View this powerpoint delivered by Rita Landgraf, secretary of the Division of Health and Social Services for the State of Delaware about the Health Care Reform Legislation. This presentation was given on June 2, 2010 at the Delaware State Chamber of Commerce's End-of-Session Legislative Brunch at Dover Downs.
Presentation: Implications of the Affordable Care Act to the Pharmaceutical Industry
Presented by: Kirsten Axelsen, Vice President, Worldwide Policy, Pfizer
Overview of what the coverage expansion and payment reforms in the Affordable Care Act mean for access to medicine and for new treatments and cures. Issues for patients and policy makers to consider as the healthcare system increasingly relies on medicine to manage conditions, avoid disease and save on healthcare system costs.
This presentation highlights the changes required of small businesses to maintain compliance with Health Care Reform regulations. Cathy Harbison, director of operations for employee benefits at Neace Lukens, served as the expert speaker to explain upcoming changes for 2011 – 2014, and the implications for businesses with less than 50 employees.
How Does Obamacare Impact Your Business Planning?Tilson
The Supreme Court has upheld the PPACA and its implementation is full steam ahead. Now is the time to begin preparing for the impact on your business and your employees. Many have forgotten the complexity, decisions, and regulatory requirements of this legislation. As we all know, the devil is in the details.
OpenScholar - The Solution for Higher EducationAcquia
Join Acquia, and Harvard’s Institute of Quantitative Social Science as we present Open Scholar, a Drupal solution for higher education.
Built by faculty members at Harvard University’s Institute of Quantitative Social Science, Open Scholar is a free, pre-configured, and fully customizable solution that enables universities and colleges to deploy turnkey websites for professors, researches and students. In seconds, faculty members can create their own social website to publish research, share blog posts, follow and track projects, and interact with their community. With the click of a button researchers can create collaboration websites to work on projects, attract grant funding and share results in an open environment for peer review.
Partnered with Harvard University’s Institute of Quantitative Social Science, we invite you to register to learn more and how Acquia can help your institution deploy Open Scholar tomorrow. No additional resources needed!
Attendees will:
* Watch a demonstration of the Open Scholar application
* Learn how to speed deployment of microsites for faculty members, projects, and departments
* Understand how Open Scholar will help universities reduce costs while giving faculty fully functional social websites
* Hear how Acquia’s fully managed solutions for higher education can simplify Open Scholar deployment and management
This webinar is intended for higher educational institutions looking for an easier way to deploy social publishing websites that facilitate faculty engagement, promote research, and deploy the next generation of social networking and website publishing on campus.
Presentation: Implications of the Affordable Care Act to the Pharmaceutical Industry
Presented by: Kirsten Axelsen, Vice President, Worldwide Policy, Pfizer
Overview of what the coverage expansion and payment reforms in the Affordable Care Act mean for access to medicine and for new treatments and cures. Issues for patients and policy makers to consider as the healthcare system increasingly relies on medicine to manage conditions, avoid disease and save on healthcare system costs.
This presentation highlights the changes required of small businesses to maintain compliance with Health Care Reform regulations. Cathy Harbison, director of operations for employee benefits at Neace Lukens, served as the expert speaker to explain upcoming changes for 2011 – 2014, and the implications for businesses with less than 50 employees.
How Does Obamacare Impact Your Business Planning?Tilson
The Supreme Court has upheld the PPACA and its implementation is full steam ahead. Now is the time to begin preparing for the impact on your business and your employees. Many have forgotten the complexity, decisions, and regulatory requirements of this legislation. As we all know, the devil is in the details.
OpenScholar - The Solution for Higher EducationAcquia
Join Acquia, and Harvard’s Institute of Quantitative Social Science as we present Open Scholar, a Drupal solution for higher education.
Built by faculty members at Harvard University’s Institute of Quantitative Social Science, Open Scholar is a free, pre-configured, and fully customizable solution that enables universities and colleges to deploy turnkey websites for professors, researches and students. In seconds, faculty members can create their own social website to publish research, share blog posts, follow and track projects, and interact with their community. With the click of a button researchers can create collaboration websites to work on projects, attract grant funding and share results in an open environment for peer review.
Partnered with Harvard University’s Institute of Quantitative Social Science, we invite you to register to learn more and how Acquia can help your institution deploy Open Scholar tomorrow. No additional resources needed!
Attendees will:
* Watch a demonstration of the Open Scholar application
* Learn how to speed deployment of microsites for faculty members, projects, and departments
* Understand how Open Scholar will help universities reduce costs while giving faculty fully functional social websites
* Hear how Acquia’s fully managed solutions for higher education can simplify Open Scholar deployment and management
This webinar is intended for higher educational institutions looking for an easier way to deploy social publishing websites that facilitate faculty engagement, promote research, and deploy the next generation of social networking and website publishing on campus.
