Affordable Care Act The Decision Is In Pbc Partnership For Aging

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Affordable Care Act - The Decision Is In (What is included, what is not and how much does it all cost.)
A presentation for the Palm Beach County Partnership for Aging by Paul Gionfriddo of
Our Health Policy Matters.
705 South Palmway
Lake Worth FL 33460
561-307-5588

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Affordable Care Act The Decision Is In Pbc Partnership For Aging

  1. 1. 1
  2. 2.  What the Court Decided. The Effect of the Court’s Decision on You and Me. What the Decision Means for the Future of Medicare and Medicaid. A Gathering Storm – Public Policy and Health in the Post-ACA World. 2
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  7. 7. 1713.7 14.3 13 12.8 4.5 4 7
  8. 8.  Is the individual mandate constitutional either because it relates to interstate commerce or because it is a tax? Is the Medicaid expansion to 133% of poverty constitutional, or does it “coerce” states into participating in Medicaid? If either answer is no, can the unconstitutional part be “severed” from the rest of the law? 8
  9. 9.  Individual mandate is constitutional, but not as a “command” under Commerce Clause, but because it is a tax. Mandatory Medicaid expansion is unconstitutional; states can opt out of expansion and keep their existing Medicaid programs. Unconstitutional portion is severable from the rest of the law. 9
  10. 10.  “It is estimated that four million people each year will choose to pay the IRS rather than buy insurance. … That Congress apparently regards such extensive failure to comply with the mandate as tolerable suggests that Congress did not think it was creating four million outlaws. It suggests instead that the shared responsibility payment merely imposes a tax citizens may lawfully choose to pay in lieu of buying health insurance.” Roberts Decision, p.37-38 10
  11. 11.  “Nothing in our opinion precludes Congress from offering funds under the Affordable Care Act to expand the availability of health care, and requiring that States accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding.”Roberts Decision, p. 55 11
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  13. 13.  Subsidies for families earning up to $91,000+. Medicaid eligibility up to 133% of poverty. Equitable pricing of mental health benefits. Consumer protections – pre-existing condition coverage, no cancellations for chronic illnesses, no annual/lifetime caps, children stay on parents’ plan until age 26. Mandated minimum loss ratios of 80% to 13
  14. 14.  Medicare pays out 93-96 cents for every $1 in. $1.1 billion in ACA-mandated 2012 rebates to private insurance company customers by plans not meeting 80-85 cent MLR requirements. Over $124 million in rebates to1.25 million Florida residents. Average rebates in FL: $94 (large group), $190 (small group), $240 (individual). 14
  15. 15. Population Winner or Loser? You or your family  Winner – no member has a chronic exclusions for pre- disease or existing conditions for condition, such as anyone as of 2014. mental  Jury’s Out – newly illness, cancer, heart Medicaid eligible disease, or diabetes. people in a state Affects 133 million thinking of opting out people. of the Medicaid expansion. 15
  16. 16. Population Winner or Loser You are a Medicare  Winner. Donut hole recipient. Affects 48 closes and prevention million people. services are intact. 16
  17. 17. Population Winner or Loser You want a single  Loser. Maybe next payer, Medicare-for-all generation. program or you want a totally market-driven insurance system with little or no government involvement. 17
  18. 18. Source: CMS Projections, 201234% 33%2011 2021 18
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  20. 20.  Assets as of 1/1/11: $344 billion 2011 Income: $530 billion 2011 Expenditures: $549 billion Assets as of 1/1/12: $325 billion Enrollment: 48.7 million (8.3 million disabled) Average benefit per enrollee: $12,042 Part D (Drug) benefit only: $1,870Source: Medicare Trustees Annual Report, 2012 20
  21. 21.  Medicare did not contribute to the debt. Medicare funding deficit is a downstream threat – trust fund has enough money for 12 more years. To keep Medicare as we know it solvent for 75 more years, Medicare taxes would have to increase by 0.67% on Medicare taxpayers and 0.67% on their employers. Source: Medicare Trust Fund Trustees 2012 Report 21
  22. 22. 12.0% Source: Medicare10.0% Trustees Annual Report, 20128.0% Current - With ACA6.0% ACA Provider Cuts4.0% Overridden All ACA Cuts Overridden2.0%0.0% Current FY2040 FY2085 Year 22
  23. 23.  3.6 million donut hole recipients saved drug money in 2011. › Florida: 238,362 Total savings: $2.1 billion › Florida: $142 million Savings per person: $604 › Florida: $596Source: CMS Fact Sheet, 2/2/2012 23
  24. 24.  14.3 million Medicare recipients received at least one free preventive service during the first 5+ months of 2012.Source: CMS Release, June 11, 2012 24
  25. 25. Current and Projected Medicare and Medicaid Costs (Billions) Medicare MedicaidSource: CMS 2012 Projections $1,006.90 $957.30 $590.80 Federal $458.90 61% 2012 2021 25
  26. 26.  Florida family Medicaid eligibility limit 2012: $23,052 for a family of four. Medicaid eligibility to 133% of poverty - $30,700 for a family of four (2012). Fed pays 100% of the expansion cost first three years, 90% thereafter. Affects 17 million people nationally. 26
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  28. 28. Source: FL Attorney General Pam Bondi, Supreme Court Brief, 2012 $574,000,000 $351,000,000 Currently Medicaid Newly Eligible BecauseEligible, But Not Enrolled of ACA 28
  29. 29.  Effects on people with mental illnesses and other chronic conditions. Affects basic benefits package – would not have to cover all mandated services or drugs. Affects single adults with chronic conditions/disabilities, because single adults are among those newly eligible for Medicaid. 29
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  31. 31. Prevention, not treatment, accountsfor half of our health gains over the last century. 31
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  33. 33.  29,000 local public health employees were lost between 2008 and 2010. › NACCHO Survey, March 2011 “Cuts to Essential Public Health Services Jeopardize Americans’ Health” › ASTHO Press Release, April 2011 FL cut $55.6 million and 229 FTEs from DOH in 2011. › Health News Florida, August 2011 33
  34. 34.  Started with $16 billion over ten years – less than 2% of overall ACA funding. $5 billion cut in February 2012 to help fund payroll tax cut, unemployment benefits, and MD Medicare payments. House voted complete repeal in April 2012. (Current U.S. Senate will not agree.) 34
  35. 35.  The SCOTUS ruling doesn’t end the debate. According to an AP/GfK poll released in June, 77% of the public still wanted the President and Congress to work on health reform. Will a market-based approach, including Medicare privatization, get more traction in Congress as it becomes a focal point of Romney’s campaign for President? 35
  36. 36.  High risk pools for  Adverse selection and people with chronic high cost. illnesses.  Would eventually Prevent discrimination affect nearly against people with everyone, because pre-existing conditions over 25% of us have a only if they maintain lapse in coverage each continuous coverage. year. Insurance sale  Plans to be regulated across state lines. to the lowest state Medicaid block grant to standard. states.  More uninsured and 36
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  39. 39. Thank you!http://pgionfriddo.blogspot.co m 39

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