Affordable care act

INNOVATIONS IN PATIENT CARE
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Talking About The Affordable Care Act (ACA)

EHR | PMS | HIE | PHR

The Digest

• This program is accompanied by a seven page digest of the
benefits of the affordable care act that most directly affect
individuals.

• The Digest is a solidly researched and easy to read tool that will
provide what you need to convince your voters that they should
support the affordable care act and only vote for those who do.

• The digest has been used in at least two dozen community
meetings and personally presented to at least 1500 individuals
chosen at random in public gatherings.

• The ‘read only’ digest may be freely copied for free distribution to
volunteers and voters.

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Agenda

A. Introduction
B. ACA big picture
D. Medicaid and Medicare
E. The new insurance market
F. Cost controls and regulations
G. Subsidies for individuals, retirees and small business.
H. Essential Health Benefits
I. Health insurance benefits already in effect
J. Questions

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Talking About the Affordable Care Act

Big Picture

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ACA is a law that makes affordable healthcare possible.

IN 2009 THE NEED FOR THIS WAS URGENT
• President Obama was driven to make
health care reform his highest priority by
the simple fact that the cost of health care
is pushing the country and its people
rapidly toward bankruptcy.

BUT THIS FIGHT STARTED DECADES AGO
• President Obama, 280 Democratic
Representatives and Senators in the 111th
Congress passed ACA using help from
presidents Truman, Eisenhower, Kennedy,
Nixon, Johnson, Reagan, Clinton, and G. W.
Bush

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If Implemented As Written…

CREATES NEW JOBS
• The healthcare industry, at 14.3 million jobs will generate 3.2 million new
American jobs between 2008 and 2018
• According to the Bureau of Labor Statistics this is more than any other
industry

REDUCES THE DEFICIT
• reduces the 20 year deficit by $1.5 Trillion

BRINGS QUALITY, AFFORDABLE HEALTH CARE
• for 94% of our residents

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If Implemented As Written…

RELIES ON COMPETITION, BUT HOLDS INSURANCE COMPANIES
RESPONSIBLE:
Starting in 2014, the Act relies on competition: including universal coverage;
“single Risk” pool underwriting; risk adjustment pools to manage premiums;
the creation of co-op insurance companies; transparency; state regulation
plus federal oversight.
Companies with unreasonable premiums can be excluded from exchanges.

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Because we all benefit, we all have a responsibility

• ACA requires both implementation by
the states and the voters ongoing
support.

• Good health comeS from healthy living.

• Employers and insurance companies
can benefit by helping employees.
They are authorized to credit us up to
20% of total premiums to encourage
healthy behavior.

• $30,000,000 has been allocated for this
year to jump start state consumer
assistance offices.

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Medicaid and Medicare

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President Obama strengthened Medicaid and
Medicare…even in 2009

• 2009 RECOVERY ACT
REIMBURSEMENT FOR COSTS TO STATE MEDICAID PROGRAMS
has saved Minnesota (in ’09 -’10), $1,673,476,158 thru Sept 30, 2010.

• THROUGH ACA
Medicare coverage was improved and the trust fund strengthened.

• TODAY, IN 2011
medicare is now providing comprehensive and free preventive care

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Medicaid and Medicare Continue to Benefit under the
Affordable Care Act…

• 2010-2019 ACA EXTENDS THE LIFE OF
MEDICARE UNTIL 2029

• 2010 BEGINS TO CLOSE THE MEDICARE PART
D DONUT HOLE.
Jan 1, 2011 the ACA started a 50% discount off the
negotiated prices of brand name drugs and
biologics in the donut hole and other discounts on
generic drugs.
ACA closes the donut hole by 2020.

• 2011 ALL MEDICARE INSUREDS WILL PAY THE
SAME PREMIUMS
to all Medicare insurance providers.
The ACA phases out subsidies to private Medicare
Advantage plans over six years.

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In 2010…
• 2010 MEDICAID
State Medicaid coverage must equal and may
exceed ACA coverage.
THE ACA EXPANDS MEDICAID COVERAGE
by increasing qualifying income levels to 1.33 times
the Federal Poverty Level or less.

• FOR THOSE THAT CANNOT AFFORD
INSURANCE
See Medicaid, above. All others left uninsured
may use one of the 7.900 Community Health
Clinic offices (see below) or they may use
emergency Rooms.
Undocumented immigrants and others not
qualified for ACA programs may also purchase
commercial insurance outside of the
exchanges.

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Eldercare Locator (2010)

www.eldercare.gov
Or call 1-800-677-1116 for community based services and benefits, counseling,
transportation, meals, home care and caregiver support services.

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Stopping Fraud

• 2010 ACA IS AGGRESSIVE ABOUT STOPPING FRAUD.

