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SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
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SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?

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  • OPTIONAL – show Mission 2010 video DVD
  • Prior to World War II, health care didn’t cost much because we didn’t have much in the way of technology or medications. During the War, America imposed wage controls to prevent runaway inflation. There was a shortage of workers, and employers were encouraged to compete for workers by offering benefits such as health insurance, which was inexpensive. After the war, as the devastated European nations were rebuilding their infrastructure, they had little choice but to build health care systems through their governments. America, meanwhile, maintained its employer-based system.
  • In the 1960s, Congress realized that there were limitations to an employer-based health insurance model because some people don’t work. The result was the enactment of Medicare (federally funded) to cover the elderly and Medicaid (joint federal and state funding) to help cover the poor. America still had a draft in the 1960s, so most American men were required to serve in the military and were entitled to VA health benefits for life. So Medicaid was designed to cover women and children. Now that we’ve had a volunteer army for years, millions of adult men find themselves without insurance coverage even if they have full-time jobs because they are not eligible for VA benefits. Breakdown of current national payor mix: 52% Employer 28% Government 5% Individual 15% Uninsured
  • In 1986, Congress decided to address the problem of the uninsured by requiring that hospitals treat every person who walks into the emergency room, even if the person can pay nothing. This requirement covers all persons in America, even if they are here illegally. No other organization or individual – not even physicians – are required to treat anyone who comes into their building seeking care. Only hospitals. The EMTALA obligation on hospitals is unlimited, so hospitals cannot manage the budget impact by limiting the number of uninsured patients they will treat. It is also an unfunded mandate – an obligation imposed by government without providing any new dollars to cover the cost. As the cost of health care increases, the unfunded mandate on hospitals increases. It’s fair to say that EMTALA is one of the largest – if not the largest – unfunded mandate ever imposed by Congress on private business. Ironically, it was enacted through the now-controversial legislative process called budget reconciliation by a Democratic House and a Republican Senate and signed into law by President Reagan. So President Reagan in essence signed the law that guarantees every person living in America, legally or illegally, the right to health care. And President George W. Bush reinforced that policy when he said, “People have access to health care in America. After all, you just go to an emergency room.”
  • 219,500 adults will be eligible for subsidies in 2014
  • This may be a good place to highlight your community benefit numbers.
  • The major changes made in the health care reform bill will go into effect over a 10 year phase in period.
  • We have heard a lot about the doughnut hole that many seniors on Part D Medicare face each year. They get Medicare assistance with their prescription drug costs until their total drug costs hit $2830. Then the seniors have to pay the next $1720 out of pocket. When their total climbs past $4550, Medicare will begin to help again. The $1720 that seniors have to pay out of pocket is known as the doughnut hole. Obviously, it places a tremendous burden on seniors living on fixed incomes and is often the reason some seniors decide not to take all of their medications. A small step began last year offering a transitional rebate of $250 – 30,173 Medicare beneficiaries have already received the tax free rebate. With the phase in of other transitional steps over the next decade, the doughnut hole will be closed by 2020.
  • Who is eligible? Tax credits Citizens and legal residents in families with incomes between 133% and 400% of poverty who purchase coverage through the exchange. Cost Sharing Subsidies With incomes up to 250% of poverty are also eligible for reduced cost sharing paid for by the federal government How will subsidies be provided? Premium tax credits: refundable (for those w/ no tax liability) and advanceable (for use at time of purchase of health insurance). Cost Sharing Subsidies : the cost sharing is reduced so that the insurance plan on average pays a greater share of covered benefits; sets maximum out-of-pocket spending limits. How will subsidies be provided: Many of these details will be addressed through the rulemaking process ie. How to apply, what the lower deductibles and copayments will be for cost sharing etc.
  • The Congressional Budget Office estimates that 8 million people will purchase coverage thru the exchanges in 2014…growing to 24 million in later years. Exchanges will reduce administrative costs by 18%.
  • This law removes all catogorical requirements changing Medicaid to an income based eligibility program.
  • For children under 18, effective September 23, 2010, no denial of coverage for pre-existing conditions. -100,000 children in SC are NOW eligible for insurance coverage
  • 58,000 businesses eligible in SC; credits average $10,000 per company Partial tax credit = up to 35% 88% of small businesses in SC have 25 or fewer employees Elimination of premium increases for the entire group due to 1 employee’s pre-existing condition.
