The Affordable Care Act is a comprehensive health reform law that was passed in 2010. It expands access to health insurance coverage through Medicaid expansion, health insurance exchanges, and prohibiting denial of coverage for pre-existing conditions. It also enhances Medicare benefits, provides consumer protections, and focuses on prevention, wellness, and public health. The law aims to increase the number of Americans with health insurance and decrease the cost of health care.

1. Affordable Care Act
Presented by:
Doyle Forrestal, Regional Outreach Specialist
U.S. Department of Health & Human Services Region VIII
August 2011

2. What is the Affordable Care Act?
Affordable Care Act: The comprehensive health
care reform law enacted in March 2010.
• The law was enacted in two parts: The Patient Protection
and Affordable Care Act was signed into law on March 23,
2010 and was amended by the Health Care and Education
Reconciliation Act on March 30, 2010.
• The name ―Affordable Care Act‖ is used to refer to the final,
amended version of the law.

3. 3
Major Provisions
1) Coverage Expansions
 Medicaid Expansions
 Medicare Enhancements
2) Private Insurance Reforms
3) State-Based Health Insurance Exchanges
4) Prevention and Wellness
5) Health Care System Redesign and Payment Reform
 Accountable Care Organizations
 Medical Homes

4. Medicaid Expansions
• Expands the Medicaid Program: Expands the Medicaid program to more
Americans. States have the option to expand their programs now, and the program
will be expanded nationwide in 2014.
• By 2014: Medicaid will be available to all individuals under age 65 with incomes up
to 133% of the Federal Poverty Level (FPL)
▫ This is approximately $14,404 for an individual in 2009
• Expansion creates a uniform minimum eligibility threshold--allows for childless
adults to qualify
• Federal Government will provide states funding for newly eligible:
▫ 100% from 2014-2016
▫ 95% for 2017
▫ 94% for 2018
▫ 93% for 2019
▫ 90% for 2020 and beyond.

5. 5
Medicare Enhancements
• $250 rebate for donut hole (2010)
▫ In Colorado, 42,351 Medicare beneficiaries received a one-time, tax free $250 rebate to
help pay for prescriptions in the ‗donut hole‖ coverage gap.
• 50% discount on brand name prescriptions (2011)
▫ Starting January 1, 2011—Seniors who fall into the Medicare prescription drug coverage gap
known as the ―donut hole‖ will receive a 50% discount on covered brand name prescription
drugs and lower co-pays for generic drugs.
• Free preventive services and free annual wellness exam (2011)
▫ Starting Jan. 2011—Medicare recipients will receive an annual ―wellness exam‖ and are now
eligible to obtain certain preventive services with no out-of-pocket-costs:
 Mammograms, Colonoscopies
 Cholesterol and diabetes screening
 Prostate cancer screening
 Annual flu shot
• Medicare donut hole eliminated by 2020
• Medicare trust fund extended by 12 years
▫ More tools to crack down on waste, fraud and abuse and to recover wrongful payments
▫ This will help extend the life of the Medicare Trust fund to at least 2029, a 12 year
extension

6. Eliminates Insurance Company Discrimination
• As of September 23, 2010:
▫ health plans cannot limit or deny benefits or deny coverage outright for a child
younger than age 19 simply because the child has a ―pre-existing condition.‖
▫ health plans that cover children must make coverage available to children
up to age 26.
▫ prohibits health plans from putting a lifetime dollar limit on most benefits
▫ requires health plans to cover many preventive services without charging a
copayment, coinsurance, or deductible.
• In 2014, the Act will prohibit insurance companies from denying coverage
or charging more to any person based on their medical history.
• The Act also restricts and phases out the annual dollar limits a health plan
can place on most of your benefits—and does away with these limits
entirely in 2014.

