About us.. Pennsylvania Health Access Network (PHAN) is a
broad, non-partisan coalition that works to ensure all
Pennsylvanians have access to quality, affordable health coverage.
Represent approximately 60 organizations and a million consumers
across the state. Recognized by media, lawmakers (R and D), state
and federal officials, and consumer advocacy organizations as a
credible source of information. Work to monitor implementation and
push for reforms to be as consumer friendly as possible.
Slide 3
The Affordable Care Act Also known as Obamacare, the Health
Care Law, ACA, Patient Protection and Affordable Care Act, PPACA
Signed into law on March 23 rd, 2010 Upheld by the Supreme Court as
Constitutional Subject of attacks and misinformation campaign
launched by opponents still fighting for repeal
Slide 4
Before health care reform.. Family income down by 5%, health
insurance costs up 80% Medical bills leading cause of family
bankruptcy Rx drug costs were hurting seniors on fixed incomes
Rising costs threatened the future solvency of Medicare and
Medicaid Small businesses were paying 18% more than large companies
for similar wages People with pre-existing conditions had no
protections
Slide 5
Insurance Reforms Say goodbye to pre-existing conditions. No
more lifetime limits. Annual limits go away in 2014. Pulling
coverage when you get sick now illegal Streamlined appeals process
Children can stay on parents plan until 26
Slide 6
Insurance Reforms Continued ER access Direct access to OBGYN
Medical Loss Ratio Justify rate hikes. Rate increases fell from 75%
in 2010 to 14% so far in 2013. Gender discrimination illegal. Age
rating capped. Free Preventive Care
Slide 7
Additional Free Preventive Care for Women Breast-feeding
supplies and counseling Contraception Additional STD testing for
younger women and women at risk Cervical Cancer Screening Domestic
violence screenings Folic Acid for pregnant women, RH
incompatibility screening for pregnant women and follow-up for at
risk women Urinary tract or other infection screening for pregnant
women STI counseling Tobacco screening and intervention for all
women, expanded for pregnant women
Slide 8
Health Reform and Medicare New Benefits for Seniors Free
preventive care under Traditional Medicare Went into effect January
1, 2011 Includes colonoscopies, mammograms, annual wellness exam,
annual flu shot, screenings for diabetes, and more
Slide 9
Health Reform and Medicare Closing the donut hole 52.5%
discount on brand name drugs and 21% on generic. In 2012, 222,703
Pennsylvanians saved over $168 million, an average of $753 per
beneficiary. Cracking down on waste, fraud, and abuse Since 2009,
$14.9 billion in fraudulent payments have been returned to Medicare
Trust Fund
Slide 10
Medicare Advantage Private insurance 1997 Payouts roughly equal
to cost of traditional Medicare 2003 Congress votes to increase
payouts 2009 Medicare pays 14% more per beneficiary than
traditional Medicare
Slide 11
Medicare Advantage and ACA Every Medicare Advantage plan is
rated on a 1 to 5 star system. Rating of 1 3 stars means: No more
bonus payments Must increase rating in 3 years Rating of 4-5 star
means: Bonus payments, but every dollar must to be used to benefit
seniors Only for 5 star plans: Seniors can switch into 5 star plan
anytime of year Check your rating and compare plans in your area at
www.medicare.gov/find-a-plan or calling 1-800-MEDICARE
www.medicare.gov/find-a-plan
Slide 12
Medicare Advantage and ACA Medical Loss Ratio Its working In
2011: Medicare Advantage enrollment increased by 10% and premiums
fell by an average of 7%
Slide 13
Small Businesses Employ 3.2 million workers in Pennsylvania
Only 48% can afford to offer health insurance Pay 18% more for
coverage because they lack the bargaining power of large
corporations Small businesses do not have to provide coverage for
employees. 95% of businesses in PA are small. Defined as 50 or
fewer full time employees or full-time equivalent (100 or fewer
part time workers). Seasonal workers are not considered, no matter
how many hours they work. Franchises small businesses.
Slide 14
Tax Credits for Small Businesses A tax credit up to 35% (up to
50% in 2014) of premium costs available to employers with fewer
than 25 employees who cover at least 50% of workers health costs.
Up to 25% credit available to non-profits SHOP exchange allows
small business owners to purchase insurance for employees with
greater bargaining power. 2015 employers will be able to send
employees to pick out coverage of choice
Slide 15
Health Insurance Marketplace Uninsured, small business owners,
people paying more than 9.5% of pay on premiums & Members of
Congress Qualified Health Plan Tax credits and cost-sharing
subsidies Provide information about prices and benefits in simple
terms
Slide 16
Ambulatory patient services Emergency services Hospitalization
Maternity and newborn care Mental health services Prescription
drugs Habilitative &Rehabilitative services Laboratory services
Preventive and wellness care Pediatric services Essential Health
Benefits Package
Slide 17
** Second lowest cost silver plan is used in figuring out the
reductions in cost sharing and premium tax credits for individuals
Level Monthly Premium CoPay or Out- of-Pocket Costs
PlatinumHighestLowest GoldHighLow SilverMiddle BronzeLowHigh
Slide 18
Premium Tax Credit Eligibility FPL100%400% Annual 1 person $11,
490$45,960 Hourly Full/Part time 1 person $5.52/$11.04$11.32/$22.64
Annual 4 persons household $23,550$94,200 Hourly Full/Part time 4
persons $22.09/$44.19
Slide 19
How Tax Credits Work Paid directly to insurance company
Marketplace lets you know how big of a credit youre eligible for.
