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2013 ACA AOSW Conference June 7
 

2013 ACA AOSW Conference June 7

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    2013 ACA AOSW Conference June 7 2013 ACA AOSW Conference June 7 Presentation Transcript

    • In Support of Our Patients and Our Profession: Social Work Leadership to Advance the Goals of National Health Reform in the Post‐Election EraJanlee Wong, MSWExecutive DirectorNational Association of Social WorkersCA Chapter
    • Learning Objectives• Social Work Policy on Healthcare Reform• The Healthcare Reform Plan:– Affordable Care Act (ACA) or Obamacare• Opportunities for Social Workers• What Social Workers Need to DoSlides available via: Google “slideshare Janlee Wong”
    • A Growing CrisisNonelderly Uninsured in US:2004 – 43 million2010 ‐ 49 million
    • Why Does NASW Support the ACA?“NASW supports a national health care policy that ensures the right to universal access to a continuum of health and mental health care throughout all stages of the life cycle.”
    • The Plan:Reform Health InsuranceCover the Uninsured• Dependent coverage to age 26 (2010)• Limits on insurance premium increases (2010)• No cost-sharing for preventive services (2012)(cancer screening; mammography, etc.)• No annual caps (2014)• Guaranteed Issue - No Pre-ex exclusions (2014)• Close Medicare donut hole by 2020• More choice of plans in the individual market andguarantee of comprehensiveness (2014)
    • Starting in 2014, most employers (> 50 FTEs) must offer health insurance that is: • Affordable– (individual premiums no more than 9.5 percent of annual income) • Adequate – (a plan that covers 60% ‐ 90% of allowable medical expenses until deductible is met) • Comprehensive – adheres to Essential Health Benefits (EHB)
    • Cover the Uninsured Under ACA11.7, 4%264.2, 84%20, 6%18, 6%(millions)Undocumented (ACA ineligible) Insured ACA Exchange Medicaid Expansion
    • What Income Qualifies For Expanded Medicaid and Exchange PlansFederal Poverty Line (FPL)$15,415 $31,810 $44,680 $92,200 Individual Family of 4I33% FPL Medicaid 400% FPL Exchange
    • HHS will approve state exchanges or run them in states opting outDevelop and approve insurance plans offered in the Exchange• Essential Health BenefitsManage enrollment • Outreach, Assisters, Navigators
    • Essential Health Benefits• ambulatory patient services • emergency services • hospitalization • maternity and newborn care • mental health and substance abuse disorder services • prescription drugs • rehabilitative and habiliative services and devices • laboratory services • preventive and wellness services and chronic disease management • pediatric services, including oral and vision care
    • The EHB and State Benchmark Plans• States operating their own exchanges choose a “benchmark” plan• Benchmark must comply with the EHB• All other plans in exchange are modeled against the benchmark • In CA:  the benchmark plan is Kaiser Small Group HMO
    • How To Pay For It$382 Billion New RevenueIncrease Medicare Tax On Rich,  $210 Insurer Fee,  $60 Cadillac Plan Tax,  $32 Drug & Device Tax,  $47 Reduce Tax Deductions,  $18 Other,  $15 
    • How To Pay For It: Reduce Spending $194 BillionReduce Medicare Advantage, $132Reduce Medicare Home Health, $40Reduce Hospital Payments, $22
    • ACA Policy IncentivesProvision• Eliminating hospital DSH payments• Hospital re‐admission penalties• Fees ($2K ‐ $3K) for large employers not offering health insurance Policy• Fewer uninsured admitted• Quality standard, no fee for service incentives• Encourages employer provided healthcare
    • 2014 ‐ Only 6 months away!Major components of health reform –Medicaid expansion and state insurance exchanges – need to be up and running on 1/1/2014Open enrollment for exchanges begins on 10/1/2013
    • CA Health Exchange Websitewww.healthexchange.ca.gov
    • How will enrollment be conducted in CA?• “No wrong door”– Medi‐Cal enrollment, 58 counties with in person, mail telephone and online, certified assisters• CalHEERS – California Healthcare Eligibility, Enrollment, & Retention System  (Accenture)• Covered CA website: fact sheets, subsidy calculator and consumer phone number• Simple Income Eligibility Determination:  Single income standard, no assets test
    • CMS – public awareness material –available in 10 languages:www.marketplace.cms.gov/getofficialresources/get‐official‐resources.html
    • divulgaciónImpremedia, Telemundo Station Group and Univision— 1.2 million uninsured Latinos
    • Special SAMHSA enrollment toolkits for people with Behavioral Health Needs(coming soon)
    • Two pressing priorities for the social work profession • ACA Enrollment • Medicaid expansion
    • Support for our Uninsured ClientsAll social workers should be familiar with the insurance enrollment process in their states
    • Social Workers Skilled ContributionTake two aspirin and see me in 2 weeks• Home and community visit and support systems• Psychosocial assessment• Case management• Behavioral techniques• Advocacy and policy
    • ACA Opportunities for Social Workers• Exchange Navigators (BSW level)• Post‐discharge staff (ACA re‐admit penalties); greater need for hospital Social Workers • Increased $ for Federally Qualified Health Centers  ‐training, experience• More insured patients in Community Mental Health Centers and specialized programs (e.g., Ryan White‐funded clinics)• Specific ACA demo projects (primarily elderly)– community based care transitions– care coordination/health homes for dually eligible– Independence at Home– Medicare Accountable Care Organizations
    • NASW Resources:http://www.socialworkers.org/assets/secured/documents/practice/quickguidetotheaca.pdfhttp://www.socialworkers.org/assets/secured/documents/practice/health/hcronsumerfactsheet.pdf
    • Advocacy Priority for all social workers: Medicaid Expansion
    • Why is the Medicaid expansion important?• Significantly reduce uncompensated care burden at hospitals• Keep federal health care subsidies in state (otherwise flowing to other states)• People will be inclined to seek care earlier (particularly important for oncology patients)• Insurance coverage = less stress for families• Address health disparities
    • A state without the expansion:Only individuals with incomes from 100% ‐ 400% of FPL will be eligible for Federal subsidies to purchase insurance policies on the new health care“marketplaces” (aka exchanges)• Most non‐expansion states have extremely low Medicaid eligibility thresholds for single adults (or offer no Medicaid coverage to this population)• Result ‐ single adults under 100% will have no health insurance
    • No Medicaid expansion = worsening health disparitiesA lot of people will come in, file applications and find they are not eligible for help because they are too poor. We’ll have to tell them, ‘If only you had a little more money, you could get insurance subsidies [to purchase coverage on the exchange], but because you are so poor, you cannot get anything.Bee Moorhead, executive director, TX Impact 
    • How to Advocate• Share your firsthand experiences on the need for healthcare reform!– Cost savings by insuring the uninsured– Prevention and wellness • Consider yourself an expert on:– Human and fiscal impact of being uninsured, underinsured  – Psychosocial effects of cancer• Become active in your state NASW chapter; your state health coalition
    • Simple Advocacy ActSend an e‐mail to your governor and state legislators with the message:“As your constituent – and an oncology social worker concerned about worsening health disparities ‐ I urge you to approve the Medicaid expansion.”
    • Questions?
    • Contact Info:Stacy Collins, MSWNational Association of Social Workersscollins@naswdc.orgJanlee Wong, MSWNational Association of Social WorkersCA Chapternaswca@naswca.orgGoogle:  slideshare Janlee Wong