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Dr. David Stein & Ms. Terry Zdun-Hoyer November 20, 2013 Evaluating options under the Affordable Care Act (ACA)

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Presentation on theme: "Dr. David Stein & Ms. Terry Zdun-Hoyer November 20, 2013 Evaluating options under the Affordable Care Act (ACA)"— Presentation transcript:

1 Dr. David Stein & Ms. Terry Zdun-Hoyer November 20, 2013 Evaluating options under the Affordable Care Act (ACA)

2 Introduction Affordable Care Act (ACA)overview A real life story Options for a free people in a free marketplace Q&A

3 The Patient Protection and Affordable Care Act (PPACA) commonly called the Affordable Care Act (ACA) or "Obamacare", is a United States federal statute Signed into law by President Barack Obama on March 23, 2010 Represents the most significant regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965 Act was passed by Congress when the Democrats controlled the House of Representatives, the Senate and the White House. The final version passed with no Republican votes. Source: Medical News Today &

4 Doctor visits Prescription drugs Hospitalization Maternity & newborn care Preventive care Note: Any plan not meeting the criteria is in violation of the grandfather clause of the law and insurance companies must cancel them. Source: HIRSP Authority

5 Small Employer PlansLarge Employer Plans Estimated relinquished grandfather status: Low-end 49% Mid-range 66% High-end 80% Estimated relinquished grandfather status: Low-end 34% Mid-range 45% High-end 64% Source: Federal Registry, June 17, 2010 In report submitted by: Departments of Treasury, Labor, and Health & Human Services

6 A: Everyone in America

7 Bilateral knee replacement 2009 Joined individual HIRSP high risk pool after employer COBRA coverage expired in 2011 Received cancelation notice July 10, 2013 Victim vs. Informed Citizen Just go shopping

8 Government FundedPrivate Corporations 1. Common Ground Healthcare Cooperative Recd $56.4M loan in 2012 to set up organization 2. Molina Healthcare of Wisconsin, Inc. Formerly Abri Health Plan Focused on low income Medicaid and Medicare 3. Compcare Health Services Insurance, subsidiary of Blue Cross/Blue Shield 4. Wisconsin Physicians Insurance Corporation (WPS) Sources: HIRSP Authority, Hoovers, BizTimes, Company Websites

9 1.Federal tax information provided to the exchange to determine benefit eligibility may not be adequately protected 2.Information will be shared with seven federal agencies 3.Navigators arent required to undergo background checks 4.Navigators had less than a month of training My conclusion: Have not & will not use the exchange Source: Examiner, Fox News

10 Phone # Phone # Compcare Health Service Insurance (Blue Cross/Blue Shield) An agent to contact me in not less than 2 weeks Wisconsin Physicians Service (WPS) Information send and received within week


12 27.6% % increase based on max usage 40.1% % increase based on actual usage WPS Plans Total Max Annual Cost $14,500 silver plan $20,279 gold plan Based on 2013 actual usage $11,003 bronze plan $19,873 platinum plan Current Plan 5000 Total Max Annual Cost $11,364 Based on 2013 actual usage $7,856 Not sure if my doctor is in or out of network Current cost $151/wk up to high of $390/wk Verified to private enterprise website:

13 Business private insurance exchanges Company self-insurance Insurance offered thru trade or other associations Association for Mature American Citizens (AMAC) Help offered thru community groups Samaritan Ministries Concierge services Lasik eye surgery Bartering Services

14 Pros You can not be denied coverage even if you have a pre-existing illness Healthcare providers may offer self-pay or reduced-pay options Cons Nothing affordable about ACA Cant keep your insurance and/or doctor Government website/navigators cant be trusted Catastrophic plans only for those under 30 or with a qualified hardship exemption

15 Based on my shopping experience I have concluded that I will be forced to: Move to self-pay with my current medical provider Find & use specialty operations such as DynaCare [for blood work], Marquette Dental School and CT/MRI scan facilities Only sign up for government controlled healthcare if & when I need it

16 1. Educate yourself – Knowledge Empowers 2. Obamacare is not free it is government- controlled healthcare 3. One size does not and can not fit everyone 4. Encourage healthcare providers to promote market-driven solutions 5. Investigate non-traditional healthcare options 6. A fix cant fix this law Push congress to Repeal the Affordable Care Act

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