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Presentation on Patient Protection and Affordable Care Act

  1. 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
  2. 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 to be if you were sick. ı
  3. As conditions in health care improved, the practice of medicine in the United States shifted from home to hospital. People went to a hospital to get better, benefitting from advances in technology and medicine.
  4. By the 1960s, health care in the United States was at a crossroads. Access to treatment had increased, but so did the corresponding price tag. With the passage of Medicare in 1965, the United States government solidified its commitment to government-sponsored health care.
  5. Thai immigration to America was nearly nonexistent before 1960. By the 1970s, approximately 5,000 Thais had immigrated to the United States. During the 1980s, the number of Thai individuals immigrating to the United States averaged at about 6,500 each year. As of 1990, there were approximately 91,275 people of Thai ancestry living in the United States. By 2002, the number of Thais living in Los Angeles alone exceeded 80,000, the largest Thai population outside of Thailand.
  6. No matter where you are, finding reliable health care in a foreign country can be challenging, especially one that is 8,300 miles (5,200 km) away.
  7. WHEN VISITING THAILAND Founded in 1979, Samitivej Hospitals is one of the leading private hospital groups in Thailand. Samitivej Sukhumvit Hospital is recognized as one of the leading private hospitals in Southeast Asia.
  9. 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.
  10. 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 in 2013. 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 investment income for families making more than $250,000 per year ($200,000 for individuals). 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 for individuals).
  11. THE HEALTH INSURANCE EXCHANGE Under the Health Care Reform law, the health insurance exchange is a marketplace designed to offer affordable high-quality health insurance options. The exchange is designed to help families who have no insurance or do not get adequate insurance at work and cannot afford to buy it in the costly individual or small group market. It is also for small businesses that cannot afford small group health insurance.
  12. THE HEALTH INSURANCE EXCHANGE By the end of 2010, a temporary national high-risk pool provided health coverage to individuals with pre-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 health insurance plans to consider. This would include comparisons of covered services, premiums, co-pays and deductibles, as well as out-of-pocket limits on expenses. ı Each 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 insurance exchange 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.
  13. 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.
  14. 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
  15. 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.
  16. 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.
  17. 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.....
  18. 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.
  19. HEALTH CARE REFORM FOR BUSINESSES IN 2018 There 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 special occupations.
  20. SMALL BUSINESS HEALTH CARE TAX CREDIT This credit helps small businesses and small tax-exempt organizations afford the cost of covering 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).
  21. CHANGES TO FLEXIBLE SPENDING ARRANGEMENTS Effective January 1, 2011, the cost of an over-the-counter medicine or drugs cannot be reimbursed from Flexible Spending Arrangements or health reimbursement arrangements unless a prescription is obtained. The change does not affect insulin, even if purchased without a prescription, or other health care expenses such as medical devices, eye glasses, contact lenses, co-pays and deductibles. A similar rule goes into effect on January 1, 2011 for Health Savings Accounts.
  22. “OPTIONAL” EMPLOYER REPORTING REQUIREMENTS Starting in tax year 2011, the Affordable Care Act requires employers to report the value of the health insurance coverage they provide employees on each employee’s annual Form W-2. However, to provide employers the time they need to implement these changes, the IRS will defer the reporting requirement for 2011, making them optional.
  23. 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
  24. 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.
  25. 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.
  26. CALLING 9-1-1 DURING A MEDICAL EMERGENCY* Just a few examples of medical emergencies when it is imperative to call 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 wound Just 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.
  27. MAKING A HOSPITAL “GREEN” The EPA estimates that hospitals use twice (maybe 2 1/2 times) as much energy per square foot as regular buildings. Hospitals in the United States use 836 trillion BTUs of energy yearly (over 2.5 times the energy intensity and CO2 emissions of commercial office buildings), while producing 28.575 million tons of CO2 and over 30 pounds of CO2 emissions per square foot on an annual basis.
  29. EDWARD J. LARSON, PH.D. Edward J. Larson holds the Hugh and Hazel Darling Chair in Law and is University Professor of History at Pepperdine University and recipient of the 1998 Pulitzer Prize in History. He served as Associate Counsel for the U.S. Congress Committee on Education and Labor (1983-87) and an attorney with a major Seattle law firm (1979-83) and retains an appointment at the University of Georgia, where he has taught since 1987. The author of seven books and over one hundred published articles, Larson writes mostly about issues of science, medicine and law from an historical perspective. His books include A Magnificent Catastrophe:The Tumultuous Election of 1800 (2007);Evolution: The Remarkable History of a Scientific Theory (2005, 2006 rev. ed.);Evolution's Workshop: God and Science in the 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 America's Continuing 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.
  30. CRAIG B. GARNER For the past eight years, Craig has been the Chief Executive Officer and Chairman of the Board of Trustees at Coast Plaza Hospital in Norwalk, California. Previously, Craig practiced law as an attorney and partner specializing in health care issues. He serves on the advisory board for the College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, and on the board of directors for LVS Health Innovations, an evidence-based health management company 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 of Seaver 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 as they navigate their way through the health care system. Craig has also contributed over a dozen health care and hospital-related articles to the This Emotional Life Web site, a companion to the three-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. 

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