Affordable Care Act Summary Provisions of the act are phased.docx
- 1. Affordable Care Act Summary Provisions of the act are phased in over ten years. 2010 National temporary high risk pool for those denied coverage. >82,000 previously uninsured persons gained coverage including more than 250 in Nebraska Young adults up to 26 y.o. covered under parents’ plans. >3 million previously uninsured young adults covered, including 18,000 in Nebraska No lifetime or annual limits on coverage 105 million people benefit, including 700,000 in Nebraska No denial by insurers of children for pre-existing conditions No co-payments for preventive care 10-12 million have accessed preventive care, including approximately 360,000 in Nebraska Tax credits for small employers (<25 employees) to provide health care coverage. An estimated 360,000 small businesses with 2 million employees benefited in 2011 $250 rebate for Medicare beneficiaries in Part D coverage gap (doughnut hole) 4 million seniors benefited in 2010 including 26,072 in Nebraska Scholarships and loan forgiveness programs for health professionals choosing primary care
- 2. Primary care & other health professions training grants A number of grants have been made to Nebraska institutions Comparative Effectiveness Research Grants Prevention Research and Service Grants A number of these grants have also been made to Nebraska institutions. 2011 Grants to employ and train primary care nurse practitioners No co-pay for Medicare preventive services including comprehensive risk assessment and prevention plan In 2011, an estimated 32.5 million people with traditional Medicare or Medicare Advantage received one or more preventive benefits free of charge. In 2012 alone, >25 million people with traditional Medicare, including nearly ~250,000 in Nebraska, have received at least one preventive service at no cost to them. Requires insurers to maintain Medical loss ratios or 80 (small group) or 85% (large group). Provides for states to review and approve premium rate increases 12.8 million subscribers received insurance rebates totaling >$1 billion, including $4.8 million for 22,500 Nebraska families. Insurance rate reviews have saved consumers another $1 billion in premium costs. 50% discount on brand name prescriptions filled during Part D coverage gap Since inception 5.4 million seniors have saved $4.1 billion; in Nebraska seniors have saved $27.5 million since 2010 because of donut hole rebates or discounts. 10% Medicare & Medicaid bonus for primary care physicians and general surgeons in shortage areas Increase Medicare payments to hospitals in low cost areas Increased funding for Community Health Centers
- 3. Nebraska Community Health Centers have received >$19 million in additional funding 2012 Bonus payments to high quality Medicare Advantage plans Incentive Medicare and Medicaid payments to Accountable Care Organizations that demonstrate quality and efficiency. ACOs have been demonstrated to lower annual health care costs for Medicare beneficiaries. Further shrinking of the Medicare Part D coverage gap 2013 Simplified insurance claims processing and payment Begin phasing in federal subsidies to close Part D coverage gap Increased Medicaid payment for primary care 2014 Citizens and legal residents required to have health coverage (phase in penalties for those without) Employers (>50 employees) who do not offer coverage pay assessment Employer assessment $2000/employee if no coverage. Employers offering coverage who have employees using premium credits in an exchange pay the lesser of $3000 for each employee receiving credit or $2000/employee. Employers (>200 employees) required to enroll employees automatically in employer coverage. Employees may opt out of employer coverage State based health benefit exchanges for individuals and small business (<100 employees); at least two multistate plans in each exchange All insurers required to offer essential benefits package Deductibles for small groups limited to $2000/individual,
- 4. $4000/family Insurers required to guarantee issue and renewal—age rating limited to 3:1 Subsidies for premium and out-of-pocket expenses: premiums 133-400% FPL; OOP 100-400% FPL Members of Congress and their staffs will be phased out of the FEHBP and into the exchanges Expand Medicaid eligibility to everyone <65 with incomes up to 133% FPL This was made optional for the states by the Supreme Court decision in June 2012. If Nebraska opts in approximately 100,000 uninsured Nebraskans will obtain coverage at an estimated cost to the state of $140-168 million through 2020. But Nebraska will receive $2.9- 3.5 billion of federal funds that will stimulate new economic activity and finance over 10,000 new jobs each year. Reduce amount eligible for catastrophic coverage in Medicare Part D (till coverage gap eliminated in 2020) 2016 States may form interstate compacts allowing insurers to sell across state lines, thus increasing market competition for insurance 2018 Taxes on “Cadillac” health care plans— >$10,200 individual; >$27,500 family. Cadillac” plan taxes are indexed to 2010 dollars 2020 Medicare Part D coverage gap (doughnut hole) phased out What Health Care Reform is NOT