  • The House voted to repeal HC reform on Jan 19 by a vote of 245 - 189. The bill will not likely move forward and starts the process for the GOP to dismantle the bill piecemeal. 26 R controlled states many of them considering legislation that challenges implementation.
  • 28 states includes the 26 states signed onto the FL suit as well as VA and OK. (VA and OK are not part of the Medicaid suit). The FL suit includes both mandate and Medicaid unconstitutional. South Carolina is part of the FL lawsuit. A federal judge recently ruled the individual mandate unconstitutional therefore the entire bill is unconstitutional. This suit will go before the Supreme Court and ultimately they will determine the constitutionality of the bill. 26 R controlled states many of them considering legislation that challenges implementation.
  • Medicaid is an economic engine for the state -provides $6 billion into the state economy -Medicaid means jobs for SC citizens -Medicaid’s annual spending is the equivalent of landing a Boeing plant in SC every year
  • Expanding coverage to 32 million people.
  • Transcript

    • 1. health care reform: what does it mean for you?
    • 2. On August 6 & 7, AccessHealth SC and a variety of partners collaborated to provide FREE medical, vision and dental services at SC Mission 2010 in Greenville
    • 3. Over 1,200 patients were provided more than $550,000 in care 44% were employed full or part time 56% were unemployed a sobering success
    • 4. today’s talk
      • historical background
      • gaps in coverage
      • goals of health care reform
      • what does it mean for me?
      • new realities post election
      • final thoughts
    • 5. evolution of u.s. health care policy
      • Our system is the result of several major policy decisions rather than one, unified health care policy
            • Employer-based coverage
            • Government-sponsored coverage
            • EMTALA
    • 6. the start of employer-sponsored coverage
      • During World War II, wage controls administered by the federal government’s Office of Price Administration led employers to offer health insurance as a benefit in lieu of wage increases
    • 7. the start of medicare & medicaid To provide coverage for the elderly as well as poor women and children, Congress enacted Medicare & Medicaid in the mid-1960s
    • 8. emtala
      • Emergency Medical Treatment and Active Labor Act of 1986 is arguably the largest unfunded mandate ever imposed on private business
      • The law requires hospitals to screen and stabilize (treat) every patient who comes to the hospital ED, regardless of the patient’s ability to pay and regardless of what it costs the hospital to provide the care
    • 9. policy decisions have left a gap in coverage for sc
      • 2.2 million have employer-based health insurance
      • 1.2 million rely on a government-sponsored program for coverage
      • 178,000 have coverage purchased in the individual market
      • 760,000 South Carolinians have no coverage
      • *Source: Kaiser Family and Robert Wood Johnson Foundations
    • 10. sc’s uninsured: who are they?
      • 552,000 people from working families
          • Pay taxes to support government coverage for others
      • 422,000 childless adults (do not qualify for Medicaid)
      • 219,500 adults between 139-399% of federal poverty levels
      • 147,500 children
      • *Source: Kaiser Family Foundation
    • 11. what happens when the uninsured need care? remember emtala?
        • Last year, SC hospitals provided more than $1 billion worth of care for which they received no direct payment
        • Those financial losses were passed along to insured patients and their employers
    • 12. broad goals of reform
      • increasing coverage
        • will expand coverage to almost 500,000 of the 760,000 uninsured South Carolinians
      • payment reform
        • will change the way hospitals/providers receive payment
    • 13. broad goals of reform
      • delivery system reform
        • includes delivery system reforms that hold great promise for improving care
      • insurance reform
        • includes provisions to protect consumers and increase access to health insurance
    • 14.  
    • 15. health reform: what does it mean for you?
