HEALTH CARE REFORM What It Means for You Ohio Consumers for Health Coverage January 2011
Introduction In March 2010, Congress passed and the President signed comprehensive health reform legislation. It is known as the Affordable Care Act.
Our Role in Reform UHCAN Ohio and the Ohio Consumers for Health Coverage worked to give Ohioans a voice in health care reform. We made our voices heard based on the stories we heard from Ohio families.
What We’ll Cover • What is the Affordable Care Act? • Who does it help? • And how? • How will we pay for it?
How Reform Expands Affordable Coverage Remember hearing, “If you like your coverage, you can keep it?” Well, it’s true. The Affordable Care Act keeps the current private, employment-based health insurance system, with • More accountability; • More help for people who need it; • More choices for people who already have coverage; These improvements will be phased in between 2010 -2014.
Questions to Think About… Now that it’s passed… What’s in it and how it will affect us? • What about reform are you hopeful about? • What questions or concerns do you have?
How’s It Work? Guaranteed issue: Prohibits denial due to pre-existing conditions Mandate: Requires almost everyone to buy insurance, so that everyone pays their fair share Subsidies: Make insurance affordable for everyone There are 3 legs in this stool – pull one out and it falls.
What is the Individual Mandate? • Applies to all US citizens and legal residents. • Exemptions for: • religious objections, financial hardship, undocumented immigrants, American Indians, people earning under the tax filing threshold, and for short gaps in coverage. • The mandate guarantees health coverage will be fair.
Pre-Reform Blueprint:What It Looks Like NOW. Chart prepared by PICO National Network, Washington D.C. 2010
Post-Reform Blueprint2014 Chart prepared by PICO National Network, Washington D.C. 2010
What is a Health Care Exchange?(2014) • A “Virtual Marketplace” – apples to apples, rating system • Run by the state or the federal government (state’s choice) • Hotline to help people shop • Insurance companies that want to sell insurance in the Exchange must be accountable for certain standards • Will allow consumers to have choices and control over their plans • Congress will get their coverage on the exchange
Helping Us with Affordable Coverage • Medicaid will be available to all adults, including childless adults, with incomes up to 133% of the Federal Poverty Level • ($29,326 for a family of 4) • SCHIP will give parents peace of mind by covering children until 2019. • Doctors accepting Medicaid will be paid more.
Helping Young Adults Nationally • September 2010 • Will allow young Americans to remain on their parents’ health insurance until their 26th birthday. Begins when insurance plan renews on or after September 23, 2010. • Over 2 million previously uninsured young adults will benefit from this provision. • January 1, 2014 • Offer young adults under age 30 the option of purchasing a low-cost Catastrophic-Plan • All other benefits listed for general population
Helping Young Adults in Ohio • Under state law: • Young adult must be unmarried and • Not yet 28 years old • Resident of the state • Not employed with possibility of any health plan in which they are eligible for coverage • Not eligible for Medicaid and Medicare
How Will Health Care Reform Help People with Chronic Health Conditions? 2010 • Can no longer deny insurance to children because of a pre-existing condition. • Will offer coverage to people with pre-existing conditions through a “High Risk Pool.”
Helping People with Chronic Health Conditions • 2010 (continued) • No more lifetime dollar caps on benefits • More limits on annual caps on benefits • Provide Medicare beneficiaries who go into the “donut hole” with a $250 rebate check… • 50% reduction in the cost of brand name drugs for Medicare beneficiaries in 2014 • Caps on out-of-pocket expenses
How Will Health Care Reform Help Older Adults? 2011 • Medicare beneficiaries who fall into the “donut hole” will pay 50% of brand name drug costs and will get 7% off generic drugs. • Immediate free preventive and wellness benefits • 2010 • $250 check for hitting the donut hole
Helping Older Adults • Also in 2011 • Medicare Advantage plans get fairer: • They cannot charge morethan traditional Medicare for certain services • Medicare Advantage plans that provide better quality care will receivebonus payments. • A percentage of these bonus payments must be used to provide additional health benefits and/or rebates to consumers.
Helping Older Adults 2014 • Like everyone else, older adults won’t be discriminated against by the insurance companies due to a pre-existing condition. • However, insurance companies are allowed to vary premiums based on age up to 3 times the premium paid by a young adult.
