Health Care Reform: Whats in the new law? And what happens now? Presented by Amy Smoucha Health Care Organizer, Missouri Jobs with Justice.

Health Care Reform:What’s in the new law?

And what happens now?

Presented by Amy SmouchaHealth Care Organizer, Missouri Jobs with Justice

What’s really in the Affordable Care Act?

The health reform law is designed to:

• Reduce health care costs, both for families and for the government.

• Make health coverage more secure for all Americans.

• Improve Medicare and Medicaid.• Modernize our health care delivery system.

Here’s how:

Reform makes health insurance more securesecure.

• Insurance companies won’t be able to turn people down because of pre-existing conditions.

• Insurance companies can’t drop your coverage because you get sick.

• Insurance companies won’t be able to charge higher premiums because of pre-existing conditions, gender, or occupation, and there will be a limit on how much they can charge based on age.

Health reform puts patients and doctors in control.patients and doctors in control.

• Insurance plans will have to cover essential services: preventive care, hospitals, physicians, prescription drugs, mental health, substance abuse, dental and vision care for children, maternity care, and other services.

• Clear appeals process if your claim is denied

Health reform encourages prevention and wellness.prevention and wellness.

• No deductibles or copayments for preventive services.

• Grants for community wellness programs• Incentives for doctors to improve

patients’ health

Reform protects ChildrenChildren.

• Starting this year, insurance companies can’t deny children insurance because of a pre-existing condition (applies to adults in 2014)

• No yearly or lifetime limits on coverage• Free preventive care• Young adults can stay on their

parents’ plan until age 26

Reform improves MedicareMedicare.

• Free preventive services• Closes the “donut hole” in drug coverage and

lowers cost of brand name drugs• Doctor incentives for better coordinated care• Enhanced payments for

primary care physicians and general surgeons

Health reform controls controls health care costshealth care costs for

Americans

• Insurance companies can’t impose annual or lifetime limits on how much they will pay

• Health insurance companies have to spend 80-85% of premiums on medical care

• Spending caps will limit the amount consumers pay out of pocket each year

• Moderate income Americans can get tax credits to make health insurance affordable

Health reform makes it easier to buy easier to buy

insuranceinsurance.

• New Insurance Exchanges allow people to compare plans, apples to apples

• Limits insurance company overhead costs (administrative and marketing) so more of our premiums go to our health care

• Allows individuals and small businesses to get better rates because they are in a bigger pool

Health Reform helps small businessessmall businesses• Affordable choices

Small businesses and their employees can get better insurance rates through the Exchange

• Premium subsidies to employersEmployers with up to 25 employees and annual wages that average less than $50,000 who purchase health care for their employees get a tax credit

Reform expands state expands state health insurance under health insurance under

MedicaidMedicaid• Medicaid will cover families and individuals with

incomes up to 133% of the Federal Poverty Level, $24,348 for a family of three.

• In Missouri, a family of three must make less than $4,584 a year now to qualify for a state health insurance program

• For the first time ever, childless adults without a disability can qualify for Medicaid.

Help for moderate-incomemoderate-income

Americans

• If your family cannot get affordable health insurance, you may be able to get a tax credit to help.

• Tax credits will be available to families earning between 133-400% of the Federal Poverty Level ($29,327-88,200 for a family of four).

• Subsidies will be on a sliding scale so premium costs will range from 2%-9.5% of income.

• Tax credits are advancable and refundable.

Sounds great – but how do we pay for it?

Access to home and community-based home and community-based services services for people with disabilities

• The Community First Choice option makes community-based services mandatory and there are no cost caps or waiting list restrictions.

• If you pay into the CLASS program for 5 years, you will be able to access the supports necessary to stay in your own home without having to spend your life savings to quality for Medicaid attendant services.

Shared responsibilityShared responsibility

Costs and responsibilities are shared among state and

federal government, businesses and individuals

Shared responsibilityShared responsibility

Federal Government• Pays for 100 percent of Medicaid expansion

from 2014-2016• Pays for 90-95 percent of Medicaid expansion

in 2017 and beyond• Shares in cost of tax credits that will go to

individuals and small businesses who purchase insurance

Shared responsibilityShared responsibilityBusinesses• Large employers will have to pay a penalty if

they do not provide coverage and one or more of their employees receives an insurance premium subsidy.

• Taxes on insurance companies that offer very high cost plans

• Fees or taxes on producers of some medical equipment, pharmaceuticals, and indoor tanning

Shared responsibilityShared responsibilityIndividuals• U.S. citizens and legal residents must purchase

health insurance or pay a penalty• Exemptions granted for financial hardship,

religious objections, those without coverage for less than 3 months, undocumented workers, incarcerated individuals, or if the lowest cost plan exceeds 8% of income

• Tax changes for some high-income individuals

Most importantly, health reform controls health care

costs for all Americans.

So that’s what’s in health reform…

What does it mean for Missouri?

• 961,000 seniors will receive free preventive services.

• 559,000 young adults will have the right to keep their family’s insurance until they turn 26.

• 171,000 seniors will have their brand-name drug costs in the Medicare Part D “donut hole” halved. Within ten years the donut hole will be fully closed.

• 180 Community Health Centers throughout MO will receive large increases in funding.

• More than 90,000 Missourians with pre-existing conditions gain access to affordable coverage this year.

• 79,900 small businesses, with more than 303,000 employees, could receive a tax credit to offset premiums.

• 495,000 uninsured Missourians will gain health coverage.

• ALL Missourians will benefit from greater peace of mind, knowing they won’t lose their health insurance if they lose their job, start a small business, or get sick.

NOW WHAT???

Weigh in on New RegulationsHealth reform lays out an important framework.

Now the Department of Health & Human Services is drawing up new regulations to comply – for example, defining “essential services” that must be covered.

Weigh in on these new regulations!

Help Spread the Word!

There are lots of people who still don’t know what’s in health reform.

Now that you know, please help educate others!

Stay Informed!

Stay Inf

www.mohealthcareforall.org

www.paraquad.org/Policy/HealthcareReform

Build a MovementFrom the New York Times, February, 1964

And the Civil Rights Act of 1964 did not include voting rights.

Join the movement!www.mohealthcareforall.org

www.mojwj.org

Employer-based coverage 53.4 %-of Americans (159 million) get their coverage through employer plans. Employer based health care premiums have been rising four times faster than wages in Missouri.

More than 12% of Americans have Medicare—45 million people.

More than 13% of Americans have Medicaid.

VA

When you hear the President or a Congressperson say that you can keep your coverage if you like what you have, these are the forms of health insurance they are referring to.

People will not be forced to change coverage.

Employer-based coverage 53.4 %-of Americans (159 million) get their coverage through employer plans. Employer based health care premiums have been rising four times faster than wages in Missouri.

What’s New? Health Insurance Exchange

More than 12% of Americans have

Medicare—45 million people.

More than 13% of Americans have

Medicaid.

VA

What’s New? Health Insurance Exchange

Congress is creating a new marketplace where people in the individual and small group markets can shop for coverage.

In the exchange, insurance companies will have to offer plans that follow the new insurance rules.

There will be several levels of plans with standard benefits.

People will be able to compare plans, apples to apples.

Significant insurance company overhead costs are eliminated.

The goal is to create a system where every person and every business has guaranteed access to affordable health coverage.Employer-based coverage 53.4 %-of Americans (159 million) get their coverage through employer plans. Employer based health care premiums have been rising four times faster than wages in Missouri.

More than 12% of Americans have Medicare—45 million people.

More than 13% of Americans have Medicaid.

VA