Presentation on Patient Protection and Affordable Care Act
HEALTH CARE REFORM IN THE UNITED STATES Edward J. Larson, Ph.D and Craig B. Garner Saturday, January 8, 2011 Royal Thai Consulate General Los Angeles, California
At the beginning of the twentieth century, hospitals, as well as their amenities, were sparse.With the limited medical technology available in the early 1900s, a hospital was not a place tobe if you were sick. ı
As conditions in health care improved, thepractice of medicine in the United Statesshifted from home to hospital. People wentto a hospital to get better, beneﬁtting fromadvances in technology and medicine.
By the 1960s, health care in the United States was ata crossroads. Access to treatment had increased, butso did the corresponding price tag. With the passageof Medicare in 1965, the United States governmentsolidiﬁed its commitment to government-sponsoredhealth care.
Thai immigration to America was nearly nonexistentbefore 1960. By the 1970s, approximately 5,000 Thais hadimmigrated to the United States. During the 1980s, thenumber of Thai individuals immigrating to the UnitedStates averaged at about 6,500 each year. As of 1990,there were approximately 91,275 people of Thai ancestryliving in the United States. By 2002, the number of Thaisliving in Los Angeles alone exceeded 80,000, the largestThai population outside of Thailand.
No matter where you are, ﬁndingreliable health care in a foreigncountry can be challenging, especiallyone that is 8,300 miles (5,200 km)away.
WHEN VISITING THAILANDFounded in 1979, Samitivej Hospitals is one of the leading private hospital groups inThailand. Samitivej Sukhumvit Hospital is recognized as one of the leading privatehospitals in Southeast Asia.
HEALTH CARE REFORM BY THE NUMBERS On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act into law. The Cost: $940 billion over ten years. Would expand coverage to 32 million Americans who are currently uninsured. In 2014, everyone must purchase health insurance or face a $695 annual ﬁne. There are some exceptions for low-income households. Employers with more than 50 employees must provide health insurance or pay a ﬁne of $2000 per worker each year if any employee receives federal subsidies to purchase health insurance. Expands Medicaid to include more families who did not previously qualify.
WHO PAYS?Drug manufacturers would pay a total of $16 billion between 2011 and 2019.Health insurers would pay $47 billion over this same period.Medical device manufacturers would pay a 2.9 % excise tax on sales, beginning in2013.A 10 % tax on indoor tanning services should raise about $2.7 billion.Starting in 2012, the Medicare Payroll Tax will include a 3.8% tax on investmentincome for families making more than $250,000 per year ($200,000 forindividuals).Beginning in 2018, businesses will pay a 40% excise tax on so-called "Cadillac"high-end insurance plans worth over $27,500 for families ($10,200 forindividuals).
THE HEALTH INSURANCE EXCHANGEUnder the Health Care Reform law, the health insurance exchange is a marketplace designedto offer affordable high-quality health insurance options. The exchange is designed to helpfamilies who have no insurance or do not get adequate insurance at work and cannot affordto buy it in the costly individual or small group market. It is also for small businesses thatcannot afford small group health insurance.
THE HEALTH INSURANCE EXCHANGEBy the end of 2010, a temporary national high-risk pool provided health coverage to individuals withpre-existing medical conditions and who have been uninsured for at least six months will be created.By 2014, state-based health insurance exchanges should provide consumers a variety of private healthinsurance plans to consider. This would include comparisons of covered services, premiums, co-pays anddeductibles, as well as out-of-pocket limits on expenses. ıEach exchange will focus on individuals and small employers with 50 to 100 employees.In 2017, states will have the opportunity to opt out of the federal requirements establishing an insuranceexchange if they can show the ability to provide coverage comparable to the new Federal law.Illegal immigrants will not be eligible to participate in any State exchange.
HEALTH CARE REFORM -- COVERAGE UP TO AGE 26 Dependent (Adult/Children) Coverage to Age 26: For plans that provide coverage for dependents, the plan now must cover dependents (adult/children) to age 26 (and this is generally tax free to the employee). This is effective for plan renewals beginning on or after September 23, 2010. This also applies to employers with cafeteria plans, as well as self- employed individuals who qualify for the self-employed health insurance deduction. “Grandfathered plans” are not required to cover adult/children to the age of 26 if the adult/child is eligible to enroll in another eligible employer-sponsored health plan. This limited exemption ends on the ﬁrst plan renewal beginning on or after January 1, 2014.
HEALTH CARE REFORM FOR INDIVIDUALS How Individuals Can Meet the Health Insurance Mandate: Enrollment in a government program such as Medicare, Medicaid, TRICARE, or Children’s Health Insurance Program (CHIP) Purchasing insurance offered by your employer Purchasing insurance through a state exchange Purchasing insurance directly from an insurer in the individual market
HEALTH CARE REFORM FOR INDIVIDUALS, CONTINUED... Individual Penalty for Not Obtaining Coverage: Individuals who do not obtain or retain qualifying health care coverage will be required to pay a penalty as part of their income tax returns. In 2014, the penalty is $95 or 1% of the individual’s income, whichever is greater. By 2016, it increases to $695 or 2.5% of income. For families, the maximum penalty is three times the per- person ﬂat-dollar penalty. The penalty for dependent children without coverage is half the cost of the individual ﬂat-dollar penalty.
