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The Affordable Care Act Workshop for Community Volunteers






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The Affordable Care Act Workshop for Community Volunteers

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1. The Affordable Care Act Workshop for Community Volunteers Funded by: Benedum Foundation The Consumer Protection Alliance Sisters of St Joseph Charitable Fund West Virginia AFL-CIO West Virginia Community Voices ? On March 23, 2010, President Obama signed comprehensive health reform, the Patient Protection and Affordable Care Act, into law. The following summary explains key health coverage provisions in the new law and incorporates changes made to the law by subsequent legislation. ? The legislation will do the following: ? Most individuals will be required to have health insurance beginning in 2014. ? Individuals who do not have access to affordable employer coverage will be able to purchase coverage through a health Insurance Exchange with premium and cost-sharing credits available to some people to make coverage more affordable. Small businesses will be able to purchase coverage through a separate Exchange. ? Employers will be required to pay penalties for employees who receive tax credits for health insurance through the Exchange, with exceptions for small employers. ? New regulations will be imposed on all health plans that will prevent health insurers from denying coverage to people for any reason, including health status, and from charging higher premiums based on health status and gender. ? Medicaid will be expanded to 133% of the federal poverty level ($14,404 for an individual and $29,327 for a family of four in 2009) for all individuals under age 65. ? The Congressional Budget Office estimates that the legislation will reduce the number of uninsured by 32 million in 2019 at a net cost of $938 billion over ten years, while reducing the deficit by $124 billion during this time period. ? On March 23, 2010, President Obama signed comprehensive health reform, the Patient Protection and Affordable Care Act, into law. The following summary explains key health coverage provisions in the new law and incorporates changes made to the law by subsequent legislation. ? The legislation will do the following: ? Most individuals will be required to have health insurance beginning in 2014. ? Individuals who do not have access to affordable employer coverage will be able to purchase coverage through a health Insurance Exchange with premium and cost-sharing credits available to some people to make coverage more affordable. Small businesses will be able to purchase coverage through a separate Exchange. ? Employers will be required to pay penalties for employees who receive tax credits for health insurance through the Exchange, with exceptions for small employers. ? New regulations will be imposed on all health plans that will prevent health insurers from denying coverage to people for any reason, including health status, and from charging higher premiums based on health status and gender. ? Medicaid will be expanded to 133% of the federal poverty level ($14,404 for an individual and $29,327 for a family of four in 2009) for all individuals under age 65. ? The Congressional Budget Office estimates that the legislation will reduce the number of uninsured by 32 million in 2019 at a net cost of $938 billion over ten years, while reducing the deficit by $124 billion during this time period.

2. 2 Topics for This PowerPoint Reform in Context Why Health Reform? What?s in the Affordable Care Act (ACA) Coverage Expansions Medicaid WV Health Benefit Exchange Changes in Medicare Insurance Reforms Controlling Costs /Improving Quality

3. 3 Health Reform in Perspective The 100 Year Debate The idea of universal health insurance isn't the brainchild of the Obama or Clinton administrations. It started in 1912 when a presidential candidate running under the Bull Moose Party called for insurance for all workers. It was Teddy Roosevelt, trying to regain the presidency. Since then, steps have been made toward universal coverage (along with many other medical innovations), but each president, Democrat or Republican, has either hit roadblocks ? or created them. The idea of universal health insurance isn't the brainchild of the Obama or Clinton administrations. It started in 1912 when a presidential candidate running under the Bull Moose Party called for insurance for all workers. It was Teddy Roosevelt, trying to regain the presidency. Since then, steps have been made toward universal coverage (along with many other medical innovations), but each president, Democrat or Republican, has either hit roadblocks ? or created them.

