This document discusses opportunities for social workers under the Affordable Care Act and the importance of Medicaid expansion. It summarizes key provisions of the ACA, such as dependent coverage until age 26 and prohibiting pre-existing condition exclusions starting in 2014. The document urges social workers to help enroll uninsured clients and advocate for Medicaid expansion in their states to reduce health disparities and provide coverage to low-income individuals. Social workers are well-positioned to help with enrollment and address psychosocial needs not met by other professions.

1. In Support of Our Patients and Our
Profession: Social Work Leadership to
Advance the Goals of National Health
Reform in the Post‐Election Era
Janlee Wong, MSW
Executive Director
National Association of Social Workers
CA Chapter

2. Learning Objectives
• Social Work Policy on Healthcare Reform
• The Healthcare Reform Plan:
– Affordable Care Act (ACA) or Obamacare
• Opportunities for Social Workers
• What Social Workers Need to Do
Slides available via:
Google “slideshare Janlee Wong”

3. A Growing Crisis
Nonelderly Uninsured in US:
2004 – 43 million
2010 ‐ 49 million

4. Why Does NASW Support the ACA?
“NASW supports a national health care policy that ensures the
right to universal access to a continuum of health and mental
health care throughout all stages of the life cycle.”

5. The Plan:Reform Health Insurance
Cover the Uninsured
• Dependent coverage to age 26 (2010)
• Limits on insurance premium increases (2010)
• No cost-sharing for preventive services (2012)
(cancer screening; mammography, etc.)
• No annual caps (2014)
• Guaranteed Issue - No Pre-ex exclusions (2014)
• Close Medicare donut hole by 2020
• More choice of plans in the individual market and
guarantee of comprehensiveness (2014)

6. Starting in 2014, most employers
(> 50 FTEs) must offer
health insurance that is:
• Affordable
– (individual premiums no more than 9.5 percent of
annual income)
• Adequate
– (a plan that covers 60% ‐ 90% of allowable medical
expenses until deductible is met)
• Comprehensive – adheres to Essential Health
Benefits (EHB)

7. Cover the Uninsured Under ACA
11.7, 4%
264.2, 84%
20, 6%
18, 6%
(millions)
Undocumented (ACA ineligible) Insured ACA Exchange Medicaid Expansion

8. What Income Qualifies For Expanded
Medicaid and Exchange Plans
Federal Poverty Line (FPL)
$15,415
$31,810
$44,680
$92,200
Individual Family of 4
I33% FPL Medicaid 400% FPL Exchange

9. HHS will approve state exchanges or run them
in states opting out
Develop and approve insurance plans offered in
the Exchange
• Essential Health Benefits
Manage enrollment
• Outreach, Assisters, Navigators

11. Essential Health Benefits
• ambulatory patient services
• emergency services
• hospitalization
• maternity and newborn care
• mental health and substance abuse disorder services
• prescription drugs
• rehabilitative and habiliative services and devices
• laboratory services
• preventive and wellness services and chronic
disease management
• pediatric services, including oral and vision care

12. The EHB and State Benchmark Plans
• States operating their own exchanges
choose a “benchmark” plan
• Benchmark must comply with the EHB
• All other plans in exchange are modeled
against the benchmark
• In CA: the benchmark plan is Kaiser
Small Group HMO

13. How To Pay For It
$382 Billion New Revenue
Increase
Medicare Tax On
Rich, $210
Insurer Fee, $60
Cadillac Plan Tax,
$32
Drug &
Device Tax,
$47
Reduce Tax
Deductions, $18
Other, $15

14. How To Pay For It:
Reduce Spending $194 Billion
Reduce
Medicare
Advantage, $132
Reduce
Medicare Home
Health, $40
Reduce Hospital
Payments, $22

15. ACA Policy Incentives
Provision
• Eliminating hospital
DSH payments
• Hospital re‐
admission penalties
• Fees ($2K ‐ $3K) for
large employers not
offering health
insurance
Policy
• Fewer uninsured
admitted
• Quality standard, no fee
for service incentives
• Encourages employer
provided healthcare

