Beth Faiman MSN, APRN-BC, AOCN Cleveland Clinic Taussic Cancer Institute Pre-Doctoral Research Fellow Case Western Reserve University Cleveland, Ohio America’s Affordable Health Choices Act and Medicare: HR 3962 What does this mean to you?

Objectives of this review:  To increase understanding of the Bill and how it may affect you  Review the key components of the bill and describe three key issues that may impact you  Question and answer

What is Health Care Reform About?  July 31, 2009 the House Energy and Commerce Committee approved HR 3200 by a vote  Recently Revised- now HR 3962  Ongoing process …. much debate!

Objectives of the Bill:  The Bill focuses upon:  Providing coverage and choice  Affordability  Shared Responsibility  Prevention and Wellness  Workforce Investments

Coverage and Choice  Health Insurance Exchange  Opportunity to shop  A public health insurance option  Financed only by its premiums  Guaranteed coverage and insurance market reforms  Essential benefits

Affordability  Sliding scale affordability credits  Caps annual out-of-pocket spending  Expands Medicaid  Improves Medicare

Shared Responsibility  Person’s individual responsibility to maintain health insurance  Employer responsibility to provide insurance  Assistance for small businesses  Government

Controlling Costs  Modernization and improvement of Medicare  Public health insurance option  Improving payment accuracy and eliminating overpayments

Prevention and Wellness  Expansion of community health centers  Creation of community based health and wellness programs

Workforce Investments  More training of nurses and doctors  More scholarships and incentives for underserved areas  Train more primary care physicians, Graduate medical education

Key Health Policy Concerns  “Donut hole” for medicare patients and high cost of medications  Re-hospitalizations within 30 days  Advanced Directives

Medicare   The rising costs of health care are a burden on our families and a drain on our long-term economic growth.   If we continue on the course we are on, health care expenditures will reach 20 percent of GDP within a decade.   Rapidly rising health care costs are leading our nation down a fiscally unsustainable path.

Medicare   Medicare’s Hospital Insurance Trust Fund extended to 2024   Reduce beneficiary premiums for physician and outpatient services by about $43 billion over the next 10 years.

Medicaid   Medicaid has been the remedy of both choice and necessity   Medicaid insures poor and sick, children and pregnant women, enables people with disabilities to achieve community integration   Also- treats uninsured women for breast or cervical cancer, compensates for Medicare's inadequacies in providing care for the elderly poor

Medicaid   Lacks a uniform definition of poverty for adults.   For children and pregnant women, the program establishes a national income-eligibility floor of 133% of the federal poverty level.   No similar floor for other adults   Income-eligibility threshold for those adults who do fall into existing coverage categories can be as low as 17% of the federal poverty level for working parents

High Cost of Prescriptions  Patients should be able to take the best medication for them regardless of cost  Drug price negotiation for Part D  “Catastrophic” co-pay is a consequence  This bill will address this concern

Re-hospitalizations  1 out of 5 patients are readmitted to the hospital  Hospitals will be penalized if patients are readmitted  This will hopefully improve quality of care  This is similar to current reimbursement policies

Advanced Directives  Advanced Directives are not routinely discussed until it is too late.  Discusses patient wishes  End of life services available  Beneficial to the individual and the individual’s family  Should be updated periodically as the health of the individual changes

Final Thoughts from the Group….. Thank you!