4. 4 100 Year Effort: Highlights 1933-45 Social Security 1963 - 1969 Medicare and Medicaid

5. 5 Republican/Democrat Reform 1969-1974 Supports system HMOs 1993-2001 Children?s Health Insurance Program (CHIP) 1/22/2013

6. 6 Medicare Part D 2001-2009 ACA 2009 1/22/2013

7. 7 March 23, 2010 President Obama signs Affordable Care Act (ACA) March 23, 2010 President Obama signs the Affordable Care Act ? the new health reform law. With him is Marcellus Owens, whose mother died because she did not have insurance. Reminding us what the ACA is about.March 23, 2010 President Obama signs the Affordable Care Act ? the new health reform law. With him is Marcellus Owens, whose mother died because she did not have insurance. Reminding us what the ACA is about.

8. 8 Why Health Reform? 72 Percent of Americans think health care system needs major overhaul A Call for Change: The 2011 Commonwealth Fund Survey of Public Views of the U.S. Health System

9. 9 The Uninsured

10. 10 Declining Employer- Sponsored Insurance

11. 11 Increasing Costs

12. 12 Comparison to Other Nations

13. 13 Goals of the ACA Expand coverage to most Americans New regulation of the insurance industry Control health care cost increases Improve the quality of care and work towards better health outcomes

14. 14 GETTING COVERED 1/22/2013

15. 15 Two Basic Expansions of Coverage Expand Medicaid to 133% of the federal poverty level (FPL) Create Exchanges, which we will discuss later

16. 16 Medicaid Today in West Virginia Federal/State Partnership: West Virginia receives $2.85 from the federal government for every dollar we invest Covers low income children, seniors and people with disabilities Medicaid will be expanded to all individuals under age 65 with incomes up to 133% of the federal poverty level ($14,404 for an individual and $29,327 for a family of four in 2009) based on modified adjusted gross income. This expansion will create a uniform minimum Medicaid eligibility threshold across states and will eliminate a limitation of the program that prohibits most adults without dependent children from enrolling in the program today (though as under current law, undocumented immigrants will not be eligible for Medicaid). Eligibility for Medicaid and the Children?s Health Insurance Program (CHIP) for children will continue at their current eligibility levels until 2019. People with incomes above 133% of the poverty level who do not have access to employer- sponsored insurance will obtain coverage through the newly created state health insurance Exchanges. ? ? The federal government will provide 100% federal funding for the costs of those who become newly eligible for Medicaid for years 2014 through 2016, 95% federal funding for 2017, 94% federal funding for 2018, 93% federal funding for 2019, and 90% federal funding for 2020 and subsequent years. States that have already expanded adult eligibility to 100% of the poverty level will receive a phased-in increase in the FMAP for non-pregnant childless adults. ? Medicaid payments to primary care doctors for primary care services will be increased to 100% of Medicare payment rates in 2013 and 2014 with 100% federal financing. Medicaid will be expanded to all individuals under age 65 with incomes up to 133% of the federal poverty level ($14,404 for an individual and $29,327 for a family of four in 2009) based on modified adjusted gross income. This expansion will create a uniform minimum Medicaid eligibility threshold across states and will eliminate a limitation of the program that prohibits most adults without dependent children from enrolling in the program today (though as under current law, undocumented immigrants will not be eligible for Medicaid). Eligibility for Medicaid and the Children?s Health Insurance Program (CHIP) for children will continue at their current eligibility levels until 2019. People with incomes above 133% of the poverty level who do not have access to employer- sponsored insurance will obtain coverage through the newly created state health insurance Exchanges. ? ? The federal government will provide 100% federal funding for the costs of those who become newly eligible for Medicaid for years 2014 through 2016, 95% federal funding for 2017, 94% federal funding for 2018, 93% federal funding for 2019, and 90% federal funding for 2020 and subsequent years. States that have already expanded adult eligibility to 100% of the poverty level will receive a phased-in increase in the FMAP for non-pregnant childless adults. ? Medicaid payments to primary care doctors for primary care services will be increased to 100% of Medicare payment rates in 2013 and 2014 with 100% federal financing.

