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The Patient Protection and Affordability Act: Implications for Grantmakers. Michael R. Cousineau , Dr.PH University of Southern California 2011. Health Reform Laws Enacted. H.R.3590  Patient Protection and Affordable Care Act Related Bills: H.CON.RES.254 H.RES.1203 H.R.3780 H.R.4872

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the patient protection and affordability act implications for grantmakers

The Patient Protection and Affordability Act: Implications for Grantmakers

Michael R. Cousineau, Dr.PH

University of Southern California

2011

USC Center for Community Health Studies

health reform laws enacted
Health Reform Laws Enacted
  • H.R.3590 Patient Protection and Affordable Care Act
  • Related Bills:
    • H.CON.RES.254
    • H.RES.1203
    • H.R.3780
    • H.R.4872
    • S.1728 
  • Became Public Law No: 111-148
  • http://www.thomas.gov/cgi-bin/bdquery/z?d111:HR03590:@@@D&summ2=3&

USC Center for Community Health Studies

three components of health care system and policy
Three Components of Health Care System and Policy
  • Access and equity
  • Costs and efficiency
  • Quality

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health coverage u s 1987 2008
Health Coverage U.S. 1987 - 2008

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costs how much do we spend
Costs: How much do we spend?
  • 2.4 Trillion, 2007
  • Projected to increase to $3.6 Trillion by 2014
  • Source: California HealthCare Foundation, 2010

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health spending share of gdp
Health Spending – Share of GDP

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quality
Quality
  • Only about half of services that doctors provide are evidence-based, and represent good medical practice
  • Errors, 44,000 deaths per year due to medical errors

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grading the aca
Grading the ACA
  • Access B
  • Costs C+
  • Quality C+

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implementation timeline
ImplementationTimeline

Full Implementation in 2014

Initial regulations (In effect now)

Most items phase in over the next two years

2010

2011

2012

2013

2014

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how does it affect private insurance
How does it Affect Private Insurance?
  • No Pre-existing conditions children now, adults 2014
  • High-risk pool established
  • Young adults can remain on their parents’ health plan until age 26
  • No lifetime caps or restrictive annual limits on coverage
  • Rescissions
  • No co payments for prevention

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how does ppaca expand coverage
How does PPACA Expand Coverage?
  • Expands Medicaid to all up to 133% of the federal poverty threshold
  • Health Insurance Exchange with Approved Health Benefit plan
  • Subsidies 133% and 400% of the federal poverty threshold
  • Estimated 35 million Americans

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individual mandate
Individual Mandate

Penalties for being uninsured:

$695 per adult

$2,085 per family

2.5% of household income

Maximum Amount - Whichever is greater

Exceptions:

  • No prosecutions 2014-2016
  • Financial hardship
  • Religious objections
  • American Indian ethnicity
  • Uninsured for <3 months
  • Income below tax filing threshold
  • Cost of least expensive plans >8% income
  • Incarcerated
  • Undocumented

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medicaid expansion
Medicaid Expansion
  • Those with incomes up to 133% of poverty
  • Does not include undocumented immigrants
  • Non citizens 5 year waiting period for subsidies

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health benefit exchange
Health Benefit Exchange
  • A new market for those in the individual market
  • Incorporates Medicaid
  • Provision for small businesses
  • Approved plans with an essential benefit package but different tiers
  • Provides subsidies in the form of tax credits for those from 134-400% FPL
  • Family premium limits ranging from 2.0% to 9.5% of income

USC Center for Community Health Studies

california health benefit exchange
California Health Benefit Exchange
  • A website that provides standardized comparison information on qualified health plan plans
  • A calculator for applicants to compare costs across plans
  • A web-based eligibility portal to help link individuals to health cover options available to them;
  • A toll-free consumer assistance hotline 

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how does it affect employers
How Does it Affect Employers?

Employers in Los Angeles County, by Firm Size, 2006

Small businesses: (<25 employees) can obtain coverage with subsidies (tax credits)

(N=289552)

(more than 1 million workers)

Source: Employer Firms, Establishments, Employment, [and] Annual Payroll and Receipts by Firm Size and State, 2006. U.S. Small Business Administration, Office of Advocacy. http://www.sba.gov/advo/research/st_06.pdf

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how does it improve quality and hold down costs

How Does it Improve Quality and hold down costs?

C+

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benefits and payments 2011 to 2013
Benefits and Payments 2011 to 2013
  • Medicaid physician payments increased for primary care services (2013 & 2014)
  • Medicare – preventive services & annuals at no cost
  • Elimination of the Medicare Part D “donut hole”

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health care delivery reform and practice redesign
Health Care Delivery Reform and Practice Redesign

Accountable Care Organizations

Payment for Quality Outcomes

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payment reform
Payment Reform

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what it means for california
What it Means for California
  • Extend health coverage to 3.8 million uninsured Californians
  • Protect and improve coverage for 21 millionCalifornians with employer-based or individual health insurance
  • Guarantee that 800,000 Californians with pre-existing conditions can obtain coverage
  • Allow 3.2 million young adults in California to obtain coverage on their parents’ insurance plans
  • (Sources: UCLA Center for Health Policy Research, Kaiser Family Foundation)

USC Center for Community Health Studies

slide22

Estimated Number of People in Los Angeles CountyAges 0–64 Years Eligible for Health Insurance and SubsidiesUnder the Patient Protection and Affordable Care Act

Source, CHIS, 2007. UCLA Center for Health Policy Research. Analysis by USC Center for Community Health Studies, 2010

USC Center for Community Health Studies

implementation in california
Implementation in California
  • Establishment of the California Health Exchange Board, AB 1602, SB 900 Peter Lee new CEO
  • Basic Health Plan, which is an option for the states, (SB 703), currently has not been reported out of committee
  • Establishment of Accountable Care Organizations (ACOs)
  • State Medi-Cal Budget

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problems and limitations
Problems and Limitations
  • People not covered
    • Undocumented immigrants
    • Those unable or unwilling to purchase coverage
  • Funding for DSH hospitals
  • State Medi-Cal Payments

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challenges moving forward
ChallengesMoving Forward
  • Logistical Challenge
  • Workforce
  • Political Challenges
  • Legal Challenges
  • Financial
    • The on going state budget crisis and the federal deficit
    • General economy

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health reform and the safety net
Health Reform and the Safety Net
  • With more people covered, what will be its role?
  • Medicaid 1115 Waiver (A Bridge to Health Reform).
    • Low income Health Insurance Program
    • The conversion of Medicaid SSI to managed care
    • System and practice redesign for Los Angeles County and its partners
    • A provider of last re sort to a system of choice

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thoughts for grant makers
Thoughts for Grant-makers
  • Stay informed
  • Continue to monitor and engage but also participate, and provide feedback about what is working
  • Promote learning and active community-based research
  • Making value-added investments, leveraging and partnering, build on what is there
  • Identifying, engaging and empowering new partners
  • Promoting and testing innovation, and encourage thinking out of the box
  • Educating and engaging the community

USC Center for Community Health