1. The ACA’s Impact Upon
Insurers, Providers,
and People
BCBR PULSE EVENT
NOVEMBER 12, 2013
SPEAKERS:
Susan Levy, Women’s Health
Julia Hutchins, ColoradoHealthOp
Sharon Caulfield, Caplan and Earnest LLC

2. 
Passed in March 2010

Market-based health care reform with additional
public support
◦ Labeled “Obamacare”
◦ Heritage Foundation Model
◦ Massachusetts experience
◦ Private insurance companies sell standardized products
through state or federal marketplace “exchange”
◦ Support for premium payments for those at low end of
Federal Poverty Level multipliers
◦ Expansion of state Medicaid programs
The Affordable Care Act

3. 
Research, Commissions, New Funding
Consumer Website
(www.healthcare.gov)
Medicaid and CHIP Payment
Advisory Commission
Health Care Workforce Commission
Comparative Effectiveness
Research
New Prevention Council
Health Centers & National Health
Service Corps
Expansion of Drug Discount
Program
Prevention and Public Health Fund
Federal Coordination of Care Office
Reinsurance Program for Retiree
Coverage
Chronic Disease Prevention in
Medicaid
Center for Medicare and Medicaid
Innovation
Grants to Establish Wellness
Programs
Teaching Health Centers
Medical Malpractice Grants
Funding for Health Insurance
Exchanges
Graduate Medical Education
National Quality Strategy
Rebates and Tax Credits
Medicare Beneficiary Drug Rebates
Small Business Tax Credits
Medicaid Drug Rebate
New Requirements on Non-profit
Hospitals
Many elements of the ACA

4. 
Medicare / Medicaid Reform

Closing the Medicare Drug Coverage Gap

Medicare Payments for Primary Care

Medicare Prevention Benefits

Medicare Premiums for Higher-Income Beneficiaries

Medicare Advantage Payment Changes

Medicaid Health Homes

Medicaid Payments for Hospital-Acquired Infections

Medicaid Long-Term Care Services

Medicaid Community-Based Services


Medicaid Coverage for Childless Adults (State Option)
Miscellaneous

Generic Biologic Drugs

Tax on Indoor Tanning Services

Nutritional Labeling

CLASS Act (repealed)

Changes to Tax-Free Savings Accounts
More elements of the ACA

5.  Insurance Reform

Pre-existing Condition Insurance Plan (phasing out)

Adult Dependent Coverage to Age 26

Consumer Protections in Insurance

Insurance Plan Appeals Process

Coverage of Preventive Benefits

Minimum Medical Loss Ratio for Insurers
ACA Elements already in place

6. Source: The Washington Post
Who gets insurance – and how?

7. Health Exchange Options
Source: http://www.foxbusiness.com/personal-finance/2013/10/16/why-staterun-health-exchanges-are-faring-better/?intcmp=obinsite

8. 


Better care for
Individuals
Better Care for
Populations
Lower Per Capita
Costs
The Goals: The Triple Aim

9. Patience
Persistence
Reaching the Goals --

10. The #1 Goal: Healthy People