How Will Health Care Reform Help People with Disabilities? 2010 • Limits on annual insurance caps • Nolifetime insurance dollar limits 2011 (delayed) • “CLASS” program: voluntary insurance program to provide community-based assistance services and support
Help for People with Disabilities 2011 (continued) • States may be selected for incentive payments to expand home and community based services between 2011 and 2015. • “Community First Choice Option” will allow states to get additional Medicaid money to: • add community-based attendant services as part of their Medicaid benefit for people who qualify for nursing home care. • help with transition out of a nursing home.
How Will Health Care Reform Help Persons with Low Incomes? • More coverage • People up to 133% of the Federal Poverty Level • In 2010: $14,403 for an individual • Expanded categories means more people covered! • Subsidized premiums • Based on percentages of income
How Will Health Care Reform Help Women? • The ACA ends discrimination based on gender • 2010: • For new plans, changed costs for preventive care: • Includes services such as mammograms, immunizations, and screenings for cancer and diabetes. • No longer require pre-authorization or referral for OB-GYN care. • 2014: the law ends the common practice of “gender rating.” • An insurer will no longer be able to charge women more than men for the same coverage. • Insurance companies will no longer be able to deny coverage due to a pre-existing condition such as breast or cervical cancer, pregnancy, or C-section.
How Will it Help Immigrants? • If you are an immigrant with current insurance and you like it, you may keep it • As a lawfully present immigrant, you may choose in 2014 to join the exchange • If you lack legal status in the U.S. you can’t buy insurance or get subsidies, but your family members who are citizens or legal immigrants may do so.
How Will Health Care Reform Help Minority Communities? • Minority communities currently experience less access to health care and worse outcomes than the population as a whole. • The Affordable Care Act will provide loan repayments and scholarships for students from disadvantaged backgrounds seeking to work in medically underserved areas. • The expansion of Medicaid and the availability of subsidies will help to reduce the access disparity.
How Will Health Care Reform Help Minority Communities? Grants for community health programs and community health workers to promote wellness and address disparities • Regularizes data tracking on health disparities. • Supports programs that develop cultural competency in the health care work force.
How Will Health Care Reform Help Small Businesses? Fewer than 1/2 of Ohio’s small businesses provide health coverage 2010 • Tax credits will become available to qualified small businesses, those with fewer than 25 employees and average wages less than $50,000. Full credit for those with 10 or fewer employees and average wages not exceeding $25,000. (Owners wages don’t count). 2014 • Small Businesses can use the Exchange as part of a large pool of purchasers, which will reduce premiums.
Strengthening the Safety Net for All Ohioans • Federally Qualified Health Centers (FQHCs) • offer a comprehensive source of primary care • located in areas that have a shortage of providers. • serve people of all incomes who have private, public or no insurance, • required to have a sliding scale for persons with low incomes. • Total of $11 billion nationally in new funding for health centers over 5 years • By 2015, FQHCs will serve 700,000 additional Ohioans to get ongoing primary care at health centers in their communities.
Strengthening the Safety NetFor All Ohioans • Hospital Charity Care and Community Benefits • Non-profit hospitals get valuable tax-exemptions to address community needs • New requirements for Non-Profit Hospitals: • Develop written financial assistance policies • Limit what they charge for services • Observe fair billing and debt collection practices • Conduct regular community needs assessments • More federal oversight of hospitals
How Will We Pay for Health Care Reform? 2010 • Increased government oversight over Medicare waste. • Medicare Advantage plans will no longer be paid 14% more than traditional Medicare to care for their beneficiaries. 2011-2013 • Increased revenues from people who will no longer be permitted to put as much tax free income into Flexible Spending Accounts.
How Will We Pay for Health Care Reform? 2013 • Upper income individuals and families will contribute more to the Medicare Trust Fund, including a tax on net investment income (excluding retirement plans). 2014 • Everyone must pay their fair share by purchasing health insurance for themselves and their dependents, if they don’t already have it (“Individual Mandate”). 2018 • Insurers will have to pay a 40% excise tax on high cost group plans. The tax is on the cost of coverage in excess of $27,500 (family coverage) and $10,200 (individual coverage)
How Will Health Care Reform Control Costs? Competition • It will establish a Health Insurance Exchange Prevention • Pilot programs such as Medicare paying a doctor or hospital for the total care for a person with a certain disease, rather than a payment for every test or procedure. • Investing in preventative care
How Will Health Care Reform Control Costs? Efficiency: • Insurance companies must use MORE of their premium dollar to pay health care claims, and LESS for profits, administration, etc. • If they fail to do this, they will have to provide a rebate to their customers. • Providing funding to make electronic medical records more widespread • Gathering and disseminating research on which treatments work, and which don‘t
How Reform Improves Quality and Reduces Costs of Care • The ACA promotes new ways to pay for and deliver care to improve quality & care coordination • patient-centered primary care demos & pay more for primary care • Center for Medicare & Medicaid Innovations to test and approve new models • Independence at Home, Medication Management • Care transitions, reduce preventable readmissions • Expand and improve health care workforce • Measure and develop strategy for improving quality
So, What Can I Do? Make a difference • Share your story: Tell your friends, neighbors, faith community members and lawmakers how the Affordable Care Act is helping you and your family get the care you need to stay healthy. Got to www.ohioconsumersforhealth.org Select the “Tell your Story” tab. • Spread the Word: Write a Letter to the Editor or an article for your community newspaper or a group newsletter. • Volunteer!: Join us! (OCHC, Ohio Campaign, Dental Access Now!)
Dental health is Ohio’s top unmet health need. Dental Care is Unaffordable and Inaccessible for Many Ohio Residents • Due to low numbers of dentists serving rural and low-income patients • 3 times as many Ohioans lack dental insurance as health insurance • At least 850,000 Ohioans live in HPSA’s (dental health professional shortage areas ) • 50% of Ohio adults have had at least one tooth removed due to tooth decay or gum disease
The dental care shortage impacts the most vulnerable the hardest. Mothers with gum disease have higher rates of pre-term birth Appalachian & non-white Ohio adults are more likely than others to have had teeth removed Early detection of cavity-causing bacteria by the time the first tooth erupts is critical to preventing Early Childhood Caries disease. How You Can Help: • Become a supporter of this campaign! • Contact: David Maywhoor, Dental Project Director • firstname.lastname@example.org, (614)456.0060x225 • Share your personal or family story of people who are suffering or have suffered a dental issue. • Contact: Raquel Rios, Outreach Coordinator • email@example.com, (614)456.0060x230
Shining the Light on the Health Care System • Received conflicting information from different doctors? • Had to act as a communicator between doctors? • Have you ever had to repeat the same medical tests, such as x-rays or blood tests? • Have you ever been readmitted to the hospital for something that could have been prevented? • Left the doctor’s office or hospital confused about what to do? Have you ever…
Making Health Care Reform Work for Ohio’s Older Adults • 77% of older adults currently have chronic health conditions • Over 25% of Ohio Medicare patients report their doctor doesn’t listen, explain, show respect, or spend enough time with them. • Older adults and people with chronic conditions • Make the HEAVIEST USE of healthcare • With the POOREST OUTCOMES • With the GREATEST CHALLENGES • And with the HIGHEST COST • Goal #1: • Improve the health care system so it delivers: • high quality, • comprehensive, • and coordinated care • to older adults with chronic conditions. Goal #2: Build a strong, lasting consumer voice for better care by mobilizing older adults and their families.
Become a supporter of this campaign! • Share your personal or family story of an older adult or caregiver who is struggling to get better care at lower cost. • Contact: Julia Nielsen Bingman Ohio Coordinator of the Campaign for Better Care • firstname.lastname@example.org, (614)456.0060x229 How You Can Help: It will work for everyone. When we meet the challenge of making our health care delivery system work for older and chronically-ill adults…
Where Can I Learn More About Health Care Reform? Ohio Consumers for Health Coverage www.ohioconsumersforhealth.org More helpful resources for health care reform: • Healthcare.gov • www.aarp.org • www.communitycatalyst.org • www.familiesusa.org • www.kff.org • www.piconetwork.org
Acknowledgements Many thanks to AARP, Community Catalyst, Families USA, and the PICO National Network for sharing with us their own resources and presentations, some of which are incorporated into this presentation.
FOR MORE INFORMATION Cathy Levine, Executive Director, UHCAN Ohio OCHC, Co-Chair (614) 456-0060 x 222 email@example.com Col Owens, Senior Attorney, Legal Aid of Southwest Ohio OCHC Co-Chair 215 E. Ninth Street Cincinnati, Ohio 45202 (513) 300-3042 firstname.lastname@example.org Kathleen Gmeiner, UHCAN Ohio and OCHC Project Director (614) 456-0060 x 223 email@example.com