Debt Ceiling Lifted and Government Reopens – till January 15th

The House GOP coalesced around this plan with changes to the Affordable Care Act, such as nixing subsidies to Congress and staff and a repeal of the medical device tax.

The White House, HHS and Healthcare Community and Advocates PROMOTE HEALTH INSURANCE for the Uninsured ---request people to go to Healthcare.gov and review options for health insurance:

  • People will be able to apply for advance premium tax credits in exchanges in a variety of ways, including online, by paper application, and over the phone through call centers. There is a standard paper application, which is three pages plus appendices for individuals and longer for families.
  • Plan choices will be arrayed online based on where you live. A standard, short summary of coverage will be provided for all plans.  This will explain covered benefits and cost sharing and provide illustrations of how coverage would work for common medical events, such as having a baby. This summary will make it easier for consumers to compare plans.  When looking online, consumers are expected to be able to sort and compare plans based on the standard coverage elements they care most about.
  • All insurers will be required to cover mostly the same benefits, including some services that are often excluded or limited today for people buying their own insurance (e.g., maternity care, mental health, and prescription drugs).

Coverage will be standardized into tiers (from bronze to platinum). Deductibles and co-pays will typically vary from plan to plan, but all plans in a given tier will provide the same overall level of protection to consumers.

But, probably the single biggest step to make buying insurance simpler than today is the prohibition of what’s known as “medical underwriting.” With no medical underwriting, largely uniform benefits, and standardized tiers of coverage, consumers should have a much easier time applying for insurance and comparing prices. Consumers will have to make tradeoffs between the level of the premium, the degree of patient cost-sharing, and the breadth of a plan’s provider network, but they will have access to information to help make those decisions.

And, consumers will have the benefit of trained assisters to help them make these comparisons and answer their questions.  The ACA requires the establishment of Navigators and other similar programs and provides resources to pay and train assisters.

The expansion of Medicaid under the Affordable Care Act (ACA) provides a link between new private coverage options available through either Health Insurance Marketplaces or employers and the existing Medicaid program, which previously had many gaps in coverage for adults. However, the June 2012 Supreme Court ruling made the expansion of Medicaid optional for states, and as of September 2013, 26 states did not plan to implement the expansion. In states that do not expand Medicaid, over five million poor uninsured adults have incomes above Medicaid eligibility levels but below poverty and may fall into a “coverage gap” of earning too much to qualify for Medicaid but not enough to qualify for Marketplace premium tax credits. This group is estimated at 8 million and will have very limited coverage options and are likely to remain uninsured

TAX CREDITS You Should Know About in new ACA Marketplace Health Insurance Plans:

According to the Kaiser Family Foundation: Tax credits have the potential to cover a substantial portion of the premiums paid by current individual market enrollees: We estimate that current individual market purchasers will face an average premium per family for the second-lowest-cost silver plan of $8,250 in 2014. Across all current individual market purchasers anticipated to continue buying coverage, the average tax credit their families would be eligible for would be $2,672. Assuming all eligible current enrollees applied for a tax credit, the subsidy would reduce the premium for the second-lowest-cost silver plan by an average of 32% across all people now buying insurance in the individual market.

About half (48%) of people now buying their own insurance would be eligible for a tax credit that would offset their premium. This does not include over one million adults buying individual insurance today who will be eligible for Medicaid starting in 2014 (i.e., they have family income up to 138% of the poverty level and are living in states that have decided to expand Medicaid under the ACA). For this group, the average subsidy would be $5,548 per family, which would reduce their premium for the second-lowest-cost silver premium by an average of 66%.

Insurance Exchange “Marketplaces” Went Live October 1

Exchanges were available in all 50 states and DC, with a mix of operating models: 15 states and DC will operate their own exchanges, 7 states will employ a partnership model with the federal government, with 28 states using a federally facilitated exchange. Enrollment expectations in the exchanges vary, with the Congressional Budget Office (CBO) predicting 8 million enrollees by the end of 2014.

Individuals will also be able to apply for Medicaid coverage. Under the Affordable Care Act (ACA) states have the option to expand Medicaid coverage to all residents with incomes up to 138% of the federal poverty level (FPL). As of today, 24 states have chosen to expand their programs. Individuals will complete a single application and will be directed to the program for which they qualify – Medicaid, subsidized coverage in the exchange, or un-subsidized coverage.

As part of the Affordable Care Act, all Americans are required to have health insurance or face fines. To do that, subsidies are made available for middle- and low-income individuals and families. For those with the lowest incomes, an expansion of Medicaid provides coverage. The federal government covers the full cost of the expansion through 2016 and no less than 90 percent of the cost after that. The program is designed to insure about 14 million Americans who are eligible, uninsured and living in poverty.

US Supreme Court 2013 Fall Session: Schuette v. Coalition to Defend Affirmative Action

The Michigan amendment takes race out of the process. At issue is language that says state colleges and universities “shall not discriminate against, or grant preferential treatment to, any individual or group on the basis of race, sex, color, ethnicity, or national origin.”

Last term, in a case challenging the University of Texas’s use of race in making some admission decisions, the court declined to revise its holding in Grutter. The justices sent the case back to a lower court for a closer look at whether the university had used all the tools at its disposal to increase racial diversity before resorting to the use of race.

The toughest questioning came from Justice Sonia Sotomayor, who has said affirmative action helped lift her out of a poor Hispanic neighborhood in the Bronx and allowed her entry into Princeton University and Yale Law School.

The Supreme Court supporting climate change policy responsibility -  allowed the Environmental Protection Agency's ability to regulate greenhouse gas emissions as a pollutant to stand Tuesday, even as it agreed to examine how the agency could demand greater pollution controls through the permitting process.


