The document summarizes President Trump's campaign promises on healthcare and the status of the Republican efforts to repeal and replace the Affordable Care Act. It outlines Trump's six main healthcare promises and provides updates on the American Health Care Act (AHCA) passing the House but facing challenges in the Senate. It describes changes proposed in the AHCA and amendments, including impacts on Medicaid funding, the individual marketplace, and pre-existing conditions protections.
Dr. Pam Silberman, President and CEO of the N.C. Institute of Medicine, provides an overview of the Affordable Care Act in North Carolina as part of a NCACC Annual Conference workshop on Aug. 24, 2013.
Dr. Pam Silberman, President and CEO of the N.C. Institute of Medicine, provides an overview of the Affordable Care Act in North Carolina as part of a NCACC Annual Conference workshop on Aug. 24, 2013.
Understanding Wisconsins Health Plan Optionsnekiminurse
Wisconsin has been a leader in trying to provide low cost health insurance for those individuals who are unable to access or qualify for employer sponsored plans. This presentation was part of a kaizen event for clinic personnel on the prior authorization proccess.
Read the latest benefits information from Independent Medicare broker Erin Hart from American HealthCare Group. Learn about Medicare income limits, care plans, and topics to consider when planning for health benefits in retirement.
Medicare 101 Presentation from Erin Hart, American HealthCare GroupMary Hagan
Erin Hart is an independent licensed Medicare Broker who helps retirees and seniors decide which Medicare benefit is the best choice for them. She meets with individuals or employer and community groups.
Are you prepared for the risk of needing long term care for you or your spouse? Even if you think you are prepared, this presentation will provide even the casual observer some important information. Don't wait until it's too late when you cannot do anything about this, start designing your plan now with the help of this presentation.
Understanding Wisconsins Health Plan Optionsnekiminurse
Wisconsin has been a leader in trying to provide low cost health insurance for those individuals who are unable to access or qualify for employer sponsored plans. This presentation was part of a kaizen event for clinic personnel on the prior authorization proccess.
Read the latest benefits information from Independent Medicare broker Erin Hart from American HealthCare Group. Learn about Medicare income limits, care plans, and topics to consider when planning for health benefits in retirement.
Medicare 101 Presentation from Erin Hart, American HealthCare GroupMary Hagan
Erin Hart is an independent licensed Medicare Broker who helps retirees and seniors decide which Medicare benefit is the best choice for them. She meets with individuals or employer and community groups.
Are you prepared for the risk of needing long term care for you or your spouse? Even if you think you are prepared, this presentation will provide even the casual observer some important information. Don't wait until it's too late when you cannot do anything about this, start designing your plan now with the help of this presentation.
Got Healthcare? Affordable Care Act PP (July 2013)Kevin Kane
The Affordable Care Act presentation that Citizen Action of Wisconsin presents with around the state. How the ACA impacts you and how to talk about it.
2016 presidential candidates & healthcareMarket Edge
The positions of the presidential candidates on healthcare and the Affordable Care Act (ACA) are noteworthy as healthcare consumes $3 trillion, almost $10,000 for every man, woman and child in the United States.
The positions of the presidential candidates on healthcare and the Affordable Care Act (ACA) are noteworthy as healthcare consumes $3 trillion, almost $10,000 for every man, woman and child in the United States.
Harvard's Robert Greenwald on Texas MedicaidOneVoiceTexas
Robert Greenwald, JD, Clinical Professor of Law and Director of Center for Health Law and Policy Innovation at Harvard Law School, presented an in-depth analysis forum of the federal health reform Affordable Care Act and associated transformation of the Texas Medicaid system. On January 24 in Austin, he spoke to sever audiences on the challenges and opportunities specific to Texas including why the Affordable Care Act’s Medicaid expansion is so important to the provision of cost- effective, high quality care and treatment to low income uninsured Texans.
Professor Greenwald has over 20 years of experience in the fields of health law and policy. His Center is recognized as a national leader in Affordable Care Act implementation and in efforts to improve healthcare access and health outcomes for the uninsured and underinsured.
One Voice Texas and the Harris County Healthcare Alliance sponsored the event.
