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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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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Introduction

Pat KittlerPat Kittler

• Background• Purpose• Accompanied Digest• http://bit.ly/ACADIGEST2011 or on National Field

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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: http://bit.ly/ACADIGEST2011

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Agenda

A. IntroductionB. ACA big pictureC. Medicaid and MedicareD. The new insurance marketE. Cost controls and regulationsF. Subsidies for individuals, retirees and small business.G. Essential Health BenefitsH. Health insurance benefits already in effectI. Questions

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Talking About the Affordable Care Act

Big PictureBig Picture

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. $1,0662. $5,5383. $7,4214. $13,1005. $21,439

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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 111th Congress passed ACA using help from presidents Truman, Eisenhower, Kennedy, Nixon, Johnson, Reagan, Clinton, and G. W. Bush

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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 industry

REDUCES THE DEFICIT• reduces the 20 year deficit by $1.5 Trillion

BRINGS QUALITY, AFFORDABLE HEALTH CARE• for 94% of our residents

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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.

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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!

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Medicaid and Medicare Medicaid and Medicare

Talking About the Affordable Care Act

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.

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President Obama strengthened Medicaid and Medicare…even in 2009

• 2009 RECOVERY ACT • REIMBURSEMENT FOR COSTS TO STATE MEDICAID PROGRAMS

• has saved Minnesota (in ’09 -’10), $1,673,476,158 thru Sept 30, 2010.

• 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.

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Medicaid and Medicare Continue to Benefit under the Affordable Care Act…

• 2010-2019 ACA EXTENDS THE LIFE OF MEDICARE UNTIL 2029

• 2010 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 2020.

• 2011 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.

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More on the Donut Hole…

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The Donut Hole will disappear by 2020

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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.

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Eldercare Locator (2010)

www.eldercare.gov Or call 1-800-677-1116 for community based services and benefits,

counseling, transportation, meals, home care and caregiver support services.

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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.

• Medicare and Medicaid received just under $3 Billion in 2009 from fraud recovery.

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Talking about the Affordable Care Act

The New Insurance MarketThe New Insurance Market

QUESTION: Which of the following can HHS always do to restrain premium increases? 1) Restrict the insurance company’s application2) Nothing3) 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

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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.

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Talking about the Affordable Care Act

Cost Controls and RegulationsCost Controls and Regulations

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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.

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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.

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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.

• 2010 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 64.

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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 2014

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Talking About the Affordable Care Act

Essential Health Benefits are defined in the ExchangeEssential Health Benefits are defined in the Exchange

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 competitive2) Those that are appropriate to the benefits required by the ACA3) Those that the insurance company board of directors are

willing to provide4) Those that their medical director tells them are necessary

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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

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“…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…”

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Talking About the Affordable Care Act

Health Benefits Already ActivatedHealth Benefits Already Activated

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 192) It subsidized state pre-existing condition insurance3) It created a federal insurance program4) It banned denial for pre-existing conditions for everyone

beginning in 2014

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Provisions that went into effect in 2010 include…

1) 2010 CHILDREN: THREE PROVISIONS TOOK EFFECT IN 2010.• Coverage denial for pre-existing conditions is banned if less than

age 19, AND FOR EVERY INSURED ON Jan 1, 2014. • Children must be accepted as insured under parents plan up to a

ge 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 2019.

2) 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.

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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.

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More Provisions!

• 2010 MUST PROVIDE EMERGENCY SERVICES • without prior authorization whether in or out of network.

• 2010 ENDS RESCISSIONS • except for fraud.

• 2010 BANS DISCRIMINATION BASED ON INCOME • unless self insured.

• 2010 BANS DUMPING

• 2010 ENSURES QUALITY OF CARE

• 2010 MUST PROVIDE AN INDEPENDENT APPEALS PROCESS

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Talking About the Affordable Care Act

Questions?Questions?

Blog: http://my.barackobama.com/page/community/blog/patkittler

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Feedback!

Your feedback is important to us, and helps us cater these presentations to your needs in the future. Please send an email to:

[email protected]@[email protected]

With:1) One thing you liked about the presentation2) One thing that could be changed to improve it3) One thing you will do differently as a result of the presentation

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AddendumThe statutory citations, shown as “SEC. Xxxx”, are to H.R.3590, P.L.111-148

as amended by H.R. 4782. 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 here2 . Web site addresses cited will provide expanded information concerning the paragraph. For updates see pkittler’s blog3. For help with the digest, or for suggestions or comments, please e-mail, [email protected] . The web site reference address appears as footnotes at the end of the digest.

• KEY POLITICAL QUESTIONS ARE ANSWERED IN A SHORT PAPER from the Center of Budget and Policy

• Priorities at http://www.cbpp.org/files/5-17-10health.pdf.