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How does the health care law impact you?

How does the health care law impact you?. Presented by Know Your Care Wisconsin, Wisconsin Alliance for Retired Americans, Wisconsin Alliance for Women’s Health, Wisconsin Council on Children and Families. What is the ACA?.

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How does the health care law impact you?

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  1. How does the health care law impact you? Presented by Know Your Care Wisconsin, Wisconsin Alliance for Retired Americans, Wisconsin Alliance for Women’s Health, Wisconsin Council on Children and Families

  2. What is the ACA? • Stands for “Affordable Care Act” -- otherwise known as the health care law or “Obamacare” • Health insurance reform • Became law on March 23, 2010 • Different parts affect different groups of people, two main stages • Stage 1 focuses on patient protections (now) • Stage 2 focuses on expanding coverage (2014)

  3. Finances of ACA • Builds on existing private insurance system and seeks to outlaw abuses, fill gaps • Aims to rein in health care costs; reduces deficit by over $100 billion by 2020; by $1.3 trillion by 2030 (according to Congressional Budget Office). • Congressional Budget Office is the non-partisan “scorekeeper” on budget issues for Congress.

  4. Stage 1 (now) • Outlaws insurance denials based on preexisting conditions for kids (applies to adults in 2014) • Added $5B to state “preexisting pools” to allow more participants and reduce premiums until 2014 when it will be illegal to discriminate against adults with preexisting conditions.

  5. Preexisting Conditionsin Wisconsin • Nearly 1 million in Wisconsin under age 65 have a preexisting condition that would deny coverage to them if they bought insurance on their own • An additional 1.5 million non-elderly Wisconsinites have preexisting conditions that would cause them to be denied coverage or charged excessive rates. Source: U.S. Department of Health & Human Services, January 2011

  6. Preexisting Condition Examples • Diabetes • Arthritis • Heart disease • Obesity • Asthma • Cancer • Stroke • High blood pressure • Hypertension • Stress disorders • High cholesterol • Kidney disease • Alcohol and drug abuse • Hepatitis • ADHD • Adjustment disorders • HIV/AIDS • Alzheimer’s • Angina (chest pain) • Chronic obstructive pulmonary disease (COPD) • Pancreatitis • Dermatomyositis • Emotional disturbances • Emphysema (lung disease) • Major organ transplant

  7. Stage 1 (now) • Allows young adults to stay on parents’ policies until they are 26 • Eliminates lifetime limits • Phases out annual limits (gone in 2014) • Can’t drop coverage after a person gets sick or for an honest mistake on your insurance application

  8. Stage 1 (now) • Insurance must spend at least 80% of your premiums on medical care (rebate checks were due by August 1) • Double digit premium increases must be publicly reviewed, are subject to approval • Small business tax credits: Up to 35% back if providing employees health insurance ($40 billion in credits by 2019)

  9. Stage 1 (now) Additions to Medicare: • Preventive services such as checkups and screenings with no Part B co-pay or deductible. • 50% discount on brand-name drugs when you hit the “donut hole” coverage gap. • Solvency of Medicare extended through efficiencies, fighting waste, prevention, ending subsidies to insurance companies

  10. Stage 1 (now) • Many preventive care services must now also be offered by private insurance without co-pay or deductible. • Over 1.1 million Wisconsinites already benefiting. • Includes things such as: • Mammograms, blood pressure screenings, many cancer screenings, immunizations, diet & losing weight, quitting smoking, etc. • Full list at www.healthcare.gov

  11. Stage 1 (now) • Additional women’s preventive services added on August 1, 2012 • Includes things such as: • Well-woman visits, gestational diabetes screening, birth control, breastfeeding support, supplies, and counseling, human papillomavirus testing for women over 30, counseling for STIs, counseling and screening for HIV, and screening and counseling for victims of domestic violence. • More at www.healthcare.gov

  12. Why Prevention? • Chronic diseases are responsible for 7 in 10 American deaths and account for 75% of U.S. health spending. • BUT chronic diseases are often preventable. • Often because of cost, Americans use preventive services at about half the recommended rate. Source: U.S. Department of Health and Human Services.