HEALTH CARE REFORM FOR INDIVIDUALS, CONTINUED...Limitations on Pre-Existing Conditions and Plan Limits Currently, group health plans are not be able to impose pre- existing condition exclusions on children under age 19. Additionally, group health plan are not be able to impose lifetime or restrictive annual limits on beneﬁts under the plan. Beginning in 2014, a group health plan would not be able to impose any annual limits. In addition, effective in 2014, group health plans would be completely prohibited from imposing pre-existing condition exclusions on plan participants.
HEALTH CARE REFORM FOR INDIVIDUALS, CONTINUED... Legal Challenges to the Individual Requirement Are Pending: At least one Federal Court in Virginia has ruled that the requirement is unconstitutional. The United States Supreme Court may ultimately make the ﬁnal decision. Stay tuned.....
HEALTH CARE REFORM FOR BUSINESSES IN 2014 The new law does not require employers to offer health insurance coverage to their employees. For “large employers” (those with 50 or more full-time employees) the law imposes a penalty ($2,000 per employee) if any of their full-time employees qualify for and receive federal subsidies. The large employer penalty does not apply for the ﬁrst 30 employees. Small business tax credits are available to help offset the employer contribution and provide an incentive.
HEALTH CARE REFORM FOR BUSINESSES IN 2018There will be a 40% tax on expensive heath care plans, dubbed"Cadillac plans."These high cost health plans are deﬁned as having a value of$10,200 for a single employee or $27,500 for a family.There are exclusions for high risk jobs and other specialoccupations.
SMALL BUSINESS HEALTH CARE TAX CREDITThis credit helps small businesses and small tax-exempt organizations afford the cost ofcovering their employees. Must cover at least 50% of the cost of health care coverage for some of its workers based on the single rate. Must have less than the equivalent of 25 full-time workers (for example, an employer with fewer than 50 half-time workers may be eligible). Must pay average annual wages below $50,000 The credit is worth up to 35% of a small business’ premium costs in 2010 (25% for tax-exempt employers). On January 1, 2014, this rate increases to 50% (35% for tax-exempt employers).
CHANGES TO FLEXIBLE SPENDING ARRANGEMENTSEffective January 1, 2011, the cost of an over-the-countermedicine or drugs cannot be reimbursed from FlexibleSpending Arrangements or health reimbursementarrangements unless a prescription is obtained.The change does not affect insulin, even if purchased without aprescription, or other health care expenses such as medicaldevices, eye glasses, contact lenses, co-pays and deductibles.A similar rule goes into effect on January 1, 2011 for HealthSavings Accounts.
“OPTIONAL” EMPLOYER REPORTING REQUIREMENTSStarting in tax year 2011, the Affordable Care Act requiresemployers to report the value of the health insurancecoverage they provide employees on each employee’s annualForm W-2.However, to provide employers the time they need toimplement these changes, the IRS will defer the reportingrequirement for 2011, making them optional.
FINDING THE HOSPITALS IN YOUR COMMUNITY Hollywood Presbyterian Kaiser Permanente Medical Center 4867 Sunset Boulevard Los Angeles, CA 90027 1300 North Vermont Avenue (323) 783-4011 Los Angeles, CA 90027 (323) 913-4800 Hollywood Community Cedars-Sinai Medical Center Hospital 8700 Beverly Boulevard 6245 De Longpre Avenue Los Angeles, CA 90048 Los Angeles, CA 90028 (310) 423-3277 (323) 462-2271 Good Samaritan Hospital Children’s Hospital of LA 1225 Wilshire Boulevard 4650 Sunset Boulevard Los Angeles, CA 90017 Los Angeles, CA 90027 (213) 977-2121 (310) 660-2450
THE PEOPLE AT YOUR HOSPITAL Anesthesiologist Paramedic Radiologist A doctor specialized in Paramedics are the most These Doctors review the administering drugs which highly trained EMT’s, who are results of imaging devices can cause unconsciousness capable of delivering critical (X-Rays, CT’s MRI’s...) to or lack of feeling in patients. care en route to a hospital. diagnose or treat disease. Doctor (MD/DO) Pediatrician Registered Nurse Also known as a physician., This is a doctor who RN’s provide direct care to this person diagnoses, specializes in the care of patients as prescribed by a prescribes drugs, practices infants, children and doctor. They monitor vital signs medicine and orders tests. adolescents. and administer drugs. EMT Psychiatrist/Psychologist Surgeon These are emergency workers These are mental health A broad ﬁeld of doctors with basic medical training. professionals who assess a patient’s specializing in the surgical They are capable of emotional state. They may also (invasive) treatment of performing CPR and basic ﬁrst provide counseling. illness. aid.
