The document discusses the Affordable Care Act and proposals to improve the US healthcare system further. It outlines how the ACA established protections for those with pre-existing conditions, prevented lifetime spending caps, and provided access to preventative care. However, it notes healthcare costs remain high and not all states have expanded Medicaid. The document proposes ideas like improving the ACA insurance marketplaces, expanding Medicaid eligibility, increasing transparency around healthcare costs, and regulating insurance rate increases. The overall message is that the ACA made progress but more work is needed to improve access and affordability.

1. The Affordable Care Act & Beyond
Making health care more secure and
returning control to consumers moving forward
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2. Before the
Affordable Care Act
It was legal for health
insurance Companies to
DENY COVERAGE
to kids with cancer and other
pre-existing conditions.
We cannot go back.
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3. Denied
Pre-existing
condition
We cannot go back.
This January
It became illegal for health
insurance companies to
DENY COVERAGE
to people with cancer and to
cancer survivors
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4. Starting this year
It became illegal for health
insurance Companies to
DENY COVERAGE or
CHARGE HIGHER RATES
to all people with pre-
existing conditions
We are moving
forward.
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5. Freedom:
• Every American should have the freedom to control their own
medical decisions without interference from insurance
companies.
Access to Health Care is an
American Value

6. Access to Health Care is an
American Value
Opportunity:
• Americans who lack access to stable
and affordable health coverage do
not have a fair shot at the American
dream. They face a constant threat
of having their lives and careers
devastated by health disasters that
also become financial disasters.
• Every American should have the
opportunity to change jobs or start a
small business without losing health
coverage.

7. Access to Health Care is an
American Value
Responsibility:
• Everyone should take responsibility for getting health care
coverage for themselves and their families so long as it is made
affordable and accessible.
• The insurance industry should be able to make reasonable profit
but in return should be held accountable by not profiting from
abusive practices and discrimination.

8. Access to Health Care is an
American Value
Cooperation:
• The cost of healthcare cannot be stabilized by one
good actor or business, it requires cooperation from
many sectors – civic, private and public.

9. Moving Beyond The
Affordable Care Act
How the national health care law
advances American health care values and how we
can advance them further.
--Passed March 23, 2010
--The first stages of reform
are here,
But first, we’re talking about
this because…

10. It’s the law of the land and it’s time to move forward. The
private market failed to guarantee access to affordable health
coverage. For the first time everyone will have somewhere to
go to get good coverage at a reasonable price, no matter what.
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11. Early Reforms
The Affordable Care Act holds insurance industry
and government responsible for:
• Preventive care coverage & screenings with no co-pays
or deductibles
• Young adults can stay on parents private insurance
policies until age 26
• Preventive care without cost sharing for seniors on
Medicare
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12. Because of
healthcare reform
over 3 million young
adults are now
covered on their
parents’ policy.
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13. Early Reforms
Insurance industry violations of health care freedom
now outlawed by the Affordable Care Act
• Preexisting condition exclusions
• Lifetime limits
• Dropping coverage after a person gets sick
• Excessive insurance industry profits and overhead capped
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14. Sami’s Story
“My 7-year-old son, Sami, suffers from a
disease that causes tumors to grow all
over his body. Sami’s treatments could
not continue if we hit our insurance
policy’s life time limit. Thanks to the
Affordable Care Act, insurance companies
can no longer impose lifetime limits or
deny health coverage to children like Sami
with preexisting conditions. We can’t go
back to being on our own against the
insurance companies.”
--Tracy, Appleton, Wisconsin
.
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15. The Affordable Care Act ends health
insurance industry assault on
opportunity and freedom of 1.3 million
Wisconsinites
• More than 1.3 million
Wisconsinites under the age of
65 have been diagnosed with pre-
existing conditions that, without
health reform, could lead to
denials of coverage or
discriminatory rates.
• As we age, the risk of insurance
industry discrimination escalates.
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16. Just Some of the Examples of Preexisting
Conditions

17. Gender Discrimination
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18. The Cost of
Healthcare
“The two main lessons are the notion that there was a
pre-existing double-digit trend, and that it was
variable…It could have gone up 100% for a sick guy
and gone down some for a healthy guy."
-Jonathan Gruber, MIT economist
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20. Every dollar that
health coverage
increases…
…is one less dollar
our families can
spend on the basics
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21. Amount a typical
family of four pays for
health care
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22. As of This Year:
Health coverage guaranteed to everyone who buys insurance
on their own or works for a small business
through new consumer-friendly competitive marketplaces at
Healthcare.gov. Guaranteed care that can never be taken
away.
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23. Competitive Health
Marketplace for Middle
Class: Healthcare.gov
• Coverage more secure: Insurance companies can
never deny or drop coverage due to medical conditions
• Coverage more affordable: premium tax credits on a
sliding scale to guarantee affordable options.
• New options, such as nonprofit member owned
cooperatives to keep insurance companies honest.
• No discriminatory pricing based on medical condition,
age, or gender.
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24. Remy’s Story
“I own a small café. Over 20 years ago I
beat cancer, but ever since then no
insurance company would sell me a policy
because my cancer is called a preexisting
condition. Thanks to the Affordable Care
Act, no insurance company will be
allowed to discriminate against me
because I’m a cancer survivor.”
--Remy, Pepin, Wisconsin
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25. The Next Big Thing:
• Coverage must be more affordable
• Not everyone is covered yet
• First step was coverage, more to do to improve
care.
• We can go above and beyond the law, and other
states are.
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26. We pay more than other countries, a lot more.
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27. And the disparity is getting worse, not better.