7. Pre-Existing Condition Insurance Program
• On July 1,2010 Secretary Sebelius announced the establishment of the Pre-
Existing Condition Insurance Program (PCIP) to provide coverage for eligible
Americans who have been uninsured for six months because of a pre-existing
condition.
• This program helps build a bridge to 2014, when Americans will have access to
quality, affordable care in health insurance Exchanges.
• The PCIP, which is administered by GettingUsCovered in Colorado, provides a
health coverage option if:
▫ you have been uninsured for at least six months,
▫ you have a pre-existing condition or have been denied health coverage because of
your health condition,
▫ and are a U.S. citizen or are residing here legally.
• Covers a broad range of health benefits, including primary and specialty care,
hospital care, and prescription drugs. All covered benefits are available to
you, even to treat a pre-existing condition.
• To learn more about Colorado‘s Pre-Existing Condition Insurance Plan, called
GettingUSCovered, please call 1-877-779-0387 or visit
www.gettinguscovered.org

8. Health Exchanges
• One-Stop Shopping and Accessibility: The new Exchanges will
supply easy to understand, standard, accessible information on
available health insurance plans, so people can compare and easily
identify the quality, affordable option that is right for them.
• Provides credits & subsidies to purchase insurance: The new
Exchanges will provide credits and subsides up to 400% of the
federal poverty level to help individuals and families purchase
insurance.
• Out of pocket limits: Going forward, plans in the health insurance
Exchanges, and all new plans, will have a cap on what insurance
companies can require beneficiaries to pay in out-of-pocket
expenses, such as co-pays and deductibles.

9. Health Exchanges
State-based health insurance Exchanges will be established to
provide families with the same private insurance choices that the
President and Members of Congress will have, to foster
competition and increase consumer choice.
State-based health insurance exchanges
▫ state-based, competitive marketplaces where individuals and
small businesses can purchase qualified private coverage
▫ Must be operational by Jan. 1, 2014
▫ Coordination between Exchange, Medicaid and CHIP coverage
▫ Grants for Navigators: entities that have relations with
consumers and can provide information and facilitate
enrollment
▫ Four benefits categories, bronze, silver, gold, platinum

10. Small Business Statistics
 On average, a small business spends 18% more for the
same health insurance policy purchased by a large
business.
 Nationally, health insurance premiums for family
coverage at a small business increased by 123 percent
between 1999 and 2009.
 U.S. businesses spend nearly three times as much per
worker per hour for health benefits, making it difficult to
compete in a global economy.*
*Source: New America Foundation and University of Denver’s Center for Colorado’s Economic Future.
“The future of Colorado Health Care: A preview to the forthcoming report on an economic analysis of
health care . . .” www.coloradohealth.org/studies.aspx

11. Benefits for Small Businesses
and Non-Profits
• No small business mandate to provide insurance
• Tax credit for small businesses that insure their
employees
• Reduced cost for purchasing health insurance
through the Exchange

12. Individual and Employer Responsibility
• Starting in 2014, individuals will be required to have health
insurance
• Businesses with fewer than 50 full-time employees are
exempt from any requirement to contribute toward
employee health coverage
• Large employers are required to pay a shared responsibility
fee only if they do not offer coverage and have one or more
full-time employees that receives coverage through an
exchange
 More than 96 percent of employers with 50 or more employees
already offer their employees health insurance coverage

13. National Prevention, Health Promotion, and
Public Health Council
The National Prevention Strategy: America’s Plan for Better
Health and Wellness
▫ On June 16, 2011 the National Prevention, Health Promotion, and
Public Health Council, announced the release of the National
Prevention Strategy ,a comprehensive plan that will help increase
the number of Americans who are healthy at every stage of life.
▫ The National Prevention Strategy focus on the importance of:
 access to quality medical care
 clean air and water
 safe outdoor spaces for physical activity
 safe worksites
 healthy foods
 violence-free environments
 healthy homes
▫ Everyone—businesses, educators, health care institutions,
government, communities and every single American—has a role in
creating a healthier nation.

14. Prevention and Public Health Investment Fund
• The Affordable Care Act invests in prevention through the Creation of the
Prevention and Public Health Investment Fund (the ―Fund‖).
• This new initiative has new resources – $15 billion over ten years in mandatory
spending – to expand and sustain the necessary infrastructure to prevent disease,
detect it early, and manage conditions before they become severe.
• The Fund reinforces a renewed focus on prevention and public health to improve
well-being and improve quality of care.
• For FY2010, $500 million is dedicated to improving community and clinical
prevention efforts, strengthening public health infrastructure, improving research
and data collection and bolstering the training of public health and primary care
professionals.

15. Additional Resources
The Affordable Care Act created a new consumer
friendly website to find information about
health reform.
www.healthcare.gov
www.cuidadodesalud.gov

16. Contact Information
Doyle Forrestal
Regional Outreach Specialist, Region VIII
U.S. Department of Health & Human Services
Doyle.Forrestal@hhs.gov
303-844-7335