Transcript Slide 1

The Patient Protection & Affordable
Coverage Act of 2010 as Amended
(by the Health Care and Education Affordability Reconciliation Act)
How Its Provisions Address Our Principles
Spring, 2010
Prepared for Health Care for America Now! – Michigan
By Randy Block, Director, Michigan Unitarian Universalist Social Justice Network
Objectives
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Reveal some health reform myths
Identify health reform principles
Show how new law addresses principles
Health Reform Principles
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Comprehensive Benefits
Universal Coverage
Affordable
Cost Effective/Adequate Revenues
Acceptable Quality
Equity in Access
Choice of Providers
Myths About Health Reform
Source: FactCheck.org, March 19, 2010
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MYTH #1: Congress passed “government run health care”.
FACT: New system builds on current health insurance system.
MYTH: #2: Americans premiums will go up. Americans premiums will go
down.
FACT: CBO indicates most people’s premiums won’t change significantly.
MYTH #3: The bill cuts Medicare by $500 billion.
FACT: No benefit reductions, but cuts Medicare Advantage overpayments.
MYTH #4: Medical Malpractice is the biggest driver of health care spending.
FACT: CBO reported that total spending could be cut by only about 0.5%.
Comprehensive Benefits
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No plans can charge for preventive services (2010).
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Creates voluntary public, long term care policy (2011).
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Medicaid attendant care program for persons with disabilities
(2011).
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HHS Secretary to define 4 comprehensive benefit packages.
Limits cost sharing for low & middle income (2014).
Universal Coverage
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Lifetime coverage limits prohibited (2010).
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No pre-existing condition denials for children (2010).
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If 26 or younger, covered on parents’ policies (2010).
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High risk pool for people with pre-existing conditions (2010).
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Medicare preventive care provided at no charge (2011).
Universal Coverage
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Health insurance exchanges open for buying insurance (2014).
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Adult policies can’t be denied due to health or pre-existing
conditions (2014).
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Legal immigrants eligible for cost sharing via exchange (2014).
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State can offer plan for uninsured up to 200% poverty (2014).
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CBO Report: Plan to cover 32 million additional people.
Affordability
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Small business tax credits (35% of premiums) to purchase
insurance (2010). Rises to 50% by 2014.
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Temporary employer insurance for employees 55+ (2010).
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Close Medicare prescription donut hole (2010 – 2020).
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Expand community health centers & school clinics (2011).
Affordability
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Annual deductibles caps: $2,000/individual & $4,000/family (2014).
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Annual out of pocket cost caps for small business plans:
$2,000/individual and $4,000/family (2014).
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Expand Medicaid to individuals up to 133% of poverty. Fed’s pay
100% of costs 2014-16; phase down to 90% by 2020.
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Premium and cost sharing credits for individuals and families
between 100% and 400% of poverty.
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Cut Medicare Part B premium costs for low-income (2014).
Cost Effectiveness/Revenues
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Policies must spend 80-85% revenues on medical care (2010).
CBO report: Law projected to cost $960 billion over 10 years
and reduce national debt by $138 billion by 2020. To cut $1.2
trillion from national deficit between 2020 & 2030.
Wellness program grants for small employers and Medicare
programs create individual prevention plans (2011).
New annual fees on pharmaceutical manufacturers (2011).
Cost Effectiveness/Revenues
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High income families to pay 3.8% on investment income (2013).
All persons (but lowest income) required to buy health
insurance or pay penalties (2014).
Employers with 50+ employees pay fines if don’t cover their
employees or provide unaffordable insurance (2014).
Employers pay excise tax on high cost health plans (2018).
Acceptable Quality
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Establish health insurance ombudsman program (2010).
Begin a national strategy to improve health care quality, patient
outcomes and population health (2011).
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Link provider payments to quality outcomes (2012).
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Require fast food/vending machine nutrition labeling (2012).
Equity in Health Care Access
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Health professional cultural competence training (dates vary).
Requires data collection by race, sex, primary language,
disability and rural status; research to reduce disparities (2012).
Legal immigrants eligible for financial assistance in the
exchange (2014).
Prohibits health discrimination by gender (2014).
Abortion payments beyond Hyde amendment not permitted
(2014).
Choice of Providers
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Consumers allowed to choose primary care doctor under new
plans (2010).
Medicare to provide more incentives to health professionals to
serve low and moderate income people (2010).
Higher reimbursement for primary care doctors and other
providers to serve Medicaid populations. (2013 & 2014).
Other Insurance Reforms
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HHS website with insurance information by state (2011).
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Demonstration grants to evaluate tort reform options (2011).
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Medicare Advantage plans lose subsidies but could gain
bonuses for high quality (2012).
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Create non-profit health insurance co-ops in all states by 2013.
Concluding Remarks
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The 2010 Affordable Health Care for America health reform law
is not a government run health system, but regulates and
expands existing private and public insurance systems.
The new law has many provisions that address reform principles
of making health coverage more comprehensive, affordable,
universal, cost-effective, higher quality, allowing more provider
choice and enhancing health equity.
The law is projected to expand coverage to 32 million people.
Health advocates need to be informed and vigilant to ensure
that reform is wisely implemented at both federal and state
levels.