THE AFFORDABLE

CARE ACTValerie Stannard

WHAT IS IT EXACTLY?

It is a health care law that wishes to improve our current health care system by increasing access to health coverage for Americans and introducing new protections for people who have health insurance.

SOME KEY FACTS ABOUT THE ACT:

Consumer Rights and Protections

More Affordable Coverage

Better Access to Care

Strengthens Medicare

CONSUMER RIGHTS AND PROTECTIONS

In the past, insurance companies could take advantage of you. Now, the act puts into place a Patient’s Bill of Rights that protects you from abusive practices.

End to pre-existing condition discrimination. Children can no longer be pushed away for a pre-existing

condition. This will soon follow for ALL Americans in 2014. End to coverage cancelations.

Insurance companies can no longer drop your coverage when you get sick due to a mistake you made on your application.

End to limits on care. Under the health care law, insurers can no longer impose

lifetime dollar limits on essential health benefits and annual limits are being phased out by 2014.

THE PATIENT’S BILL OF RIGHTS •Provides Coverage to Americans with Pre-existing Conditions: You may be eligible

for health coverage under the Pre-Existing Condition Insurance Plan.

•Protects Your Choice of Doctors: Choose the primary care doctor you want from your plan’s network.

•Keeps Young Adults Covered: If you are under 26, you may be eligible to be covered under your parent’s health plan.

•Ends Lifetime Limits on Coverage: Lifetime limits on most benefits are banned for all new health insurance plans.

•Ends Pre-Existing Condition Exclusions for Children: Health plans can no longer limit or deny benefits to children under 19 due to a pre-existing condition.

•Ends Arbitrary Withdrawals of Insurance Coverage: Insurers can no longer cancel your coverage just because you made an honest mistake.

•Reviews Premium Increases: Insurance companies must now publicly justify any unreasonable rate hikes.

•Helps You Get the Most from Your Premium Dollars: Your premium dollars must be spent primarily on health care – not administrative costs.

•Restricts Annual Dollar Limits on Coverage: Annual limits on your health benefits will be phased out by 2014.

•Removes Insurance Company Barriers to Emergency Services: You can seek emergency care at a hospital outside of your health plan’s network.

MORE AFFORDABLE COVERAGE

The law helps you by bringing down health care costs and making sure your health care dollars are spent wisely. Insurance companies will now be accountable to

their customers for how they are spending premium dollars, and how much they are raising rates.

Value for Your Premium Dollar. If insurance companies don’t spend at least 80 percent of your

premium dollar on medical care and quality improvements rather than advertising, overhead and bonuses for executives, they will have to provide you a rebate.

Stopping Unreasonable Rate Increases. Insurance companies are required to publicly justify their

actions if they want to raise rates by 10 percent or more. Small Business Tax Credits.

The tax credit will benefit an estimated two million workers who get their insurance from an estimated 360,000 small employers who will receive the credit in 2011 alone.

BETTER ACCESS TO CARE The health care law builds on what works in our

health care system and fixes what’s broken by providing you with more health insurance choices and better access to care.

Free Prevention Benefits. Insurers are now required to cover a number of recommended

preventive services, such as cancer, diabetes and blood pressure screenings, without additional cost sharing such as copays or deductibles.

Coverage for Young Adults. Young adults who can’t get coverage through their jobs can stay on their

parents’ plans until age 26. Coverage for Americans with Pre-Existing Conditions.

More than 50,000 Americans with pre-existing conditions have gained coverage through the new Pre-Existing Condition Insurance Plan. This temporary program makes health coverage available and more affordable for individuals who are uninsured and have been denied health insurance because of a pre-existing condition.

Affordable Insurance Exchanges. One-stop marketplaces where consumers can choose a private

health insurance plan that fits their health needs.

STRENGTHENING MEDICARE Nearly 50 million older Americans and Americans with

disabilities rely on Medicare each year. The new health care law makes Medicare stronger by

adding new benefits, fighting fraud, and improving care for patients.

