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The Truth About Health Reform: What It Means To Us

The Truth About Health Reform: What It Means To Us. Ellen R. Shaffer PhD MPH Joe Brenner MA EQUAL Health Network Center for Policy Analysis www.equalhealth.info 415-922-6204 ershaffer@gmail.com. ,. The Truth About Health Reform What It Means To Women Seniors. ,. 2.

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The Truth About Health Reform: What It Means To Us

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  1. The Truth About Health Reform:What It Means To Us Ellen R. Shaffer PhD MPH Joe Brenner MA EQUAL Health Network Center for Policy Analysis www.equalhealth.info 415-922-6204 ershaffer@gmail.com , EQUAL Health Network

  2. The Truth About Health ReformWhat It Means ToWomen Seniors , 2 EQUAL Health Network EQUAL Health Network

  3. EQUAL Health Network Equitable, Quality, Universal, Affordable health care Network for progressive policy and advocacy Links: Public health, women, seniors, faith groups Policy-makers Center for Policy Analysis, anchor 3 EQUAL Health Network

  4. EQUAL’s Program:Making Health Reform Work Educate Handout and website: summary of the law Implement Comment on regulations Improve Next steps toward EQUAL health care 4 EQUAL Health Network

  5. ACA: Historic Achievement Patient Protection and Affordable Care Act Most substantial health reform since Medicare and Medicaid in 1965 Expands coverage Improves quality Begins to control costs Complex, some misunderstandings 5 EQUAL Health Network

  6. I. How We Got Here: The ProblemsII.Major ImprovementsIII. Making it WorkIV. Fixing the Future , 6 EQUAL Health Network EQUAL Health Network

  7. EQUAL Health Network

  8. Does Everyone Deserve Health Care? Will it Hurt Me? • I’ve worked hard, I’ve gotten what I’m supposed to get. I have what I need and if the other people don’t, then that’s their problem. • So your average person has fairly good access. They’re happy with their physician and they’re frightened that something’s going to happen to that. • Anna Deveare Smith EQUAL Health Network

  9. We’re All In This Together • I am approaching retirement and worried that I won't be able to afford drugs when I'm ill. • My daughter graduated from college recently and is concerned about keeping a job. • The costs of health insurance encourage layoffs. We need to encourage job creation! EQUAL Health Network

  10. A Doctor’s View • I believe it is essential to bring quality health care to this country. • How many people must get sick and die before we adopt a reasonable working affordable health care system not determined by the drug industry and insurance companies? EQUAL Health Network

  11. Crisis in Costs, Access, Quality $2.5 trillion a year Health care inflation growing faster than economy 50 million uninsured Outcomes in U.S. worse than countries with universal coverage U.S. companies and workers: constraint on competitiveness 11 EQUAL Health Network

  12. Employment-Based Insurance Most people under age 65 get insurance through work – but employers don’t have to provide it Large employers: 96% offer Small employers: 43% offer (fewer than 50 employees) 12 EQUAL Health Network

  13. The Decline in Employer Coverage 69.0% Private employer-provided health insurance Over 15 percentage point decline Percent covered by own employer insurance 54.9% Source: Economic Policy Institute, State of Working America, 2006/2007 EQUAL Health Network

  14. Women At Risk • Lower income • Less likely to get insurance through work • More likely to be covered as dependents • Caretakers for families • Longer lives • Gender discrimination • Can charge higher rates for insurance • Reproductive health care EQUAL Health Network

  15. Medicare At Risk • Popular federal government program covers entire population over age 65 • Due to go bankrupt in 2017 • More efficient than private sector health plans • But still affected by the problems of the overall health care system EQUAL Health Network

  16. Adjusted odds of mortality by race and insurance status EQUAL Health Network

  17. The Political Challenge:Controlling Costs = Reducing Income Effective cost control would improve access and quality But it involves reducing payments to the health care industry Provokes political opposition 17 EQUAL Health Network

  18. $2.5 Trillion: Spending or Income?Industry Opposes Income Constraints , 18 EQUAL Health Network EQUAL Health Network

  19. What Do You Think? • Great law – about time! • Pretty good, wish it were single payer • All depends how it gets implemented… EQUAL Health Network

  20. We Are All Ambassadors • If you’re here today, you stand to benefit • Whether insured or not, employed or not • What you do – or don’t do – will make a difference EQUAL Health Network

  21. II.Major Improvements , 21 EQUAL Health Network EQUAL Health Network

  22. Immediate Benefits +Phased-In Benefits Expanded Coverage Better Affordability Curbing Insurance Abuses Down payments on Cost Control: Quality Improvements, Primary care, Public Health and Prevention, Rate Regulations Protecting Medicare , 22 EQUAL Health Network EQUAL Health Network

  23. Timeline: ACA Benefits Phased In 2010-2013 Consumer protections from insurance co. practices Affordability and quality improvements 2014: Major coverage expansions Health Insurance Exchanges For individuals, small business employees Individual Mandate Subsidies to 400% of poverty ($88,000/yr family of 4) Employers contribute to Exchange if employees use subsidy Medicaid Expanded Everyone up to 133% of poverty level 2020: “Donut hole” in Medicare drug coverage gone 23 EQUAL Health Network

  24. Immediate Improvementsin 2010 Coverage: New High Risk Pool for uninsured Coverage for Young Adults through Age 26 on parents’ plans Affordability: Small business tax credits of up to 35% Rebates begin to close gaps in Medicare coverage for drug costs – the “donut hole” Reduces cost of early retiree coverage 24 EQUAL Health Network