The Affordable Care Act touches the lives of most Americans. In fact, nearly 21 million will be at risk if Obamacare is struck down, and may even lose health insurance completely if the law is ruled unconstitutional. This webinar will discuss what the outcome may be if ACA is repealed.
Mary Agnes Carey: "After the mandate, states plot their own futures for healt...reportingonhealth
Mary Agnes Carey's slides from the Center for Health Journalism webinar, "After the mandate, states plot their own futures for health coverage," 2.5.18
More info: https://www.centerforhealthjournalism.org/content/mandate-gone-what-happens-health-exchanges-now
A health insurance roadmap takes a look at some simple solutions to the complex issues facing health insurance, medicare, medicaid, long term care insurance, and the high cost of health expenses in retirement.
This will work because so much of this is already in place and a lot of the rest would be quick and easy to implement. As in all areas, knowledge is power. Consumers can take control of your insurance portfolio by becoming educated about insurance. Better education and understanding will lead to positive results for consumers and for the insurance industry.
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Who Knew Health Care Could Be This Complicated?Cedric Dark
A talk I gave to the Spring Branch Democrats (Houston, TX) just as the "Skinny Repeal" was released to the public and hours before it's ultimate failure.
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CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
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2. Health Promotion and Education:
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ACCORDING TO apic.org,
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ACCORDING TO pewtrusts.org,
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VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
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1. Who Knew Healthcare Could Be
This Complicated?
Cedric Dark, MD, MPH
Founder and Executive Editor, Policy
Prescriptions®
2.
3. Donald J. Trump
• Repeal and Replace
Obamacare with HSAs
• Full deductions for health
insurance
• Block grant for Medicaid
• Insurance Across State
Lines
• Importing drugs from
overseas
• Price Transparency for
Providers
Campaign Promises on Health Care
4. Donald J. Trump
• Repeal and Replace
Obamacare with HSAs
• Full deductions for health
insurance
• Block grant for Medicaid
• Insurance Across State
Lines
• Importing drugs from
overseas
• Price Transparency for
Providers
Campaign Promises on Health Care
5. Donald J. Trump
• Repeal and Replace
Obamacare with HSAs
• Full deductions for health
insurance
• Block grant for Medicaid
• Insurance Across State
Lines
• Importing drugs from
overseas
• Price Transparency for
Providers
Campaign Promises on Health Care
6. Donald J. Trump
• Repeal and Replace
Obamacare with HSAs
• Full deductions for health
insurance
• Block grant for Medicaid
• Insurance Across State
Lines
• Importing drugs from
overseas
• Price Transparency for
Providers
Campaign Promises on Health Care
7. Donald J. Trump
• Repeal and Replace
Obamacare with HSAs
• Full deductions for health
insurance
• Block grant for Medicaid
• Insurance Across State
Lines
• Importing drugs from
overseas
• Price Transparency for
Providers
Campaign Promises on Health Care
8. Donald J. Trump
• Repeal and Replace
Obamacare with HSAs
• Full deductions for health
insurance
• Block grant for Medicaid
• Insurance Across State
Lines
• Importing drugs from
overseas
• Price Transparency for
Providers
Campaign Promises on Health Care
9. Donald J. Trump
• Repeal and Replace
Obamacare with HSAs
• Full deductions for health
insurance
• Block grant for Medicaid
• Insurance Across State
Lines
• Importing drugs from
overseas
• Price Transparency for
Providers
Campaign Promises on Health Care
10. Overall Plan
• Save $170 billion
• 20 million lose insurance
• Who knows what happens to
Medicaid?
21. What AHCA does…
• Eliminates individual mandate
• Changes to Individual Marketplace
• Changes to Medicaid
22.
23.
24. The Affordable Care Act
ACA Medicaid
Expansion
Obamacare
(Healthcare.Gov)
Everything Else
25. Medicaid changes in AHCA
• converts federal Medicaid funding into a per capita
cap, with a pre-set growth amount
• ends the enhanced federal financing for newly
eligible adults
• repeals the requirement that state Medicaid plans
cover essential health benefits
26.
27. How much is getting taken away from the
individual marketplace?
$312,000,000,000
28.