Lower Cost of Prescription Drugs. The law provides relief for people in the donut hole – the ones with the

highest prescription drug costs. Free Preventive Services.

Seniors can receive recommended preventive services such as flu shots, diabetes screenings, as well as a new Annual Wellness Visit, free of charge.

Fighting Fraud. The health care law helps stop fraud with tougher screening

procedures, stronger penalties, and new technology. Improving Care Coordination and Quality.

This Administration is testing and supporting innovative new health care models that can reduce costs and strengthen the quality of health care.

Providing Choices while Lowering Costs. The number of seniors who joined Medicare Advantage plans increased

by 17 percent between 2010 and 2012 while the premiums for such plans dropped by 16 percent – and seniors across the nation have a choice of health plans.

Medicare Trust Fund With and Without the Affordable Care Act:

Source: http://www.whitehouse.gov/healthreform/healthcare-overview

MYTHS AND FACTS ABOUT THE ACT AND SYSTEM

Health insurance reform will use my tax dollars to fund abortions.No. The health insurance reform legislation

maintains the status quo of no federal funding for abortions, except in cases of rape, incest or when the life of the woman is endangered.

Businesses will suffer under health reform.Health insurance reform lowers costs for

American businesses, especially small businesses, who are struggling to remain profitable and competitive under the status quo.

MYTHS AND FACTS ABOUT THE ACT AND SYSTEM CONT. This bill does nothing to bring down the

cost of health care.Not true. The health policy experts and

economists who have looked at this legislation have said we are pursuing every possible mechanism to reduce health care costs.

Health reform will lead to a government takeover of health care.False. The Affordable Care Act puts people,

not health insurance companies or government, in charge of health care.

MYTHS AND FACTS ABOUT THE ACT AND SYSTEM CONT. Employers will stop offering insurance to

their workers in 2014 when the law is implemented. Independent analyses conducted by the

RAND Corporation, Urban Institute, the Congressional Budget Office and Mercer, have found that employers will continue to offer health coverage to their workers.

The Affordable Care Act‘s individual responsibility requirement is unconstitutional. Legal experts and federal judges appointed

by Democrats and Republicans agree that the Affordable Care Act is constitutional.

5 IMPORTANT NUMBERS ON HEALTH REFORM

54,000,000 Americans now have coverage for preventative services free of cost.

32,500,000 people with Medicare now use a free preventative service.

3,600,000 seniors have saved $2.1 BILLION on their prescription drugs.

2,500,000 more young adults have health insurance through their parent’s plan.

50,000 uninsured people with pre-existing conditions have gained coverage.

HOW THE AFFORDABLE CARE ACT IS BENEFITTING PENNSYLVANIA

Cheaper Prescription Drugs for People with Medicare $156,108,903 in total savings for 235,820 seniors, averaging $661.98 in savings

per person in 2011. Free Preventive Services

2,363,000 people and 1,509,076 seniors with Medicare get preventive services for free.

No more Lifetime Limits on Care 4,582,000 people no longer have a lifetime limit on their care.

Health Insurance on Your Parent's Plan 64,798 more young adults under age 26 now have insurance on their parent's plan.

Better Value for your Premium Dollar 3,421,000 people protected by the 80/20 rule that requires insurers to spend 80%

of premiums on care & quality. Covered by Pre-Existing Condition Insurance Plan

4,567 people who were uninsured because of a pre-existing condition now have coverage.

Building Affordable Insurance Exchange $34,832,212 to help States build new marketplaces where consumers will have the

same kinds of choices as members of Congress. Improving Public Health

$28,300,000 in grants to improve public health. Community Health Centers

$26,800,000 to support and expand community health centers.

HOW MUCH DOES THIS ACT COST?

