The Affordable Care Act: Just the Facts Insurance companies could cherry pick who they would insure....

The Affordable Care Act:

Just the Facts

• Insurance companies could cherry pick who they would insure.

– 129 million Americans with pre-existing conditions watched their premiums skyrocket.

– Thousands had their policies cancelled just as they became ill.

– Tens of millions with insurance were underinsured, and many who had coverage were afraid of losing it if they got ill or switched jobs.

– 50 million Americans had no insurance at all.

The Background

• Insurance company profits were soaring, and so were health insurance premiums. – Premiums had doubled over the last decade, increasing >10% each

year, on average 2-3x faster than core inflation.

• Hospitals provided more and more uncompensated care for uninsured patients, and passed that cost back on to you.

• Physicians had more and more denied claims for services provided, and passed that cost back on to you.

• Providers maintain large billing offices to comply with the paperwork of dozens of insurers. They passed that cost back on to you.

The Background

• Medical illness became the number one cause of bankruptcy in the United States.

• Americans spent $2.6 trillion on health care ($8233/person) in 2010, more than twice the next highest national spender on health care, Switzerland.

• The CMS projects that without reform, this spending will rise to $4.6 trillion by 2020, or 20% of GDP.

The Background

In March 2010, President Obama signed into law theAffordable Care Act.

The Health Care Law

• Ends the worst insurance company abuses

• Makes health insurance more affordable

• Provides better options for coverage

What the ACA Means for You: 3 Things to Know

TODAY, it is illegal for insurance companies to: • Deny coverage to you or your children because of a pre-

existing condition like asthma or diabetes.

• Put lifetime and annual caps on how much care they will pay for if you get sick.

• Cancel your coverage when you get sick by finding a mistake on your paperwork (rescission).

The ACA Ends Insurance Abuse

“Low Health Insurance Caps Leave Patients Stranded”

-- USA Today

“Newborn Denied Health Insurance Coverage Days After Life Saving Heart Surgery”

-- ABC News

“WellPoint Routinely Targets Breast Cancer Victims for Rescission”

-- The Huffington Post

The ACA Ends Insurance Abuse

Consumers Can Now Appeal Decisions By Their Health Plans

Cancer screenings such as mammograms & colonoscopies Vaccinations such as flu, mumps & measles Tobacco cessation counseling and interventions Blood pressure screening Cholesterol screening Birth control Depression screening And more . . .

Visit www.healthcare.gov/prevention for a full list.

ACA Makes Health Insurance More Affordable

for Every American

In many cases, you can get preventive services for free:

http://www.healthcare.gov/prevention

BEFORE: insurers spent as much as 40 cents of every premium dollar on overhead, marketing, and CEO salaries.

TODAY: the new 80/20 rule says insurers must spend at least 80 cents of your premium dollars on your health care.

If they don’t, they must repay the money.


for Every American

60% / 40%

80% / 20%


for Every American

“Missouri, Illinois customers getting rebates under health care law”

-- St. Louis Post-Dispatch

“Health insurance rebates to go to 81,000 Ohio policyholders”

-- Cleveland Plain Dealer

“Health rebate checks arriving under Affordable Care Act”

-- The Tampa Tribune

Young adults under the age of 26 can now stay on their parents’ health plans.

“I honestly don’t know what we would have done…. There was no way we could have afforded it. I might not be here right now.”

--Kylie L., 23, in Illinois, who credits the health care law for enabling a life-saving heart transplant


for Families

Insurers are prohibited from excluding pre-existing medical conditions for children under the age of 19.


for Families

BEFORE, small businesses paid an average of 18 percent more for health insurance than large companies.

TODAY, small businesses can get tax credits to help pay for coverage for their employees.– These credits are available now up to 35% of

premium costs. In 2014, they will cover 50%.

ACA Makes Health Insurance More Affordable for Small Businesses

“In 2010, we paid close to $11,000 for employees’ health insurance. The tax credit cut our costs by over $2,000. For a small business struggling to keep health coverage, that makes all the difference. We were actually considering dropping our insurance, but the tax credit tipped the balance and helped us maintain coverage.”

--Matt H. in Montana

ACA Makes Health Insurance More Affordable for Small Businesses

• Free preventive services such as mammograms, colonoscopies and an annual wellness visit. No copay or deductible.

