Health Care Reform:       Understanding the Affordable Care Act          What’s really in the new law?Presented by Amy Smo...
Health care legislation is designed to:• Reduce health care costs, both for  families and for the government.• Provide Ame...
Here’s how:
Significant Changes    to Private Health        InsurancePurchased by Individuals and     Small Businesses
The ACA gives us more   security and control• Insurance companies won’t be able  to turn people down because of pre-  exis...
Health insurance plans must cover       essential services.• Insurance plans will have to cover preventive care,  hospital...
Financial protections for people with insurance• Insurance companies can’t impose  annual or lifetime limits on how  much ...
Health reform makes it                        easier to buy                         insurance.• New Insurance Exchanges al...
Strengthening Critical    Public Health Insurance Programs
Improves Medicare.• Closes the “donut hole” in drug coverage and  lowers cost of brand name drugs• Provides preventive ser...
Improves Medicare.• Free preventive services in 2011• Medicare Advantage plans  cannot charge higher co-pays  than traditi...
ACA fixes   Medicare Part D.                 D• Closes the “donut hole” in  drug coverage and lowers  cost of brand name d...
Supports early retirees.Federal funds are currently available to helpbusinesses afford the cost of health insurancefor ear...
Access to home and community-based  services for people with disabilities• The Community First Choice option makes  commun...
The law expands State                      health insurance programs                           for those who need it.• Sta...
Tax Credits forIndividuals and Small     Businesses
Support for small businesses• Premium subsidies to employers  Employers with up to 25  employees and annual wages  that av...
Help for                        moderate-income                              Americans• Families and individuals will rece...
Health reform encourages      prevention and wellness.• No deductibles or copayments for preventive  services.• Grants for...
ACA protects Children.                      Children• Insurance companies can’t deny children  insurance because of a pre-...
ACA helps  people with medical conditions.                      conditions• People with a disability or mental illness can...
ACA gives caretakers more choices. • People in the sandwich generation   and caretakers will have guaranteed   coverage an...
ACA protects seniors in               nursing homes.                       homes• Elder Justice Act:  – Authorizes new cri...
Reform strengthens the    delivery system.• Doctor incentives for better  coordinated care• Pilot projects in evidence-bas...
Health Reform, Mental Health and         Social Services:       Paradigm Shifts
Paradigm Shift #1:Affordable, quality health insurance coveragewill not be tied to a particular job or employer.  • People...
Paradigm Shift #2:People with chronic illness, mental illness orother disabilities will not have to go intocomplete povert...
Paradigm Shift #3:The Affordable Care Act takes huge leapsforward:  • Preventive care will be free or very low cost  • All...
Paradigm Shift #4:Community groups and social service providerswill have to reassess our work, resources andservices!  • W...
Sounds great – but how   do we pay for it?
Shared responsibilityCosts and responsibilities are   shared among state and     federal government,  businesses and indiv...
Shared responsibilityFederal Government• Pays for 100 percent of Medicaid expansion  from 2014-2016• Pays for 90-95 percen...
Shared responsibilityIndividuals• U.S. citizens and legal residents must purchase  health insurance or pay a penalty• Pena...
Shared responsibilityBusinesses• Large employers (50+ employees) may have to  pay a penalty if they do not provide coverag...
NOW WHAT???
The key to all of this is making sure reformis implemented in Missouri without delay.Health Insurance Exchange Legislation...
Continue strong       civic engagementDecide•What we like about the ACA•What we want improved•What we want changedWork to ...
Getting beyond spinAnd political divides            In 1962 the AMA           released an album            featuring Ronal...
Build a MovementFrom the New York Times, February, 1964And the Civil Rights Act of 1964 did not include voting rights.
Stay Informed!www.healthcare.govwww.kff.orgwww.mohealthcareforall.orgwww.paraquad.org/Policy/HealthcareReformhttp://hcfgkc...