      • grandfather on Medicare
      • brother who is uninsured
      • aunt with pre-existing conditions
      • daughter just out of college
      • friend who is a small business owner
    • 16. grandfather on medicare
      • Additional benefits for traditional Medicare coverage:
      • Free preventive screenings such as colonoscopies, mammograms
      • A free annual physical or “wellness” visit
      • prescription assistance for “doughnut-hole” coverage gap
      Note: Individuals with Medicare Advantage plans may see changes in their benefits depending on how their insurance company responds to reduced funding for this type of plan
    • 17. grandfather on medicare
      • prescription assistance
      • Transitional rebates to help 61,000 SC seniors in the prescription drug “doughnut hole”
        • A $1,720 gap in Medicare coverage of prescription meds
            • Starts when annual drug costs exceed $2,830
            • Ends when annual costs exceed $4,550
        • “ Doughnut hole” closed by 2020
        • First year rebate (2010) = $250
    • 18. brother who is uninsured
      • beginning in 2014, all U.S. citizens and legal residents must have coverage or pay a penalty
      • Low-income individuals & families will have access to subsidies to help buy private health insurance
          • For individuals and families between 133-400% of FPL, the bill provides tax credits and cost-sharing assistance to reduce premium costs of insurance purchased through health insurance exchanges
          • 477,000 SC citizens will receive the benefit of premium tax credits through reform
    • 19.
      • insurance exchanges
      • “ Small companies and individuals who don’t have insurance through work will be able to purchase insurance through newly created marketplaces, known as insurance exchanges, created and regulated by states.
      • … Think of it as an Orbitz or Travelocity for health care plans”
      • - USA Today
      brother who is uninsured
    • 20. brother who is uninsured
      • medicaid expansion
      • By 2014 states must extend Medicaid eligibility to all legal residents up to 133% of poverty and under 65 years old
      • 133% FPL is $14,404 for individual and $29,327 for family of 4
      • From 2014-2016 the federal government will cover 100% of state costs
    • 21. aunt with pre-existing condition
        • Establishes a temporary national high-risk insurance pool for individuals with pre-existing conditions and early retirees - those 55 or older but not yet eligible for Medicare
        • In 2014, no denial of coverage or exorbitant premiums for adults with pre-existing conditions
        • No higher premium based on gender or medical history in 2014
    • 22. daughter out of college
      • Dependent adult children can stay on parent health policy until age 26 (effective Sept. 23, 2010)
      • In 2014, young adults can purchase health insurance through the exchange
        • allowing coverage flexibility and portability when changing jobs
    • 23. friend who is a small business owner
        • Small businesses are eligible for subsidies to offer insurance and have access to the exchanges
        • Employers with 10 or fewer employees who earn, on average, less than $25,000 a year can get a 50% tax credit for providing health insurance
        • Employers with 25 or fewer employees who earn, on average, less than $50,000 can receive a partial tax credit of up to 35%
            • 88% of businesses in SC have 25 or fewer employees
    • 24.
        • 714,000 seniors on Medicare will no longer pay a co-pay for preventive services (2010)
      •   30,173 Medicare beneficiaries already received a one-time, tax-free $250 rebate (2010)
        • 18,100 young adults have access to insurance coverage through their parents’ health plans (2010)
        • 57,900 small businesses are eligible for a tax credit (2010)
        • 477,000 citizens will receive premium tax credits (2014)
        • Almost 500,000 of the 760,000 uninsured will be covered ( 2014 )
      what reform means to south carolina
    • 25.  
    • 26. new realities post election
      • repeal, replace, defund?
        • The House voted to repeal HC reform on Jan 19 by a vote of 245 – 189; total repeal of the law is unlikely for now
        • Republicans will move forward to defund the bill, undo several unpopular provisions and slow implementation
        • New House committee chairs will hold committee oversight hearings on reform
    • 27. new realities post election
        • legal and legislative challenges
          • 28 states have filed suit claiming the individual mandate is unconstitutional
          • 26 states are included in the FL Medicaid suit
          • 38 state legislatures are considering various forms of legislation that challenge implementation
    • 28. new realities post election
      • state medicaid crisis
      • $228 M shortfall from current fiscal year
      • Additional $663 M requested to maintain program at current rate plus 10% growth
          • 100,000 people added to Medicaid since December 2007
      • Services for 970,000 Medicaid beneficiaries are at stake
      • $2.2 B in healthcare expenditures at risk!
    • 29. final thoughts
      • health reform will expand coverage to a lot of people
      • many details still to come through the regulatory process
      • challenges exist for full implementation of the law
      • no matter what, we’re here to provide for the health care needs in our communities!
    • 30. final thoughts
      • south carolina hospitals are:
      • working diligently to cut costs, improve quality and patient safety, and meet advancing technology demands
      • ranked by the federal government as one of the top five states making improvements in quality and safety
      • leading the nation in improving healthcare safety and responsiveness
      • working to improve the health of South Carolinians
    • 31.
      • Questions?

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