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The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
The Affordable Care Act and You
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The Affordable Care Act and You

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The Affordable Care Act and You

The Affordable Care Act and You

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  • In places with high rates of uninsurance
  • Transcript

    • 1. Sheldon Weisgrau Presentation to Via Christi 50+, Wichita October 23, 2013
    • 2.  Introduction  Health care and health insurance ◦ Why do we need health reform?  The Affordable Care Act (aka “Obamacare”)  Q&A ◦ What’s really in the law? ◦ The ACA and Medicare ◦ The Health Insurance Marketplace Health Reform Resource Project 2
    • 3. Health Reform Resource Project 3
    • 4.    Assist in public education and stakeholder engagement related to health reform Provide technical assistance to advocacy organizations and other stakeholders Assist Kansas entities in securing grants and programs available under the Affordable Care Act (ACA) Health Reform Resource Project 4
    • 5.  Supported by Kansas Grantmakers in Health: ◦ ◦ ◦ ◦ ◦ ◦ Kansas Health Foundation Health Care Foundation of Greater Kansas City REACH Healthcare Foundation Sunflower Foundation: Health Care for Kansans United Methodist Health Ministry Fund Wyandotte Health Foundation Health Reform Resource Project 5
    • 6. Health Reform Resource Project 6
    • 7. Health Reform Resource Project 7
    • 8.  Access ◦ 48 million uninsured in U.S. (18% of pop < age 65)  360,000 uninsured in Kansas (14% of pop <65)  67,000 uninsured in Sedgwick Co (15.5% of pop <65) ◦ Millions more underinsured ◦ Employment-based health insurance declining Health Reform Resource Project 8
    • 9.   Access Quality ◦ Inconsistent ◦ Disparities ◦ Infections, medical errors, patients harmed Health Reform Resource Project 9
    • 10.    Access Quality Cost ◦ Highest in the world ◦ Increasing faster than salaries and inflation ◦ Main driver of long-term budget deficits Health Reform Resource Project 10
    • 11.  The uninsured: ◦ Receive less preventive and prenatal care ◦ Go without medical care and prescription drugs due to cost ◦ Diagnosed at later stage of illness ◦ Hospitalized for avoidable conditions ◦ Less healthy ◦ Earn less (and have less financial protection) ◦ Have higher death rates Health Reform Resource Project 11
    • 12.  Communities with high rates of uninsurance ◦ More difficulty recruiting and retaining physicians ◦ ER crowding and diversion ◦ Insured patients have lower access, quality, and satisfaction Health Reform Resource Project 12
    • 13. Health Reform Resource Project 13
    • 14.  906 pages, 10 titles 1. Access to private health insurance 2. Expanded Medicaid coverage 3. Medicare reform 4. Wellness and prevention 5. Health care workforce 6. Fraud and abuse 7. Access to drugs and biologics 8. Voluntary long-term care insurance (CLASS) 9. Revenue measures 10. Manager’s amendment and reconciliation Health Reform Resource Project 14
    • 15. Health Reform Resource Project 15
    • 16.   Make better health insurance coverage more available and affordable for legal residents Reform health care delivery and financing to provide better quality and outcomes, more cost effective care Health Reform Resource Project 16
    • 17.  What it does ◦ Builds on the existing system of coverage Health Reform Resource Project 17
    • 18.  What it does ◦ Builds on the existing system of coverage  What it does not do ◦ Does not create “government-controlled” or “socialized” health care Health Reform Resource Project 18
    • 19.  What it does ◦ Builds on the existing system of coverage  What it does not do ◦ Does not create “government-controlled” or “socialized” health care ◦ Does not create “death panels” Health Reform Resource Project 19
    • 20.  What it does ◦ Builds on the existing system of coverage  What it does not do ◦ Does not create “government-controlled” or “socialized” health care ◦ Does not create “death panels” ◦ Does not eliminate (or make big changes to) Medicare Health Reform Resource Project 20
    • 21.  Extends health insurance coverage to 25-30 million uninsured ◦ Expands the Medicaid program ◦ Authorizes Medicare financing and delivery reform ◦ Restructures markets for individual and small group insurance  Health Insurance Marketplace Health Reform Resource Project 21
    • 22.  Extends health insurance coverage to 25-30 million uninsured ◦ Prohibits insurers from denying coverage to those with pre-existing conditions (guaranteed issue) or charging them more (community rating) Health Reform Resource Project 22
    • 23.  Extends health insurance coverage to 25-30 million uninsured ◦ Prohibits insurers from denying coverage to those with pre-existing conditions (guaranteed issue) or charging them more (community rating) ◦ Mandates that most people maintain insurance coverage Health Reform Resource Project 23
    • 24.  Extends health insurance coverage to 25-30 million uninsured ◦ Prohibits insurers from denying coverage to those with pre-existing conditions (guaranteed issue) or charging them more (community rating) ◦ Mandates that most people maintain insurance coverage ◦ Provides tax credits to help individuals and small businesses purchase insurance Health Reform Resource Project 24