Join our movement!www.mohealthcareforall.org
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Understanding aca ambassadors

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  • More info: Amy Smoucha, amy@mojwj.org
  • 1.2 million Missourians under the age 65 have pre-existing conditions. The prohibitions against dropping coverage take effect this year, 2010. More than 90,000 Missourians with pre-existing conditions will gain coverage this year through a temporary high risk pool. More info: Amy Smoucha, amy@mojwj.org
  • More info: Amy Smoucha, amy@mojwj.org
  • The prohibitions against lifetime limits take effect this year. No annual limits allowed by 2014. Out of pocket caps for consumers: set at current HAS limits, $5,950 for individuals and $11,900 for families More info: Amy Smoucha, amy@mojwj.org
  • People got very confused about the “Health Insurance Exchange.” They got it mixed up with the “public option.” Some folks called it “socialism.” A health insurance exchange is a marketplace where the insurance companies have to provide plans that follow the new rules. They had to have the essential benefits package, can’t charge more in premiums because we are women or because we have preexisting conditions. They can’t have annual caps on what they will pay, etc. The only insurance plans allowed in the exchange are those that follow the new rules. Also [read slide] More info: Amy Smoucha, amy@mojwj.org
  • 961,000 Missourians will get free preventive care. 171,000 Missourians will see the gap in their coverage cut in half and the whole donut hole will be closed in 2020. The donut hole refunds begin June 15 this year and continue every month to people who hit the donut hole. Participants do NOT need to fill out any forms. Be vigilant against con artists asking for personal information and report any incidents to 800-MEDICARE. More info: Amy Smoucha, amy@mojwj.org
  • The Community First Choice Act is a state option. The states do get an enhanced federal match (an increase of 6 percentage points). Income eligibility can go up to 150% of FPL. The systems design includes a requirement that individual/representative select, manage and dismiss workers. Services are controlled “to the maximum extent possible” by the individual/representative regardless of employer of record. CLASS Act is a long term care insurance program; no pre-existing condition exclusions and there is a guaranteed benefit. Is opt-out participation. Will work best if as many people as possible participate. More info: Amy Smoucha, amy@mojwj.org
  • In 2014 over 400,000 Missourians could be covered. Feds pay 100% of the costs for the first few years and eventually cover 90% of the cost. This is HUGE shift in public policy - - no longer tying health care to welfare programs. More info: Amy Smoucha, amy@mojwj.org
  • Refundable and advance-able More info: Amy Smoucha, amy@mojwj.org
  • More info: Amy Smoucha, amy@mojwj.org
  • More info: Amy Smoucha, amy@mojwj.org
  • More info: Amy Smoucha, amy@mojwj.org
  • More info: Amy Smoucha, amy@mojwj.org
  • Understanding aca ambassadors

    1. 1. Health Care Reform: Understanding the Affordable Care Act What’s really in the new law?Presented by Amy Smoucha, Missouri Jobs with Justice and Missouri Health Care for All
    2. 2. Health care legislation is designed to:• Reduce health care costs, both for families and for the government.• Provide Americans guaranteed access to affordable health coverage.• Strengthen and protect Medicare and Medicaid.• Modernize our health care delivery system.
    3. 3. Here’s how:
    4. 4. Significant Changes to Private Health InsurancePurchased by Individuals and Small Businesses
    5. 5. The ACA gives us more security and control• Insurance companies won’t be able to turn people down because of pre- existing conditions. This took effect in 2010 for children and in 2014 for everyone.• Insurance companies can’t drop your coverage because you get sick.• Insurance companies won’t be able to charge higher premiums because of pre-existing conditions, gender, or occupation, and there will be a limit on how much they can charge based on age.
    6. 6. Health insurance plans must cover essential services.• Insurance plans will have to cover preventive care, hospitals, physicians, prescription drugs, mental health, DME, rehabilitation, habilitation services, substance abuse, dental and vision care for children, maternity care, and other services.• Insurance companies won’t be able to charge deductibles or copayments for preventive services.