Based on silver level plan, but you pick the plan you want. Tax
credits based on projected income
Slide 20
More cost-sharing help Folks at or below 250% of FPL
($28,725/yr individual; $58,875/yr family of 4) eligible for
reduced cost sharing Must be getting Premium Tax Credit Have to be
enrolled in a silver-level plan Caps on out of pocket expenses
Slide 21
To Recap: Members of Congress, uninsured folks, small business
owners, and people paying too much for health insurance can enroll
in coverage through a new marketplace. Every plan sold must meet
certain quality standards, including offering 10 essential health
benefits. Tax credits and cost sharing subsidies ensure you can
afford to purchase health insurance Watch for income changes
Slide 22
But HOW do I get it? (continued..) Talk to a navigator or
certified application counselor Visit
localhelp.healthcare.govlocalhelp.healthcare.gov Visit
www.healthcare.govwww.healthcare.gov Call 1-800-318-2596 Customer
service representatives - 24/7 English and Spanish Language line
for 150 additional languages SHOP call center for Employers
800-706-7915 Monday Friday 9 a.m. 5 p.m. EST
Slide 23
Enroll during the Initial Open Enrollment Period Your coverage
is effective On or before December 15, 2013 January 1, 2014 Between
the 1st and 15th day of January - March First day of the following
month Between the 16 th and the last day of December - March First
day of second following month May enroll or change Qualified Health
Plan Within 60 days in individual market and 30 days in small group
market from triggering event
Slide 24
Loss of minimum essential coverage Material contract violations
by Qualified Health Plans Gaining or becoming a dependentGaining or
losing eligibility for premium tax credits or cost-sharing
reductions Gaining lawful presenceRelocation resulting in new or
different Qualified Health Plan selection Enrollment errors of the
Marketplace Exceptional circumstances Special Enrollment Period
Qualifying Events
Slide 25
Medicaid Expansion: Supreme Court Ruling Changes the Game Text
here ACA envisions everyone making less than 138% of FPL will go
into an expanded Medicaid program Supreme Court ruling makes
Medicaid expansion optional to states Pennsylvania has not yet
opted in Painting by Theresa BrownGold of Art as Social
Inquiry
Slide 26
Hows it work? States receive 100% Federal Match 2014, 2015, and
2016 Slowly goes down, until steadying out at 90%
Slide 27
Who makes less than 138% of FPL? 613,000 Pennsylvanians Many
working moms and dads; folks making too much to qualify for
Medicaid, but not enough to buy health insurance Graphic credit:
Maternity Care Coalition
Slide 28
Fiscal Benefits for Pennsylvania 3 Independent Fiscal Studies:
Economic WIN for PA Save taxpayers hundreds of millions to over a
billion dollars on money otherwise going to treat uninsured in ER
Creates 35,000 new, good-paying jobs plus generates billions in new
tax revenue Other opportunities for state to save money
Slide 29
Slide 30
Whats at stake Nearly a half million Pennsylvanians will be
left with no options for coverage. PA hospitals will lose $8.1
billion in federal hospital payments between 2013-2022 while
continuing to face annual uncompensated care costs of $1
billion.
Slide 31
Whats it cost? $1.64 over next ten years every study finds the
savings and revenue generated offset spending. Pennsylvania will
have to pay all administrative costs and a small portion of
coverage costs starting in 2017.
Slide 32
Whats Healthy PA? Not traditional Medicaid expansion Silver
level coverage and regular Medicaid package Elderly, Medically
fragile, and people with disabilities will get regular Medicaid
coverage. Includes work requirements and premiums Could see benefit
cuts Nothing is settled. Lengthy waiver process Tell lawmakers and
Governor Corbett you want Medicaid expansion in 2014.
Slide 33
Individual Mandate Those who choose not to get coverage will
pay a penalty: 2014 $95 or 1% of income, whichever is higher 2015
$325 or 2% 2016 $695 or 2.5% of income Exemptions: Religious
Uninsured for less than 3 months Cant find coverage that costs less
than 8% of income Folks that would qualify for Medicaid expansion
but live in states that arent expanding
Slide 34
Next steps Sign up for PHAN emails www.pahealthaccess.org to
receive info on: Policy calls, free webinars, Action Alerts, and
More!www.pahealthaccess.org Call or write your state legislators in
Harrisburg. Tell them to expand Medicaid today! Look for PHAN on
Facebook and Twitter www.facebook.com/pahealthaccess.org
@pahealthaccess www.facebook.com/pahealthaccess.org Tell your
friends and family what youve learned! Athena Ford
[email protected]