29. Socioeconomic Classes in America
• Poor
• Working Class
• Middle Class
• The Rich
• The Super Rich (The 1%)
40. Winners & Losers in AHCA
• Changes to the individual marketplace
– Winner: insurance more affordable for middle class
– Winner: insurance more affordable for young
– Loser: insurance more expensive for working class
– Loser: insurance more expensive older people
– Loser: the poor
43. Manager’s Amendment
• Allows for regular block grant as well as per capita
grants
• Allows for work requirement in Medicaid
• LimPhase out ACA taxes sooner
• If tax credit > premium, you lose the difference
51. The MacArthur Amendment
• Keeps ACA’s market reforms:
– Prohibition on preexisting condition exclusions
– Prohibition on discrimination based on gender
– essential health benefits
– Guaranteed issue and renewability requirements
– Coverage of adult children up to age 26 on their parent’s plans
– Community rating, except as permitted by waiver
• Waivers:
– Allowed if: “reduce premium costs, increase the number of
persons with healthcare coverage, or advance another benefit
to the public interest in the state, including the guarantee of
coverage for persons with pre-existing medical conditions.”
52.
53.
54. What’s optional now?
Pre-existing conditions
• Can be waived if >63 day
lapse in coverage
• Allows for experience rating
• Premiums may spike
(surcharges)
Essential Health Benefits
• Can be waived
(1) ambulatory patient services
(2) emergency services
(3) hospitalization
(4) maternity and newborn care
(5) mental health and substance use
disorder services including behavioral
health treatment
(6) prescription drugs
(7) Rehabilitative services
(8) laboratory services
(9) preventive and wellness services and
chronic disease management
(10) pediatric services
55. How much more?
• Metastatic cancer $142,650
• Diabetes $5,600
• Rheumatoid Arthritis $26,580
• Heart attack $57,960
• Pregnancy $17,320
59. Donald J. Trump
• Repeal and Replace
Obamacare with HSAs
• Full deductions for health
insurance
• Block grant for Medicaid
• Insurance Across State
Lines
• Importing drugs from
overseas
• Price Transparency for
Providers
His grade after first semester as
President
60. Donald J. Trump
• Repeal and Replace
Obamacare with HSAs
• Full deductions for health
insurance
• Block grant for Medicaid
• Insurance Across State
Lines
• Importing drugs from
overseas
• Price Transparency for
Providers
Campaign Promises on Health Care
61. Donald J. Trump
• Repeal and Replace
Obamacare with HSAs
• Full deductions for health
insurance
• Block grant for Medicaid
• Insurance Across State
Lines
• Importing drugs from
overseas
• Price Transparency for
Providers
Campaign Promises on Health Care
62. Donald J. Trump
• Repeal and Replace
Obamacare with HSAs
• Full deductions for health
insurance
• Block grant for Medicaid
• Insurance Across State
Lines
• Importing drugs from
overseas
• Price Transparency for
Providers
Campaign Promises on Health Care
63. Donald J. Trump
• Repeal and Replace
Obamacare with HSAs
• Full deductions for health
insurance
• Block grant for Medicaid
• Insurance Across State
Lines
• Importing drugs from
overseas
• Price Transparency for
Providers
Campaign Promises on Health Care
64. Donald J. Trump
• Repeal and Replace
Obamacare with HSAs
• Full deductions for health
insurance
• Block grant for Medicaid
• Insurance Across State
Lines
• Importing drugs from
overseas
• Price Transparency for
Providers
Campaign Promises on Health Care
66. Donald J. Trump
• Repeal and Replace
Obamacare with HSAs
• Full deductions for health
insurance
• Block grant for Medicaid
• Insurance Across State
Lines
• Importing drugs from
overseas
• Price Transparency for
Providers
Campaign Promises on Health Care
67. Donald J. Trump
• Repeal and Replace
Obamacare with HSAs
• Full deductions for health
insurance
• Block grant for Medicaid
• Insurance Across State
Lines
• Importing drugs from
overseas
• Price Transparency for
Providers
His grade after first semester as
President
68. Who Knew Healthcare Could Be
This Complicated?
