SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
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The document discusses the key aspects of recent US healthcare reform legislation and what it may mean for various groups of people. It outlines the goals of expanding coverage, reforming payments and delivery systems. It then explains how specific provisions may impact individuals like seniors on Medicare, the uninsured, those with pre-existing conditions, young adults, and small businesses. While challenges to implementation remain, the reform aims to significantly increase the number of insured Americans over time.
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SC Hospital Association Presentation: Health Care Reform - What Does It Mean for You?
- 1. health care reform: what does it mean for you?
- 2. On August 6 & 7, AccessHealth SC and a variety of partners collaborated to provide FREE medical, vision and dental services at SC Mission 2010 in Greenville
- 3. Over 1,200 patients were provided more than $550,000 in care 44% were employed full or part time 56% were unemployed a sobering success
- 7. the start of medicare & medicaid To provide coverage for the elderly as well as poor women and children, Congress enacted Medicare & Medicaid in the mid-1960s
Editor's Notes
- OPTIONAL – show Mission 2010 video DVD
- Prior to World War II, health care didn’t cost much because we didn’t have much in the way of technology or medications. During the War, America imposed wage controls to prevent runaway inflation. There was a shortage of workers, and employers were encouraged to compete for workers by offering benefits such as health insurance, which was inexpensive. After the war, as the devastated European nations were rebuilding their infrastructure, they had little choice but to build health care systems through their governments. America, meanwhile, maintained its employer-based system.
- In the 1960s, Congress realized that there were limitations to an employer-based health insurance model because some people don’t work. The result was the enactment of Medicare (federally funded) to cover the elderly and Medicaid (joint federal and state funding) to help cover the poor. America still had a draft in the 1960s, so most American men were required to serve in the military and were entitled to VA health benefits for life. So Medicaid was designed to cover women and children. Now that we’ve had a volunteer army for years, millions of adult men find themselves without insurance coverage even if they have full-time jobs because they are not eligible for VA benefits. Breakdown of current national payor mix: 52% Employer 28% Government 5% Individual 15% Uninsured
- In 1986, Congress decided to address the problem of the uninsured by requiring that hospitals treat every person who walks into the emergency room, even if the person can pay nothing. This requirement covers all persons in America, even if they are here illegally. No other organization or individual – not even physicians – are required to treat anyone who comes into their building seeking care. Only hospitals. The EMTALA obligation on hospitals is unlimited, so hospitals cannot manage the budget impact by limiting the number of uninsured patients they will treat. It is also an unfunded mandate – an obligation imposed by government without providing any new dollars to cover the cost. As the cost of health care increases, the unfunded mandate on hospitals increases. It’s fair to say that EMTALA is one of the largest – if not the largest – unfunded mandate ever imposed by Congress on private business. Ironically, it was enacted through the now-controversial legislative process called budget reconciliation by a Democratic House and a Republican Senate and signed into law by President Reagan. So President Reagan in essence signed the law that guarantees every person living in America, legally or illegally, the right to health care. And President George W. Bush reinforced that policy when he said, “People have access to health care in America. After all, you just go to an emergency room.”
- 219,500 adults will be eligible for subsidies in 2014
- This may be a good place to highlight your community benefit numbers.
- The major changes made in the health care reform bill will go into effect over a 10 year phase in period.
- We have heard a lot about the doughnut hole that many seniors on Part D Medicare face each year. They get Medicare assistance with their prescription drug costs until their total drug costs hit $2830. Then the seniors have to pay the next $1720 out of pocket. When their total climbs past $4550, Medicare will begin to help again. The $1720 that seniors have to pay out of pocket is known as the doughnut hole. Obviously, it places a tremendous burden on seniors living on fixed incomes and is often the reason some seniors decide not to take all of their medications. A small step began last year offering a transitional rebate of $250 – 30,173 Medicare beneficiaries have already received the tax free rebate. With the phase in of other transitional steps over the next decade, the doughnut hole will be closed by 2020.
- Who is eligible? Tax credits Citizens and legal residents in families with incomes between 133% and 400% of poverty who purchase coverage through the exchange. Cost Sharing Subsidies With incomes up to 250% of poverty are also eligible for reduced cost sharing paid for by the federal government How will subsidies be provided? Premium tax credits: refundable (for those w/ no tax liability) and advanceable (for use at time of purchase of health insurance). Cost Sharing Subsidies : the cost sharing is reduced so that the insurance plan on average pays a greater share of covered benefits; sets maximum out-of-pocket spending limits. How will subsidies be provided: Many of these details will be addressed through the rulemaking process ie. How to apply, what the lower deductibles and copayments will be for cost sharing etc.
- The Congressional Budget Office estimates that 8 million people will purchase coverage thru the exchanges in 2014…growing to 24 million in later years. Exchanges will reduce administrative costs by 18%.
- This law removes all catogorical requirements changing Medicaid to an income based eligibility program.
- For children under 18, effective September 23, 2010, no denial of coverage for pre-existing conditions. -100,000 children in SC are NOW eligible for insurance coverage
- 58,000 businesses eligible in SC; credits average $10,000 per company Partial tax credit = up to 35% 88% of small businesses in SC have 25 or fewer employees Elimination of premium increases for the entire group due to 1 employee’s pre-existing condition.
- The House voted to repeal HC reform on Jan 19 by a vote of 245 - 189. The bill will not likely move forward and starts the process for the GOP to dismantle the bill piecemeal. 26 R controlled states many of them considering legislation that challenges implementation.
- 28 states includes the 26 states signed onto the FL suit as well as VA and OK. (VA and OK are not part of the Medicaid suit). The FL suit includes both mandate and Medicaid unconstitutional. South Carolina is part of the FL lawsuit. A federal judge recently ruled the individual mandate unconstitutional therefore the entire bill is unconstitutional. This suit will go before the Supreme Court and ultimately they will determine the constitutionality of the bill. 26 R controlled states many of them considering legislation that challenges implementation.
- Medicaid is an economic engine for the state -provides $6 billion into the state economy -Medicaid means jobs for SC citizens -Medicaid’s annual spending is the equivalent of landing a Boeing plant in SC every year
- Expanding coverage to 32 million people.