The Affordable Care Act and You

1. The Affordable Care Act and You What You Need to Know About the ACA

2. Why Did We Need Health Reform? Do you know anyone who: • Stayed in a job he didn’t like just to keep health insurance? • Works in a job (or several) that doesn’t offer coverage? • Doesn’t earn enough to buy insurance? • Can’t find a job that provides health benefits? • Has been denied coverage due to a pre-existing condition? • Has large medical debt?

3. It’s the Law March 23, 2010: The U.S. enacts comprehensive health reform legislation: • The Patient Protection & Affordable Care Act • “Obamacare” • “Affordable Care Act” • “ACA” It’s not perfect, but it’s a good start

4. The Building Blocks of the ACA Expandsaccessto insurance Increasesconsumer protections Emphasizespreventionandwellness Improvesqualityand outcomesof care Lowers health care costs

5. Expands Access to Insurance Medicaid Expansion All adults up to 138% of the Federal Poverty Level are eligible. Private insurance through the “Exchange” Offers choices of private insurance plans with financial help available to those who qualify.

6. Federal Poverty Levels for 2012

7. Exchange: Insurance Marketplace in 2014 • Creates one-stop shop • for easy comparison of coverage options Fun Facts about the Exchange: • Congress will get its coverage through the same Exchanges. • Gives consumers more choice and control • 1.4 mil Ohioans may use Exchange • Subsidies for individuals and tax credits for small businesses are available to make it more affordable • Offers coverage options through a website and helpline

8. Navigators – How to Get Help with the Exchange The Exchange is required to create a navigator program to • Inform people about their new insurance options • Help people enroll in their plan of choice • Help people keep their coverage (stay enrolled) Navigators will be trusted community members or insurance brokers. The Navigator does not choose a plan or influence the choice of a plan. Navigators must receive no direct or indirect payments from health insurers

9. Individual Responsibility Requirement • “The Mandate” Beginning in 2014, most individuals will be required by law to purchase or obtain health insurance coverage. How Can I Obtain Coverage? • Employer • Medicaid/CHIP • Medicare/TRICARE • The Exchange: Financial help through subsidies will be available Who is Exempt from the Mandate? • Individuals with financial hardship • Individuals with religious objection • Undocumented immigrants • Individuals whose income is below the threshold required to file a tax return • Individuals where the lowest cost health plan available exceeds 8% of their income 9

10. Why is the Mandate Necessary? All 3 legs of the stool are required to provide available and affordable to everyone. Without all three components, it couldn’t achieve these goals. • Guaranteed issue • Prohibits denial due to pre-existing conditions. • 2. Subsidies • Make insurance more affordable • 3. The Mandate • Requires almost everyone to buy insurance, so that everyone pays their fair share

11. Increases Consumer Protections • Ends discrimination based on pre-existing conditions and gender • Young adults can stay on their parent’s policy until age 26 • Prohibits lifetime and annual dollar caps on benefits • Prohibits cancelling policies, except for non-payment or fraud • Protects the consumer right to choose their doctor 11

12. Emphasizes Prevention and Wellness • Eliminates co-pays and deductibles for preventive care • Expands funding for Community Health Centers • Create a Prevention and Public Health Fund to expand prevention and public health programs • Requires chain restaurants to disclose the nutritional content • Permits employers to offer employees rewards up to 30% of the cost of coverage for participating in a wellness program 12

13. Improves Quality and Outcomes • Requires hospitals to do community needs assessments • Requires data on race and ethnicity to be collected • Provides funding to increase workforce development activities • Establishes Patient-Centered and Innovation Research Institutes • Reduces payments to hospitals for preventable complications and readmissions 13

14. Reducing Health Disparities • Health Disparities are the differences in rates of disease, health outcomes and access to healthcare found between different groups of people. • Why are they important to fix? • Improve health outcomes • How does the ACA address health disparities? • Potential to add resources to communities

15. Lowers Health Care Costs • Focuses on prevention, primary care and public health • Creates competition among health plans • Gradually lowers prescription costs for Medicare Recipients and closes coverage gap “doughnut hole” by 2020 • Fights waste, fraud, and abuse in the current system • Incentivizes hospitals to reduce preventable complications and readmissions 15

16. What’s Happening Now in Ohio? • Office of Health Transformation is working to implement the ACA • Ohio is modernizing health care system to provide better care at lower cots. • Consumers and other stakeholders are organizing to ensure the Exchange and Navigator Program work for all Ohioans • Hospital are assessing community needs to improve public health Will Ohio expand Medicaid to 138% FPL? Will Ohio build its own exchange? 16

17. What Can You Do? • Share this information with you friends and family • Schedule a presenter to attend a club or organization meeting • Learn how to write a Letter to the Editor • Attend a “Meet Your Legislator” Event • Stay informed by following us on Facebook and Twitter • Join our newsletter by signing up on our website 17

18. Questions? • Just Ask! • You can also submit a question at www.uhcanohio.org. • We will post new questions and answers every Tuesday and Friday. 18

19. Need Help? FOR MORE INFORMATION www.uhcanohio.org www.ohioconsumersforhealth.org www.healthcare.gov www.aarp.org www.kff.org Call our helpline at 614-456-0060 x233 UHCAN Ohio Ohio Consumers for Health UHCAN Ohio 370 S. 5th St Ste G3 Columbus, OH 43215 614-456-0060 @UHCANOhio @KathleenOCHC #OCHContheRoad 19