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Implications of Obamacare for Health Communicators Amy Lischko, DSc Susan Koch-Weser, ScD Tufts University School of Medicine Department of Public Health.

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Presentation on theme: "Implications of Obamacare for Health Communicators Amy Lischko, DSc Susan Koch-Weser, ScD Tufts University School of Medicine Department of Public Health."— Presentation transcript:

1 Implications of Obamacare for Health Communicators Amy Lischko, DSc Susan Koch-Weser, ScD Tufts University School of Medicine Department of Public Health and Community Medicine

2 Brief overview

3 3

4 Never happened in US health policy Four essential elements: – Coverage and Access Coverage does not always equal access – Delivery System Reform Quality, Efficiency, Effectiveness, Cost, Workforce, Innovation, Fraud & Abuse, Liability, and much more – Prevention, Wellness, Public Health Improving health status from within the health system – Health In All Policies Improving health status and population health from outside the health system National Prevention Strategy “Comprehensive” Health Reform 4

5 I.Affordable and Available Coverage II.Medicaid and CHIP III.Delivery System Reform and Medicare IV.Prevention and Wellness V.Workforce Initiatives VI.Fraud & Abuse, Transparency, Elder Justice Act + VII.Biological Similars – (Pharmaceutical Innovation) VIII.CLASS – Community Living Assistance Services & Supports (repealed: January 2013) IX.Revenue Measures X.“Manager’s Amendment” (amendments to I-IX) I.Plus the Health Care and Education Reconciliation Act The ACA’s Ten Titles 5

6 Key Questions How does the ACA health make health care more affordable and accessible? What is the individual mandate and how important is it to the law’s success? Will the U.S. maintain an employer-based system? How will we pay for the coverage expansions? What are the recent ACA developments? What are the challenges and opportunities for a health communications professional? 6

7 How does the ACA make health care more affordable? All people with incomes up to 133% FPL will be eligible for Medicaid (SC ruled this feature optional for states) People earning between 133 and 400% FPL and not offered an affordable plan through employer will be eligible for sliding-scale subsidies and will pay 3 to 9.5% of income towards premiums Cost sharing subsidies based on income and limits on deductibles Donut hole in Medicare Part D gradually filled Many experiments to explore various ways to reduce costs including payment and system reform, malpractice reform and wellness incentives 7

8 How does the ACA make health care more accessible? Small group and Non-group markets: – Guarantee issue and renewability – No health underwriting: rating on age (3:1), geography, family composition and tobacco No lifetime limits or rescinding coverage Limit waiting periods to 90 days Young people stay on parents’ plan until 26 Health Exchanges to coordinate eligibility and purchase of health insurance 8

9 What is the individual mandate and how important is it to the law’s success? Requires U.S. citizens and legal residents to have coverage by 2014 Phased-in penalties, maxing out at 2.5% of income Exemptions for: – Religion – Hardship – Affordability (No plan available

10 Will the U.S. maintain an employer-based system? Employers with 25 or fewer low-income (average wage <50,000) can receive tax credit Employers with >50 employees who have at least 1 employee receiving tax credit may be fined – Offering: $3000 per employee with credit or $2000 FT employee – Non-Offering: $2000 per employee excluding first 30 employees Employers with >200 employees, auto-enroll In MA, no drop in coverage but ACA is different, some estimate high drop rates for small employers...early numbers suggest no movement yet 10

11 How will we pay for health care reform? Tax on individuals who do not purchase coverage Penalties on larger employers whose employees seek tax credits Tax on “Cadillac” plans Limit FSA amount and use & Increase threshold for itemized deduction Increase Medicare Part A tax for higher income wage earners Impose new fees on Rx, Medical device companies and fully insured insurance products (maybe) Tax indoor tanning salon use Medicare payment reductions 11

12 ACA has survived 3 “near death” experiences – January 2010 Massachusetts Senate Election – US Supreme Court decision in June 2012 – November 6, 2012 federal elections Political furor abating – Public polling more supportive, fewer want repeal – Congress looking to modifications, not repeal Much action moves to states – State Health Insurance Exchanges: 26 states established or partnered with HHS; 24 states default to federal exchange – Medicaid Expansions: 28 expanded 21 did not expand 2 under discussion What are the Recent ACA Developments? 12

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14 What are the Recent ACA Developments? Delivery System Innovation Is Accelerating – 254 Accountable Care Organizations serving 4 million Medicare enrollees – New Medicare penalties on hospitals with high rates of readmissions & infections Uninsured estimates are lower – CDC estimates from first 3 months found estimates of uninsured dropped from 14.4 to 13.1 (41 million) Medicare and overall rate of spending growth is down – – 9.7% rate of growth – – ~4-4.9% rate of growth – Private growth in 2011 at 3.9%, lower than overall economic growth for first time in more than a decade 14

