What you need to know

Transcription

1 Exploring The Affordable Care Act What you need to know Maternal Child Adolescent Health Advisory Board Meeting August 1, 2013 Vanessa Raditz,

2 Why do we need this training? Many people are confused April 2013 Kaiser Family Foundation poll:

3 Why do we need this training? Many people are confused We need to focus on Wellness not Sickness The ACA can help us do this Focus on prevention, primary care, public health

4 Why do we need Health Reform? The system is broken and people are falling through the cracks

5 The Affordable Care Act (ACA)

6 The Affordable Care Act (ACA) Expand Access Health Insurance Exchange Expanded Medicaid Health Center Expansion Workforce Expansion Care Delivery Models Prevention Subsidized Unsubsidized Previously eligible Newly eligible Primary Care Public Health Quality Improvements Improve transparency and accountability & consumer protections Improve access to medical technologies

7 The Individual Mandate A federal law requiring most citizens to be enrolled in a health insurance plan or pay a penalty Penalty: $95 per adult, or 1% of family income $325 per adult, or 2% of family income $695 per adult, or 2.5% of family income

8 Mandate Exemptions Undocumented immigrants Legal immigrants in U.S. less than 5 years Income below the threshold for filing a tax return (In 2013: $10,000 for single, $20,000 for family) If cheapest policy will still cost more than 8% of their annual household income Individuals part of a religion opposed to acceptance of benefits for a health insurer Incarcerated individuals Members of a Native American Tribe

9 Medicaid Expansion Currently eligible: Children, Pregnant women, disabled, elderly, and some parents of children that meet income guidelines (Generally <100% FPL) Newly eligible starting Jan 1 st 2014: Non-disabled, childless adults at or below 138% FPL Must be US citizen or legal resident >5yrs!

10 Medicaid Expansion Medicaid currently covers 1 in 5 Americans After reform: will cover 1 in 4 Americans o Healthcare for the Homeless, Barbara DiPietro Medicaid Expansion is a Women s Health issue: Women more likely to experience poverty & financial hardship Women make up more than 2/3 of the Medicaid population Medicaid finances nearly half of all births in the US 11% of children <100% FPL still uninsured

11 Medicaid Expansion by State Supreme Court ruled that the ACA is constitutional, but said that states could choose whether or not they want to expand Medicaid. CA is first to expand! In CA, we call Medicaid MediCal

12 The Exchange An online marketplace where individuals and small businesses can compare and enroll in health insurance plans with support from state and fed. govt. Plans are regulated: Essential Health Benefits Preventive Services with no co-pay or deductible

13 The Exchange Essential Health Benefits Previously, only 10% of plans purchased on the private market covered Maternity & Newborn care. Now Essential, along with: Ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care

14 The Exchange Essential Health Benefits Preventive Services with no co-pay Yearly physical, well women checks, routine prenatal care visits, early detection screenings, immunizations, breastfeeding counseling and support and supplies, contraceptive methods, screenings for domestic violence, Autism screenings and so much more!

15 The Exchange An online marketplace where individuals can compare and enroll in health insurance plans Plans are regulated Essential Health Benefits Preventive Services with no co-pay Cannot be denied for pre-existing conditions or charged more Cannot be charged more for being a woman!

16 Covered California You can go online right now to find out how much insurance will cost for you and your family Open Enrollment begins October 1 st, 2013 Benefits begin January 1 st, 2014 Try using this calculator on Covered California s website!

17 Choosing your Plan There are four different levels of coverage They all have same Essential Health Benefits Pay more monthly or more at time of service?

18 Choosing your Plan

19 Tax Credits and Subsidies

20 Upcoming Challenges Challenge 1: Education and Enrollment Certified Educators and Enrollers in the Community Online Challenge 2: What will happen to Safety Net Programs? What will happen to CMSP? How will people roll-over to expanded MediCal? Healthy Families has rolled over to MediCal with some complications Hospitals losing some funding to help pay for the ACA- what will happen? FamPact, Every Women Counts, AIM, etc what will happen in the long-term? Challenge 3: The Remaining Uninsured Undocumented, those objecting for political reasons, and many others Of the 60 million currently uninsured in the US, 30 million will still be uninsured by 2016

21 Remembering our Goals Remembering our Goals High quality, innovative medicine Increasing access & affordability Low-cost to insurers, providers, and patients Keeping people healthy! Focus on Prevention Long-term impacts on community wellness, stronger local economies Long-term decreases to medical costs

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23 For Further Reading FAQ about the exchange: CA: News and Fact Sheets: Kaiser Family Foundation: Know your Care: National Exchange Marketplace: National Association Of Community Health Centers: Preventive services: Preventive health for women: a.html

24 Quiz Go through these slides as a Powerpoint, and imagine that a patient, a community member, or a friend is asking you this question and try to think of what you would say to them. Then click to check your answer! You can also take this quick 10-question quiz online: Please me: vanessar@phealthcenter.org if you have any questions or want more information or resources Please refer patients with more questions to Resource Clinic, Wednesdays from 11am to 1pm.

25 Question 1 Q: What is the Individual Mandate? A: A Federal Law requiring most citizens of the United States to be enrolled in a health insurance plan, or pay a penalty.

