Post ACA Cost of Health June 2014

The Affordable Care Act & Beyond

Making health care more secure and returning control to consumers moving forward

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Before the Affordable Care

Act

It was legal for health insurance Companies to

DENY COVERAGE

to kids with cancer and other pre-existing

conditions.

We cannot go back.

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DeniedPre-existing

condition

We cannot go back.

This January

It became illegal for health insurance

companies to

DENY COVERAGE

to people with cancer and to cancer survivors

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Starting this year

It became illegal for health insurance Companies to

DENY COVERAGE orCHARGE HIGHER RATES

to all people with pre-existing conditions

We are moving forward.

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Freedom:

• Every American should have the freedom to control their own medical decisions without interference from insurance companies.

Access to Health Care is anAmerican Value

Access to Health Care is anAmerican Value

Opportunity:

• Americans who lack access to stable and affordable health coverage do not have a fair shot at the American dream.  They face a constant threat of having their lives and careers devastated by health disasters that also become financial disasters.

• Every American should have the opportunity to change jobs or start a small business without losing health coverage.

Access to Health Care is anAmerican Value

Responsibility:

• Everyone should take responsibility for getting health care coverage for themselves and their families so long as it is made affordable and accessible.

• The insurance industry should be able to make reasonable profit but in return should be held accountable by not profiting from abusive practices and discrimination.

Access to Health Care is anAmerican Value

Cooperation:

• The cost of healthcare cannot be stabilized by one good actor or business, it requires cooperation from many sectors – civic, private and public.

Moving Beyond The Affordable Care Act

How the national health care lawadvances American health care values and

how we can advance them further.

--Passed March 23, 2010

--The first stages of reform are here,

But first, we’re talking about this because…

It’s the law of the land and it’s time to move forward. The private market failed to guarantee

access to affordable health coverage. For the first time everyone will have somewhere to go to get good coverage at a reasonable price, no matter

what. Text BADGERCARETo 414-376-6728

Early Reforms

The Affordable Care Act holds insurance industry and government responsible for:

• Preventive care coverage & screenings with no co-pays or deductibles

• Young adults can stay on parents private insurance policies until age 26

• Preventive care without cost sharing for seniors on Medicare

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Because of healthcare reform

over 3 million young adults are now covered on their parents’

policy.

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Early Reforms

Insurance industry violations of health care freedom now outlawed by the Affordable Care Act

• Preexisting condition exclusions

• Lifetime limits

• Dropping coverage after a person gets sick

• Excessive insurance industry profits and overhead capped

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Sami’s Story“My 7-year-old son, Sami, suffers

from a disease that causes tumors to grow all over his body. Sami’s treatments could not continue if we hit our insurance policy’s life time limit. Thanks to the Affordable Care Act, insurance companies can no longer impose lifetime limits or deny health coverage to children like Sami with preexisting conditions. We can’t go back to being on our own against the insurance companies.”

--Tracy, Appleton, Wisconsin.Text BADGERCARETo 414-376-6728

The Affordable Care Act ends health insurance industry assault

on opportunity and freedom of 1.3 million Wisconsinites

• More than 1.3 million Wisconsinites under the age of 65 have been diagnosed with pre-existing conditions that, without health reform, could lead to denials of coverage or discriminatory rates.

• As we age, the risk of insurance industry discrimination escalates. Text BADGERCARE

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Just Some of the Examples of Preexisting Conditions

Gender Discrimination

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The Cost of Healthcare

“The two main lessons are the notion that there was a pre-existing double-digit trend, and that it was variable…It could have gone up 100% for a sick guy and gone down some for a healthy guy."

-Jonathan Gruber, MIT economist

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Every dollar that health coverage

increases…

…is one less dollar our

families can spend on the

basics

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Amount a typical family of four

pays for health care

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As of This Year:

Health coverage guaranteed to everyone who buys insurance on their own or works for a small business through new consumer-friendly competitive marketplaces at Healthcare.gov. Guaranteed care that can never be taken away.

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Competitive Health Marketplace for

Middle Class: Healthcare.gov

• Coverage more secure: Insurance companies can never deny or drop coverage due to medical conditions

• Coverage more affordable: premium tax credits on a sliding scale to guarantee affordable options.

• New options, such as nonprofit member owned cooperatives to keep insurance companies honest.

• No discriminatory pricing based on medical condition, age, or gender. Text BADGERCARE

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Remy’s Story“I own a small café. Over 20 years

ago I beat cancer, but ever since then no insurance company would sell me a policy because my cancer is called a preexisting condition. Thanks to the Affordable Care Act, no insurance company will be allowed to discriminate against me because I’m a cancer survivor.”

--Remy, Pepin, Wisconsin

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The Next Big Thing:

• Coverage must be more affordable

• Not everyone is covered yet

• First step was coverage, more to do to improve care.