    7. 7. Financial protections for people with insurance• Insurance companies can’t impose annual or lifetime limits on how much they will cover.• Spending caps will limit the amount consumers pay out of pocket each year.• Insurance companies have to spend at least 80-85% of premiums on medical care.• Modest income Americans will be eligible for tax credits to help pay for insurance premiums.
    8. 8. Health reform makes it easier to buy insurance.• New Insurance Exchanges allow people to compare plans, apples to apples• The ACA limits insurance company overhead costs (administrative and marketing) so more of our premiums go to our health care• Allows individuals and small businesses to get better rates because they are in a bigger pool
    9. 9. Strengthening Critical Public Health Insurance Programs
    10. 10. Improves Medicare.• Closes the “donut hole” in drug coverage and lowers cost of brand name drugs• Provides preventive services with no co-pays or deductibles• Provides incentives for better coordinated care and use of evidence- based medicine• Enhanced payments for primary care physicians and general surgeons
    11. 11. Improves Medicare.• Free preventive services in 2011• Medicare Advantage plans cannot charge higher co-pays than traditional Medicare.• Enhanced payments for primary care physicians and general surgeons• Medicare Trust Fund solvency is extended by 9 years
    12. 12. ACA fixes Medicare Part D. D• Closes the “donut hole” in drug coverage and lowers cost of brand name drugs – As many as 15% of seniors with chronic illness stop taking their medicines when they hit the gap.• Expands the Medicare Part D low-income subsidy to help struggling seniors afford their prescription costs.• Extends annual Part D enrollment period
    13. 13. Supports early retirees.Federal funds are currently available to helpbusinesses afford the cost of health insurancefor early retirees (ages 55-64).
    14. 14. Access to home and community-based services for people with disabilities• The Community First Choice option makes community-based services mandatory and there are no cost caps or waiting list restrictions.• Law originally included a voluntary long term care insurance program, the CLASS. This has since been put on hold and is not funded.
    15. 15. The law expands State health insurance programs for those who need it.• State health insurance programs under Medicaid will cover all families and individuals with incomes up to 133% of the Federal Poverty Level – $24,348 for a family of three. – Currently in Missouri, a family of three must make less than $4,584 a year to qualify for Medicaid• For the first time ever, childless adults without a disability can qualify for Medicaid.
    16. 16. Tax Credits forIndividuals and Small Businesses
    17. 17. Support for small businesses• Premium subsidies to employers Employers with up to 25 employees and annual wages that average less than $50,000 who purchase health care for their employees get a tax credit• Affordable choices Employees of small businesses may purchase insurance through the Exchange
    18. 18. Help for moderate-income Americans• Families and individuals will receive tax credits to help pay for health insurance, depending upon our income.• Tax credits will be available to families earning between 133-400% of the Federal Poverty Level ($29,327-88,200 for a family of four).• Tax credits are designed to keep premium costs between 2%-9.5% of income, on a sliding scale.
    19. 19. Health reform encourages prevention and wellness.• No deductibles or copayments for preventive services.• Grants for community wellness programs• National standards for restaurant nutrition labeling• Incentives for doctors to improve patients’ health
    20. 20. ACA protects Children. Children• Insurance companies can’t deny children insurance because of a pre-existing condition (will also apply to adults in 2014)• No yearly or lifetime limits on coverage• Free preventive care• All insurance plans will cover kids’ dental and vision care• Young adults can stay on their parents’ plan until age 26
    21. 21. ACA helps people with medical conditions. conditions• People with a disability or mental illness can work part-time and still qualify for Medicaid.• Mental health parity – mental health care must be covered just like physical health care.• Insurance companies won’t be able to refuse or charge more to cover people with pre-existing conditions.• A new, temporary high-risk pool will help people with pre-existing conditions gain immediate access to insurance.
    22. 22. ACA gives caretakers more choices. • People in the sandwich generation and caretakers will have guaranteed coverage and affordable choices. • Young adults can stay on their parents’ plan until age 26.
