Broad ACA powerpoint. Hide slides to tailor to different audiences.

1. Health Care Reform:
Understanding the Affordable Care Act
What’s really in the new law?
Presented by Amy Smoucha, Missouri Jobs with Justice
and Missouri Health Care for All

2. Health care legislation is designed to:
• Reduce health care costs, both for
families and for the government.
• Provide Americans guaranteed access to
affordable health coverage.
• Strengthen and protect Medicare and
Medicaid.
• Modernize our health care delivery
system.

3. Here’s how:

4. Significant Changes
to Private Health
Insurance
Purchased by Individuals and
Small Businesses

5. The ACA gives us more
security and control
• Insurance companies won’t be able
to turn people down because of pre-
existing conditions. This took effect in 2010
for children and in 2014 for everyone.
• Insurance companies can’t drop your coverage
because you get sick.
• Insurance companies won’t be able to charge higher
premiums because of pre-existing conditions,
gender, or occupation, and there will be a limit on
how much they can charge based on age.

6. Health insurance plans must cover
essential services.
• Insurance plans will have to cover preventive care,
hospitals, physicians, prescription drugs,
mental health, DME, rehabilitation, habilitation
services, substance abuse, dental and vision care for
children, maternity care, and other services.
• Insurance companies won’t be able
to charge deductibles or copayments
for preventive services.

7. Financial protections
for people with insurance
• Insurance companies can’t impose
annual or lifetime limits on how
much they will cover.
• Spending caps will limit the amount consumers pay
out of pocket each year.
• Insurance companies have to spend at least 80-85%
of premiums on medical care.
• Modest income Americans will be eligible for tax
credits to help pay for insurance premiums.

8. Health reform makes it
easier to buy
insurance.
• New Insurance Exchanges allow people to
compare plans, apples to apples
• The ACA limits insurance company overhead
costs (administrative and marketing) so more
of our premiums go to our health care
• Allows individuals and small businesses to get
better rates because they are in a bigger pool

9. Strengthening Critical
Public Health
Insurance Programs

10. Improves Medicare.
• Closes the “donut hole” in drug coverage and
lowers cost of brand name drugs
• Provides preventive services with no co-pays
or deductibles
• Provides incentives for better coordinated
care and use of evidence-
based medicine
• Enhanced payments for
primary care physicians and
general surgeons

11. Improves Medicare.
• Free preventive services in 2011
• Medicare Advantage plans
cannot charge higher co-pays
than traditional Medicare.
• Enhanced payments for primary
care physicians and general surgeons
• Medicare Trust Fund solvency is
extended by 9 years

12. ACA fixes
Medicare Part D.
D
• Closes the “donut hole” in
drug coverage and lowers
cost of brand name drugs
– As many as 15% of seniors with chronic illness
stop taking their medicines when they hit the gap.
• Expands the Medicare Part D low-income
subsidy to help struggling seniors afford their
prescription costs.
• Extends annual Part D enrollment period

13. Supports early retirees.
Federal funds are currently available to help
businesses afford the cost of health insurance
for early retirees (ages 55-64).

14. Access to home and community-based
services for people with disabilities
• The Community First Choice option makes
community-based services mandatory and
there are no cost caps or waiting list
restrictions.
• Law originally included a voluntary long term
care insurance program, the CLASS. This has
since been put on hold and is not funded.

15. The law expands State
health insurance programs
for those who need it.
• State health insurance programs under Medicaid
will cover all families and individuals with
incomes up to 133% of the Federal Poverty Level
– $24,348 for a family of three.
– Currently in Missouri, a family of three must make less
than $4,584 a year to qualify for Medicaid
• For the first time ever, childless adults without
a disability can qualify for Medicaid.

16. Tax Credits for
Individuals and Small
Businesses

17. Support for small businesses
• Premium subsidies to employers
Employers with up to 25
employees and annual wages
that average less than $50,000
who purchase health care for
their employees get a tax credit
• Affordable choices
Employees of small businesses
may purchase insurance through the
Exchange

18. Help for
moderate-income
Americans
• Families and individuals will receive tax credits to
help pay for health insurance, depending upon
our income.
• Tax credits will be available to families earning
between 133-400% of the Federal Poverty Level
($29,327-88,200 for a family of four).
• Tax credits are designed to keep premium costs
between 2%-9.5% of income, on a sliding scale.

19. Health reform encourages
prevention and wellness.
• No deductibles or copayments for preventive
services.
• Grants for community wellness programs
• National standards for restaurant nutrition
labeling
• Incentives for doctors to improve
patients’ health

20. ACA protects Children.
Children
• Insurance companies can’t deny children
insurance because of a pre-existing condition
(will also apply to adults in 2014)
• No yearly or lifetime limits on coverage
• Free preventive care
• All insurance plans will cover
kids’ dental and vision care
• Young adults can stay on their
parents’ plan until age 26

21. ACA helps
people with medical conditions.
conditions
• People with a disability or mental illness can work
part-time and still qualify for Medicaid.
• Mental health parity – mental health care must
be covered just like physical health care.
• Insurance companies won’t be able to refuse or
charge more to cover people with pre-existing
conditions.
• A new, temporary high-risk pool
will help people with pre-existing
conditions gain immediate access
to insurance.

22. ACA gives caretakers more choices.
• People in the sandwich generation
and caretakers will have guaranteed
coverage and affordable choices.
• Young adults can stay on their
parents’ plan until age 26.

23. ACA protects seniors in
nursing homes.
homes
• Elder Justice Act:
– Authorizes new criminal background checks on
long-term care workers
– Requires greater transparency of nursing homes
– Requires better information about the quality of
nursing care and improves complaint process.

24. Reform strengthens the
delivery system.
• Doctor incentives for better
coordinated care
• Pilot projects in evidence-based
medicine
• Enhanced payments for primary care
physicians and general surgeons

25. Health Reform, Mental Health and
Social Services:
Paradigm Shifts

26. Paradigm Shift #1:
Affordable, quality health insurance coverage
will not be tied to a particular job or employer.
• People with temporary or long-term illnesses will
have coverage options.
• People in the sandwich generation and
caretakers will have guaranteed coverage and
affordable choices.
• If we are laid off or choose to work less
(for example to start a small
business), we will be able to
purchase affordable coverage.

27. Paradigm Shift #2:
People with chronic illness, mental illness or
other disabilities will not have to go into
complete poverty or quit all work just to get
health care.
• They will have affordable coverage options
through the Health Insurance Exchanges
and new Medicaid program.
• Coverage will not be dependent upon
being disabled or having children. Those
in poverty or with limited incomes will get
significant help affording coverage.

28. Paradigm Shift #3:
The Affordable Care Act takes huge leaps
forward:
• Preventive care will be free or very low cost
• All insured children will have dental and vision
coverage.
• Essential benefits package will close a lot of the
“gaps” people encounter.
• Caps on out of pocket costs, and
deductibles will mean less medical
debt, less bankruptcy, etc.

29. Paradigm Shift #4:
Community groups and social service providers
will have to reassess our work, resources and
services!
• What will be the new “gaps”?
• What is needed for coordination of care?
• How should charitable and philanthropic
resources be reallocated or reexamined?

30. Sounds great – but how
do we pay for it?

31. Shared responsibility
Costs and responsibilities are
shared among state and
federal government,
businesses and individuals

32. Shared responsibility
Federal Government
• Pays for 100 percent of Medicaid expansion
from 2014-2016
• Pays for 90-95 percent of Medicaid expansion
in 2017 and beyond
• Shares in cost of tax credits and premium
subsidies

33. Shared responsibility
Individuals
• U.S. citizens and legal residents must purchase
health insurance or pay a penalty
• Penalties are phased in for those who do not
• Exemptions granted for financial hardship,
religious objections, those without coverage
for less than 3 months, undocumented
workers, incarcerated individuals, or if the
lowest cost plan exceeds 8% of income
• Tax changes for some high-income
individuals

34. Shared responsibility
Businesses
• Large employers (50+ employees) may have to
pay a penalty if they do not provide coverage
and one or more of their employees receives
an insurance premium subsidy.
• Taxes on insurance companies that offer
very high cost plans
• Fees or taxes on producers of some
medical equipment and pharmaceuticals

35. NOW WHAT???

36. The key to all of this is making sure reform
is implemented in Missouri without delay.
Health Insurance Exchange Legislation.
•A bill passed the MO House last session.
– Generally it’s a strong bill based on good models.
– Serious problems with governance and conflict of interest
provisions
•Missouri Senate leaders are currently trying to block
funding and planning for a “Health Insurance
Exchange”
Federal Budget Cuts pose huge threats to
existing programs and federal funding.

37. Continue strong
civic engagement
Decide
•What we like about the ACA
•What we want improved
•What we want changed
Work to separate fact from spin

38. Getting beyond spin
And political divides
In 1962 the AMA
released an album
featuring Ronald
Reagan warning that
Medicare will lead to
socialism and
destruction of
American Democracy

39. Build a Movement
From the New York Times, February, 1964
And the Civil Rights Act of 1964
did not include voting rights.

40. Stay Informed!
www.healthcare.gov
www.kff.org
www.mohealthcareforall.org
www.paraquad.org/Policy/HealthcareReform
http://hcfgkc.org/resources/health-reform
www.covermissouri.org

41. Join our movement!
www.mohealthcareforall.org