The Health Care Law and

Transcription

1 The Health Care Law and

2 Office of the Regional Director Community Resource California-Based, extensive travel to AZ, NV, Indian Country, and HI. Day-to-day, week-to-week, month-to-month Educate the public on the benefits of healthcare reform -- Healthcare.gov -- CuidadodeSalud.gov (Spanish)

3 The Problem Small businesses paid an average of 18 percent more than big businesses for the same coverage. The system allowed discrimination based on pre-existing conditions. Premiums had more than doubled over the last decade.

4 The Health Care Law In March 2010, President Obama signed into law the Affordable Care Act.

5 Framework of Health Reform Call to Action Control Your Own Destiny Importance of Federal AND State AND Local Involvement in ACA Implementation Federal Framework AND State Implementation

6 Framework of Health Reform 32 million more insured people by 2014 (92% of non-elderly population) million Americans covered via new Exchanges. More than 525,000 insured in Arizona by Potential for more than 503,000 individuals (non-group) covered via new Arizona Health Insurance Exchange.

7 What the Law Means for You: 5 Things to Know Saves small businesses money through tax credits Helps businesses find better coverage options Builds on employer-based insurance No pre-existing condition discrimination Makes health care more affordable

8 Individual Mandate January 1, 2014 Exemptions include: Financial hardship; Religious objections; Native Americans Without coverage for less than 3 months; Incarcerated individuals; and Cost exceeds 8% of individual s income.

9 Employer Requirements (Shared Responsibility) Less than 50 Employees exempt from penalties.

10 The Law Saves Small Businesses Money Who qualifies? The New Small Business Tax Credit Businesses and non-profits with 25 or fewer full-time employees and average wages of $50,000 or less. What s the maximum tax credit? The maximum tax credit is 35% of the cost of coverage, rising to 50% in How is it calculated? The tax credit is available on a sliding scale businesses with 10 or fewer full-time employees and average wages below $25,000 receive the full credit.

11 The Law Saves Small Businesses Money In 2010, we paid close to $11,000 for employees health insurance. The tax credit cut our costs by over $2,000. For a small business struggling to keep health coverage, that makes all the difference. We were actually considering dropping our insurance, but the tax credit tipped the balance and helped us maintain coverage. --Matt H. in Montana Go to to learn more.

12 The Law Helps Businesses Find Coverage [Small business tool screen grab]

13 The Law Provides Better Coverage Options Beginning in 2014, small businesses will be able to shop in the new Affordable Insurance Exchanges. Exchanges will make it easy to find health plans, enroll your employees, and consolidate billing. Exchanges will allow you to spread your risk across a big pool of workers just like large businesses.

14 The Law Builds on Employer-based Insurance The average US family and their employer pay $1,000 a year extra in health insurance costs to cover care for the uninsured. If a company has more than 50 employees and chooses not to cover its workers, it may have to pay an assessment to help offset its employees health care costs. Under the law, small businesses with fewer than 50 full time employees will not be required to pay this assessment.

15 Affordable Insurance Exchanges State-based health insurance Exchanges will be established to provide families and employers/employees with the same private insurance choices that the President and Members of Congress have, to foster competition and increase consumer choice. Must be operational by Jan. 1, 2014; Certification, at least Conditional = January 1, $30 Million in Grants to AZ Coordination between Exchange, Medicaid, and CHIP coverage Grants for Navigators: entities that have relations with consumers and can provide information and facilitate enrollment Four benefits categories: bronze, silver, gold, platinum

16 Affordable Insurance Exchanges Essential Benefits Package: Take into account the health care needs of diverse segments of the population, including women, children, persons with disabilities, and others. Essential Benefits Package Required Categories: Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health/substance use disorder services/bh treatment Prescription drugs Rehabilitative and habilitative services/devices Laboratory services Preventive/wellness services and chronic disease mgt Pediatric services, including oral/vision care

17 The Law Stops Insurance Companies from Taking Advantage of You It is now illegal for insurance companies to: Deny coverage to children because of a pre-existing condition like asthma or diabetes. Put a lifetime cap on how much care they will pay for if you get sick. Cancel your coverage when you get sick by finding a mistake on your paperwork. And more

18 The Law Makes Health Care More Affordable TODAY, we have the new 80/20 rule: insurance companies must spend at least 80 cents of your premium dollar on your health care or improvements to care. If they don t, they must repay the money. 80% / 20%

19 The Law Makes Health Care More Affordable Leading experts say the 80/20 rule is already working: Financial analysts noted that health care cost growth was near its all time low, saying it reflects the impact of the industry s adaptation to the health reform [80/20] regulations. In addition, the independent Government Accountability Office found that many insurance companies were responding to the 80/20 rule by reducing administrative expenses and lowering premiums.