28. Inflation-Adjusted Change in Medicare and Commercial Health Insurance
Claims Costs, 2003-2012
Medicare has actually done a better job than private insurance
at holding down the high cost of care.

29. BadgerCare for low income
Wisconsinites
• The Affordable Care Act gives billions in federal dollars to
WI to fill in the holes in BadgerCare.
• Gov Walker’s approach costs Wisconsin $149 million more
in this budget & forced thousands off BadgerCare. 84,700
are currently denied BadgerCare.
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30. • The good news is that because of the Affordable Care
Act people forced off of BadgerCare will have access
to the new health insurance marketplaces.
• The bad news is that it will be hard for very low
income people to afford because the law assumed that
this group would end up on BadgerCare.
• The additional good news is we can accept these
federal funds at any time.
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31. Before You Assume This is
A Partisan Issue…
• Chris Christie, New Jersey, (R)
• Jan Brewer, Arizona, (R)
• Rick Scott, Florida, (R)
• Terry Branstad, Iowa (R)
• Rick Snyder, Michigan, (R)
• Brian Sandoval, Nevada, (R)
• Susana Martinez, New Mexico, (R)
• Jack Dalrymple, North Dakota, (R)
• John Kasich, Ohio, (R)
Conservative Governors Who Support Accepting Federal
Funds

32. Terry’s Story
"I'm a personal care worker, I work at a
group home and makes $9 an hour
taking care of people's health. Even
though I work to keep other people
healthy, I do not have affordable health
care myself. I have not been able to
qualify for BadgerCare, in fact I'm just
over number 141,000 on the waiting
list. I'm father of three, I want to give
my children their chance at the
American dream but without health
insurance, we're looking at an
uncertain future."
-Terry O, Milwaukee
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33. Why This Matters To
Cost.
Insurance companies, now prevented from charging more based
on preexisting conditions and gender, make prices based on
state/community data.
• Individual rates in WI are over $250 more per year by
refusing funds for BadgerCare
• For two reasons:
• New low income individuals purchasing plans, tend to be
sicker.
• More uninsured using emergency rooms, uncompensated
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34. State Doing Worse
As other states improve their
health sector, if we don’t
improve we’ll fall behind.
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35. Why Is This Even An
Issue?
• Big Insurance wants to repeal health
reform so it can continue to profit
from discrimination.
• Some unscrupulous politicians want
to sabotage the implementation of
health reform in order to further
their political ambitions.
•There are ideological opponents who refuse to accept health reform
and cannot be swayed by any amount of facts showing the benefits.

36. Idea 1: Improve the
Purchasing Power of the
Marketplace.
• The idea of the marketplace is for all of us to
collectively negotiate lower rates.
• Next year, small businesses can join the
marketplace the same way individuals can.
• We could improve cost by bringing individuals,
small businesses and large businesses together to
negotiate.
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37. • The federal Medicaid funds for BadgerCare is not
the only way to improve BadgerCare
• Another source: “Basic Health Plan”
• Thousands more Wisconsin citizens could be
covered by BadgerCare: saving both them and the
state money and reducing health care costs.
Idea 2: Improve
BadgerCare Even
Further.
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38. Idea 3: Hold Insurance
Companies Accountable.
Wisconsin has consumer
protection powers it has never used:
1. Review rate increases: Wisconsin could
prevent excessive rate increases year to
year.
2. Directly negotiate with insurers to reduce
rates for everyone purchasing coverage.
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39. • If consumers can’t see what
procedures cost, they can’t shop
around
• If advocates can’t access data, we
can’t share what works
Idea 4: Make
Healthcare
Transparent.
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40. The Affordable Care Act is
Worth Improving
Insurance companies must now play fairly.
It’s the law.
• PROTECTION: Working families no longer can be denied coverage for
preexisting conditions, risk losing their coverage when they get sick or hit a
“lifetime limit”.
• PREVENTION: Preventative care must be covered free of charge by
insurance companies--including mammograms for women and wellness visits
for seniors.
And we can do better!
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41. The Affordable Care Act is Worth
Improving
Insurance companies must now play fairly.
It’s the law.
• FAIRNESS: Millions of Americans have received a rebate because their
insurance company spent too much of their premium on administrative
costs or CEO bonuses.
• PEACE OF MIND: Families will not be forced into bankruptcy when
someone gets sick, and can get affordable coverage no matter where they
choose to work or what gender they are; with no loopholes or fine print in
their policy!
And we can do better!
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43. Questions?
• Kevin Kane
Lead Organizer
Citizen Action of Wisconsin
414 550 8280 (cell) @KevinKane
kevin.kane@citizenactionwi.org
Facebook.com/CitizenActionWI
www.CitizenActionWI.org
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