• We can go above and beyond the law, and other states are.

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We pay more than other countries, a lot more.

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And the disparity is getting worse, not better.

Inflation-Adjusted Change in Medicare and Commercial Health Insurance Claims Costs, 2003-2012

Medicare has actually done a better job than private insurance at holding down the high cost

of care.

BadgerCare for low income Wisconsinites

• The Affordable Care Act gives billions in federal dollars to WI to fill in the holes in BadgerCare.

• Gov Walker’s approach costs Wisconsin $149 million more in this budget & forced thousands off BadgerCare. 84,700 are currently denied BadgerCare.

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• The good news is that because of the Affordable Care Act people forced off of BadgerCare will have access to the new health insurance marketplaces.

• The bad news is that it will be hard for very low income people to afford because the law assumed that this group would end up on BadgerCare.

• The additional good news is we can accept these federal funds at any time. Text BADGERCARE

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Before You Assume This is A Partisan

Issue…

• Chris Christie, New Jersey, (R)

• Jan Brewer, Arizona, (R)

• Rick Scott, Florida, (R)

• Terry Branstad, Iowa (R)

• Rick Snyder, Michigan, (R)

• Brian Sandoval, Nevada, (R)

• Susana Martinez, New Mexico, (R)

• Jack Dalrymple, North Dakota, (R)

• John Kasich, Ohio, (R)

Conservative Governors Who Support Accepting Federal Funds

Terry’s Story"I'm a personal care worker, I work at a

group home and makes $9 an hour taking care of people's health. Even though I work to keep other people healthy, I do not have affordable health care myself. I have not been able to qualify for BadgerCare, in fact I'm just over number 141,000 on the waiting list. I'm father of three, I want to give my children their chance at the American dream but without health insurance, we're looking at an uncertain future."

-Terry O, MilwaukeeText BADGERCARETo 414-376-6728

Why This Matters To Cost.

Insurance companies, now prevented from charging more based on preexisting conditions and gender, make prices based on state/community data.

• Individual rates in WI are over $250 more per year by refusing funds for BadgerCare

• For two reasons:

• New low income individuals purchasing plans, tend to be sicker.

• More uninsured using emergency rooms, uncompensated care Text BADGERCARE

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State Doing Worse

As other states improve their health sector, if we don’t improve we’ll fall behind.

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Why Is This Even An Issue?

• Big Insurance wants to repeal health reform so it can continue to profit from discrimination.

• Some unscrupulous politicians want to sabotage the implementation of health reform in order to further their political ambitions.

•There are ideological opponents who refuse to accept health reform and cannot be swayed by any amount of facts showing the benefits.

Idea 1: Improve the Purchasing Power of

the Marketplace.• The idea of the marketplace is for all of

us to collectively negotiate lower rates.

• Next year, small businesses can join the marketplace the same way individuals can.

• We could improve cost by bringing individuals, small businesses and large businesses together to negotiate.

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• The federal Medicaid funds for BadgerCare is not the only way to improve BadgerCare

• Another source: “Basic Health Plan”

• Thousands more Wisconsin citizens could be covered by BadgerCare: saving both them and the state money and reducing health care costs.

Idea 2: Improve BadgerCare

Even Further.

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Idea 3: Hold Insurance Companies

Accountable.Wisconsin has consumer

protection powers it has never used:

1. Review rate increases: Wisconsin could prevent excessive rate increases year to year.

2. Directly negotiate with insurers to reduce rates for everyone purchasing coverage.

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• If consumers can’t see what procedures cost, they can’t shop around

• If advocates can’t access data, we can’t share what works

Idea 4: Make Healthcare

Transparent.

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The Affordable Care Act is Worth Improving

Insurance companies must now play fairly.

It’s the law.

• PROTECTION: Working families no longer can be denied coverage for preexisting conditions, risk losing their coverage

when they get sick or hit a “lifetime limit”.

• PREVENTION: Preventative care must be covered free of charge by insurance companies--including mammograms for

women and wellness visits for seniors.

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The Affordable Care Act is Worth Improving

Insurance companies must now play fairly.

It’s the law.

• FAIRNESS: Millions of Americans have received a rebate because their insurance company spent too much of their

premium on administrative costs or CEO bonuses.

• PEACE OF MIND: Families will not be forced into bankruptcy when someone gets sick, and can get affordable coverage no matter where they choose to work or what gender they

are; with no loopholes or fine print in their policy!

And we can do better!Text BADGERCARETo 414-376-6728

Questions?

• Kevin KaneLead OrganizerCitizen Action of Wisconsin414 550 8280 (cell) @KevinKanekevin.kane@citizenactionwi.org

Facebook.com/CitizenActionWIwww.CitizenActionWI.org

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