20 The Law Makes Health Care More Affordable TODAY, insurance companies must publicly justify their actions if they want to raise premiums by 10 percent or more. And states have more power to block these hikes.

21 The Law Increases Your Access to Affordable Care Young adults under the age of 26 can now stay on their parents health plans. I honestly don t know what we would have done. There was no way we could have afforded it. I might not be here right now. --Kylie L., 23, in Illinois, who credits the health care law for enabling a life-saving heart transplant

22 Two Years Later: The Benefits of the ACA for Arizona Providing new coverage options for young adults Health plans are now required to allow parents to keep their children under age 26, without job-based coverage, on their family s coverage, and, thanks to this provision, 2.5 million young people have gained coverage nationwide. As of June 2011, 59,563 young adults in Arizona gained insurance coverage as a result of the new health care law.

23 The Law Increases Your Access to Affordable Care In many cases, you can get preventive services for free: Cancer screenings such as mammograms & colonoscopies Vaccinations such as flu, mumps & measles Blood pressure screening Cholesterol screening Tobacco cessation counseling and interventions Birth control Depression screening And more Visit for a full list.

24 Two Years Later: The Benefits of the ACA for Arizona Covering preventive services with no deductible or co-pay In 2011, 637,233 people with Medicare in Arizona received free preventive services such as mammograms and colonoscopies or a free annual wellness visit with their doctor. And 54 million Americans with private health insurance gained preventive service coverage with no costsharing, including 1,056,000 in Arizona.

25 The Law Increases Your Access to Affordable Care There are new plans in every state for people who have been locked out of the insurance market because of a pre-existing condition like cancer or heart disease. At the end of 2011, 1,783 Arizonans were insured through the PCIP program. When I was diagnosed, they told me I had a 60 percent chance of being cured. That's pretty good odds, but I was also terribly worried about finances. Now I don't feel like we can't afford the treatment." --Gail O. in New Hampshire For more, visit

26 The Law Increases Your Access to Affordable Care There are thousands of new doctors and nurses in communities around the country and millions more patients getting care.

27 The Law Strengthens Medicare Free preventive services such as mammograms and colonoscopies and a free annual wellness visit with your doctor. A 50% discount on brand-name medications for those in the prescription drug donut hole an average savings of nearly $600 per person in The donut hole will be closed in Strong anti-fraud measures, including tougher penalties for criminals. Tools to help doctors to spend more time with elders and improve care coordination just like they do at leading hospitals such as the Mayo Clinic and Cleveland Clinic.

28 Two Years Later: The Benefits of the ACA for Arizona Making prescription drugs affordable for seniors Thanks to the new health care law, 70,045 people with Medicare in Arizona received a $250 rebate to help cover the cost of their prescription drugs when they hit the donut hole in In 2011, 65,729 people with Medicare received a 50 percent discount on their covered brand - name prescription drugs when they hit the donut hole. This discount resulted in an average savings of $563 per person, and a total savings of $36,977,657 in Arizona. By 2020, the law will close the donut hole.

29 Did You Know The law builds on our private health insurance system. The law gives states significant flexibility in implementing the law. If states can identify their own path to accomplish the same goals, they re free to take it. The law does not add to the deficit. According to the independent Congressional Budget Office, the law is paid for.

30 What the Law Means for You: 5 Things to Know Saves small businesses money through tax credits Helps businesses find better coverage options Builds on employer-based insurance Stops pre-existing condition discrimination. Makes health care more affordable

31 Learn More Social Networks

32 Contact Information Herb K. Schultz Regional Director, Region IX U.S. Department of Health & Human Services 90 Seventh Street, Suite San Francisco, CA (415) Main Number (415) Direct Number (415) Cell Phone HHS Website: