Obamacare: What is in it for millions of poor American?
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The document discusses key aspects of Obamacare (the Affordable Care Act) and its impact on healthcare coverage for millions of poor Americans. It explains that Obamacare expands Medicaid eligibility and creates online marketplaces to provide coverage for up to 32 million uninsured people. However, an estimated 23 million will still lack insurance by 2019. Obamacare also prohibits denying coverage due to pre-existing conditions but does not mandate insurance. While it aims to expand access, critics argue it fails to achieve universal coverage or effectively control costs.
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Obamacare: What is in it for millions of poor American?
- 1. ObamacareObamacare What is in it for millions of poorWhat is in it for millions of poor American?American? Monower MostafaMonower Mostafa
- 2. Obamacare “The Patient Protection and Affordable Care Act (PPACA)” signed into law on March 23, 2010 Nickname (!) “Obamacare” !!
- 3. Obamacare Just look at the Title once again!! “The Patient Protection and Affordable Care Act” `Patient Protection’ `Affordable Care’ The fact is that the Patients were not ‘protected’ The fact is that the Care was not `Affordable’
- 4. Medicaid and Medicare Two such Laws still exists in the US, created in 1965 Medicaid Medicare
- 5. Medicaid: Coverage and cost Coverage Medicaid provides comprehensive inpatientand outpatient health care coverage, including many services and costs Medicare does not cover, most notably, prescription drugs, diagnostic and preventive care, and eye glasses Coverage varies from state to state Medicaid can pay Medicare deductibles and 20% portion of charges not paid by Medicare Medicaid can also pay the Medicare premium
- 6. Medicaid: Coverage and cost Cost In some states, Medicaid charges small amounts for certain services Beneficiaries Total number of Medicaid beneficiaries: 70.4 million (2011)
- 7. Medicare: Coverage and cost Medicare A Federal Program covering almost everyone 65 or over Certain people on Social Security disability Some people with permanent kidney failure
- 8. Medicare: Coverage and cost Coverage Medicare hospital insurance (Part A) provides basic coverage for hospital stays and post- hospital nursing facility and home health care Medicare medical insurance (Part B) pays most basic doctor and laboratory costs, and some outpatient medical services, including medical equipment and supplies, home health care, and physical therapy. Medicare prescription drug coverage (Part D) pays some of the costs of prescription medications.
- 9. Medicare: Coverage and cost Cost One must pay a yearly deductible for both Medicare Part A and Part B, and make hefty copayments for extended hospital stays. Under Part B, you must pay the 20% of doctors' bills Medicare does not pay, and sometimes up to 15% more.
- 10. Medicare: Coverage and cost Part B also charges a monthly premium. Under Part D, you must pay a monthly premium, a deductible, copayments, and all of your prescription drug costs over a certain yearly amount and up to a ceiling amount, unless you qualify for a low-income subsidy Beneficiaries Total number of Medicare beneficiaries: 48.84 million (2011)
- 12. Expanded coverage In 2010, there were 50 million people left without any health insurance The new Law will provide coverage to as many as 32 million people by the year 2019, according to Congressional Budget Office (CBO) However, the fact is that about the CBO predicts that about 23 million will still be uninsured in 2019
- 13. Expanded coverage The expanded coverage comes through two major ways: • 16 million will be included in the Medicaid expanding the definition of ‘Low-income’ and by including those without children • Another 16 million will buy insurance from ‘Online Market’ that provides them broad choices: `Bronze’, `Silver’, `Gold’, `Platinum’ and `Catastrophic’ • Federal Government will provide some subsidy to help families with income as high as $88,000 • Employers with more than 49 people on the payroll must provide health insurance • The Law offers tax credit to smaller companies
- 14. Insurance Regulation • Prohibits bad practices of Insurance Companies `denying’ medical bills • The practice of denying coverage based on pre-existing conditions – a medical condition that existed before some applies or enrolls in a new health insurance policy – is not confined to only serious diseases; it can also include relatively minor conditions such as asthma or a previous sports injury. • “Guaranteed issue”- Insurance companies are requires to issue, or renew, a policy to anybody, regardless of any ‘pre-existing conditions’
- 15. Insurance Regulation • But buying an ‘insurance plan’ is not mandatory, quite contrary to other industrialized countries • In fact, Obama called this Reform not as ‘Healthcare Reform’ rather as ‘Health Insurance Reform’!! • Unlike other industrialized countries, US Insurance companies are still allowed to `deny’ claims but they are required to Report, how many claims they reject each year
- 16. Funding The new Law is projected to cost at least $940 billion over the 10 years (2010 to 2020) New taxes and fees are imposed on big winners of current health care system- drug companies, medical device makers, Insurance companies etc.