WHAT IS A MEDICAL EMERGENCY?* Possible Medical Emergency Potential Symptoms Heart Attack Chest discomfort; discomfort in other areas of the upper body, including one or both arms; shortness of breath. Uncontrolled Bleeding Just about all bleeding can be controlled, but shock or even death may result if left unattended. Altered Mental Status The individual may be unresponsive. This may include fainting, unconsciousness or any other sudden change in mental status. Commonly known as “respiratory distress,” this may include Difﬁculty Breathing sudden breathlessness and/or severe shortness of breath. In some cases, a person makes a sound, followed by unusual Seizures stiffening, progressing to possible jerking of the arms and legs. Serious or body-altering physical injury, including blunt force Physical Trauma trauma to the head, neck, spine and/or abdomen.*This list contains just a few examples of a medical emergency and is not a substitute for an examination by a medical practitioner. If you are ever in doubt of whether a situation is an emergency, call 9-1-1 immediately.
CALLING 9-1-1 DURING A MEDICAL EMERGENCY*Just a few examples of medical emergencies when it is imperative tocall 9-1-1 Anaphylaxis (life-threatening allergic reaction) Stroke Chest pain Sudden blindness Drug overdose Serious Burns Heart attack Bleeding that will not stop Shortness of breath Broken bones with an open woundJust a few examples of when 9-1-1 should not be called For information To get a ride to a doctor’s appointment When the power goes out For paying tickets To report a broken ﬁre hydrant For your pet When your water pipes burst As a prank *This list contains examples of a medical emergency and is not a substitute for an examination by a medical practitioner. If you are ever in doubt of whether a situation is an emergency, call 9-1-1 immediately.
MAKING A HOSPITAL “GREEN”The EPA estimates that hospitals use twice (maybe 2 1/2 times) asmuch energy per square foot as regular buildings.Hospitals in the United States use 836 trillion BTUs of energyyearly (over 2.5 times the energy intensity and CO2 emissions ofcommercial ofﬁce buildings), while producing 28.575 million tonsof CO2 and over 30 pounds of CO2 emissions per square foot onan annual basis.
EDWARD J. LARSON, PH.D.Edward J. Larson holds the Hugh and Hazel Darling Chair in Law and is University Professor ofHistory at Pepperdine University and recipient of the 1998 Pulitzer Prize in History. He servedas Associate Counsel for the U.S. Congress Committee on Education and Labor (1983-87) andan attorney with a major Seattle law firm (1979-83) and retains an appointment at the Universityof Georgia, where he has taught since 1987.The author of seven books and over one hundred published articles, Larson writes mostly aboutissues of science, medicine and law from an historical perspective. His books include AMagnificent Catastrophe:The Tumultuous Election of 1800 (2007);Evolution: The RemarkableHistory of a Scientific Theory (2005, 2006 rev. ed.);Evolutions Workshop: God and Science inthe Galapagos Islands (2001); Sex, Race, and Science: Eugenics in the Deep South (1995);Trial and Error: The American Controversy Over Creation and Evolution (1985, 2003 rev. Ed.)and the Pulitzer Prize winning Summer for the Gods: The Scopes Trial and AmericasContinuing Debate Over Science and Religion (1997). His next book, An Empire of Ice: Scott,Shackleton and the Heroic Age of Antarctic Science, is due out in 2011.
CRAIG B. GARNERFor the past eight years, Craig has been the Chief Executive Officer and Chairman of the Boardof Trustees at Coast Plaza Hospital in Norwalk, California. Previously, Craig practiced law as anattorney and partner specializing in health care issues. He serves on the advisory board for theCollege of Osteopathic Medicine of the Pacific, Western University of Health Sciences, and onthe board of directors for LVS Health Innovations, an evidence-based health managementcompany focused on creating sustainable active and healthy lifestyles.Craig is also on the Board of Directors of the Los Angeles Opera and the Board of Visitors ofSeaver College at Pepperdine University. He has recently completed his book, Hospital Stay –Health Care Made Simple, which addresses the many concerns of patients and their families asthey navigate their way through the health care system. Craig has also contributed over a dozenhealth care and hospital-related articles to the This Emotional Life Web site, a companion to thethree-part PBS documentary series that explores ways of improving our social relationships,learning to cope with depression and anxiety, and becoming more positive, resilient individuals.
MORE INFORMATION ON HEALTH CARE http://www.healthreform.gov/ http://www.cms.gov/ http://www.dhcs.ca.gov/Pages/default.aspx http://www.cdph.ca.gov/Pages/DEFAULT.aspx http://hospitalstay.com/ http://notsomuch.org/