  25. Immediate Improvements Stops Insurance Abuses: Discrimination against children with pre-existing conditions prohibited Rescissions Illegal (withdrawal of care) Bans lifetime limits on coverage Down payments on Cost Control: Quality Improvements, Primary care Public Health and Prevention Rate Regulations 25 EQUAL Health Network

  26. Insured Through Work?New Protections Benefit You • Bankruptcy protection: Limits on out-of-pocket spending • Insurance abuse protection: No recissions: cannot withdraw coverage • Workplace abuse protection: You don’t have to keep your job to keep your health insurance EQUAL Health Network

  27. Medicare • Insolvency delayed almost 2 decades • Changes to Medicare Advantage • Promising trials on quality improvement EQUAL Health Network

  28. Coverage , 28 EQUAL Health Network EQUAL Health Network

  29. Coverage Currently 50 million uninsured ACA Expands coverage to 32 million people currently without insurance , 29 EQUAL Health Network EQUAL Health Network

  30. Coverage: Medicaid Will cover everyone up to 133% of poverty 16 million would be newly covered Begins 2014 Maintenance of Effort til Then , 30 EQUAL Health Network EQUAL Health Network

  31. Health Insurance Exchanges: Who Offer guaranteed coverage to: Uninsured individuals Self-employed Small businesses Members of Congress and staff Safety net if insured & lose a job. NOT FOR MEDICARE BENEFICIARIES! , 31 EQUAL Health Network

  32. Parity for Mental Health • Based on Wellstone-Domenici Act of 2008 • Mental illness covered at parity with physical illnesses • January 1, 2010- Employers with 50 or more employees • California • AB 1600 to cover employers with fewer than 50 employees EQUAL Health Network

  33. Affordability EQUAL Health Network

  34. Affordability: Insurance Exchange Plans Subsidies for insurance premiums for incomes up to 400% of federal poverty limit $88,000 for family of 4 Limits on out-of-pocket costs ($5,950 for individuals and $11,900 for families in ) to prevent medical bankruptcies , 34 EQUAL Health Network EQUAL Health Network

  35. Premiums on the Exchange Premium contributions limited based on income as a percent of Federal Poverty Level (FPL): • 150% FPL ($16,245/yr): $ 68/month • 200% FPL ($21,660/yr): $113 • 250% FPL ($27,075/yr): $191 • 300% FPL ($32,490/yr): $ 257 Hardship exemption: Available if lowest cost plan exceeds 8% of an individual’s income EQUAL Health Network

  36. Affordability: Individuals Still a big concern Can still be too expensive for some , 36 EQUAL Health Network EQUAL Health Network

  37. New: Insurance Exchange Example: 4-person family at 180% FPL($40,000) , 37 EQUAL Health Network EQUAL Health Network

  38. New: Insurance Exchange Example: 2-person family at 550% FPL($80,000)No Subsidy , 38 EQUAL Health Network EQUAL Health Network

  39. Early Retiree Reinsurance Program • Reimburses plan sponsors for certain claims between $15,000 and $90,000 for retirees age 55-64. EQUAL Health Network

  40. Insurance Reform: Limits on Insurance Premiums • Cannot charge more if: • You are sick • You are female (Gender-rating) • Age-rating limited, 3:1 • No more annual or lifetime limits • Administrative costs limited • No underwriting • Easier to compare plans , 40 EQUAL Health Network EQUAL Health Network

  41. Cost Control: Regulating Premiums Expanding Public Health Protecting MedicareImproving Quality , EQUAL Health Network EQUAL Health Network

  42. Regulating Premiums • 80-85% of premium must be spent on health care (vs. admin., profit) • Exchanges: Secretary of HHS can reject “unreasonable” rate hikes • CA: Stopped 39% Wellpoint, 19% Aetna • State laws can expand EQUAL Health Network

  43. Public Health: Overview 95 cents of each care dollar is for treating illness For the first time, an ongoing investment in prevention and public health Moving from a “sick care” system to a wellness-based system. Focus on prevention to improve the public’s health and help control costs EQUAL Health Network

  44. Leading causes of preventable deaths Tobacco Smoking OverweightandObesity Alcohol consumption Infectious diseases Toxicants Traffic collisions Incidents involving firearms Sexually transmitted diseases Drug abuse EQUAL Health Network

  45. Prevention can make a difference • Tooth Decay is most common chronic disease in children (fluoridation, sugar education) • Half the adults and 1 in 4 children are overweight or obese (exercise, good nutrition) • 10% of adults and youth smoke regularly (stronger tobacco policies, taxes) • More than 1 in 4 adults have high blood pressure or high cholesterol (diet and activity) • Marty Fenstersheib, Sta Clara Cty EQUAL Health Network

  46. Public Health “National Prevention, Health Promotion & Public Health Council” - departmental Secretaries across the federal government. Fund HHS Office of the Secretary to expand and sustain a national investment in prevention and public health programs $500 million/yr Starting 2015 - $2 billion/yr Public health workforce loan repayment Monitor minority health Source: American Public Health Association , 46 EQUAL Health Network EQUAL Health Network

  47. Public Health Grant Programs • Public Education Campaigns • Centers on Excellence on Depression • Education and Training Grants & Loan Repayment • Community Health Centers • School-based Health Clinics • Community Transformation Grant • Early Childhood Home Visitation EQUAL Health Network

  48. Access • $11 Billion to Community Health Centers • Important models of high quality primary care • Adds access for newly insured EQUAL Health Network

  49. What Happens to Medicare? , 49 EQUAL Health Network EQUAL Health Network

  50. 3 Facts – The New Law Will: • Improve many Medicare benefits Quality Improvement Programs set models for health care system NO CUTS in basic Medicare benefits • Extend Medicare’s solvency by 12 years to 2029. • Help people obtain long-term care at home. NCOA EQUAL Health Network

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