Affordable Care Act & the Fight Against Cancer

The Affordable Care ActIt’s Impact on the Fight Against Cancer

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Our Health Care Principles

1. Health Care Freedom must be restored. Medical decisions should be controlled by patients in consultation with their healthcare providers, without interference from insurance companies

2. Everyone should have health security, – the ability to purchase quality coverage at a fair and affordable price.

3. Health Care discrimination by insurance companies is a violation of fundamental rights, especially against people with preexisting conditions, and must be outlawed.

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The Affordable Care ActThe new national health care law, achieves

these principles

--Passed March 23, 2010

--Reforms Come in 2 Stages

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Stages of Reform

Stage 1 (in effect now)• Outlaws worst health insurance

abuses including denials based on preexisting conditions for children (adults with preexisting conditions will be covered in 2014).

• Creates new standards for insurance, such as allowing young adults to stay on parents policies until they are 26.

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Stages of Reform

Stage 2 (goes into effect 2014)• Expand BadgerCare (Medicaid) to almost

all low income Wisconsinites.

• Create competitive health marketplace to guarantee coverage to everyone who does not have good insurance at work.

• Require Members of Congress to buy the same plans offered to everyone else in the new marketplace.

• Strengthen Medicare for Seniors.5


Stage 1 Reforms

Insurance Practices Outlawed now under the Affordable Care Act

• Preexisting condition exclusions (kids now/everyone in 2014)

• Lifetime limits • Dropping coverage after a person gets sick• Excessive insurance industry profits and

overhead (80-85% of your premium dollars must be spent on medical care, not profits)

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Stage 1 ReformsThe Affordable Care Act guarantees • Preventive care coverage (ex: Mammograms,

checkups, etc) with no cost sharing (co-pays,

deductibles, etc)• Young adults can stay on parents policies until

age 26• Immediate access to coverage for people with

serious pre-existing conditions through high-risk pools

• Preventive care without cost sharing for seniors on Medicare

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Stage 1 ReformsMore guarantees • Requires health plans to cover essential

benefits such as coverage for cancer screening, treatment and follow-up care

• Limits out-of-pocket maximums for individuals and families enrolling in qualified health plans

• Gives patients new right to appeal denied claims with their insurer

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The Affordable Care Act Ends Discrimination for 2.5 Million

Wisconsinites Under 65

• Nearly 1 Million in Wisconsin under age 65 have a preexisting conditions that would deny coverage to them if they bought insurance on their own

• An additional 1.5 million non-elderly Wisconsinites have preexisting conditions that could cause them to be denied coverage or charged excessive rates.

(Source: U.S. Department of Health & Human Services, January 2011)

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Just Some of the Examples of Preexisting Conditions

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The Faces of Reform

How the Affordable Care Act is already helping people across Wisconsin who would otherwise be the victims of health insurance discrimination

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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.

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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. Starting in 2014 under 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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Stage 2: Guaranteed Affordable Health Care

(2014)• Wisconsin, with federal funding,

creates a new competitive health marketplace, while keeping what works now in place.

• The new health marketplace options are voluntary. If you have good coverage through your job you can keep it.

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Competitive Health Marketplace for

Middle Class• Created by each state to meet unique

needs by 2014.• Access through website, similar to

Travelocity or Consumer Reports, chose your own private insurance carrier and standards benefits plan.

• System voluntary: can stay with current health insurance if it works for you.

• Consumers in control, with clear information, clear comparisons, and real competition.

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Competitive Health Marketplace

• Makes coverage more secure by ensuring that people cannot be denied coverage due to preexisting conditions or have coverage dropped when they get sick.

• Members of Congress will be required to get their coverage through the same competitive marketplace

• Makes coverage more affordable, by providing tax credits on a sliding scale to middle class Wisconsinites.

• Bans discriminatory pricing based on medical condition, age, or gender.

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Gender Discrimination

• Under our current system, women are charged more then men by health insurers.

• This and other kinds of discrimination are outlawed in the new competitive health marketplace.

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Stabilizes & Expands BadgerCare to low income

Wisconsinites

• BadgerCare expanded to include every citizen who meets income requirements

• Wisconsin’s contribution of BadgerCare expansion is substantially reduced.

• Eliminates the risk of BadgerCare cuts.

• Affects 337,000 Wisconsinites Badger- Care (Medicaid) recipients with serious and chronic diseases such as Cancer, Lung Disease, Diabetes & Heart Disease.

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Strengthen Medicare

The Affordable Care Act protects Medicare benefits for seniors and strengthens the program for future generations by

• cracking down on waste, fraud, and abuse in Medicare,

• ending handouts to insurance companies, and

• providing free preventive care to decrease costly emergency room visits and reduce health care costs long-term.

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Faces of Reform

The human impact of the new competitive health marketplace . . . .

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John’s Story

"I have a tooth that is in infected and needs to be removed, which normally costs $100, but because I have Hemophilia the drugs are between $50,000 & $100,000 just to stop the bleeding. I have been denied insurance because of my condition, any employer-based care would require me to wait a year. I have no way of dealing with my conditions the way things are now. That is why I am looking forward to the new health marketplace."

--John, Small Business Owner, Albany, WI

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Steve’s Story"I suffered from a deteriorating spine

problem for about 10 years...We discovered what so many Americans have had the misfortune of discovering-It was impossible to purchase health insurance on the free market if you were considered high risk (had a pre-existing condition)...We applied many times over the years to every health insurance company we could find and were flat out rejected…with little other option I took a 20 hour flight to Malaysia to get treatment. Under the Affordable Care Act, I will have a right to coverage so I can get treatment here in the U.S.”

--Steve, Verona, Wisconsin 22


We Must Change• Health costs increased over 200% in

Wisconsin since 2000

• Est: 45,000 individuals die each year because of lack of access to coverage

• Majority of all bankruptcies in America are Medical Bankruptcies

• Our current system incentivizes waiting on treatments through deductibles & co-pays instead of early treatment

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The Affordable Care Act is Worth Protecting

1. Guarantees health care freedom. Working families no longer can be denied coverage for preexisting conditions, lose their coverage when they get sick, or have to haggle with insurance companies about claims and crucial medical treatments.

2. Everyone will have the peace of mind of knowing that they and their families have guaranteed access to affordable coverage options, no matter what..

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Affordable Care Act is Worth Protecting

3. Increased opportunity: families will not be forced into bankruptcy when someone gets sick, and will be free to pursue economic opportunities without being constrained by health insurance access issues.

4. Wisconsin should work to improve the new law by implementing it in a way that works for everyone, not special interests such as the health insurance industry.

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How You Can Help

• Our speaker’s bureau is always looking for new chances to speak. Invite us to your next event!

• We need speakers to present this presentation to others, generally only once a month, let us know if you’re interested!

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Questions?

• Kevin Kane

Healthcare Organizer

Citizen Action of Wisconsin

414 550 8280 (cell)

[email protected]

facebook.com/got.healthcare

citizenactionwi.org

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• Dawn Anderson

Executive Director

Wisconsin Breast Cancer Coalition

414-963-2103

[email protected]

facebook.com/got.healthcare

standupandspeakout.org

mailto:[email protected]

mailto:[email protected]

Economy & Finance

Affordable Care Act & the Fight Against Cancer