- 17. Others Subsidies will be provided for senior citizens who can’t afford to pay for their prescriptions under Medicare To encourage more medical students into family practice, the law is supposed to- pay the medical school debt of primary care doctors sharply raises Medicaid payments for primary care
- 18. Interrogating `Obamacare’ Can `Obamacare’ solve the American health care problem? Generally speaking: The PPACA is designed to attain to major objectives: Extending the insurance coverage to millions (perhaps 32 only!) still uninsured To end some of the insurance companies’ harsher practices
- 19. Interrogating `Obamacare’ What about “Universal Health coverage”? What about “non-profit health insurance system’? What about ‘cost control’? What about ‘equal access to health services’? Unfortunately- Obamacare is quite silent in responding to these questions raised by many Americans!!
- 20. Interrogating `Obamacare’ The PPACA reveals the fact that “an unfettered market is not the ultimate solution to human problem”!! “Even with this ambitious reform, the United States will still have the most complicated, the most expensive, and the most inequitable healthcare system of any developed nation.” What do you think?
- 21. Thank you
Notes de l'éditeur
- In 1965, the Medicare program was created to provide health insurance for the elderly population, and in 1972 coverage for those under 65 with disabilities was added. Medicare is administered by the federal government, and since all the reimbursement (paying) is done only by the government, Medicare is known as a single payer system. Medicare is financed by income taxes, payroll taxes, and out-of-pocket payments made by enrollees, including premiums to enroll in certain part of Medicare.
- Medicaid was established in 1965 to cover the poor and disabled. By federal law, states that receive federal funding for Medicaid must cover certain very poor groups of individuals, including pregnant women, children, the elderly, and the disabled. States can expand eligibility beyond these federally defined floors if they so choose. It’s important to understand that not every poor person is covered by Medicaid – childless adults are not covered, and people who are not poor enough are not covered. Medicaid is administered by state governments, so there are essentially 51 different Medicaid programs (50 states plus the District of Columbia). Beyond the mandatory coverage requirements, states may choose to expand eligibility if they have the resources. States also choose how they contract with providers. For example, they may reimburse providers on a fee-for-service basis or purchase premiums through managed care plans. Medicaid is financed jointly by the federal and state governments. The federal government will match the amount a state spends on Medicaid at least dollar-for-dollar. For particularly poor states, the federal government will match each state dollar spent on Medicaid with more than one federal dollar, such that the federal government overall finances the majority of Medicaid costs. Benefits are fairly comprehensive, and importantly, Medicaid covers a huge portion of the country’s long-term care costs. Part of this is because a lot of middle-class and low-income families lose a ton of money paying nursing homes to take care of elderly members of the family. Once they’ve exhausted their resources, they become eligible for Medicaid long-term care. Despite the good coverage in Medicaid, reimbursement rates are low, so beneficiaries may have difficulty finding a provider that accepts Medicaid. You sometimes hear that Medicaid has “Cadillac coverage”, but that coverage isn’t any good if no one takes it. A Cadillac doesn’t do you much good if you’re only allowed to drive it on certain roads.
- The State Children’s Health Insurance Program was designed in 1997 to supplement Medicaid by covering low-income children who are ineligible for Medicaid. For instance, it might cover a child whose family has an income 200% of the FPL, which is too much for Medicaid. S-CHIP is administered and financed similarly to Medicaid. Like Medicaid, reimbursement rates are low, so some providers do not see S-CHIP patients. There is also a lot of under-enrollment in S-CHIP; it is estimated that more than 7 out of 10 children in America are actually eligible for public insurance but they are not enrolled. Finally, like Medicaid, there are strict and arbitrary eligibility requirements for different groups of people.