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1 Pat Kittler, Jan. 26, 2011 *All activities in this presentation will be subject to state and/or federal law Talking About The Affordable Care Act.

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Presentation on theme: "1 Pat Kittler, Jan. 26, 2011 *All activities in this presentation will be subject to state and/or federal law Talking About The Affordable Care Act."— Presentation transcript:

1 1 Pat Kittler, Jan. 26, 2011 *All activities in this presentation will be subject to state and/or federal law Talking About The Affordable Care Act

2 Introduction Pat Kittler 2 Background Purpose Accompanied Digest or on National Fieldhttp://bit.ly/ACADIGEST2011

3 The Digest This program is accompanied by a seven page digest of the benefits of the Affordable Care Act that most directly affect individuals. The Digest is a solidly researched and easy to read tool that will provide what you need to convince your voters that they should support the Affordable Care Act and only vote for those who do. The digest has been used in at least two dozen community meetings and personally presented to at least 1500 individuals chosen at random in public gatherings. The ‘read only’ digest may be freely copied for free distribution to volunteers and voters. Download Digest: 3

4 Agenda A. Introduction B. ACA big picture C. Medicaid and Medicare D.The new insurance market E.Cost controls and regulations F.Subsidies for individuals, retirees and small business. G.Essential Health Benefits H.Health insurance benefits already in effect I.Questions 4

5 Talking About the Affordable Care Act Big Picture 5 POLL: According to the Department of Health And Human Services, without the Affordable Care Act, health insurance was projected to cost, on average, how much per individual, per year in 2018? 1. $1,066 2.$5,538 3.$7,421 4.$13,100 5.$21,439

6 ACA is a law that makes affordable healthcare possible. IN 2009 THE NEED FOR THIS WAS URGENT President Obama was driven to make health care reform his highest priority by the simple fact that the cost of health care is pushing the country and its people rapidly toward bankruptcy. BUT THIS FIGHT STARTED DECADES AGO President Obama, 280 Democratic Representatives and Senators in the 111 th Congress passed ACA using help from presidents Truman, Eisenhower, Kennedy, Nixon, Johnson, Reagan, Clinton, and G. W. Bush 6

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8 If Implemented As Written… CREATES NEW JOBS The healthcare industry, at 14.3 million jobs will generate 3.2 million new American jobs between 2008 and 2018 According to the Bureau of Labor Statistics this is more than any other industrythis is more than any other industry REDUCES THE DEFICIT reduces the 20 year deficit by $1.5 Trillion BRINGS QUALITY, AFFORDABLE HEALTH CARE for 94% of our residents 8

9 If Implemented As Written… RELIES ON COMPETITION, BUT HOLDS INSURANCE COMPANIES RESPONSIBLE: Starting in 2014, the Act relies on competition, including: universal coverage; “single Risk” pool underwriting; risk adjustment pools to manage premiums; the creation of co-op insurance companies; transparency; state regulation plus federal oversight. Companies with unreasonable premiums can be excluded from exchanges. 9

10 Because we all benefit, we all have a responsibility ACA requires both implementation by the states and the voters ongoing support. Good health comes from healthy living. Employers and insurance companies can benefit by helping employees. They are authorized to credit us up to 20% of total premiums to encourage healthy behavior. $30,000,000 has been allocated for this year to jump start state consumer assistance offices. Check for the Truth! 10

11 Medicaid and Medicare Talking About the Affordable Care Act 11 POLL: How familiar are you with the Medicare Part D “Donut hole”? 1)Very well, it affects people in my family. 2)I know what it is, but I don’t know anyone who falls into it. 3)I’ve heard it mentioned, but am not sure what exactly it is. 4)I am unfamiliar with the donut hole.

