AFFORDABLE CARE ACT. And the Aging Population Jan Figart, MS & Laura Ross-White, MSW. A Sign of the Times: Health Trends and Ethics

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1 AFFORDABLE CARE ACT And the Aging Population Jan Figart, MS & Laura Ross-White, MSW A Sign of the Times: Health Trends and Ethics LiveStream:

2 Learning Objectives Describe the history of the Affordable Care Act (ACA). Describe the implementation of ACA beginning in Describe key provisions of the ACA.

3 Learning Objectives Explain the impact of the key provisions of the ACA on the aging population. Explain the triple aims under the Centers for Medicare and Medicaid. Explain the implications of the triple aims regarding health care cost, quality, and outcomes.

4 What do you want to know before you leave today? Why we need the ACA? ACA Basics? Marketplace Overview? What is it going to look like?

5 What do you want to know before you leave today? How it s going to work? Who is paying for this? Aging Population Benefits?

6 Healthcare Spending Realities

7 Rising Healthcare Costs

8 Healthcare Spending

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10 HEALTHCARE SPENDING VS. HEALTH OUTCOMES We spend so much You think we d be healthier

11 How the Health Systems are Doing

12 You know we re in the bottom

13 HEALTHCARE REFORM Transforming the Delivery and Business of Healthcare

14 This is not a new concept The Heritage Foundation was one of the strongest early backers of an individual mandate.

15 This is not a new concept The central element in the Heritage proposal is a two-way commitment between government and citizens. Under this social contract the federal government would agree to make it financially possible for every American family to purchase at least a basic package of medical care including catastrophic insurance. In return, government would require, by law, every head of household acquire at least a basic health plan for his or her family.

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17 Major Tenants of ACA Payment reform Quality Delivery system redesign

18 Who does it impact? Everyone! Changes that may impact you o Financial Protection o Easier Access to Health Insurance o Tax Credits

19 Financial Protections No annual or lifetime limits Spending caps will limit the amount consumers pay out of pocket each year Insurance companies have to spend at least 80% of premiums on medical care

20 Financial Protections Eligible Tax Credits Insurers must justify premium increases ACA limits insurance companies overhead costs (administration and marketing) Allows individuals and small businesses to get better rates because they are in a bigger pool

21 Medical Loss Ratio: 20/80 80 cents out of every dollar in premiums must be paid out for policyholders medical care If the full 80% is not paid out for medical care, the insurance company must send you a refund check every year

22 Implications for Small Businesses Premium subsides to employers Employers with up to 25 employees and annual wages than average less than $50,000 and purchase healthcare for their employers are eligible for tax credits Affordable choices Employees of small businesses may purchase insurance through the Exchange

23 Easier to Buy Insurance Insurance Exchanges will allow people to compare plans, apples to apples Families and individuals will receive tax credit, depending upon income, to help pay for health insurance coverage

24 Easier to Buy Insurance Marketplaces offer multiple Qualified Health Plans, including certain private health insurance plans Marketplaces will open October 1, 2013

25 Easier to Buy Insurance Ability to find coverage to fit your individual needs Marketplaces will provide basic information on: Plan premiums Deductibles Out-of-pocket costs

26 Tax Credits for Middle-Income Families Tax Credits are available depending on income to assist with health insurance costs

27 Tax Credits for Middle- Income Families Tax Credits will be available to families earning between 133%-400% of the Federal Poverty Level Family of 4 $29,327 to $88,200 Tax Credits are designed to keep premium costs between 2% - 9.5% of income, based upon a sliding scale

28 Did you know??? True or False All members of Congress must buy insurance from their state s health care exchange?

29 Who and How the ACA helps Children Insurance companies can no longer deny children insurance because of a preexisting condition (will apply to adults beginning in 2014) No yearly or lifetime limits on coverage

30 Who and How the ACA helps All insurance plans will cover children s vision and dental Young adults can stay on their parents plan until age 26 Coverage is available even if child is married or has own child (child and spouse are not covered)

31 Who and How the ACA helps Women Insurance companies can no longer deny women insurance because of a preexisting conditions such as: Breast or Cervical Cancer Pregnancy or C-Section Domestic Abuse An insurer will no longer be able to charge women more than men for the same coverage

32 Who and How the ACA helps Native Americans Permanently authorizes the Indian Health Care Improvement Act and: Improves access to 1.9 million Native American served by Indian Health Services Update of IHS scholarship program Authorizes the transfer of funds and equipment of IHS funded facilities

33 Who and How the ACA helps People with medical conditions People with a disability or mental illness can work part-time and still quality for Medicaid Mental healthcare must be covered just like physical health care Insurers cannot refuse or charge more to cover those individuals with pre-existing conditions New, temporary high-risk pool will help people will pre-existing conditions gain immediate access to health insurance

34 Who and How the ACA helps Legal Immigrants Eligible for: Purchasing health insurance from the State Exchange (2014) with no waiting periods Premium tax credits, cost-sharing reductions, temporary high-risk pools, and basic health plans offered by a state

35 Prevention and Wellness No deductibles or copayments for preventative services Grants for community wellness programs National standards for restaurant nutrition labeling Incentives for doctors to improve patient s health

36 The Patient and Doctor Have Control Insurance plans will have to cover essential services: Preventative care Hospitals Physicians Prescription Drugs Substance Abuse Dental and Vision for: Children Maternity Care Clear appeals process if your claim is denied

37 Improving the Healthcare Workforce The ACA will provide loan repayments and scholarships for students who work in underserved areas The ACA offers grant opportunities for health programs at colleges and universities to increase the racial diversity of the healthcare workforce

38 Changing the System of Healthcare Delivery Physician Incentives for quality coordinated care Funding for pilot projects in evidencedbased medicine Enhanced payments for primary care physicians and general surgeons Use of Health Informatics Expansion of State Medicaid services

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40 MyHealth Access Network A non-profit organization Health Information Organization Created by a grass roots, community-driven effort of more than 50 organizations Focused on a common objective To improve the health of our community by improving the Tulsa area healthcare system For the benefit of all patients, employers, and providers Not just technology It s medical transformation

41 Comprehensive Primary Care Initiative (CPCi) Improved care coordination; Increasing patients access to care; Delivering preventive care; Engaging patients and caregivers in managing their own care, and Providing individualized, enhanced care for patients living with multiple chronic diseases and higher needs. Seven in the country: Tulsa Oklahoma

42 Expansion of State Health Insurance Programs Federal Exchange

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44 How do we pay for the ACA? Multiple funding mechanisms are built into the ACA legislation The ACA does NOT add to the deficit! $143 billion in savings this decade

45 How do we pay for the ACA? Examples of funding mechanisms: $2,000 per employee fine for large businesses (50+ employees) who do not provide health insurance for employees Higher taxes will be imposed on those earning more than $200,000 individual/$250,000 couple Medicare Advantage plans will be reimbursed at the regular Medicare rate Educational Reform on Student Loans

46 SHARED RESPONSIBILITIES OF THE ACA Federal, Business, and Individual Responsibilities

47 Federal Government Pays for 100% of Medicaid expansion from Pays for 90%-95% of Medicaid expansion in 2017 and beyond Shares in costs of tax credits and premium subsidies

48 Businesses Large employers (50+ employees) may have to pay a penalty if they do not provide coverage AND one or more of their employees receives an insurance premium subsidy Taxes on insurance companies that offer very high cost plans Cadillac plans Fee or taxes on producers of some medical equipment and pharmaceuticals

49 Individuals U.S. citizens and legal residents must purchase health insurance or pay a penalty Penalties are phased in for those who do not purchase health insurance

50 Individuals Exemptions granted for: Financial hardship Religious objections Those without coverage for less than 3 months Undocumented workers Incarcerated individuals Or, if the lowest cost plan exceeds 8% of income Tax changes for some high-income individuals

51 ACA AND THE AGING POPULATION How our aging population is impacted

52 Provisions of ACA affecting Seniors Ten Titles of the ACA have impact on aging programs Title I. Quality, Affordable Health Care for All Americans Title II. The Role of Public Programs Title III. Improving the Quality and Efficiency of Health Care Title IV. Prevention of Chronic Disease and Improving Public Health Title V. Health Care Workforce Title VI. Transparency and Program Integrity Title VII. Improving Access to Innovative Medical Therapies Title VIII. Community Living Assistance Services and Supports Act (CLASS Act) Title IX. Revenue Provisions Title X. Reauthorization of the Indian Health Care Improvement Act

53 ARE YOU CONFUSED? Let s think about our aging population There is a lot of misinformation out there I don t want my Medicare to change

54 Study by the National Council on Aging focused on ACA NCOA identified the top 12 facts that every senior should know about the health reform law. The Straight Talk poll reveals that only 17% of seniors knew the correct answers to more than half the factual questions posed about these key aspects of new law, Only 9% knew the correct answers to at least two-thirds of the questions. None of the 636 older adults interviewed for the poll knew the correct answers to all 12 of the factual questions.

55 Study by the National Council on Aging focused on ACA Only 22% of seniors understood that the new law would not cut their basic Medicare benefits. Almost twice as many seniors (42%) held the incorrect view that the law would cut their basic Medicare benefits 37% said they did not know.

56 What our aging population does know about ACA Only 14% of seniors knew that the law does not cut Medicare payments to doctors; 45% answered incorrectly and 41% said they did not know. Only 24% of seniors knew that it is projected to extend the solvency of the Medicare Trust Fund. Only 28% knew that the law improves the availability of long-term care at home for seniors with disabilities.

57 What our aging population does know about ACA Only 22% knew about improvements in chronic care. Only 33% knew about the new, free yearly wellness visit Medicare will now provide. Two out of three seniors either did not know (43%) or gave the wrong answer about the future growth of Medicare spending. Only 34% knew that it will continue to grow under the new law, just more slowly.

58 Elder Justice Act Authorizes new criminal background checks on long-term care workers Requires better information about the quality of nursing care and improves complaint processes

59 Medicare under ACA Closes the donut hole in drug coverage and lowers the cost of brand name drugs Provides incentives for quality coordinated care and the use of evidenced based medicine

60 QUESTIONS??? For more information contact: Jan jfigart@csctulsa.org Or Laura lrwhite@csctulsa.org