16. 2014 ‐ Only 6 months away!
Major components of health reform –
Medicaid expansion and state insurance
exchanges – need to be up and running
on 1/1/2014
Open enrollment for exchanges begins
on 10/1/2013

17. CA Health Exchange Website
www.healthexchange.ca.gov

18. How will enrollment be
conducted in CA?
• “No wrong door”
– Medi‐Cal enrollment, 58 counties with in person,
mail telephone and online, certified assisters
• CalHEERS – California Healthcare Eligibility,
Enrollment, & Retention System (Accenture)
• Covered CA website: fact sheets, subsidy
calculator and consumer phone number
• Simple Income Eligibility Determination:
Single income standard, no assets test

19. CMS – public awareness material –
available in 10 languages:
www.marketplace.cms.gov/getofficialresources/get‐official‐
resources.html

20. divulgación
Impremedia, Telemundo Station Group and
Univision— 1.2 million uninsured Latinos

21. Special SAMHSA enrollment toolkits
for people with
Behavioral Health Needs
(coming soon)

22. Two pressing priorities for the social
work profession
• ACA Enrollment
• Medicaid expansion

23. Support for our Uninsured Clients
All social workers should be familiar with the
insurance enrollment process in their states

24. Social Workers Skilled Contribution
Take two aspirin and see me in 2
weeks
• Home and community visit and
support systems
• Psychosocial assessment
• Case management
• Behavioral techniques
• Advocacy and policy

25. ACA Opportunities for Social Workers
• Exchange Navigators (BSW level)
• Post‐discharge staff (ACA re‐admit penalties); greater
need for hospital Social Workers
• Increased $ for Federally Qualified Health Centers ‐
training, experience
• More insured patients in Community Mental Health
Centers and specialized programs (e.g., Ryan White‐
funded clinics)
• Specific ACA demo projects (primarily elderly)
– community based care transitions
– care coordination/health homes for dually eligible
– Independence at Home
– Medicare Accountable Care Organizations

26. NASW Resources:
http://www.socialworkers.org/assets/secured/documents/practice/quickguidetotheaca.pdf
http://www.socialworkers.org/assets/secured/documents/practice/health/hcronsumerfactsheet.pdf

27. Advocacy Priority for all social
workers:
Medicaid Expansion

29. Why is the Medicaid expansion
important?
• Significantly reduce uncompensated care
burden at hospitals
• Keep federal health care subsidies in state
(otherwise flowing to other states)
• People will be inclined to seek care earlier
(particularly important for oncology patients)
• Insurance coverage = less stress for families
• Address health disparities

30. A state without the expansion:
Only individuals with incomes from 100% ‐ 400%
of FPL will be eligible for Federal subsidies to purchase
insurance policies on the new health care
“marketplaces” (aka exchanges)
• Most non‐expansion states have extremely low Medicaid
eligibility thresholds for single adults (or offer no Medicaid
coverage to this population)
• Result ‐ single adults under 100% will have no health
insurance

31. No Medicaid expansion =
worsening health disparities
A lot of people will come in, file applications and
find they are not eligible for help because they are
too poor. We’ll have to tell them, ‘If only you had a
little more money, you could get insurance subsidies
[to purchase coverage on the exchange], but
because you are so poor, you cannot get anything.
Bee Moorhead, executive director, TX Impact

32. How to Advocate
• Share your firsthand experiences on the need for
healthcare reform!
– Cost savings by insuring the uninsured
– Prevention and wellness
• Consider yourself an expert on:
– Human and fiscal impact of being uninsured,
underinsured
– Psychosocial effects of cancer
• Become active in your state NASW chapter; your
state health coalition

33. Simple Advocacy Act
Send an e‐mail to your governor and state
legislators with the message:
“As your constituent – and an oncology social
worker concerned about worsening health
disparities ‐ I urge you to approve the Medicaid
expansion.”

34. Questions?

35. Contact Info:
Stacy Collins, MSW
National Association of Social Workers
scollins@naswdc.org
Janlee Wong, MSW
National Association of Social Workers
CA Chapter
naswca@naswca.org
Google: slideshare Janlee Wong