17. Current Medicaid Coverage Federal government sets minimum eligibility standards for children. In West Virginia, parents qualify for Medicaid if they make less than 35 percent of the FPL (about $6,100 a year). Childless adults do not qualify even if they are penniless. Low-wage workers will be the primary beneficiaries of this expansion. Currently, the federal government sets minimum eligibility standards for children covered by Medicaid. For example, state Medicaid programs must cover infants up to 150 percent of the FPL. But for adults (other than those who are disabled or pregnant), the federal government does not establish minimum eligibility levels, and states are free to establish their own rules. In West Virginia, parents qualify for Medicaid if they make less than 35 percent of the FPL (about $6,100 a year); childless adults do not qualify even if they are penniless. Low-wage workers will be the primary beneficiaries of this expansion. Currently, the federal government sets minimum eligibility standards for children covered by Medicaid. For example, state Medicaid programs must cover infants up to 150 percent of the FPL. But for adults (other than those who are disabled or pregnant), the federal government does not establish minimum eligibility levels, and states are free to establish their own rules. In West Virginia, parents qualify for Medicaid if they make less than 35 percent of the FPL (about $6,100 a year); childless adults do not qualify even if they are penniless.

18. 18 Medicaid in 2014 under the ACA Covers all low income adults to 133% of FPL, that is $14,400 for a single person and $24,400 for a family of three 122,000 ? 157,000 uninsured West Virginians will be covered

19. 19 Medicaid in 2014 and beyond under the ACA Federal government pays 100% of the expansion for the first three years. In 2020 and beyond, the feds will pay 90% for the Medicaid expansion.

21. Medicare and the ACA Emphasis on prevention and wellness ? many preventive benefits and screenings now free to encourage healthier lifestyles Will decrease and eliminate subsidy for Medicare Advantage plans and sets limits for their administrative costs Targets perpetrators of health care fraud and abuse

23. Health Exchange = New Marketplace to Buy Health insurance

24. Health Benefit Exchange An exchange is a marketplace that allows small businesses and individuals to compare insurance policies and choose policies that best suits their needs. Policies offered through a web site, 1-800 number, or in person.

25. 25 Health Benefit Exchange Beginning on January 1, 2014 there will be significant tax credits for moderate and middle-income individuals. An estimated 178,000 West Virginians will qualify for tax credits in the exchange.

26. 26 An Example of Tax Credits for Individuals in the Exchanges Family of four with annual income of $55,000. They pay $345 a month in premiums and the tax credits equal $840 a month. Additional tax credits to assist with deductibles and copayments plus out-of-pocket maximum protection.

27. 27 The Exchange and Small Businesses Eligibility for the exchange is 50 or fewer employees, about 42,000 West Virginia businesses employing 280,000 people.

28. 28 Small Business Tax Credits 2010 through 2013 Employers with 10 or fewer employees and average salary of $25,000 or less 35% tax credit (25% for nonprofits) Phased out to employers with 25 or fewer employees making on average $50,000 or less.

29. 29 Small Business Tax Credits 2014 and beyond Same focus on very small businesses The tax credit is increased to 50% of the employers? premium contribution (35% for nonprofits). Limited to two years after 2014.

31. 31 Senate Bill 408 Adopted in March 2011, SB 408 establishes the West Virginia Health Benefit Exchange. Only the second exchange established in the country, since passage of the ACA. Housed in the Offices of the Insurance Commissioner, and governed by a ten member board.

32. 32 Board Composition Four agency heads: Insurance Commissioner Chair of the Health Care Authority Commissioner of Medicaid Director of the state?s CHIP program

33. 33 Board Composition Continued Three consumer representatives Individual consumers Small business Organized labor Three industry representatives Insurance companies Medical providers Insurance agents

34. 34 What Is the Mission of the Exchange in West Virginia? Three models: Utah: market organizer Massachusetts: active purchaser Negotiations with insurance companies

35. 1/22/2013

36. 36 Insurance Reforms for Plan Year Beginning After September 23, 2010 Ends pre-existing exclusions for children Young adults can stay on their parent?s policy until age 26 Prohibits lifetime caps and limits annual caps on benefits Limits on insurance companies? administrative cost

37. 37 Insurance Reforms Effective for Plan Year Beginning After September 23, 2010 Prohibits cancelling policies, except for non-payment or fraud For new plans sold after September 23, 2010: Must cover effective preventive measures with no cost sharing Patient protections

38. 38 Insurance Reforms 2014 An end to pre-existing exclusions for everyone An end to gender underwriting Guarantee issuance and renewal

39. Impact of the ACA Expanding health insurance coverage and the new regulations of the insurance industry will have an impact on: Entrepreneurship How insurance companies will compete in the future

40. 40 Individual Responsibility Beginning in 2014, individuals must have health insurance or pay a penalty. Exemptions for religious objections and financial hardship. Without individual responsibility, we cannot adopt the major insurance reforms.

41. 41 Two Ways to Reduce Costs in Health Care Focus on prevention, primary care and public health Innovation in how we pay for health care and how health services are provided

42. 42 Focus on Prevention, Primary Care and Public Health Expands Community Health Centers Expands National Health Service Corp More doctors More doctors for rural areas New funding for Public Health Increases appropriations to community health centers and National Health Service Corp and increases appropriations for public health Increases payment to primary care doctors that treat Medicaid patients Increases Medicare payment by 10% for primary care providers and general surgeons practicing in under-served areas Increases appropriations to community health centers and National Health Service Corp and increases appropriations for public health Increases payment to primary care doctors that treat Medicaid patients Increases Medicare payment by 10% for primary care providers and general surgeons practicing in under-served areas

43. Cost Containment ?The current (payment) system, based on volume and intensity, does not disincentivize, but rather pays more for overuse and fragmentation.? Mark McClellan

44. 44 Innovation in Health Care Delivery Accountable Care Organizations Independent Payment Advisory Board Value-based purchasing Patient-Center Outcome Research Institute Innovation Center within CMS

45. 45 Reduction in the Growth of Medicare Reduces the annual growth from 6.8 % to 5.5%

46. 46

47. 47 What Does the ACA Cost?

48. 48 How Can We Afford That? New Taxes and reduced growth in Medicare ACA will reduce the deficit by $210 billion Who says so? The Congressional Budget Office

49. 49 Revenues Tax Increases

50. 50 How will ACA Save Money?

51. 51 Revenues: Reductions in the Growth in Medicare

52. Threats to the ACA Court cases. The partisan divide continues. US Supreme Court is likely to make the final decision on the individual mandate. Repeal or repeal and replace.

53. Threats to the ACA Continued Debt ceiling process 2012 budget debate 2012 election

54. 54 Kaiser Family Foundation Quiz Ten true or false questions 36% of Americans got 0 to 4 questions right 40% got 4 to 5 questions right 25% got 7 to 10 questions right Only 0.4% of Americans got all ten questions right

55. 55 Knowledge Equal Support?

56. 56 Opportunities to Be Involved OIC has scheduled Consumer Advocate meetings on the development of the exchange on the third Monday of the month at 1 pm. You can participate by conference call or in person. Contact Perry Bryant to participate.

57. 57 Opportunities to Be Involved Health Care Implementation Coalition meets every other month. You can participate by conference call or in person. Contact Perry Bryant to be involved in the Health Care Implementation Coalition.

58. 58 We have an Opportunity to: Expand health insurance to virtually every West Virginian. You are the critical link in the public education campaign. Educate 50 co-workers, friends, etc. Participate in the OIC?s development of the health insurance exchange Join the Implementation Coalition

59. 59 Need Help: Contact Us Perry Bryant ? perrybryant@suddenlink.net Renate Pore ? renatepore@gmail.com Lisa Diehl -- lisadiehl@zoominternet.net www.wvahc.org www.healthreformwv.org www.healthcare.gov 1/22/2013


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