15 Want to learn more? Bill Text and Section-by-Section Summary – protection-affordable-care-act-as-passed.pdf Congressional Budget Office: cbo.gov Joint Tax Committee: jtc.gov Obama Administration Site: healthcare.gov Commonwealth Fund: cmwf.org Kaiser Family Foundation: kff.org Health Reform GPS: healthreformgps.org Politico’s PULSE: 15

16 Challenges and Opportunities Can we effectively convey health plan information about health plans so that consumers can make informed choices? Will the newly enrolled be able to use their plan once enrolled? How do we achieve patient-centered outcomes?

17 Selected research and practice areas Health Insurance Literacy Patient Engagement Patient Centered Outcomes Research Institute

18 Health Insurance Literacy Health insurance literacy is the capacity to find and evaluate information about health plans, select the best plan given financial and health circumstances, and use the plan once enrolled. – Health Insurance Literacy Expert Roundtable, 2011 A collaboration between Consumers Union University of Maryland College Park American Institutes for Research (AIR)

19 Health Insurance Literacy (1) Key Informant Interviews with Consumer Assistants Consumers don’t understand risk and personal liability for care “I’m not going to pay $300 a month because I am not going to use $300 a month of anything” Can’t fully assess their needs or the services the plans cover Fall back on brand and word of mouth “People tend to assume that because you have a particular policy from a particular carrier, you have good insurance”

20 Health Insurance Literacy (2) Key Informant Interviews with Consumer Assistants Consumers do not understand Cost sharing terms necessary for assessing tradeoffs between plans How to obtain care – Finding PCP Provider network restrictions, drug formularies, referral and preauthorization How to verify or appeal billing statements (esp. preventive vs. diagnostic tests) “Often, for example, it’s a colonoscopy, which is technically preventive, but it gets, more often than not, coded as diagnostic because they find something” Navigate deductibles (in-network, out-of-network, and drugs)

21 Health Insurance Literacy Problems Terminology e.g. coinsurance, annual benefit limit, screening vs. diagnostic test (Quincy 2010, 2011) Stay on same plan even when there is a better choice (Gruber 2009) As choices and complexity increase ability to choose “optimal” plan decreases (Shaller 2005, Wood 2011) Self-efficacy – consumers dread shopping for insurance and are not confident about their choices (Isaacs 1996, Quincy 2010, 2011) Numeracy affects comprehension of plans, use of data tables (Kutner et. al. 2006, Greene et. al. 2008, Wood 2011) Measuring Health Insurance Literacy: A Call to Action, Sponsored by Consumers Union in partnership with University of Maryland College Park & American Institutes for Research (AIR), February 2012

22 Health Insurance Literacy (HIL) Measure

23 Patient Engagement Patient Activation – knowledge, skills, ability, and willingness to manage his or her own health care Patient Engagement – broader concept that combines patient activation with interventions designed to increase activation and promote positive patient behavior “Health Policy Brief: Patient Engagement,” Health Affairs, February 14, 2013

24 Patient Activation Measure

25 "Health Policy Brief: Patient Engagement," Health Affairs, February 14,

26 "Health Policy Brief: Patient Engagement," Health Affairs, February 14,

27 Patient-Centered Outcomes Research Institute PCOR is a relatively new research field that considers patients’ needs and preferences and focuses on outcomes most important to them.

28 Selected PCORI Projects When Kidneys Fail: Helping Patients Choose the Treatment Best for Them The two main types of renal dialysis significantly alter patients’ lives in different ways. Michigan researchers are developing a tool to guide patients toward a better-informed choice. The PROMIS in Putting Patients’ Waiting Room Time to Good Use Patients struggle to provide their full health perspective; a Baltimore team examines whether an iPad questionnaire can improve patient-doctor communication. What Do Patients and Caregivers Want In Mobile Health Apps? Ask Them Julie Singer struggles to manage her husband’s health and treatments as he recovers from a stroke; researchers are consulting with patients and caregivers as a first step in developing new mobile tools for stroke survivors. Improving Quality of Life for Latinas with Breast Cancer Most Hispanic women with breast cancer face extra challenges in dealing with the disease. One researcher aims to find out if culturally relevant group support can help such women and their caregivers. Transforming Community-Based Research on the High Plains Research reports can be difficult to understand; a “Boot Camp Translation” project in Colorado makes evidence-based recommendations accessible for diverse communities.

29 Questions?


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