Beth Faiman MSN, APRN-BC, AOCN Cleveland Clinic Taussic Cancer Institute Pre-Doctoral Research Fellow Case Western Reserve University Cleveland, Ohio America’s.

Beth Faiman MSN, APRN-BC, AOCNBeth Faiman MSN, APRN-BC, AOCN

Cleveland Clinic Taussic Cancer InstituteCleveland Clinic Taussic Cancer Institute

Pre-Doctoral Research FellowPre-Doctoral Research Fellow

Case Western Reserve UniversityCase Western Reserve University

Cleveland, Ohio Cleveland, Ohio

America’s Affordable Health America’s Affordable Health Choices Act and Medicare: Choices Act and Medicare:

HR 3962HR 3962What does this mean to you?What does this mean to you?

Objectives of this review: Objectives of this review:

To increase understanding of the Bill To increase understanding of the Bill and how it may affect youand how it may affect you

Review the key components of the Review the key components of the bill and describe three key issues bill and describe three key issues that may impact youthat may impact you

Question and answerQuestion and answer

What is Health Care Reform What is Health Care Reform About?About?

July 31, 2009 the House Energy and July 31, 2009 the House Energy and Commerce Committee approved HR Commerce Committee approved HR 3200 by a 31-28 vote3200 by a 31-28 vote

Recently Revised- now HR 3962 Recently Revised- now HR 3962

Ongoing process …. much debate!Ongoing process …. much debate!

Objectives of the Bill: Objectives of the Bill:

The Bill focuses upon:The Bill focuses upon:

Providing coverage and choiceProviding coverage and choice

Affordability Affordability

Shared ResponsibilityShared Responsibility

Prevention and WellnessPrevention and Wellness

Workforce InvestmentsWorkforce Investments

Coverage and ChoiceCoverage and Choice

Health Insurance ExchangeHealth Insurance Exchange

Opportunity to shopOpportunity to shop

A public health insurance optionA public health insurance option

Financed only by its premiumsFinanced only by its premiums

Guaranteed coverage and insurance Guaranteed coverage and insurance market reformsmarket reforms

Essential benefitsEssential benefits

AffordabilityAffordability

Sliding scale affordability creditsSliding scale affordability credits

Caps annual out-of-pocket spendingCaps annual out-of-pocket spending

Expands MedicaidExpands Medicaid

Improves MedicareImproves Medicare

Shared ResponsibilityShared Responsibility

Person’s individual responsibility to Person’s individual responsibility to maintain health insurance maintain health insurance

Employer responsibility to provide Employer responsibility to provide insuranceinsurance

Assistance for small businesses Assistance for small businesses

GovernmentGovernment

Controlling CostsControlling Costs

Modernization and improvement of Modernization and improvement of MedicareMedicare

Public health insurance optionPublic health insurance option

Improving payment accuracy and Improving payment accuracy and eliminating overpaymentseliminating overpayments

Prevention and WellnessPrevention and Wellness

Expansion of community health Expansion of community health centerscenters

Creation of community based health Creation of community based health and wellness programsand wellness programs

Workforce InvestmentsWorkforce Investments

More training of nurses and doctorsMore training of nurses and doctors

More scholarships and incentives for More scholarships and incentives for underserved areasunderserved areas

Train more primary care physicians, Train more primary care physicians, Graduate medical educationGraduate medical education

Key Health Policy ConcernsKey Health Policy Concerns

““Donut hole” for medicare patients Donut hole” for medicare patients and high cost of medicationsand high cost of medications

Re-hospitalizations within 30 days Re-hospitalizations within 30 days

Advanced Directives 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 PrescriptionsHigh Cost of Prescriptions

Patients should be able to take the best Patients should be able to take the best medication for them regardless of costmedication for them regardless of cost

Drug price negotiation for Part D Drug price negotiation for Part D

““Catastrophic” co-pay is a consequence Catastrophic” co-pay is a consequence

This bill will address this concern This bill will address this concern

Re-hospitalizationsRe-hospitalizations

1 out of 5 patients are readmitted to the 1 out of 5 patients are readmitted to the hospital hospital

Hospitals will be penalized if patients are Hospitals will be penalized if patients are readmittedreadmitted

This will hopefully improve quality of careThis will hopefully improve quality of care

This is similar to current reimbursement This is similar to current reimbursement policies policies

Advanced Directives Advanced Directives Advanced Directives are not routinely Advanced Directives are not routinely

discussed until it is too late. discussed until it is too late.

Discusses patient wishes Discusses patient wishes

End of life services availableEnd of life services available

Beneficial to the individual and the Beneficial to the individual and the individual’s family individual’s family

Should be updated periodically as the Should be updated periodically as the health of the individual changes health of the individual changes

Final Thoughts from the Final Thoughts from the Group…..Group…..

Thank you! Thank you!