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Health Care Reform

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Kimberly Wehrli

on 12 October 2013

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Transcript of Health Care Reform

Health Care Reform
Affordable Care Act: Part 1
Affordable Care Act: Part 2
Changes to Medicare
Public Health Knowledge to Public Policy

Brainstorm: Do we have these ingredients?

Why do we need a national health care plan?

Health & Social Welfare in the U.S.

A. 1935 - Social Security Act

B. 1965 - Medicare & Medicaid Act

C. March 23, 2010 - Obama signed ACA
What took so long?
A. Complexity of ACA = Complexity of U.S. health care
*Diverse, Decentralized, Poorly Understood

B. Many still want to revisit/repeal the law

C. Some want certain provisions altered/eliminated
President Ronald Reagan

Largest expansion to Medicare Benefits

Repealed by President George H.S. Bush
Medicare Catastrophic Coverage Act of 1988
"Almost every American and advocacy group supports some form of Universal Health Insurance. But if it's not their preferred version, their second best alternative is to maintain the status quo."
-John E. McDonough
President Bill Clinton

No agreement between House & Senate

Contributed to loss of Democratic control
National Health Care Reform Campaign 1993-1994
President Lyndon Johnson

13 year effort to create national health insurance for senior citizens
Success: Medicare & Medicaid Act of 1965
Barack Obama = 8th U.S. President to undertake the effort

Franklin Roosevelt
Harry Truman
John Kennedy
Lyndon Johnson
Richard Nixon
Jimmy Carter
Bill Clinton
National Health Care Reform
Top Plans:
1. France
2. Italy
3. Spain
4. Japan
5. Norway
Other Countries' Success
Changes to Private Insurance
State Role
American Health Benefit Exchange and Small Business
Health Options Program (SHOP)

Possible expansion of State Medicaid programs
Enrollment open until January 2014
26 States refuse federal funds including Texas, which has the highest number of uninsured persons

Funding for Health Insurance Exchanges
Grants start in 2011; applications accepted through Oct 15, 2014
Cost Containment
Administrative Simplification
Single set of operating rules
Electronic funds transfers

Restructure payments
Establish Independent Payment Advisory Board
Eliminate Medicare Improvement Fund
Reduce Medicare payments
Increase drug rebate %
Prohibit federal payments

Prescription Drugs
Approve generic versions

Waste, Fraud & Abuse
Allow provider screening in public programs
Develop database, increase penalties, strengthen standards
Improving Quality/Health System Performance
Comparative effectiveness research

Grants for enhancing patient safety
Started in 2011

Dual eligible
Improve access and quality of care

Teaching Health Centers
Funded for 5 years beginning in 2011

Enhanced collection of data (March 23, 2012)

Health Disparities
Prevention & Wellness
National Strategy
Prevention and Public Health fund to expand and sustain funding for preventative medicine
Create grant program to deliver evidence-based and community-based prevention services

Coverage of preventive services
Eliminate cost sharing
Provide incentives for health behavior
modification programs
Wellness programs
Grants for small employers
Technical assistance
Employee rewards

Nutritional information required for fast food and vending machines.
Long-term Care
Community First Choice Option
Increase non-institutionally-based long-term care support

Skilled nursing facility requirements
Standardized information required to be posted on consumer-friendly websites

What is one aspect of the prevention and wellness section of the Affordable Care Act?
Individual Mandate
1. Require U.S. citizens & residents to apply for health coverage
No coverage = tax penalty
2014: $95
2015: $325
2016: $695

2. Exemptions:
Financial hardship
If lowest cost plan exceeds 8% of income
Under age 65 - $9,350 single below tax filing threshold
$18,700 for couples below tax filing threshold
Undocumented immigrants
American Indians
Incarcerated individuals

Employer Requirement
~ 50/30 Rule
Premium tax credit or cost sharing

Employer does not offer health insurance
$2000 annually X # of employees minus 30

Employer does offer insurance but > 9.5% of employee's family income
$3000 annually X # of employees buying govt subsidy health coverage

~ Employee insurance cover 60% & out of pocket fee is >9.5% family income
No penalty

~Employer with 100 full-time employees cannot use health exchanges until 2016

~Small businesses have access to SHOP


Premium & Cost-Sharing Subsidies
A. Employees with employer offering insurance does not qualify

B. Premium tax credit scale:

C. Cost sharing subsidies:
Full value of plans

D. $1 surcharge for abortion plan


Premium Subsidies to Employers: Phase I
A. Tax Credit

B. Employer contributes 50% of Premium cost
Small business 35%, 25% for non-profit (25 or less employees)

C. Employee wages annual < $50,000
Small business (10 or less employees)
wage < $25,000 = 100%
Reinsurance program: retires age > 55 not eligible for Medicare (employer/insurer 80% reimbursement)