12 President Obama strengthened Medicaid and Medicare…even in RECOVERY ACT REIMBURSEMENT FOR COSTS TO STATE MEDICAID PROGRAMS has saved Minnesota (in ’09 -’10), $1,673,476,158 thru Sept 30, THROUGH ACA Medicare coverage was improved and the trust fund strengthened by extending its probable life to 2029 (if ACA is implemented as passed). TODAY, IN 2011 Medicare and new health insurance plans are now providing comprehensive and free preventive care.Medicare and new health insurance plans are now providing comprehensive and free preventive care. 12

13 Medicaid and Medicare Continue to Benefit under the Affordable Care Act… ACA EXTENDS THE LIFE OF MEDICARE UNTIL BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE. Jan 1, 2011 the ACA started a 50% discount off the negotiated prices of brand name drugs and biologics in the donut hole and other discounts on generic drugs. ACA closes the donut hole by ALL MEDICARE INSUREDS WILL PAY THE SAME PREMIUMS to all Medicare insurance providers. The ACA phases out subsidies to private Medicare Advantage plans over six years. 13

14 More on the Donut Hole… 14

15 The Donut Hole will disappear by

16 In 2010, Medicaid is also improved… 2010 MEDICAID State Medicaid coverage must equal and may exceed ACA coverage. THE ACA EXPANDS MEDICAID COVERAGE by increasing qualifying income levels to 1.33 times the Federal Poverty Level or less. FOR THOSE THAT CANNOT AFFORD INSURANCE See Medicaid, above. All others left uninsured may use one of the 7,900 Community Health Clinic offices (see below) or they may use emergency rooms. Undocumented immigrants and others not qualified for ACA programs may also purchase commercial insurance outside of the exchanges. 16

17 Eldercare Locator (2010) Or call for community based services and benefits, counseling, transportation, meals, home care and caregiver support services. 17

18 Stopping Fraud 2010 ACA IS AGGRESSIVE ABOUT STOPPING FRAUD. Fraud costs Medicare millions of dollars every year. Fraud schemes may be carried out by individuals, companies, or groups of individuals. We can help stop it.We can help stop it. Medicare and Medicaid received just under $3 Billion in 2009 from fraud recovery. 18

19 Talking about the Affordable Care Act The New Insurance Market 19 QUESTION: Which of the following can HHS always do to restrain premium increases? 1)Restrict the insurance company’s application 2)Nothing 3)Urge the state insurance commissioner to reject the application (in 26 states) 4)Urge the state insurance commissioner and the insurance company to submit the supporting evidence to an outside mediator

20 The Affordable Care act creates a new insurance market In 2010: EXISTING GROUP HEALTH PLANS Are "grandfathered" with respect to certain reforms, until they change benefits or increase out of pocket costs beyond limits. INSURANCE EXCHANGES in 2014 Will create transparency and competition and therefore lower rates. AFFORDABLE HEALTH INSURANCE IS MANDATED in 2014 Without universal insurance costs will be uncontrollable. PENALTIES in 2014 Monthly for the non-exempt individual who fails to insure themselves and their dependents. 20

21 Talking about the Affordable Care Act Cost Controls and Regulations 21

22 The Affordable Care Act Is Called “Affordable” For A Reason SUBSIDIES FOR THOSE UNDER 400% OF THE FPL limit premiums to between 2% to 9.5% of income. limit out of pocket costs to 30% of contract costs. PREMIUM INCREASES are limited in 26 states that can reject increases. The Federal government does not have the authority to limit premiums. 22

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24 ACA has many components to control costs, most of which will come into effect in 2014 along with the exchange BANS PRICE DISCRIMINATION OF ANY KIND Except age and smoking. EXCHANGE BUYING To lower insurance premiums from what they would become under past practices, insurers are required to include everyone in a single risk pool. insurance will be sold through state operated exchanges accessible by both individuals, and small businesses. OUT OF POCKET LIMITS To qualify for the exchanges, insurers in the non-group market must limit out of pocket costs to $5,950/yr in 2010 dollars for an individual, $2,000/yr per individual in the small group market and twice these for a family. 24

25 The Affordable Care Act Is Called “Affordable” For A Reason 2010 THE LAW REQUIRES IMMEDIATE RESTRAINT OF UNREASONABLE PREMIUMS. The HHS Secretary has directed the states to have the legislation and regulations needed to approve or disapprove rates and has granted $51 million to 45 states to assist this process EMPLOYERS ARE RECEIVING SUBSIDIES FOR EARLY RETIREES. ACA reimburses employers for 80% of claims between $15,000 and $90,000 for health plans for retirees aged between 55 and

26 The Affordable Care Act also helps our economy by aiding Small Businesses SMALL BUSINESS WILL RECEIVE 35% TAX CREDITS NOW (IN 2010) SMALL BUSINESS WILL RECEIVE 50% TAX CREDITS IN