Cedric Dark, MD, MPH
Founder and Executive Editor, Policy
Prescriptions®
Repeal of ACA expected 20 Million lose coverage
Unsure how expensive HSAs would be
Cost: $100 Billion
Cost and impact highly dependent on the method:
Straight up block grant
per-capita cap
Money directly to beneficiary
Savings: $10 Billion
Happened in 2 states but no one entered; also permitted under Obamacare
Signed State Laws
Rhode Island was the first state to pass an out-of-state purchasing law, signed in 2008, to create a regional health insurance compact, similar to the design later authorized by the PPACA in 2010.
Wyoming was the first state, in March 2010, to enact a signed law based on the free-market model but also including a multi-state compact related to federal health reform.
Georgia, HB 47 - Signed into law May 2011, in the first state with a law drafted and passed since the federal Affordable Care Act became law.
Kentucky (HB 265 - Signed into law, 2012).
Maine (HB 979 - Signed into law, 2011; effective date Jan. 1, 2014).
Good rebuttal by Margot Sanger-Katz: http://www.nytimes.com/2015/09/01/upshot/the-problem-with-gop-plans-to-sell-health-insurance-across-state-lines.html?_r=0
Savings: $20 Billion
Will it save money? At best 14-18% cost savings. Could impact half of the healthcare industrial complex.
$3 trillion economy, half impacted, and 16% savings EQUALS $240 Billion
January 21, 2016: Trump’s order states that federal agencies can grant waivers, exemptions and delays of “Obamacare” provisions that would impose costs on states or individuals. That language appears to be aimed squarely at undoing the law’s unpopular requirement that individuals carry health insurance or face fines
http://www.pbs.org/newshour/rundown/trump-executive-order-affordable-care-act/
January 27, 2017: Trump administration wanted to cut ACA TV ads; backtracked when some all already been paid for by the Obama administration
February 27, 2017: Trump meets with insurance executives
January 31, 2017:
Trump renegs on drug price negotiation in Medicare promise
May 11, 2017: Trump threatens CSR payments
March 7, 2017: The day after the bill was introduced, House Freedom Caucus member Rep. Jim Jordan, R-Ohio, slammed the bill as “Obamacare in a different form.”
House Speaker Paul Ryan, House Majority Leader Kevin McCarthy and Health and Human Services Secretary Tom Price worked to defend the bill, with Speaker Ryan even holding a PowerPoint presentation to explain the AHCA.
March 7, 2017: The day after the bill was introduced, House Freedom Caucus member Rep. Jim Jordan, R-Ohio, slammed the bill as “Obamacare in a different form.”
House Speaker Paul Ryan, House Majority Leader Kevin McCarthy and Health and Human Services Secretary Tom Price worked to defend the bill, with Speaker Ryan even holding a PowerPoint presentation to explain the AHCA.
March 13, 2017: The Congressional Budget Committee released its report estimating that about 14 million more people would be uninsured next year if the original AHCA were enacted. In the next nine years or so, the number of uninsured would jump to 24 million more, according to the CBO.
AHCA gets its financing from two areas – Medicaid and Obamacare Marketplace subsidies
As an estimate to how many people are currently affected by Medicaid not being available to all “poor” people, 3 million fall into the Medicaid Gap
Medicaid spend is $545 billion annually.
So about a 15% drop off in funding per year.
----- Meeting Notes (5/18/17 22:58) -----
Reduce FMAP
Rolling back expansion
Getting rid of EHB
325M Americans >> 3% individual market >> 9.75M in marketplace
$32,000 per person
Premiums for 21 year olds go down $1200; premiums for 64 year old goes up $4,300.
For working class people— (e.g. patient care tech)
NET premium goes down $250 for 21-yr-old; up $12,900 for 64-yr-old
For middle class people— (e.g. nurses)
NET premiums drop by $3,650 for 21-yr-old; down by $700 for 64-yr-old
Winner – rich, young people
Loser – working class, old people
Poor <$20K
Working 20-40K
Middle 40-100K
Rich >$100K
SuperRich >$350K
Premiums for 21 year olds go down $1200; premiums for 64 year old goes up $4,300.
Tax credits change. Far less for all people in the working class (especially the old beause credits were pegged to premiums)
Something for people above 400% FPL.