    23. 23. ACA protects seniors in nursing homes. homes• Elder Justice Act: – Authorizes new criminal background checks on long-term care workers – Requires greater transparency of nursing homes – Requires better information about the quality of nursing care and improves complaint process.
    24. 24. Reform strengthens the delivery system.• Doctor incentives for better coordinated care• Pilot projects in evidence-based medicine• Enhanced payments for primary care physicians and general surgeons
    25. 25. Health Reform, Mental Health and Social Services: Paradigm Shifts
    26. 26. Paradigm Shift #1:Affordable, quality health insurance coveragewill not be tied to a particular job or employer. • People with temporary or long-term illnesses will have coverage options. • People in the sandwich generation and caretakers will have guaranteed coverage and affordable choices. • If we are laid off or choose to work less (for example to start a small business), we will be able to purchase affordable coverage.
    27. 27. Paradigm Shift #2:People with chronic illness, mental illness orother disabilities will not have to go intocomplete poverty or quit all work just to gethealth care. • They will have affordable coverage options through the Health Insurance Exchanges and new Medicaid program. • Coverage will not be dependent upon being disabled or having children. Those in poverty or with limited incomes will get significant help affording coverage.
    28. 28. Paradigm Shift #3:The Affordable Care Act takes huge leapsforward: • Preventive care will be free or very low cost • All insured children will have dental and vision coverage. • Essential benefits package will close a lot of the “gaps” people encounter. • Caps on out of pocket costs, and deductibles will mean less medical debt, less bankruptcy, etc.
    29. 29. Paradigm Shift #4:Community groups and social service providerswill have to reassess our work, resources andservices! • What will be the new “gaps”? • What is needed for coordination of care? • How should charitable and philanthropic resources be reallocated or reexamined?
    30. 30. Sounds great – but how do we pay for it?
    31. 31. Shared responsibilityCosts and responsibilities are shared among state and federal government, businesses and individuals
    32. 32. Shared responsibilityFederal Government• Pays for 100 percent of Medicaid expansion from 2014-2016• Pays for 90-95 percent of Medicaid expansion in 2017 and beyond• Shares in cost of tax credits and premium subsidies
    33. 33. Shared responsibilityIndividuals• U.S. citizens and legal residents must purchase health insurance or pay a penalty• Penalties are phased in for those who do not• Exemptions granted for financial hardship, religious objections, those without coverage for less than 3 months, undocumented workers, incarcerated individuals, or if the lowest cost plan exceeds 8% of income• Tax changes for some high-income individuals
    34. 34. Shared responsibilityBusinesses• Large employers (50+ employees) may have to pay a penalty if they do not provide coverage and one or more of their employees receives an insurance premium subsidy.• Taxes on insurance companies that offer very high cost plans• Fees or taxes on producers of some medical equipment and pharmaceuticals
    35. 35. NOW WHAT???
    36. 36. The key to all of this is making sure reformis implemented in Missouri without delay.Health Insurance Exchange Legislation.•A bill passed the MO House last session. – Generally it’s a strong bill based on good models. – Serious problems with governance and conflict of interest provisions•Missouri Senate leaders are currently trying to blockfunding and planning for a “Health InsuranceExchange”Federal Budget Cuts pose huge threats toexisting programs and federal funding.
    37. 37. Continue strong civic engagementDecide•What we like about the ACA•What we want improved•What we want changedWork to separate fact from spin
    38. 38. Getting beyond spinAnd political divides In 1962 the AMA released an album featuring Ronald Reagan warning that Medicare will lead to socialism and destruction of American Democracy
    39. 39. Build a MovementFrom the New York Times, February, 1964And the Civil Rights Act of 1964 did not include voting rights.
    40. 40. Stay Informed!www.healthcare.govwww.kff.orgwww.mohealthcareforall.orgwww.paraquad.org/Policy/HealthcareReformhttp://hcfgkc.org/resources/health-reformwww.covermissouri.org
    41. 41. Join our movement!www.mohealthcareforall.org
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