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Understanding aca ambassadors


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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!
  41. 41. Join our movement!