- 5. It is NOT a government takeover of health care. The only government health care programs are those that already exist - Medicare - Medicaid - Veterans Administration - Military Health Care - Indian Health Service All the rest will be provided by the same insurers or employers (now more regulated) and private and public providers as now. There will be greater choice of insurers than now. It is NOT a budget buster. 2012-2019 Net costs of coverage expansion $789 billion Net revenue and savings 932 billion Deficit reduction $143 billion CBO March 2010 The CBO has recently determined that repealing ACA would increase the deficit by $109 million from 2013-2022. It does NOT Cut Medicare Benefits Ration care Support euthanasia Provide coverage for illegal immigrants It is NOT overwhelmingly opposed by the public Source: Kaiser Family Foundation Health Tracking Poll (June 17-22, 2010)
- 6. Tell me your opinion of the following: very favorable, somewhat favorable, somewhat unfavorable, very unfavorable. Net Favorable Net Unfavorable Health Insurance Exchanges 87% 11% Tax Credits for Small Business 82 16 Gradually closing the Medicare “doughnut hole 81 15 High Risk pool for individuals with pre-existing conditions 78 19 Premium and out of pocket subsidies 76 22 Young adult coverage under parents insurance until age 26 71 27 Medicaid expansion 69 28 Federal review & approval of health plan premium increases 69 26 Requiring insurers to guarantee issue 69 29 Eliminating caps on lifetime limits of benefits 64 35 Increase Medicare tax on high earners 61 37
- 7. Federally defined minimum benefits 59 36 Require all Americans to have health coverage 34 65 What lessons can we learn from other countries? What other factors need to be considered? What lessons from History? Comparative Analysis Typical Tools of Government Power Taxation Market Interventions Provision of government goods & services Market Regulations Market subsidies or structures
- 8. Education/Workforce policies Purchaser Power Information Investor Rights Enforcement Comparative Analysis of Tools Four basic models: Government Health System Social Insurance Government provided Government managed Mean’s Tested/Special Populations Coverage Government provides care Government provides insurance Government subsidizes and manages option(s) Government as basic regulator in private market only
- 9. Lessons From Comparative Perspective Graig – Path to Universal Coverage: Compulsion/subsidization Risk-subsidization Lessons from the film? Tools/strategies --- consequences? Competition; use; outcomes; choices allowed? Political Analysis What makes the various options possible in those countries? What do we learn from the readings on history of U.S. reforms?
- 10. Magic wand exercise: If you could put in place in the US any new reform what would it be? (national, federal, or state) 5 M edicare A genda! ● O nline D iscussion ●
- 12. uiz ● G roup P roject A ssignm ent W hat is M edicare ● Largest U S C overage P rogram ● C overs seniors over age 65, people w ith disabilities ● A ll incom
- 13. e levels are covered ● S ingle payer system ● V ery popular Q uestions 1. H ow is it paid for? a. B y consum ers or the governm ent? b. If it is paid for by consum ers, w
- 14. hat types of paym ents? 2. W hat does it cover? a. A re there lim its to that coverage? 3. Is enrollm ent autom atic or voluntary? a. H ow do people get on this type of coverage? B lue = P art A R ed = P art B
- 15. Y ellow = P art C G reen = P art D W ild = M edigap P art A ● N o prem ium s ● $1,100 deductible ● H ospital coverage lim ited to 150 days, daily
- 16. costs after 60 days ● S killed nursing facility (S N F ) covered up to 100 days, daily costs after 20 days P art B ● V oluntary, autom atic enrollm ent ● P rem ium s ● D
- 17. eductible ● C oinsurance ● C overs m ost outpatient care ● M ost beneficiaries have supplem ental insurance (M edigap) P art C ● M edicare A dvantage ● V oluntary
- 18. ● 25% of beneficiaries in U S ● E ligibility ● C ontroversial ● P art D ● P rescription C overage ● E ligibility ●
- 19. V oluntary ● P rivate P lans ● D onut H ole Q uestions? Q uiz T im e! Q uestions on G roup P roject
- 20. ● B riefing D ocum ent ● Q uiz Q uestions ● P resentation Medicaid and CHIP M edicaid and C H IP W hat is M edicaid:
- 21. http://w w w .youtube.com /w atch?v=N Z J-k0uLx0A Medicaid ● State/Federal partnership program providing care to low income Americans M edicaid’s R ole in F inancing ● S afety-N et P
- 22. roviders ○ D S H P aym ents ● LT S S S tructure of M edicaid ● S tate/F ederal P artnership ● S tates A
- 23. dm inister M edicaid ○ S tate P lan and S P A s ● F ederal W aivers W ho M edicaid C overs ○ C hildren ○
- 24. Low Incom e P arents ○ P regnant W om en ○ E lderly ○ D isabled (A B D population) C hildren ● Low incom
- 25. e ● W ards of the S tate C H IP ● C reated in 1997 ● C overs children at higher incom es than M edicaid ● H igher F M A P
- 26. P regnant W om en & Low Incom e P arents A B D ● D isabled Individuals ● D ual E ligibles ● http://w
- 27. w w .youtube.com /w atch?v=6P M yIykS M C U W hat is C overed? M andatory S ervices ● P hysician’s S ervices ● H
- 28. ospital S ervices (inpatient and outpatient) ● Lab and x-ray services ● E P S D T ● F Q H C and R H C services ● F am ily planning services and supplies ●
- 29. P ediatric and fam ily nurse practitioner, nurse m idw ife services ● S N F ● H om e H ealth C are for persons eligible for S N F ● T ransportation ● O ptional S ervices
- 30. “S kin in the G am e” ● P rem ium s ● C ost S haring M anaged C are and M edicaid ● M C O
- 32. e!