At first, the price was estimated to be around $938 Billion, but it seems that the price has risen to about $1.79 Trillion.

http://www.washingtontimes.com/news/2012/mar/27/obamacare-costs-double-in-two-years/

EXPENDITURES: OLD VS. NEW

Source: http://budget.house.gov/UploadedFiles/fostertestimony1262011.pdf

FIRST, LOOK AT THE EXPENDITURES WITH AND WITHOUT THE ACT.

http://voices.washingtonpost.com/ezra-klein/2010/04/the_affordable_care_acts_spend.html

NOW, LOOK AT THE CHANGE IN THOSE UNINSURED.

http://voices.washingtonpost.com/ezra-klein/2010/04/the_affordable_care_acts_spend.html

SO WHAT’S BEEN DONE SO FAR?2010

May 23rd, 2010 = The Affordable Care Act Becomes Law.

Providing Small Business Health Insurance Tax Credits.

Allowing States to Cover More People on Medicaid.

Relief for Four Million Seniors Who Hit the Medicare Prescription Drug “Donut Hole”.

Note the graph on the next slide.

Cracking Down on Health Care Fraud.

Expanding Coverage for Early Retirees

Providing Access to Insurance for Uninsured Americans with Pre-Existing Conditions

Putting Information Online

Extending Coverage for Young Adults

SO WHAT’S BEEN DONE SO FAR?2010 CONT.

Providing Free Preventive Care.

Prohibiting Insurance Companies from Rescinding Coverage.

Appealing Insurance Company Decisions.

Eliminating Lifetime Limits on Insurance Coverage.

Regulating Annual Limits on Insurance Coverage.

Prohibiting Denying Coverage of Children Based on Pre-Existing Conditions.

Holding Insurance Companies Accountable for Unreasonable Rate Hikes.

Rebuilding the Primary Care Workforce.

Establishing Consumer Assistance Programs in the States.

Preventing Disease and Illness.

SO WHAT’S BEEN DONE SO FAR?2010 CONT. & 2011

Strengthening Community Health Centers.

Payments for Rural Health Care Providers.-------------------------------------------------------------------------------------- Prescription Drug Discounts.

Free Preventive Care for Seniors.

Bringing Down Health Care Premiums.

Addressing Overpayments to Big Insurance Companies and Strengthening Medicare Advantage.

Improving Health Care Quality and Efficiency.

Improving Care for Seniors after They Leave the Hospital.

New Innovations to Bring Down Costs.

Increasing Access to Services at Home and in the Community.

SO WHAT’S BEEN DONE SO FAR?2012

Encouraging Integrated Health Systems.

Understanding and Fighting Health Disparities.

WHAT’S GOING TO BE DONE?2012 & 2013

Providing New, Voluntary Options for Long-Term Care Insurance.

Reducing Paperwork and Administrative Costs.

Linking Payment to Quality Outcomes.------------------------------------------------------- Improving Preventive Health Coverage.

Increasing Medicaid Payments for Primary Care Doctors.

Expanded Authority to Bundle Payments.

Additional Funding for the Children’s Health Insurance Program (CHIP).

WHAT’S GOING TO BE DONE?2014 & 2015

Establishing Affordable Insurance Exchanges.

Promoting Individual Responsibility.

Ensuring Free Choice.

Increasing Access to Medicaid.

Makes Care More Affordable.

Ensuring Coverage for Individuals Participating in Clinical Trials.

Eliminating Annual Limits on Insurance Coverage.

No Discrimination Due to Pre-Existing Conditions or Gender.

Increasing Small Business Health Insurance Tax Credit.----------------------------------------------------------- Paying Physicians Based on Value Not Volume.

LINKS/RESOURCES http://www.healthcareandyou.org/what-is/

http://www.whitehouse.gov/healthreform/healthcare-overview

http://www.healthcare.gov/law/index.html

http://www.familiesusa.org/assets/pdfs/health-reform/Helping-Small-Businesses.pdf

http://budget.house.gov/UploadedFiles/fostertestimony1262011.pdf

http://www.intellectualtakeout.org/library/chart-graph/estimated-effect-affordable-care-act-total-national-health-spending?library_node=70586