This document summarizes a presentation about ongoing misunderstandings around the Affordable Care Act. It finds that years after implementation, many Americans are still confused about key aspects of the law. It then provides a quiz to test knowledge and dispel common myths. Finally, it discusses how political rhetoric contributed to the spread of misinformation but that the law's complexity also played a role in ongoing uncertainties and adjustments.
2. There is still a lot of misunderstanding
about the Affordable Care Act
When asked about the Act being in effect a few
months ago…
12% thought it had been overturned by Congress
7% thought it had been overturned by the Supreme
Court
23% didn’t know
3. How does your knowledge stack up?
This quiz, from the Henry J. Kaiser Family Foundation,
can be found at http://kff.org/quiz/health-reform-
quiz/.
4. 1. Will the health reform law require nearly all Americans to have
health insurance starting in 2014 or else pay a fine?
Yes. Starting in 2014, most U.S. citizens and legal
residents will be required to obtain health coverage, or
pay a penalty. Some exemptions will be granted, for
example, for those with religious objections or where
insurance would cost more than 8% of their income.
5. 2. Will the health reform law establish a government panel to
make decisions about end-of-life care for people on Medicare?
No. No such panels exist. While early versions of the
law did contain provisions that would allow Medicare
to reimburse physicians for voluntary discussions with
patients about end-of-life planning, these provisions
were dropped from the final legislation.
6. 3. Will the health reform law give states the option of expanding
their existing Medicaid program to cover more low-income,
uninsured adults?
Yes. As enacted, the ACA calls for the expansion of
state Medicaid programs beginning in 2014 to cover
nearly all individuals under age 65 with incomes up to
138% of the federal poverty level ($15,856 for an
individual or $26,951 for a family of three in 2013).
However, while the Supreme Court upheld the ACA, it
limited the federal government’s ability to enforce the
Medicaid expansion to low-income adults, effectively
making the Medicaid expansion a state choice.
7. 4. Will the health reform law allow undocumented immigrants to
receive financial help from the government to buy health
insurance?
No. Under the ACA, undocumented immigrants will
remain ineligible for Medicaid and will be ineligible
for the premium tax credits. They also will be
prohibited from purchasing coverage through an
exchange even at full cost.
8. 5. Will the health reform law increase the Medicare payroll tax on
earnings for upper income Americans?
Yes. The law increases the Medicare Hospital
Insurance (Part A) payroll tax on earnings for higher-
income taxpayers (more than $200,000/individual and
$250,000/couple) by 0.9 percentage points from 1.45
percent to 2.35 percent, beginning in 2013.
9. 6. Will the health reform law require employers with 50 or more
employees to pay a fine if they don't offer health insurance?
Yes, the law will do this.
10. 7. Will the health reform law cut benefits for people in the
traditional Medicare program?
No, the law does not cut benefits for people in the
traditional Medicare program. In fact, it improves
certain benefits, such as coverage of preventive
services, and closes the Medicare drug coverage gap
known as the "doughnut hole."
11. 8. Will the health reform law provide financial help to low- and
moderate-income Americans who don't get insurance through
their jobs to help them purchase coverage?
Yes, tax credits will be available to eligible U.S. citizens
and legal immigrants who purchase coverage in the
new health insurance exchanges and who have income
up to 400% of the federal poverty level ($45,960 for an
individual or $94,200 for a family of four in 2013).
12. 9. Will the health reform law create a new government-run
insurance plan to be offered along with private plans?
No. The law does not create a new government-run
health insurance plan. The existing Medicaid program
will be expanded to cover more low-income people,
government regulation of the health insurance
industry will be increased, and tax credits will be
provided to make private health insurance more
affordable for people.
13. 10. Will the health reform law create health insurance exchanges or marketplaces where
small businesses and people who don't get coverage through their employers can shop
for insurance and compare prices and benefits?
Yes, the law will do this.
14. Evolution of a misconception
1991 – The Patient Self-Determination Act requires health
care providers, including hospitals, hospices, and nursing
homes to provide information about advance directives to
admitted patients.
2003 – The Medicare Prescription Drug, Improvement and
Modernization Act began providing reimbursements for
end-of-life care discussions with terminally ill patients.
2009 – Rep. Earl Blumenauer (with three Republican
cosponsors) proposes standalone bill to reimburse office
visits discussing end-of-life issues, including living wills
and advance directives, every five years for Medicare
patients. Proposed in April, the standalone bill was soon
tabled and inserted into the Patient Protection and
Affordable Care Act that was being worked on.
15. Evolution of a misconception
July 16, 2009 – Betsy McCaughey, former lieutenant
governor of New York, called it “a vicious assault on elderly
people” because it required the elderly every five years to be
told “how to end their life sooner.”
July 24, 2009 – McCaughey wrote an op-ed saying that
presidential advisor Ezekiel Emanuel did not believe the
disabled should be entitled to medical care. Within a few
days, representatives like Rep. John Boehner were being
quoted about government-sponsored euthanasia.
August 7th, 2009 – Sarah Palin first uses the phrase “death
panel” on Facebook.
16. Results
The provision was removed from PPACA prior to it
becoming law in March 2010.
A proposed Medicare regulation to pay for end-of-life
care consultations was also deleted January 4, 2011
17. Factors in the confusion
Politics!
Access to healthcare is an emotional issue.
There have been changes and developments as the law
was being worked on and enacted.
Healthcare is a complex system with many moving
parts.
18. Examples
T. – WA. Signed up easily, but harassed for tweeting
about it.
P. – UT. Return to Medicaid after absence resulted in
fine.
M. – OR. Cover Oregon site not believed to be
working, but was able to register successfully.
19. What about us, the Document
Processing and Validation team?
Adjustment period as we wait for programming, and as
programming that we thought we were done waiting
for gets corrected.
Some changes in what we see in the documents.
Potential for increase in work as more people obtain
healthcare coverage.
20. Our Cause
Serve as a catalyst to transform health
care, creating a person-focused and
economically sustainable system.
21. Cambia can be a leader.
Value: Nonprofit
“Our status as a taxpaying nonprofit reflects our
commitment to serving others before ourselves.”
22. Our Values
Trust - We act with integrity and ethical clarity to inspire trust in us by those
with whom we serve and work.
Accountability - We deliver on our promises, and we accept responsibility,
individually and collectively, for our actions and decisions.
Agility - We believe that our ability to drive value in a challenging health care
marketplace requires speed, flexibility, courage and a bias for action.
Commitment - All of our employees live and own our Cause.
Nonprofit - Our status as a taxpaying nonprofit reflects our commitment to
serving others before ourselves.
Innovation - We embrace change and promote the development of new ideas.
Teamwork - We expect and promote a diverse team environment, working
effectively across our business portfolio, functional areas, and geographies to
achieve our Cause.
Leadership - We demonstrate courageous servant leadership, bringing out the
best in people throughout our company and the communities in which we
serve.
23. Our Core Strategies
Over the next 7-10 years…
Make health care more affordable and understandable for
individuals and their families.
Facilitate an economically accountable relationship between
persons and health care providers.
Deliver a diversified business portfolio that supports
individual health, promotes better medical outcomes, and
enhances a vibrant, sustainable health care system.
Maintain the financial strength of our company to provide
stability and create new value for our customers.
24. Commitment: All of our employees live
and own our Cause.
We can feel good about our company
and the role we play.