26 Question 2 Q: Will I have to pay a penalty? (Give at least 3 examples of groups who are exempt) A: Undocumented immigrants Legal immigrants in U.S. less than 5 years Income below the threshold for filing a tax return (In 2013: $10,000 for single, $20,000 for family) If cheapest policy will still cost more than 8% of their annual household income Individuals part of a religion opposed to acceptance of benefits for a health insurer Incarcerated individuals Members of a Native American Tribe

27 Question 3 Q: I heard that I will be penalized if I don t get insurance. How bad is it going to be? (What are the tax penalties for being without insurance?) A: $95 per adult and $47.50 per child, up to $285 per family, or 1.0% of family income, whichever is greater $325 per adult and $ per child, up to $975 per family, or 2.0% of family income, whichever is greater $695 per adult and $ per child, up to $2,085 per family, or 2.5% of family income, whichever is greater

28 Question 4 Q: What was the reason behind the Individual Mandate? A: Incentive for buy-in from healthy adults, spreads the risk between the very healthy and the very sick, which makes the plan feasible for insurers Without an individual mandate, health care economists project that premiums would be affected by going up 2 to 40 percent.

29 Question 5 Q: A friend of mine received an $875 rebate check from his insurer, what is a rebate check? A: The health law says that most insurers must spend at least 80 percent (85 percent for insurers covering large employers) of the premiums you pay on medical care and quality improvements. If insurers spend too much on overhead, such as salaries, bonuses, or administrative costs, as opposed to health care, they must issue premium rebates to consumers each summer.

30 Question 6 Q: I heard that there are a bunch of free preventive services now, what does this mean? A: Preventive services help prevent further complications, catch disease at an earlier stage, or help keep people well. Not Free Covered by Insurance with no Share of Cost / Co-pay Some examples (there are many more!) Blood Pressure screening for all adults Colorectal Cancer screening for adults over 50 Depression screening for adults Type 2 Diabetes screening for adults with high bp Diet counseling for adults at higher risk HIV screening for all adults at higher risk Immunization vaccines for adults and children Obesity screening and counseling for adults and children Sexually Transmitted Infection (STI) testing and prevention counseling Alcohol Misuse screening and counseling Tobacco Use screening and counseling Lead screening for children at risk of exposure Well-woman visits to obtain recommended preventive services* BRCA counseling about genetic testing for women at higher risk Mammography screenings every 1 to 2 years for women over 40 Cervical Cancer screening for sexually active women Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women* Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs* Behavioral & Autism screening for children at 18 and 24 months Oral Health risk assessment for young children Fluoride Chemoprevention supplements for children Vision screening for all children

31 Question 7 Q: I saw that I am still going to have a deductible and have a bunch of co-pays on top of my premium with the plan I want on the exchange, but I thought the point was to make sure I don t go broke. What s keeping me from having tens of thousands of dollars of debt if I get cancer? Or hit by a car? A: There are Maximum Out of Pocket annual limits included in each plan. This is supposed to keep costs within a reasonable amount in the event of catastrophic injury or illness.

32 Question 8 Q: I just turned 27 and am now off my parents insurance. I only make 15,000 dollars a year, which I know is slightly higher than the Federal Poverty Limit (FPL). What health insurance options do I have? A: Medicaid now goes up to 138% for childless adults, if you live in a state which expands Medicaid. You can also purchase insurance on the exchange with a government subsidy, if you want.

33 Question 9 Q: I work with homeless patients who usually have a really hard time with all the follow-up paperwork to get MediCal, even though they were already eligible. How does the ACA make it easier for people to access benefits they already are entitled to? A: No longer have to prove residency/address/citizenship - gets directed straight to homeland security; you can write in no fixed address. Don t have to prove income - gets directed straight to IRS Single access point - can use exchange site to get MediCal Funds in act for more outreach enrollment workers

34 Question 10 Q: My family came into the country as undocumented immigrants, but I just got approved to start my path to legal residency through the Dream Act. I have been in the country way more than 5 years. Will I be able to buy insurance on the exchange with my own money? A: No. But this may change depending on current immigration talks Further reading: Young Immigrants Shut Out of Health Reform Lawfully Present Individuals definition on coveredca

35 Question 11 Q: Where can I go to find out about the exchange marketplace in California? A: Covered California!

36 Question 12 Q: When is the open-enrollment period? What does that mean? A: Open enrollment begins October 2013, through March Future enrollment will be open only from October through December. After open enrollment, you are locked into your plan for the coming year, but you can change during the next open enrollment. You must purchase health insurance during the open enrollment period in order to obtain coverage. If you do not enroll during this period, you will not be assured a health plan will cover you either through Covered California or in the private market.

37 Question 13 Q: Will I be covered once I ve registered on Covered California s exchange during open enrollment? A: No, benefits will not start until January 1 st, 2014

38 Question 14 Q: How do I choose what plan is best for me? A: You can compare plans on coveredca.com Individuals enrolled in a level with higher monthly premiums, will pay less when coverage is needed. Individuals enrolled in a level with lower monthly premiums, will pay more when coverage is needed. All plans are eligible for federal subsidy, but even if a subsidy-eligible person chooses a Bronze, Gold, or Platinum plan, his or her subsidy amount is calculated based on the benchmark Silver Plan.

39 Question 15 Q: The reason that I don t have health insurance is not that I don t want it, it s just that it s been too expensive for me. How is shopping online on this exchange thing supposed to make health insurance more affordable for me? A: You can compare plans more easily instead of having to apply to each company separately and then comparing prices for different levels of benefits Tax credits: Tax credits are available to lower the cost of health coverage for individuals and families who meet certain income requirements and do not have health insurance from an employer or a government program. When you enroll in a health plan through Covered California, tax credits can be immediately applied to the insurance premium, which reduces the amount you pay each month. Cost-sharing subsidies: Cost-sharing subsidies reduce the amount of out-ofpocket health care expenses an individual or family has to pay. These expenses might include the copayments for health care services or other costs. Expanded MediCal! You may now be covered for free public insurance.