For working class people— (e.g. patient care tech)
NET premium goes down $250 for 21-yr-old; up $12,900 for 64-yr-old
For middle class people— (e.g. nurses)
NET premiums drop by $3,650 for 21-yr-old; down by $700 for 64-yr-old
Winner – middle class, young & middle aged people
Loser – working class, older people
Premiums for 21 year olds go down $1200; premiums for 64 year old goes up $4,300.
For working class people— (e.g. patient care tech)
NET premium goes down $250 for 21-yr-old; up $12,900 for 64-yr-old
For middle class people— (e.g. nurses)
NET premiums drop by $3,650 for 21-yr-old; down by $700 for 64-yr-old
Winner – rich, young people
Loser – working class, old people
Medicaid cuts are not just on “new enrollees” or the “able bodied” but are mostly on the poor.
----- Meeting Notes (5/15/17 17:27) -----
Better as 4 slides with red boxes
----- Meeting Notes (5/15/17 17:27) -----
Better as 4 slides with red boxes
----- Meeting Notes (5/15/17 17:27) -----
Better as 4 slides with red boxes
Reconciliation Bill
Regulatory changes
Final bill with other changes
March 20, 2017: A number of tweaks were made to the original legislation in an effort to muster votes.
1 States can apply for waivers to impose Medicaid work requirements make Medicaid recipients prove they are looking for work.
2 States receive a flat per-beneficiary payment for Medicaid recipients have the option to take a lump sum for Medicaid to allocate as they wish.
3 Every A.H.C.A. recipient gets a flat tax credit based on age – except, possibly, Americans between 50 and 64.
4 Obamacare taxes phase out in 2018 this year.
5 Medicaid allotments for older and disabled beneficiaries would grow at faster than the rate of medical inflation. (CPI-Med +1)
6 State politics in New York play no a small part in the Republicans’ health care plan.
7 If your tax credit was larger than your premium, you could save lose the difference.
(story NYTimes)
https://www.vox.com/2017/3/20/14993536/full-text-paul-ryan-managers-amendments-ahca
March 24, 2017: At Trump's request, House Speaker Paul Ryan pulled the American Health Care Act (AHCA) off the floor moments before a scheduled vote.
May 4, 2017: Republicans in the House of Representatives passed what they said was their plan to repeal and replace Obamacare, after several fits and starts, sending the measure to the Senate, where it is expected to be significantly revised.
The bill passed the House in a narrow 217-213 vote. All Democrats opposed the bill.
The bill maintains the requirement that insurers cover people with pre-existing conditions and forbids them from charging more based on a person's health. But it allows states to seek a waiver from those rules on a case by case basis. People with continuous coverage and pre-existing conditions will not be affected. Those in states that receive a waiver - and experience a lapse in coverage for two months - could face higher premiums. Waiver states will be required to implement high-risk insurance pools to help those that need coverage; the bill allocates $8 billion over five years to help underwrite those programs.
States will be allowed to seek a waiver from the federal requirement that insurers cover 10 “essential” services in every health plan they offer. Under current law, mental health and substance abuse services, prescription drugs, preventive care, maternity care, emergency services and lab services are all deemed “essential” and must be included in every plan.
http://abcnews.go.com/US/gop-health-care-plan-differs-obamacare/story?id=47205077
Grade B+
Ends individual mandate, imposes surcharge for coverage lapse
Ends Obamacare premium subsidies, offers tax credits instead
Rolls back Medicaid expansion across 30 states
Allows states to impose Medicaid work requirement
Expands health savings accounts from $3400 to $6550
Allows states to waive federal "essential health benefits" requirement and set own standard
https://www.usatoday.com/story/news/politics/2017/05/04/what-health-insurance-covers-could-change-dramatically-if-ahca-becomes-law/101289524/
http://abcnews.go.com/US/gop-health-care-plan-differs-obamacare/story?id=47205077
Grade B
Tax deductions available to more Americans, although smaller in amount.
Grade C
Per capita caps
Manager’s Amendment bumped it up to A-
Grade C
Bill doesn’t address but Obamacare provision allowing sale across state lines still intact