27 Talking About the Affordable Care Act Essential Health Benefits are defined in the Exchange 27 QUESTION: What services must insurance companies provide with respect to the essential benefits under the ACA? 1)Those that the insurance company believes will be competitive 2)Those that are appropriate to the benefits required by the ACA 3)Those that the insurance company board of directors are willing to provide 4)Those that their medical director tells them are necessary

28 Essential Health Benefits (2014) All new plans and all plans sold on an exchange must meet these requirements. Insurers may offer a low cost catastrophic plan for those under 30 and four plans varying coverage at 60%, 70%, 80% and 90% of the cost of benefits. The requirements will be defined by HHS and must include at least the following benefit coverage plus the items and services covered within the categories: Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health, substance abuse and behavioral health treatments Prescription drugs Rehabilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral and vision care 28

29 “…The law creates four tiers of coverage, plus a low-cost, bare- bones “catastrophic” plan for those who are younger than 30 and those who are exempt from the requirement to buy an insurance plan…” 29

30 Talking About the Affordable Care Act Health Benefits Already Activated 30 QUESTION: Which of the following did ACA NOT provide as a correction to the lack of pre-existing condition health insurance? 1)It immediately banned denial for pre-exisiting conditions if the insured is less than age 19 2)It subsidized state pre-existing condition insurance 3)It created a federal insurance program 4)It banned denial for pre-existing conditions for everyone beginning in 2014

31 Provisions that went into effect in 2010 include… 1) 2010 CHILDREN: THREE PROVISIONS TOOK EFFECT IN Coverage denial for pre-existing conditions is banned if less than age 19, AND FOR EVERY INSURED ON Jan 1, Coverage denial for pre-existing conditions is banned if less than age 19, AND FOR EVERY INSURED ON Jan 1, Children must be accepted as insured under parents plan up to age 26 if the plan inlcudes children in its available coverage. Children must be accepted as insured under parents plan up to age 26 if the plan inlcudes children in its available coverage. States must not reduce income eligibility for Medicaid and the Children’s Health Insurance Program (CHIP) until ) 2010 ACA CREATED A FEDERAL HIGH RISK INSURANCE PROGRAM FOR THOSE WITH PREEXISTING CONDITIONS and without insurance for six months Many states also offer high risk pools as alternatives to the federal program. 31

32 Other Provisions that went into effect in 2010: Lifetime limits on benefits are banned. Unreasonable annual benefit limits are restrained until banned. Protecting your choice of physicians. Insurance companies must provide free preventive services. 32

33 More Provisions! 2010 MUST PROVIDE EMERGENCY SERVICES without prior authorization whether in or out of network.whether in or out of network ENDS RESCISSIONS except for fraud BANS DISCRIMINATION BASED ON INCOME unless self insured BANS DUMPING 2010 ENSURES QUALITY OF CARE 2010 MUST PROVIDE AN INDEPENDENT APPEALS PROCESS 33

34 Talking About the Affordable Care Act Questions? 34 Blog:

35 Feedback! Your feedback is important to us, and helps us cater these presentations to your needs in the future. Please send an to: With: 1)One thing you liked about the presentation 2)One thing that could be changed to improve it 3)One thing you will do differently as a result of the presentation 35

36 Addendum The statutory citations, shown as “SEC. Xxxx”, are to H.R.3590, P.L as amended by H.R This is the affordable health care reform law and is referred to here as ACA. A click on anything in the text that is underlined will take you to a web site. For instance to find the law sections cited click on the underlined citation above, or go to the indicated note at the end of the digest. Type the section number into the “find” window at top center of the web site that appears or go to “find” in the edit menu. Click on the small arrow head to the right of the window. A drop down menu appears. Click on “Find next in current PDF”. For ACA regulations click here 2. Web site addresses cited will provide expanded information concerning the paragraph. For updates see pkittler’s blog 3. For help with the digest, or for suggestions or comments, please , The web site reference address appears as footnotes at the end of the digest.H.R.3590, P.L click here 2 pkittler’s blog KEY POLITICAL QUESTIONS ARE ANSWERED IN A SHORT PAPER from the Center of Budget and Policy KEY POLITICAL QUESTIONS ARE ANSWERED IN A SHORT PAPER from the Center of Budget and Policy Priorities at


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