NHMA LEADERSHIP FELLOWSHIP Washington, DC Institute a success, despite the government shutdown - all 10 Fellows learned from healthcare leaders with  Federal government expertise, stakeholders from Think Tanks, AAMC, national coalitions, lobbyists and Congress (leader Pelosi office) and others - about the important need for Public Servants who are Hispanic especially in healthcare; about the key need for national leadership to improve health care!

NHMA successfully convened Pre-Medical Student Recruitment to Medical School Conferences with the University of Texas Health Sciences Center, San Antonio and the Charles R. Drew University of Medicine and Science – with presentations from their speakers and medical student panels, E. Rios and K.Flores providing inspiration and counseling to over 600 high school and college students and their parents.  Next Steps is to create a Mentoring Program with medical students for the college students ready to apply to medical school. By creating a collaborative approach, NHMA hopes to increase the numbers of Hispanic students in medical school for 2014. Thanks to the AAMC for providing key information.

Call our office if we can support your colleagues who are premedical students!

NHMA successfully convenes its “Covered Hispanics Campaign” Forums in Los Angeles, NYC, San Antonio, Atlanta, and Chicago with the White House, HHS Region Directors, and State Marketplace leaders ---and bring answers to many questions of  over 500 providers and community leaders and students all interested in sharing information with their patients and colleagues. Thanks to the new NHMA Region Steering Committees for inviting their networks. Thanks to all the media coverage from La Opinion, MundoFox, Univision, Impacto Latino and others who participated to increase awareness to Latinos.  Thanks to the Anthem Blue Cross, Empire BC BS, and Blue Cross of Illinois for sponsoring.

Announcing the NHMA California Leadership Fellowship, supported by the California Wellness Foundation – executive leadership program for 10 Physicians in mid-career (5  years post training) from California.  Application and additional information will be available on NHMA website soon.

Sacramento Institute will be four days in April, 2014 where Fellows will learn about State Policy development and the role of stakeholders to reform health policy and programs and the introduction to Legislators and their healthcare priority legislation issues, State government committees and appointments.  The Fellows will also have a Washington, DC Institute for a day prior to the NHMA Conference at the end of March, 2015. Doctors who participate must attend both sessions.

NHMA – HHS OMH Hispanic Leadership Institute at the NHMA Conference 2014 will include How to Expand Leadership of Corporate Boards of Directors with healthcare professionals who are needed to guide the development of employee health and wellness programs.

NHMA Mentoring Programs ----This Fall we started a great program with GE- NHMA Health Professional Student Leadership and Mentoring Program and selected 50 talented students who are now in the program ---and will be attending the NHMA Conference in Washington, DC.

NHMA Council of Residents Mentoring Program is available for residents and physicians interested in participating with mentors in the NHMA Region where you are working and also to meet mentors who attend the NHMA Conference.  Applications due January 31, 2014.

NHMA 2014 CONFERENCE – “ACA and Best Practices for Hispanics”  AGENDA AT A GLANCE:  Marriott Wardman Park Hotel, Washington, DC

March 28Congressional Visits and Advocacy Meetings, Lunch in Exhibit Hall, Opening Plenary with US Department of Health and Human Services Secretary and CMS Administrator followed by Presidents of Medical Associations Response Panel

Foundation Leadership

Reception – Global Health Leaders and Innovation

NHHF Board of Directors and Corporate Advisory Board Meetings

March 29 – Insurance Company and Health System ACO and Patient Centered Medical Home Innovations

Workshops on Technology, Apps, Chronic Disease Management/Research, Prevention and Wellness, and new Cultural Competence Medical Education Programs, Journal of NHMA development, and more

Gala Awards Dinner – National Latino Leader Keynote Speaker; Awards Presentation;

March 30 – NHMA Health Professional Leadership Institute – How to Become a White House Appointee to National Commissions and How to Become a Corporate Board Member – with White House Staff, Corporate CEOs, Executive Search Firm representatives.

Register Now at www.nhmamd.org, Reserve your hotel; sign up for Posters, Recruiter Tables, Exhibit Hall to Advance Health Professions careers and share Hispanic healthcare programs and Sponsorship Opportunities information – for workshop sessions, special events, travel for students to attend. Call Dr. Elena Rios (202-628-5895) if interested in presenting innovations/best practices in health care delivery to share with hospital and medical group leaders from across the nation.


Send us your advances to share with our Networks –

Fellows Class of 2006 interested in planning a Ten Year Anniversary Meeting – for NHMA 2016 Conference – Sylvia Rosas, MD now at Boston’s Joslin Institute  wants to hear from you!

Congrats to one of our past awardees ---Dr. Sandra Hernandez appointed as President, California Health Care Foundation starting in January.

Kathy Flores, MD attends the AMA, NHMA and NMA Commission to End Health Care Disparities in Chicago – Retreat to discuss the strategic planning to build advocacy, cultural competence, medical education and data collection of the 30 or so medical and pharma and nursing and corporate sponsors who make up this coalition. NHMA has been a member since its founding in 2005.

Elena Rios, MD testifies at a Congressional Briefing of the Campaign to End Obesity on how to include obesity training in medical education of the future, given the need for prevention services for future physicians.

Thanks to the NHMA Region Chairpersons and Steering Committees and all staff and supporters for convening Successful White House and NHMA ACA Forums in Los Angeles, NYC, San Antonio, Atlanta and Chicago over the past month!  We reached over 500 physicians and leaders with great training Q and A to better inform leaders about the ACA details for Latinos who are uninsured and others who can apply for insurance through the Marketplaces.



1920 L St., NW, Suite 725
Washington, DC 20036
Phone: 202-628-5895
Fax: 202-628-5898
Email: nhma@nhmamd.org