  13. Stage 2 The bulk of the health care law goes into effect on January 1, 2014 to help expand coverage

  14. Stage 2 (2014) Individual mandate in concert with: • Preexisting condition exclusions outlawed for everyone • Expansion of Medicaid (BadgerCare) • Creation of competitive health marketplace (exchange) • Addition of individual tax credits to help middle class pay for insurance in exchange • Increase small business tax credit to up to 50%.

  15. Stage 2 (2014) • Adults with preexisting conditions can’t be discriminated against (kids already protected) • Outlaws discriminatory insurance practices, like gender rating -- which means women, who are currently charged more than men in many cases, can no longer be charged more

  16. Stage 2 (2014) • Expands BadgerCare (Medicaid) to almost all low-income Wisconsinites (pending state acceptance). Includes those up to 133-138% of Federal Poverty Level: • $15,415 /year for a single adult • $31,809 /year for a family of four • Federal government covers 100% of expansion costs from 2014-16 and phases that down to 90% in 2020 and beyond. • Preserves BadgerCare program for children in current form until 2019.

  17. Stage 2 (2014) • Creates competitive health marketplace(exchange) to help uninsured small businesses and individuals pool together • Voluntary! You can keep your job-based insurance, stay on government programs like Medicare, VA, etc. • Federal funding to help set up marketplace has been rejected by Wisconsin, but the federal government is empowered to create marketplace for us • Members of Congress will be required to buy from the new marketplace!

  18. What’s the Marketplace? • Large marketplace to shop for coverage • A purchasing pool to increase buying power, reduce administrative costs • Small businesses with <100 employees and uninsured individuals eligible • Private insurance companies compete • More competition to increase choice • Marketplace can negotiate with insurers for better plans, lower costs • Insurance will still be sold outside marketplace

  19. INSURANCE PLANS EXCHANGEChoiceComparisonBillingTax Credits SMALL BUSINESSES, INDIVIDUALS

  20. How the Marketplace Works • One-stop shop through website: • Similar to Travelocity, Consumer Reports • Determines BadgerCare eligibility, too • Choose your own: • Private insurance carrier and benefits plan • Organized as Bronze, Silver, Gold, Platinum • Clear info to compare price, quality, service • Individual tax credits on sliding scale to help uninsured middle class people afford coverage…

  21. Individual Tax Credit • Must be used within new competitive health marketplace • Credit calculator:healthreform.kff.org/SubsidyCalculator.aspx • Calculator estimates that a 40 year old with family of four, making $50,000 would: • Have a premium of $12,130 for the year • With a tax credit of $8,745 • Leaving the family to pay $3,385 ($282/month)

  22. Small Business Notes • Small businesses now pay 18% more than large ones. • Businesses with <50 workers (96% of all businesses) exempt from any requirement to offer coverage. • RAND study says “marketplace” will expand coverage to 85.9% of small business employees (vs. 60.4% today), an increase of 10.5 million workers.

  23. Marketplace TBDs… • Active vs. passive (can marketplace negotiate)? • Merge the individual, small group marketplaces? • Regional exchanges? • Role of brokers? • Expanding coverage to larger firms in 2017? • Incorporation of wellness and prevention programs? • Administrative/design issues (billing, payment, web, etc.)? • Effective education and outreach?

  24. Don’t like these options? • If someone chooses not to have insurance even with these new options, they can pay the fine ($695 in 2016, less until then) as part of the “individual mandate” • However, the mandate has no impact on those insured already • Urban Institute estimates only 2-5% will be impacted by the mandate. In Massachusetts, where a state mandate is in effect already, only 1% chose to pay the fine (2009) • Covers some of the cost of the uninsured ending up in expensive emergency rooms

  25. What are your questions?

  26. Resources Email:knowyourcarewi@gmail.com Visit: www.healthcare.gov www.knowyourcare.org www.wisconsinara.org www.supportwomenshealth.org www.wccf.org www.smallbusinessmajority.org

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