Fraud costs Medicare millions of dollars every year. Fraud
schemes may be carried out by individuals, companies, or
groups of individuals. We can help stop it.

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The New Insurance Market

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The Affordable Care act creates a new insurance market

• In 2010: EXISTING GROUP HEALTH PLANS
Are "grandfathered" with respect to certain reforms, until they change benefits or
increase out of pocket costs beyond limits.

• INSURANCE EXCHANGES in 2014
Will create transparency and competition and therefore lower rates.

• AFFORDABLE HEALTH INSURANCE IS MANDATED in 2014
Without universal insurance costs will be uncontrollable.

• PENALTIES in 2014
Monthly for the non-exempt individual who fails to insure themselves and their
dependents.

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Cost Controls and Regulations

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The Affordable Care Act Is Called “Affordable” For A
Reason

• SUBSIDIES FOR THOSE UNDER
400% OF THE FPL
limit premiums to between 2% to 9.5%
of income.
limit out of pocket costs to 30%
of contract costs.

• PREMIUM INCREASES
are limited in 26 states that can reject
increases.
The Federal government does not have
the authority to limit premiums.

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ACA has many components to control costs, most of which will
come into effect in 2014 along with the exchange

• BANS PRICE DISCRIMINATION OF ANY KIND
Except age and smoking.
• EXCHANGE BUYING
To lower insurance premiums from what they would become under
past practices, insurers are required to include everyone in a single
risk pool.
insurance will be sold through state operated exchanges accessible by
both individuals, and small businesses .
• OUT OF POCKET LIMITS
To qualify for the exchanges, insurers in the non-group market must
limit out of pocket costs to $5,950/yr in 2010 dollars for an individual,
$2,000/yr per individual in the small group market and twice these for a
family.

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The Affordable Care Act Is Called “Affordable” For A
Reason

• 2010 THE LAW REQUIRES IMMEDIATE RESTRAINT OF UNREASONABLE
PREMIUMS.
The HHS Secretary has directed the states to have the legislation and
regulations needed to approve or disapprove rates and has granted $51
million to 45 states to assist this process.

• 2010 EMPLOYERS ARE RECEIVING HELP FOR EARLY RETIREES.

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The Affordable Care Act also helps our economy by aiding
Small Businesses

SMALL BUSINESS WILL RECEIVE 35% TAX CREDITS NOW (IN 2010)
SMALL BUSINESS WILL RECEIVE 50% TAX CREDITS IN 2014
KEY POLITICAL QUESTIONS ARE ANSWERED IN A SHORT PAPER
from the Center of Budget and Policy
Priorities at http://www.cbpp.org/files/5-17-10health.pdf.

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Essential Health Benefits are defined in the Exchange

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Essential Health Benefits (2014)

All new plans and all plans sold on an exchange must meet these requirements.
• Insurers may offer a low cost catastrophic plan for those under 30 and four plans varying
coverage at 60%, 70%, 80% and 90% of the cost of benefits.
• The requirements will be defined by HHS and must include at least the following benefit
coverage plus the items and services covered within the categories:
Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health, substance abuse and behavioral health treatments
Prescription drugs
Rehabilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care

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Health Benefits Already Activated

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Provisions that went into effect in 2010 include…

1) 2010 CHILDREN: THREE PROVISIONS TOOK EFFECT IN 2010.

Coverage denial for pre-existing conditions is banned if less than age 19, AND FOR
EVERY INSURED ON Jan 1, 2014.
Children must be accepted as insured under parents plan up to age 26 if the plan
inlcudes children in its available coverage.
States must not reduce income eligibility for Medicaid and the Children’s Health
Insurance Program (CHIP) until 2019.

2) 2010 ACA CREATED A FEDERAL HIGH RISK INSURANCE PROGRAM FOR THOSE WITH
PREEXISTING CONDITIONS
and without insurance for six months
Many states also offer high risk pools
as alternatives to the federal program.

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Other Provisions that went into effect in 2010:

• Lifetime limits on benefits are banned.

• Unreasonable annual benefit limits are restrained until banned.

• Protecting your choice of physicians.

• Insurance companies must provide free preventive services.

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More Provisions!

• 2010 MUST PROVIDE EMERGENCY SERVICES
without prior authorization whether in or out of network49

• 2010 ENDS RESCISSIONS
except for fraud

• 2010 BANS DISCRIMINATION BASED ON INCOME
unless self insured.

• 2010 BANS DUMPING

• 2010 ENSURES QUALITY OF CARE

• 2010 MUST PROVIDE AN INDEPENDENT APPEALS PROCESS

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Questions?

Blog:
http://my.barackobama.com/page/community/blog/patkittler

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HT T P : / / I PAT I E NTCA RE . CO M

Affordable care act

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