    • 25. Health Reform Resource Project 25
    • 26.  Enhances benefit package ◦ Covers annual wellness visit Health Reform Resource Project 26
    • 27.  Enhances benefit package ◦ Covers annual wellness visit  Reduces out-of-pocket costs ◦ No deductibles or coinsurance for preventive services Health Reform Resource Project 27
    • 28.  Enhances benefit package ◦ Covers annual wellness visit  Reduces out-of-pocket costs ◦ No deductibles or coinsurance for preventive services ◦ Phases out Part D donut hole Health Reform Resource Project 28
    • 29.  Reduces rate of cost growth Health Reform Resource Project 29
    • 30.  Reduces rate of cost growth ◦ Phases out overpayment to Medicare Advantage plans Health Reform Resource Project 30
    • 31.  Reduces rate of cost growth ◦ Phases out overpayment to Medicare Advantage plans ◦ Enables provider payment and delivery system reforms  From “volume-based” to “value-based” Health Reform Resource Project 31
    • 32.  Reduces rate of cost growth ◦ Phases out overpayment to Medicare Advantage plans ◦ Enables provider payment and delivery system reforms  From “volume-based” to “value-based” ◦ Expands fraud and abuse prevention Health Reform Resource Project 32
    • 33.  Expansion of home and community-based services  More funding for Aging and Disability Resource Centers (ADRCs)  Programs to enhance quality and patient safety, reduce readmissions  Programs to expand primary care, nursing, geriatric care workforce Health Reform Resource Project 33
    • 34. Health Reform Resource Project 34
    • 35.  Established by each state by Oct 1, 2013 Health Reform Resource Project 35
    • 36.  Established by each state by Oct 1, 2013 ◦ Administered by federal govt if state opts out Health Reform Resource Project 36
    • 37.  Established by each state by Oct 1, 2013 ◦ Administered by federal govt if state opts out  For individual and small group markets Health Reform Resource Project 37
    • 38.  Established by each state by Oct 1, 2013 ◦ Administered by federal govt if state opts out  For individual and small group markets  Provides web-based one-stop shopping ◦ Pooling mechanism for individuals and small businesses Health Reform Resource Project 38
    • 39.  Established by each state by Oct 1, 2013 ◦ Administered by federal govt if state opts out  For individual and small group markets  Provides web-based one-stop shopping ◦ Pooling mechanism for individuals and small businesses  Plans must offer “essential health benefits” package Health Reform Resource Project 39
    • 40. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Ambulatory care services Emergency services Hospitalization Maternity and newborn care Mental health and substance abuse services Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral and vision care Health Reform Resource Project 40
    • 41.  Qualify if household income is 100%-400% of Fed Poverty Level and purchase in Marketplace and no affordable employer offer Household Size 2013 Federal Poverty Guidelines 100% 400% 1 $11,490 $45,960 2 $15,510 $62,040 3 $19,530 $78,120 4 $23,550 $94,200 5 $27,570 $110,280 6 $31,590 $126,360  Businesses qualify if they meet size and salary requirements  Most Kansans who would have been covered by Medicaid expansion will be too poor to qualify for tax credits Health Reform Resource Project 41
    • 42. Health Reform Resource Project 42
    • 43.  No lifetime or annual coverage limits  Children up to age 26 on parent’s policy  Plan standardization ◦ Catastrophic, Bronze, Silver, Gold, Platinum ◦ Limits on out-of-pocket costs ◦ Standard language and definitions Health Reform Resource Project 43
    • 44.  Toll-free hotline  Agents/brokers  Navigators and Certified Application Counselors  Kansas Insurance Department ◦ 1-800-318-2596 ◦ http://www.healthcare.gov ◦ http://www.cuidadodesalud.gov ◦ Clinics, health departments, Area Agencies on Aging, community mental health centers, hospitals, etc. ◦ http://www.insureKS.org Health Reform Resource Project 44
    • 45.  Senior Health Insurance Counseling For Kansas (SHICK) ◦ Area Agencies on Aging ◦ 1-800-860-5260  1-800-MEDICARE  http://www.medicare.gov Health Reform Resource Project 45
    • 46. Health Reform Resource Project 46
    • 47.  Open Enrollment ◦ October 1, 2013 – March 31, 2014  Future years: Oct 15-Dec 7 ◦ Special enrollment periods  If you want insurance on . . . ◦ January 1, enroll by December 15, 2013  If you want to avoid the penalty . . . ◦ Enroll by February 15, 2014 Health Reform Resource Project 47
    • 48.  Marketplace opened October 1, 2013  Individual mandate – January 1, 2014  Employer responsibilities  Medicaid expansion  OUTREACH / EDUCATION / ENROLLMENT ◦ Coverage begins January 1, 2014 ◦ www.healthcare.gov ◦ http://www.cuidadodesalud.gov ◦ Enforcement delayed until 2015 Health Reform Resource Project 48
    • 49. Sheldon Weisgrau, Director Health Reform Resource Project 1129 S. Kansas Avenue, Suite B Topeka, KS 66612 (785) 408-8008 HealthReformResource@gmail.com Health Reform Resource Project 49

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