• A 50% discount on medications for those in the prescription drug donut hole – an average savings of more than $650 per person.

• Strong anti-fraud measures, providing for tougher penalties and better oversight.

• Keeps Medicare solvent 8 more years.


and Strengthens Medicare

“I am a grandmother who is trying to assist a grandson with his education. I take seven different medications. Getting the donut hole closed, that gives me a little more money in my pocket.”

- Helen R. in Pennsylvania


and Strengthens Medicare

For millions of Americans who buy their own coverage, lose their

coverage, or have no coverage at all, the law provides better options.

The ACA Provides Better Options for Getting Coverage

There are new plans in every state for people who have been locked out of the insurance market because of a pre-existing condition like cancer or heart disease.

“When I was diagnosed, they told me I had a 60 percent chance of being cured. That's pretty good odds, but I was also terribly worried about finances. Now I don't feel like we can't afford the treatment."

--Gail O. in New Hampshire

For more, visit www.PCIP.gov.


http://www.pcip.gov/

Starting in 2014:

• Discriminating against people with pre-existing conditions or because they are women will be illegal.

• There will be new State-based marketplaces – called Affordable Insurance Exchanges – where you will have a choice of private plans.

• Middle class tax credits will make buying insurance more affordable (sliding scale between 100-400% FPL).

• Funding for expanded Medicaid eligibility (up to 133% FPL).


• “One-stop shop” for the highest quality and lowest priced plan with the features important to you.

• Side-by-side comparison of plan benefits.

• Each participating plan on the exchange must provide minimum standardized benefits.

• Each plan must adhere to strict transparency and accountability criteria.

The Affordable Insurance Exchange In Arizona

• Plans will meet both state and federal standards.

• Small employers can shop at this exchange for their employees.

• Arizona has already received over $30 million in grants to set up this health insurance marketplace in state.

• The Governor’s Office of Health Insurance Exchange is in charge of planning and development.

The Affordable Insurance Exchange In Arizona

• States are given the additional flexibility to pursue their own innovative strategies to provide high quality affordable health insurance for their citizens.

• As long as basic protections in the ACA are retained, states may implement a different approach to improve heath care access.

• State waivers become effective 2017; earlier if Congress permits.

The State Innovation Waiver

So no matter what happens, you and your family will have access to affordable health insurance.


The ACA Increases Access to Care

Thousands of new doctors and nurses will be placed in communities around the country to serve millions

of new patients and decrease wait times.

• Rewards Conversion to Electronic Health Records• Allows Meaningful Use• Implements Value-Based Purchasing• Transitions from Fee For Service to Bundled

Payments

The goal of the above is to improve quality of care, improve clinical outcomes, reduce costs, and collect robust medical data to allow best practices grounded on evidence-based medicine.

The ACA Makes Important Provider Reforms

Numerous independent experts and organizations have

confirmed that the law will not add a dime

to the deficit.

The ACA Is Paid For

Ends Discrimination On Pre-existing Conditions

No More Lifetime or Annual Caps

No More Recission

Right to Appeal Insurance Company Decisions

No Copay or Deductible for Preventative Services

Children Stay on Parent’s Insurance to Age 26

80/20 Rule Limiting Insurance Company Profits

Insurance Companies Must Justify Rate Increases

Closes Medicare Part D Donut Hole

Cracks Down on Medicare Fraud

Extends Lifetime of Medicare

Small Business Tax Credit to Insure Employees

State Affordable Insurance Exchanges

Middle Class Tax Credit to Buy Insurance on Exchange

Medicaid Expansion

State Innovation Waiver

Expansion of Primary Care Providers and Clinics

EHR / QC / Bundled Payments / Better Outcomes

Paid For

In A Nutshell

Oct. 1, 2012

Electronic Recordkeeping

Value-Based Purchasing

Jan. 1, 2013

Preventive Health Care Funding Boost For Medicaid

Increasing Medicaid Payments

“Bundling” Payments

Oct. 1, 2013

Children’s Health Funding Boost

Jan. 1, 2014

Affordable Insurance Exchanges Open For Business

Individual Responsibility (Insurance Mandate)

Choice of Coverage

Jan. 1, 2014

Expanding Access to Medicaid (133% of Pov.)

Making Coverage Affordable (middle class tax credit)

Ending Annual Coverage Limits

Ending Discrimination for Pre-existing Conditions

Increasing Small Business Tax Credit (up to 50%)

Jan. 1, 2015

Tying Payments to Value

2019

Closing the Donut Hole

Consequences: Coverage expanded to an additional 32 million people by the end of 2019; 95% of non-elderly legal U.S. residents insured.

The Affordable Care Act Partners

In working together, the Partnership serves all of us.

The U.S. squanders $750 billion eachyear (30 cents of each dollar) on healthcare waste.

• unnecessary services ($210 billion)

• inefficient delivery of care ($130 billion)

• excess administrative costs ($190 billion)

• inflated prices ($105 billion)

• prevention failures ($55 billion)

• fraud ($75 billion)

2012 Institute of Medicine Report

Debunking the Myths

• Socialism is when government controls the means of production and distribution. That means all doctors and hospitals are owned and operated by the government, like in Sweden and Norway.

• With the ACA, private health insurance companies remain privately owned. In fact, insurance companies get up to 30 million new customers in exchanged for abiding by new rules that place patients first.

• Health care providers remain independent as well.

MYTH: Obamacare is Socialism

• This is basically the system we had before the ACA. Access was limited, quality was uneven and in decline and costs were escalating rapidly. It was broken.

• Free Market principles don’t work with the commodity of health insurance. The buyer can rarely make informed choices, and the seller’s incentive is to sell you their product only when you DON’T need it.

• The ACA addresses the broken parts of our health insurance industry by offering a deal: millions of new (mostly healthy) customers in exchange for accepting new regulations.

MYTH: The Unregulated Free Market is a Better Solution

• Intentional misreading of CBO report estimating up to 800,000 people might retire early or work part-time because they won’t be as dependent on their employer insurance with Obamacare

• These are voluntary choices, and may actually free up jobs and reduce unemployment.

• Experts project the law will cause a small loss of low-wage jobs, offset by gains in better paid jobs in the healthcare and insurance industries.

MYTH: Obamacare is a Job Killer

• CBO report to Congress states if the ACA is repealed, Medicare spending will increase $716 billion over the next decade.

• Critics have turned this around to reach the conclusion that if the ACA is upheld, Medicare funding will be slashed by over $700 billion.

• This is a wild and deliberate misreading of the facts, equating a huge savings with throwing grandma under the bus.

• The ACA does not cut any Medicare benefits

• The ACA strengthens Medicare

MYTH: Obamacare Will Steal Over $700 Billion From Medicare

• Only in an alternate-reality universe where saving money means stealing money.

• The savings will come from:– Ending Medicare Advantage subsidies and returning

this money back to traditional Medicare ($156B)

– Reducing in the future growth in payments to hospitals by enhancing efficiency and effectiveness ($415B)

– Decreased Medicare/Medicaid payments to hospitals providing indigent care ($56B)

– Lower payments to drug makers

– Reducing waste, fraud, and abuse

– More prevention promoting better health and better outcomes

MYTH: Obamacare Will Steal Over$700 Billion From Medicare

• Original provision to fund periodic and voluntary Advanced Directives consultations for seriously ill Medicare patients – dropped from bill.

• The law establishes the Independent Payment Advisory Board (IPAB). Makes cost-savings policy recommendations to Congress. The IPAB has no power of its own.

• But Death Panels do exist – employed by the health insurance industry to find ways to deny or cancel coverage when you need it most. They will be abolished under the ACA.

MYTH: Obamacare Has Death Panels

• Healthcare In America Is the Best in the World: NO

• The Affordable Care Act Would Add to the Deficit: NO

• The Affordable Care Act Provides Free Health Care for Undocumented Immigrants: NO

• Republicans, and Their Ideas, Were Left Out of the Bill: NO

• The Law Would Create an Army of IRS Agents: NO

• Affordable Care Act Bill Is Way Too Long and Impossible to Read!: Long YES, Impossible NO.

Obamacare Myths Are Legend

With knowledge people will vote as

they wish; in ignorance, they will

vote as they are told.

A Wise Man Once Said . . .

Learn More

http://www.healthcare.gov/

www.HealthCareActandYou.org

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The Affordable Care Act: Just the Facts Insurance companies could cherry pick who they would insure....

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