1. Understanding the Health Care Debate
Monica Bogucki, BSW, JD
2017 Copyright

2. Types of Health Care Coverage
Private health insurance (clinic and hospital)
Private long term care insurance
Government programs
Medicaid/Medical Assistance
TEFRA(Tax Equity and Fiscal Responsibility Act)
Medicare
CHIPS
TEFRA
Minnesota Care
Veterans health system
Indian Health Services

3. Key to understanding the Health Care Debate
Need to understand
Categorical eligibility
Financial eligibility
Understanding the funding streams for these programs.

4. Medicare 65 years of age and older
Those who are found disabled prior to 65 years of age

5. Medicare Medicare Parts A, B and D (federal program)
If a person purchases Medicare, then his premium is deducted from social security retirement
Because Medicare does not cover everything, most people purchase a Medicare supplemental insurance plan.

6. Dual Eligibility for Medicare and Medicaid
If a person is receiving Medicare and is low income, they can also apply for Medicaid (Medical Assistance). This will be her supplemental plan and will cover prescriptions.

7. Medicaid/Medical Assistance
This is combined federal and state funded program.
It covers low income individuals and families
It also covers long term nursing facility care
It covers foster children
It covers those who are disabled and receiving Supplemental Security Income (SSI) benefits.
TEFRA (1982)-allows a child with a disability to be covered by MA by excluding parent(s) income

8. Affordable Care Act 42 U.S.C. section 18001 (2010)
Insurance companies could no longer deny insurance coverage to a person with pre-existing condition.
Insurance companies could no longer cap lifetime benefits-unlimited benefits. (Example: Previously, insurance companies may cap lifetime benefits at $1 million.)
Summary of ACA by Kaiser Foundation-

9. Affordable Care Act
It also required insurance companies to provide “essential health benefits.”
Ambulatory patient services. [outpatient care]
Emergency services.
Hospitalization. [inpatient care]
Maternity and newborn care
Mental health and substance use disorder services, including behavioral health treatment.
Prescription drugs.
Rehabilitative and habilitative services and devices.
Laboratory services
Preventive and wellness services and chronic disease management;
Pediatric services, including oral and vision care.

10. Affordable Care Act Set up health insurance exchanges
Federal exchange- HealthCare.gov
Minnesota has a health insurance exchange (MNSURE)
Those whose income is lower can receive subsidies (tax credits) on her health insurance premiums—to reduce the cost.

11. Stakeholders Individual insured Vulnerable populations Disabled
Mental health
Elder
Those with pre-existing conditions
Insurance companies
Medical providers

12. Stakeholders Hospitals-urban and rural Medical clinics-urban and rural
Those in community based placements-
Home health care
Hospice

13. Medicaid Expansion
Each state determines who is eligible for MA (within the parameters of federal law)
MA covers individuals up to a certain income level.
MA Expansion gave the states options to covers individuals at a higher income level (but yet low income) individuals

14. Benefits of Medicaid Expansion
Access to health care
For small businesses that are unable to provide health insurance, employees have access to MA

15. Insurance Industry
Health insurance providers are pulling out of the marketplace because of higher costs of providing coverage for those with pre-existing conditions.
How do we stabilize the marketplace and keep premiums lower for individuals?

16. Long Term Impacts of not providing health insurance coverage
Loss of employment
Increase in homelessness
Lower quality of life
Increase in deaths
Increase in suffering
Increase in mental health
Increase in individual bankruptcies
Closing of medical clinics and hospitals

17. A View of Chippewa County, MN
% of children in poverty, ages %
% of children receiving free/reduced lunches %
% of children without health insurance, ages 0-19, 5.2%
Kids Count, Minnesota 2016 Fact Sheet,

18. A View of Kandiyohi County, MN
% of children living in poverty, ages 0-17, %
% of students receiving free/reduced lunch %
% of children without health insurance 4.4%
Kids Count, Minnesota 2016 Fact Sheet,

19. A View of Lac Qui Parle County, MN
% of children in poverty, age %
% of children receiving free/reduced lunch %
% of children without health insurance, ages 0-19
4.7%
Kids Count, Minnesota 2016 Fact Sheet,

20. Proposed health care bills
American Health Care Act (AHCA)
Better Care Reconciliation Act (BCRA)
Both bills propose block grants.
“The case of welfare reform illustrates a possible scenario under Medicaid block grants: both federal and state spending drop off, with state spending diverted to other uses. To accommodate these changes, it may not be sufficient to cut enrollees, or benefits, or provider reimbursement---states will likely enact all three.”
Medicaid Under Block Grants: Lessons From Welfare Reform, Michelle Ko and Marianne Bitler, (July 7, 2017),

21. Impact of Block Grants
“Following welfare reform, a number of states pursued a “race to the bottom,” with a shrinking number of families receiving cash or work or child-care related assistance….”
Medicaid Under Block Grants: Lessons From Welfare Reform, Michelle Ko and Marianne Bitler, (July 7, 2017),