This is my Adobe max 2008 presentation on cross channel digital marketing campaigns. The presentation covers work from: Nike, Xbox, Visa & McDonalds.
Blue Ocean Strategy - Creating Value Innovationsmelanie_ernst
Why still bothering what the competition is doing? Can you really win the battle? Or wouldn’t it be much nicer to get out and create your own market, where YOU are the only supplier. Blue Ocean Strategy leads you to uncontested market space, making the competition irrelevant by creating and capturing new demand, breaking the value-cost-trade off and aligning the whole system of a firm's activities in pursuit of differentiation and low cost.
Health Care Reform and Harm Reduction: Laura Hanen, Rachel McLean - HRC 2010Harm Reduction Coalition
A presentation by Laura Hanen (NASTAD) and Rachel McLean (California Department of Public Health) on what health care reform means for harm reduction and drug user health. Presented at the Harm Reduction Coalition's 8th National Conference, November 18-21, 2010 in Austin, Texas.
ACA: A Step Toward Healthcare For All (Dr. John Cavacece, DO)Zach Jarou
Presented to the American Medical Student Association (www.AMSA.org) at Michigan State University's College of Human Medicine (MSU CHM) on Tuesday, March 20, 2012
Katie Hays, US Chamber of Commerce, Health Care Panel Legislation Panel Discu...Delaware State Chamber
View this powerpoint delivered by Katie Hays, Executive Director of Government Affairs, U.S. Chamber of Commerce about the Health Care Reform Legislation. This presentation was given on June 2, 2010 at the Delaware State Chamber of Commerce's End-of-Session Legislative Brunch at Dover Downs.
Roger Kirtley, Lyons Companies, Health Care Reform Legislation Panel, June 2,...Delaware State Chamber
View this powerpoint delivered by Roger Kirtley, a Risk Management Advisor with Lyons Companies about the Health Care Reform Legislation. This presentation was given on June 2, 2010 at the Delaware State Chamber of Commerce's End-of-Session Legislative Brunch at Dover Downs.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Rita Landgraf Health Care Reform Legislation, June 1, 2010
1. Health Care Reform Care
The Knotty Issues of Health
Rita Landgraf, Secretary
Delaware Health & Social Services
2.
3. Where is Delaware Now?
April 2010:
• 177,865 Delawareans enrolled in Medicaid
• 6,440 children enrolled in the Delaware Healthy
Children Program (CHIP)
4. Uninsured
• Over the past few years uninsured in DE has risen from 9.9% to
11.2%
• Approximately 101,000 are without insurance at any given time-
(this is a 2008 estimate)
• Approximately 28% or 28,000 are eligible for public benefit
through Medicaid (21,000 or CHIP 7,000)
• Another 20% are eligible for CHAP – Community Health Access
Program
5. Who Are the Uninsured
• 23% - under the age of 19
• 54% - male
• 69% - white
• 59% - own or are buying their home
• 21%- live alone
• 80% - are above the poverty line
• 34%- with household income over %50,000
• 59% - are working adults
• 9% - are self-employed
• 21% - are non citizens
6. Uncompensated Care
• Cost Shift – providers attempt to recover unpaid or underpaid
costs of care delivered to one patient by increasing costs and
passing it on to another patient population
• 1999 – 28% cost shift in DE Hospitals due to uncompensated
care to the uninsured- For every $100 of hospital costs, the total
commercial insurance market paid an extra $28
• Health Care Costs - $6.5 billion was spent on personal health
care ($7,485 per person) in DE in 2008 – highest point in 10
years- Average rate of increase is 5% per year
7. Community Healthcare Access
Program
• Focus – to connect to primary care medical homes as well as specialty
services, linkage to Screening for Life, Medicaid an VA
• Patients with incomes below 200% of FPL ($44,000 for family of 4)
• Matched with medical service provided through community hospitals,
community health centers and a network of 521 private physicians who
participate on a voluntary basis
• Over 22,000 low-income uninsured individuals have been served by
CHAP
• Outcomes
– Fewer hospital emergency room visits
– Shorter hospital stays
– Improved rates of preventative health screenings
– Improved control of chronic disease
8. Public Law 111-148 – Historic
Legislation
Patient Protection and
Affordable Health Care
Act (H.R. 3590) into law
on March 23, 2010
Health Care & Education
Affordability Reconciliation
Act (H.R. 4782) was
signed on March 25, 2010
Included negotiated
differences between the
House and Senate bills
and revised the student
loan program
9. Purpose
• Expand Coverage and access to care
– 32 million uninsured will be covered
• New Insurance Exchange with Premium Sharing
Subsidies, and Cost Sharing Caps
• Large Expansion of Medicaid Eligibility
• Significant Insurance Market Reforms
• Emphasis on Prevention
• Bending the Cost Curve over time
11. Expanding Coverage
• Coverage for Dependents (IRS Definition) (6 months):
– Must provide coverage to a beneficiary’s dependent child until
the child turns 26
– Child does not have to live at home
• Temporary High Risk Pool (90 days to 2014)
– Citizens with pre-existing conditions who were uninsured
6 months prior to applying for coverage in the pool
– $5 billion provided
– Pool operated by HHS or states
– Delaware will participate in HHS Pool
• Health Benefits Advisory Committee led by Surgeon General
will recommend essential benefits package (established in 60
days)
11
12. Expand Coverage
• Expands Medicaid eligibility to 133 % of Federal Poverty
Level (2014) -
• approximately $14,600/ individual; $29,400/family of 4
• Includes childless adults
• Provides national base of seamless coverage – no asset
or resource test
• Federal Share (FMAP):
• 100% for newly eligible first 3 years (2014 – 2016)
• Phases down to 90% for 2020 and subsequent years
• Provides full funding for CHIP through 2015 and
continues authority through 2019. Children on CHIP
would be transitioned to Medicaid or into Exchange.
12
13. Delaware Focus
• Medicaid Expansion
States are required to extend Medicaid eligibility to everyone
younger then 65 with incomes up to 133% of FPL($29,327 family
of 4).
2014 – 2016 - Federal government pays 100%
2017 – Delaware will pick up 5% of cost
2020 - 90% of cost
Delaware provides expanded coverage to 27,000 Delawareans
up to 100% FPL - Federal government picks up 53% of the cost
2014 – the federal match will increase to 75% and by 2020 up to
90% of cost
15. Employer Sponsored Plans & Increasing
Choice for Small Business
• Sixty-one percent of working age individuals and their families receive
employer-sponsored insurance coverage, and this coverage is
increasingly in jeopardy.
• The primary source of instability in the employer-sponsored insurance
market is the decrease in employers offering health insurance coverage
to workers and their families. Between 2000 and 2008, the percentage of
firms offering health insurance coverage to their employees declined
from 69 to 63; for firms employing less than 10 workers, the decline was
even greater – from 57 to 49 percent. coverage outside the employer-
sponsored market is unaffordable or does not provide adequate
coverage for most Americans.
• Only five percent of non-elderly Americans receive coverage on the
individual market, where coverage is more expensive and limited than in
employer-sponsored plans.
• Over the past decade, average annual family premiums increased by
123%, from $5,700 in 1999 to $12,700 in 2009
16. Expanding Coverage:
Small Business Tax Credits (2010)
• Eligibility: Employers with fewer than 25 full time employees (or a
firm with fewer than 50 half time workers) who
– pay average annual wages of less than $50,000
– who provide health insurance to their employees
• Worth up to 35% of employer’s premium costs in 2010. January 1,
2014 worth up to 50%
• Gradual phase-out for firms with average wages between $25,000
- $50,000 and those with between 10 and 25 employees
• Non-Profits eligible for payroll tax deduction if they fit above
criteria –worth up to 25% of employer’s premium costs
16
17. Market Reforms & Employers
• Small Business Health Options Program Exchange – Non-profits
eligible (2014)
• Small group plans must accept every employer and individual
who applies (2014)
• Small Employer/Non-Profit: 100 employees or less the state
defines as 50 or less (2014)
• Large Employers: Can participate in Exchange, at each state's
discretion (2017)
18. Employer Responsibility (2014)
• In 2014, the Affordable Care Act requires large employers to pay a
shared responsibility fee only if they do not provide affordable coverage
• Employers with 50 or more full time employees (FTEs) who do
NOT offer coverage
– for every full-time employee that receives a premium credit for
the Exchange the employer must pay penalty
– FTE= 30 or more hours per week
– Part-time employees: Less than 30 hours per week
18
20. Insurance Market Reforms
• Bars pre-existing condition exclusions for everyone (2014)
– Bars pre-existing condition exclusions for children under 19
(6 months after enactment)
– No coverage exclusions for specific conditions
– No higher premiums or fees for such conditions
• Prohibits coverage rescissions (6 months)
– Insurers drop individual when s/he gets sick or apparent pre-
existing condition is discovered
• Prohibits annual limits (2014)
– Prior to 2014: “Restricted” annual limits, to be defined by HHS
Secretary are permitted
• Prohibits lifetime limits on coverage (6 months/September 23)
20
21. Insurance Market Reforms
• Bans discrimination based on health Status, medical condition
(mental or physical illness), disability (2014)
• Guaranteed issue and renewability
• Small group and Individual plans must accept every employer
and individual who applies
21
22. Health Insurance Exchanges (2014)
• Creates state-based “Health Insurance Exchanges”, or
marketplace to increase choice, provide competition
• Private insurance plans that meet minimum standards on benefits
and cost-sharing set forth in regulations
• Multi-state Exchanges run by HHS for states that choose not to
operate their own Exchange
22
23. Essential Benefits Package for Exchange
Plans
• Hospitalization, emergency • Mental health and substance
services, ambulatory (i.e. use disorder services
outpatient) services including behavioral health
• Prescription drugs and treatment
laboratory services • Preventative and wellness
• Rehabilitative and services and chronic disease
habilitative services and management
devices • Pediatric services including
– pre-health care reform dental and vision care
insurance policies did not • Maternity and newborn care
cover them or severely
limited the number of
treatments!
– Devices includes “DME”
23
24. Defining Exchange’s Essential Benefits
• HHS Secy. must ensure that scope of benefits are equal to scope
of benefits provided by typical employer sponsored plan
• Establish that benefits are not denied based on:
– Individual’s “present or predicted disability, degree of medical
dependency, quality of life, age or expected length of life”
• Dept. of Labor to conduct survey of employer sponsored plans,
provide report to inform HHS Secy’s determination
• Will be a chance for public comment
24
25. Making Coverage Affordable
• Tax credits provided for individuals/families between 133% -
400% Federal Poverty to buy coverage in Exchange (2014)
– approximately $11,000/individual; $88,000 family of four
• Paid by government directly to insurer
• Limits on cost sharing: deductibles, coinsurance, co-payments
– 100-200% FPL: $1,983/individual; $3,967/family
– 200-300% FPL: $2,975/individual; $5,950/family
– 300-400% FPL: $3,987/individual; $7,973/family
• Small group market plans are prohibited from deductibles greater
than $2,000 for individuals and $4,000 for families
25
26. Individual Responsibility (2014)
• Those who are uninsured add over one thousand dollars to
the average premium of families with insurance.
• Everyone will be asked to share responsibility for lowering
costs and covering more people
• Tax penalties for no coverage - IRS:
• 2014: $95
• 2015: $325
• 2016: $695 OR
• Percent of household income: 1% in 2014, 2% in 2015,
2.5% - 2016 and after
• Exempts individuals with incomes too low to pay taxes
($9,350) or if premiums exceed 8% of income
26
27. Medicaid/Chronic Disease Prevention
• 5 Year Grants to states (2011 or when HHS Sec. develops
program) for incentives for beneficiaries for:
– Tobacco cessation, weight reduction and control, cholesterol
reduction, blood pressure reduction, diabetes onset reduction
or improved management of diabetes
– States can provide sub-grants/contracts to Medicaid providers,
community based or faith-based organizations
27
28. Medicaid and Medicare Wellness
• Annual wellness visits and personalized prevention plans for
Medicare beneficiaries (Jan. 2011)
• No co-pays or deductibles for preventive services for Medicare
patients (2011)
• 1% FMAP increase for States if Medicaid program covers clinical
preventive services recommended by the Preventive Services
Task Force (2013)
• Grants to provide incentives to Medicaid beneficiaries who
successfully participate in a wellness program
29. State Preparation and Planning
Challenge for Delaware:
Maximize benefits for Delaware citizens to support
the goals of widespread access to health insurance
& health care, supporting people in community-
based settings, and promoting healthy lifestyles.
30. State Preparation and Planning
• State leadership team – Led by DHSS
– OMB – State Employee Benefit and Budget preparation
– Department of Revenue – income exemption determinations
– DMMA – Medicaid
– DSS – process applications
– DOI – oversight and certification of plans and regulate rate
bands
– DPH – prevention measures and services
– DTI and DHIN – health information network
– Health Care Commission
31. Responsibilities
• Overseeing planning, development and implementation
• Identifying ways to build on existing infrastructures and programs,
or to create a new entity within state government to house
governance and oversight
• Ensuring appropriate coordination and collaboration across state
agencies
• Engaging with relevant stakeholders to get buy-in and insights for
reform implementation
32. State Preparation and Planning
• Health Care Commission
● Public Discussions
● Coordination with Private Sector:
Doctors
Hospitals
Community Based Health Centers
Insurance Companies
Employer Network