Phase II
Employer 50% tax credit/50% contribution to premium

Number of employees: 10

Wages: $250,000 or $25,000 per employee

Employer contribution to premiums: $70,000

Tax credit amount: $35,000 (50% employers contribution)
Tax Credits are only available on SHOP exchange
Tax Changes Related to Health Insurance or Financing Health Reform
Medicine Cabinet Tax
Over the counter medication no longer qualify as medical expenses

Tax on Health Savings Account/Medical Savings Account Distributions

FSA Cap 2013
Flexible spending accounts set up by employers to cover health expenses not otherwise covered by insurance
Cap set at $2,500

Medical Deduction Threshold tax 2013
7.5% to 10%
Obama Care Taxes
Medical Device Manufacturers: 2.3%
Indoor Tanning Services: 10%
Charitable Hospitals fail to comply with requirements
Brand Name Drugs
$500,000 Annual Executive Compensation Limit for Health Insurance Executives
"Cadillac Tax" provision of ACA (2018)
“Cadillac Tax” is 40% excise tax on the portion of medical insurance plan (dental and vision benefits don’t count) costing more than $10,200 per year for individuals or 27,500 per year for families.
Health Insurance Exchanges

When does "Cadillac Tax" provision of the ACA start?
When did the Supreme Court rule that Obama Care was legal and upheld the controversial mandate that everyone must purchase health insurance or pay a fine starting in 2014?
a) July 25, 2009
b) June 28, 2012
c) August 10, 2011
d) June 28, 2008
Bundled Payment pilots started Jan 1st

Flat rate payment for "episodes" of care

Two new taxes to finance Medicare
Increase of 0.9% if income is over $200,000 or $250,000 for joint filers
3.8% tax on investment income

Insurance Exchanges for those not covered by work, Medicare or Medicaid.
Open October 1, 2013

Temporary high-risk pool
coverage for those with pre-existing conditions

Dependent coverage
for children up to age 26

Consumer protections
Website for health coverage options
Standards for insurers
Easy-to-understand Coverage Summaries for Consumers (Sept 23, 2012)
The Future
January 1, 2014
All insurance plans must have:
Emergency Svcs
Lab Svcs
Maternity Care
Mental Health & Substance Abuse tx
Outpatient and/or Ambulatory Care
Pediatric Care
Prescription Drugs
Preventative Care
Rehab & Habilitative Svcs
Vision & Dental Care for Children
Making affordable healthcare available for all Americans, regardless of their medical history or ability to pay...

Americans who can afford coverage
will be required
to purchase health insurance

Tax Penalties

Medicaid is Expanded

Businesses Must Provide Health Coverage

Govt Control Over Doctor's Decisions

Glitches in 2013:
"Family Glitch" could possibly leave 500,000 children uninsured
Funds to assist those with pre-existing conditions ran out by February

Includes Preventative Services

So Many Uninsured will have Access

Medicaid is Expanded

Cannot Discriminate

Young Adult Coverage to Age 26

82% of uninsured adults will qualify for free or low-cost insurance plans
List 1 benefit that all health insurance plans must include in 2014.
Knowledge Base
Social Strategy
Political Will

Barack Obama was the _______th President to undertake the effort of developing a national health care plan.

Prohibit lifetime limits

New policies comply with benefit categories

Limit waiting to 90 days

Temporary reinsurance program

Minimum Medical Loss Ratio for Insurers
Insurance companies now must report their profits earned versus how much money was lost through claims
Companies that did not meet the minimum ratio paid consumers a refund in 2012


Medicare Advantage Plan Payments

Medicare Independence at Home Demonstration

Medicare Value-Based Purchasing
Oct 1, 2012

Reduced Medicare Payments for Hospital Re-admissions
Oct 1, 2012
Independent Payment Advisory Board created to recommend Medicare payments without affecting coverage or quality.

Medicare Premiums for Higher Income Beneficiaries

Closing the Medicare Drug Coverage Gap
Gap between reimbursement tiers for medication payments.
Goal to close gap by 2020

Center for Medicare & Medicaid Innovation
Supports the testing and delivery of new health care payment and delivery models
Medicaid payments for Hospital Acquired Infections

Medicaid Long-term Services

Chronic Disease Prevention in Medicaid
Incentive given to those receiving Medicaid who participate in health improvement programs

Medicaid Health Homes for those with 2 or more chronic conditions

California votes to accept new funds for Medi-Cal

Payment raise for primary care providers in order to meet Medicare standards
Changes to Medicaid
Those with income up to 133% of the poverty level will now be eligible
Children with Medicaid and CHIP eligibility won't change until 2019
Percentage of funding provided by Federal Government to states expanding Medicaid:

2014-2016: 100%
2017: 95%
2018: 94%
2019: 93%
2020: 90%
Full transcript