Affordable Care Act

What is the Affordable Care Act composed of?

Patient Protection and Affordable Care Act (PPACA), enacted on March 23, 2010; and Health Care and Educational Reconciliation Act (HCERA) enacted on March 30, 2010.

Jointly the two pieces of legislation are referred to as

the Affordable Care Act (ACA), "Healthcare Reform" or "Obamacare"

The main objection of the ACA is to

expand health insurance coverage to an estimated 32 MILLION uninsured Americans and strengthens existing coverage.

the ACA does the following:

increase benefits and lower cost for consumers Provide new funding for public health and prevention Bolster our health care and public health workforce and infrastructure Foster innovation and quality of our system.

Benefits for Women

Providing insurance options, covering preventive services and lowering cost

Young adult coverage

Coverage available to children up to age 26

Strengthening Medicare

Yearly wellness visit and many free preventive services for some seniors with Medicare

Holding insurance companies accountable

Insurers must justify any premium increase of 10% or more before the rate takes effecr

Benefits of the Affordable Care Act for Americans

Health Insurance Marketplace Consumer Assistance Pre-existing conditions free preventive care Rx Discounts for Seniors Protect against health care fraud small business tax credits

When does open enrollment begin?

October

When does coverage begin?

January

When does enrollment close?

March

Patient’s Bill of Rights

Coverage Cost Care

Coverage

Ends pre-exisiting condition exclusions for children keeps found adults covered ends arbitrary withdrawals of insurance coverage guarantees your right to appeal.

Cost

Ends lifetime limits on coverage reviews premium increases helps you get the most from your premium dollars

Care

Coverage preventives care at no cost to you protects your choice of doctors Removes insurance company barriers to emergency services

10 essential health benefits

ambulatory patient services emergency services hospitalization maternity and newborn care mental health and substance use disorder services prescription drugs rehabilitative and habilative services laboratory services preventive and wellness services and chronic disease management pediatric services

# of individuals determined eligible to enroll in a marketplace plan in the U.S.

13,547,592

# of individuals determined eligible to enroll in a marketplace plan in FL

1,603,575

# of Individuals Eligible to Enroll in a Marketplace Plan with Financial Assistance in the U.S.

8,748,037

# of Individuals Eligible to Enroll in a Marketplace Plan with Financial Assistance in FL

1,114,877

timeline of the ACA: 2010

-Small business health insurance tax credits are provided -A $250 rebate check provided to seniors in the Medicare prescription drug "Donut Hole" -Establishment of consumer assistance programs -All new plans must cover free preventive care -Crack down on health care fraud -Extending coverage for young adults until age 26 -Expanding coverage for early retirees -Rebuilding of the primary care workforce -Insurance companies are held accountable for rate hikes Medicaid expansion for the states -Increased payments for rural health care providers Strengthening of community health centers

Timeline of the ACA: 2011

-For senior citizens –Receive 50% off for Medicare Part D brand name drugs –Free Preventive Care for Seniors is provided –Community care transitions program for high Medicare beneficiaries -Center for Medicare & Medicaid Innovation is established. -Community First Choice Option is established –Allows states to offer home and community based services to disabled individuals -Health Care Premiums are reduced –At least 85% of all premium dollars collected by insurance companies for large employer plans are spent on health care services and health care quality improvement -Stoppage of overpayments to big insurance companies. -Strengthening of Medicare Advantage –People enrolled in will still receive all guaranteed Medicare benefits, and will provide bonus payments for high quality care

2012

Payments are linked to quality outcomes Financial incentives to hospitals to improve the quality of care of Medicaid patients Accountable care organizations for physicians Better coordinate patient care and improve the quality Help prevent disease and illness Reduce unnecessary hospital admissions Reduction of paperwork and administrative costs Improved understanding of health disparities Collect and report racial, ethnic and language data

2013

Effective January 1, 2013 New funding to state Medicaid programs that choose to cover preventive services Establishment of a national pilot program to improve the coordination and quality of patient care Flat rate for services Increased Medicaid payments for primary care doctors Effective October 1, 2013 Open enrollment in the health insurance marketplace begins

2014

Effective January 1, 2014 Prohibiting discrimination due to pre-existing conditions or gender Elimination of annual limits on insurance coverage Ensured coverage for individuals participating in clinical trials Health care is made more affordable for middle class Tax credits will become available for people with income between 100% and 400% of the poverty line who are not eligible for other affordable coverage Establishment of the health insurance marketplace If your employer doesn’t offer insurance, you will be able to buy it directly in the marketplace Small business tax credit is increased Access to Medicaid is increase Those who earn < 133% of the poverty level (about $14,000 for individual; $29,000 for family ) will be eligible to enroll Promoting individual responsibility

2015

Effective January 1, 2015 Physicians’ payments will be based on value not volume A new provision will tie physician payments to the quality of care they provide Physicians will see their payments modified so that those who provide higher value care will receive higher payments than those who provide lower quality care

ACA requires most individuals to have health insurance beginning

January 1, 2014

Health insurance can be purchased

through an employer or individual health plan.

Health coverage can be through programs such as

Medicare, Medicaid, Florida Healthy Kids Tri-Care, federal employee health benefit plans Veteran’s health care, Indian Health Services (HIS

Exceptions to the individual mandate

Individuals that are at or below 100% of the federal poverty level and eligible for Medicaid Expansion Individuals for whom coverage would be unaffordable Under a hardship which prevents the consumer from obtaining health coverage Undocumented immigrants Individuals that are members of health care sharing ministries as well as the Amish, Mennonite, and Indian tribe communities

Individuals that do not have health coverage and who are not exempt from the federal requirement ,,,

may be subject to a Shared Responsibility Payment collected by the Internal Revenue Service (IRS) Individuals will not have to make a payment if: Coverage is unaffordable They spend less than three consecutive months without coverage They qualify for an exemption

Individual Mandate: Tax Penalty

The total annual tax penalty will be the greater of either a flat dollar amount or a percentage of taxable income: $95 per person or 1 percent of taxable income in 2014 $326 per person or 2 percent of taxable income in 2015 $695 per person or 2.5 percent of taxable income in 2016 After 2016, the tax penalty will increase annually based on a cost-of-living adjustment

Employers

-Easier for businesses to find better coverage options and builds on the employer-based insurance market already in place -Gives the consumer and business owner more control and making health care coverage more affordable –Building on Employer-Based Insurance Market –For Small Business Owners

Healthcare Providers

Holds health insurance companies accountable, protect you and your patients, and guarantee choice and control Reduces the burden of uncompensated care on physicians and hospitals by making access to care easier and more affordable than ever before for all Americans Opportunities and Incentives to Coordinate Care Strengthening the Workforce

People with Disabilities

Individuals living with a disability may have a hard time obtaining private insurance Even if they can afford to buy it, it probably doesn’t cover all of your needs

Why do we need the affordable care act?

high uninsured rate

high uninsured rate

In July 2012, the Congressional Budget Office estimated that 55 million Americans under the age of 65 are currently uninsured Representing 1 out of 5 in that population Most of the uninsured go without health coverage because they can’t afford it, and they would purchase it if they could The uninsured are less likely to receive preventive care and seek care as quickly when they are sick or injured Results in higher costs when they do seek treatment