The Federal Framework for the Transformation of Health Care: Affordable Care Act. Herb K. Schultz Regional Director, Region IX

Transcription

1 The Federal Framework for the Transformation of Health Care: Affordable Care Act Herb K. Schultz Regional Director, Region IX

2 Office of the Regional Director Community Resource California Based, extensive travel to NV, AZ, and HI. Significant contact with Pacific Territories and Island Nations. Day to day, week to week, month to month Educate the public on the benefits of healthcare reform Healthcare.gov CuidadodeSalud.gov (Spanish) Information in Other Languages

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

4 The Problem Pre existing condition discrimination Premiums had more than doubled over the last decade Fifty million Americans were uninsured, tens of millions more were underinsured, and those who had coverage were often afraid of losing it

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

6 Framework of Health Reform Three legged stool: Expanding Access and Coverage Consumer Protections Improving Quality and Lowering Costs

7 Framework of Health Reform Up to 30 million more insured people by 2014 (92% of non elderly population). 29 million Americans covered via new Exchanges. More than 4 million more insured in California by 2014 Potential for more than 2 million covered via new California Health Benefits Exchange.

8 Key Overarching Provisions Anti Discrimination Against Individuals (Individual and Group Market) Disability, Health Status, Medical Conditions, Claims Experience, receipt of health care, medical history, genetic information, evidence of insurability. Removing Barriers and Improving Access to Wellness for Individuals with Disabilities. ACA expands initiatives to increase racial and ethnic diversity and cultural competency Health Care Professions (Workforce; Cultural Competency Training; and Language Services and Community Outreach in Underserved Communities

9 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.

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

11 Expands Access Through Public Programs Medicaid: In 2014, all non elderly Americans with incomes approximately $30,000/family of four & $15,000/individual may qualify (regardless of disability). Pay your doctors more in 2013 and 2014, paid completely by the federal government for three years Bridge to Health Care Provides low income Californians in most counties opportunities to enroll in a Medi Cal like program at the county level, already providing coverage for more than 400,000 individuals. Current funding levels for Children s Health Insurance Program (CHIP) maintained through FY2015. Medicare Improves Care and Lowers Costs

12 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; Enrollment begins on October 1, 2014 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

13 Affordable Insurance Exchanges Exchanges will perform a variety of functions, including: Certifying health plans to be offered; Operating a website to facilitate comparisons; Operating a toll free hotline for consumer support, funding navigators for consumer assistance, and conducting outreach and education to consumers; Determining eligibility of consumers for enrollment and for insurance affordability programs (e.g., premium credits); and Facilitating enrollment of consumers in health plans.

14 Affordable Insurance Exchanges In 2014, refundable tax credits for people with income from 134 percent to 400 percent of the poverty level Maximum annual income of: $43,560 for 1 person; $89,400 for family of 4 These tax credits level the playing field for middle class families, the self employed and people who work more than one part time job

15 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

16 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.

17 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.

18 New Community Health Centers The Affordable Care Act provides $11 billion over the next 5 years for health centers throughout the nation $9.5 billion is designated for building new health centers in underserved areas or expanding primary care services at existing health centers An additional $1.5 billion will support major construction and renovation projects at health centers nationwide These changes will nearly double the 19 million patients receive treatment today, regardless of their insurance status or ability to pay

19 Two+ Years Later: The Benefits of the ACA for California Increasing support for community health centers The Affordable Care Act increases the funding available to community health centers in all 50 states, including the 1,159 existing community health centers in California. Health centers in California have received $385.4 million to create new health center sites in medically underserved areas, enable health centers to increase the number of patients served, expand preventive and primary health care services, and support major construction and renovation projects.

20 Health Disparities HHS Strategic Action Plan to Reduce Racial and Ethnic Health Disparities: Complimenting the community driven National Stakeholder Strategy for Achieving Health Equity. Diversity and cultural competency: ACA expands initiatives to increase racial and ethnic diversity. Health Care Professions (Workforce) Cultural Competency Training Language Services and Community Outreach in Underserved Communities

21 National Prevention Strategy Building Healthy and Safe Community Environments Expanding Quality Preventive Services in Both Clinical and Community Settings Empowering People to Make Healthy Choices Eliminating Health Disparities

22 Promoting Prevention and Improving Public Health - $90.6 Million in CA Prevention and Public Health Fund used for prevention related activities and to expand primary care workforce. Promotes prevention and wellness for Seniors and older Americans. Removes financial barriers to preventive care and encourage prevention. Awards grants that promote community health. Provides individual wellness and worksite wellness initiatives. Requires nutrition labeling.

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 Improving our Communities Community Transformation Grants ($102.6 million FY 2011) 75 grants across the county to promote collaboration Capacity Building grants and Implementation Grants to implement broad evidence and practice based policy changes in counties, states, tribes and territories Supporting implementation of five strategic directions Changes in Weight Changes in Proper Nutrition Changes in Physical Activity Changes in Tobacco Use/Prevalence Changes in Emotional Well Being and Overall Mental Health

25 Let s Move! Cities, Towns and Counties: Eliminate Childhood Obesity Five Goals Align With Let s Move! Pillars Start Early: Start Smart (Creating a healthy start for children) My Plate, My Place (Empowering parents and caregivers) Smart Serving (Providing healthy food in schools) Model Food Service (Improving access to healthy, affordable foods) Active Kids at Play (Increasing physical activity)

26 Consumer Protections Affordable health insurance for those with preexisting conditions under PCIP Bans discrimination against children with preexisting conditions Eliminates lifetime limits on insurance coverage A 50% discount on covered brand name medications for those in the prescription drug donut hole an average savings of nearly $600 per person in 2011 Young adults under the age of 26 can now stay on their parents health plans

27 Consumer Protections, Continued Eliminates annual limits on coverage in 2014, raises levels Prohibits insurance companies from dropping coverage in absence of fraud

28 You Can Help Stop Fraud and Abuse Protect your personal information. Guard your Medicare and Social Security numbers. Be suspicious of anyone who offers you free medical services or equipment. Consider joining the Senior Medicare Patrol: Volunteers do everything from explaining benefits to sending tips to investigators. For more, visit

29 Did You Know The law does not add to the deficit. According to the independent Congressional Budget Office, reform is paid for in the next 10 years. The CBO estimates that the legislation will reduce federal deficits by $124 billion the next 10 years. And 1 trillion over the second decade.

30 The Law Makes Health Care More Affordable BEFORE, insurance companies spent as much as 40 cents of every premium dollar on overhead, marketing, and CEO salaries. 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. 60% / 40% 80% / 20%

31 The Law Makes Health Care More Affordable - Rebates As of August 1, 2012: 12.8 million Americans received rebates with more than $1.1 billion. 60% / 40% Average: $151/Family 80% / 20%

32 The Law Makes Health Insurance More Affordable BEFORE, insurance companies could raise your premiums by double digits without justification. TODAY, insurance companies must publicly justify their actions if they want to raise premiums by 10 percent or more. And more states are choosing to block them.

33 The Law Helps Improve Care: Increasing Quality and Containing Costs CMS Center for Innovation Coordinate Your Care Seniors with Both Medicare and Medicaid Value Based Purchasing/Incentives for Better Quality/HIT Electronic Health Records Reducing Avoidable Hospital Readmissions/Health Care Acquired Infections Integration of Behavioral Health and Physical Health

34 Learn More Social Networks

35 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 Herb.Schultz@hhs.gov HHS Website: