care access for children of color and now also in helping low-income children climb the economic ladder, it is clear that Medicaid and CHIP are instrumental in combating health disparities and advancing health equity.

As some states debate closing the coverage gap, many others face tight budgets and are considering making cuts to their Medicaid programs, in many cases by rolling back parent eligibility or by limiting coverage for pregnant women. The connection between parent coverage and child coverage is clear, as is that between prenatal coverage, care, and future child health. This new study further demonstrates that covering parents and pregnant women is linked to a child’s success; it adds to the building evidence that investing in our Medicaid and CHIP programs means investing in the futures of our children and our communities. We applaud Congress for extending CHIP funding for two more years, and we hope that decisions surrounding Medicaid – at the federal and the state levels – allow the program to continue to provide robust coverage and improve outcomes.

If ending behavioral health discrimination were a race, it would surely be a marathon. One step at a time, progress has been made to ensure that treatment for mental health and substance use disorders is covered at parity, or equally to other forms of medical treatment under health insurance plans. As we reported last week, these wins are not yet enough to guarantee equality. The odds are still stacked against consumers with behavioral health needs.

But we moved one huge stride closer to the finish line when the federal government released a proposed regulation earlier this month spelling out how mental health and substance use disorders parity standards apply to Medicaid and the Children’s Health Insurance Plan (CHIP).

The new regulation to implement the 7-year-old Mental Health Parity and Addiction Equity Act will help an estimated 21 million Medicaid beneficiaries and 850,000 CHIP beneficiaries get better access to care.

The parity regulation, when finalized, will apply to CHIP, all versions of Medicaid managed care and partially to alternative benefit plans (ABP) in Medicaid expansion, and will protect consumers who are enrolled in those programs.

With the stakes so high, let’s look at the highlights of the proposed regulation:

  • All mental health and substance use disorders benefits offered through Medicaid managed care organizations (MCOs) are subject to parity requirements, regardless of how the services are delivered. This means if a Medicaid MCO contracts these benefits to a behavioral health management company, the overall plan is still responsible for ensuring services comply with parity.
  • Copayments, deductibles and any limits on the number of visits or length of treatment cannot be more restrictive for behavioral health services than those applied to most medical/surgical benefits.
  • Other health plan rules, policies or practices that cannot be measured by a dollar figure or number, such as prior authorization, also must meet the parity standard.
  • Plans must be more transparent about their policies. Medical necessity determination criteria for substance use and mental health benefits must be made available and plans must provide explanations when services are denied.
  • All CHIP services, regardless of whether delivered through managed care or fee-for-service must comply with parity.

For the policy wonks in the audience, check out Tim Jost’s blog on Health Affairs for a more in-depth rundown of what the proposed parity regulation covers.

With so much good news to celebrate, one might wonder whether we’re sprinting toward the parity marathon finish line with fists raised in victory. Of course, this race won’t be won so easily.

Here are just a few roadblocks that still stand in the way:

  • We are likely looking at two years or more before Medicaid enrollees will see the full benefits of this parity regulation. In addition to a comment period, the final rule will not go into effect until 18 months after it is finalized.
  • Enforcement must be stepped up. We are heartened to see that the proposed regulation outlines consequences including the possible withholding of federal Medicaid matching funds for states that aren’t in compliance with parity rules. But greater analysis of outcomes for behavioral health consumers on the ground is needed, including better data collection and reporting of consumer parity complaints with state agencies. As we’ve seen in private insurance, parity is not guaranteed by laws and regulations alone—how rigorously these laws are enforced contributes to their efficacy in ending behavioral health discrimination.
  • The parity regulation does not change the fact that the Mental Health Parity and Addiction Equity Act by design excludes fee-for-service Medicaid and all of Medicare. Behavioral health equity will not be complete until these programs are subject to the same standards as private insurance and Medicaid managed care.

The comment period for the proposed regulation is open through June 9. Community Catalyst will be submitting comments in response to the proposed rule. We will also provide template comments for state advocates who are interested in weighing in – stay tuned!

This week, Montana becomes the 29th state (plus the District of Columbia) to close the coverage gap, and the first state to get legislative approval to expand Medicaid in over a year. As a result, 70,000 low-income Montanans will soon gain health coverage, many for the first time.

This was not an easy fight. The bipartisan compromise passed through both Republican-controlled chambers this month despite the best efforts of well-funded conservative political organizations like Americans for Prosperity (AFP) and the state’s Tea Party-affiliated House leadership.

How did people prevail over politics? There are a lot of reasons, but top among them is smart, sustained, authentic community organizing.

Under the leadership of Montana Women Vote and the Montana Human Rights Network among others, a coalition of advocates had been conducting public education events and canvassing in key districts on this issue since 2013. Over the years, they built a list of thousands of volunteers who were educated and actively engaged, they trained dozens of Montanans who were trapped in the coverage gap to lift up their voices, and they engaged countless hospitals, businesses, and even city council-members in target areas.

Because of this solid groundwork, the campaign was able to generate a firestorm of support for closing the coverage gap in the weeks leading up to the final votes, including over 11,000 calls to legislators and an average of 8-10 earned media pieces a week.

By contrast, AFP did not invest time building relationships in affected communities on this issue. Instead, they invested hundreds of thousands of dollars, and assumed that would buy them the influence they needed. But they were wrong.

AFP and other conservative political organizations relied on expensive paid ads, push-polls and mailers in the weeks leading up to the vote to generate opposition to closing the coverage gap. But without pre-existing relationships on the ground, these efforts generated only 755 calls to legislators during the week of the key votes; during that same week, supporters generated nearly 6,000. And when AFP organized “town hall” events to target three Republican legislators who were considering supporting the bill, Montana citizens who supported closing the coverage gap turned out in such high numbers that AFP was forced to apologize for its tactics.

The recent success in Montana is a win for low-income Montanans, and it’s a refreshing reminder that sustained, strategic and organized consumer advocacy can triumph over moneyed interests.