The document discusses key provisions and impacts of the 2010 Affordable Care Act, including expanding coverage to millions of uninsured Americans, prohibiting denial of coverage due to pre-existing conditions, and providing benefits such as free preventative care and coverage for adult children up to age 26. It examines effects on groups like families, seniors, employers, and providers, as well as pros and cons and ongoing implementation challenges of the sweeping health reform law.

1. HEALTH CARE REFORM AND
WHAT IT MEANS TO YOU
Theresa DeLaine, MLIS, MBA
April 14, 2011

2. Disclaimer Statement
I declare and affirm under the penalties of
perjury that this presentation is a
collection of my experiences, resources,
and viewpoints. I am not authorized in
anyway to present the viewpoints or
opinions of my former, current or future
employers. In turn, they accept no
responsibility for my individual
experiences and opinions in this
particular presentation.

3. Agenda
• Current Health Care Statistics
• What is Health Care Reform?
• What’s In It for You?
• Pros of Health Care Reform
• Cons of Health Care Reform
• Current Challenges
• Key Takeaways
• Questions

4. Health Care Reform Is Needed

5. Current Health Care Statistics-Health
Insurance
• In 2006, 47 million
uninsured:
• Coverage was provided
through an employer-
59.7%
• Individuals purchasing
coverage-9.1%
• Government-funded
coverage-27.0%
(Medicare, Medicaid,
Military)
U. S. Census Bureau

6. Current Health Care Statistics-Health
Insurance
• Medicare covers most of the health care for
individuals over 65 years and the disabled.
• Accounts for 13.6% of health care coverage
in 2006.
• Medicaid accounted for 12.9% of coverage in
2006 for low-income individuals.
• Funded jointly by Federal and state
governments
US Census Bureau

7. Current Health Care Statistics-Health
Expenditures
• U.S. spends 2X as much on health care
per capita ($7,129) which is more than
any other country.
• In 2005, personal health care
expenditures were paid by private
health insurance-36%, federal
government-35%, state and local
governments-11%, and out-of-pocket
payments-15%.
National Center for Health

8. Current Health Care Statistics-Health
Expenditures
• 75% of all health care dollars are
spent on patients with one or more
chronic condition (some are
preventable)
Diabetes Obesity
Heart Disease Lung Disease
High Blood Pressure
Cancer
Health Affairs

9. Current Health Care Statistics-Health
Expenditures
• Average family health insurance
premium provided by an employer
health benefit program was $11,480
(2006).
• Employees paid $2,793 towards the
premium amount.
• From 2000 to 2006, overall inflation
increased 3.5%, wages increased 3.8%
and health care premiums increased
87%.
Kaiser Family Foundation

10. What Is Health Care Reform?
• Called “Protection and Affordable Care Act”
• Enacted on March 23, 2010. Complete law
will be phased in through 2018
• 2,700 page document
• Provides coverage for more than 95% of all
Americans
• Reduces the deficit by $138 billion over next
ten years, with future reductions more than
$1.2 trillion in the next decade
Committees on Ways & Means,

11. Health Care Reform
• Illegal immigrants will not be allowed to
buy health insurance in the exchanges.
• In 2014, everyone must purchase
health insurance or face a $695 annual
fine. There are some exemptions for
low-income people.
• No health care plan will be required to
offer abortion coverage.
CBSnews.com

12. Health Care Reform
• Starting in 2014, insurance companies
cannot deny coverage to anyone with
pre-existing conditions.
• Federal government pays 100% of
costs for covering newly eligible
individuals through 2016.
• The law will require states to expand
Medicaid to include childless adults
starting in 2014.
CBSnews.com

13. Health Care Reform
• Medicaid expands to include 133% of federal
poverty level, which is $29,327 for a family of
four.
• Law requires a 10% excise tax on indoor
tanning services.
• Increase the hospital tax rate by 0.9% points
on an individual taxpayer earning over
$200,000 ($250,000 for married filing jointly),
in 2013.
CBSNews.com

14. What’s In It For You?

15. Families with Children
• Can add or keep your
children on your health
insurance policy until
they turn 26 years old
• Young adult children
can join or remain on
your plan whether or
not the are:
• Married, living with you,
In school, Financially
dependent on you, or
Eligible to enroll in their
employer’s plan
HealthCare.gov

16. Families with Children
• There will be a 3.8% tax on investment
income for families making more than
$250,000/year and ($200,000 for
individuals).
• Starting in 2018,insurance companies will
pay 40% excise tax on “Cadillac” high-end
insurance plans worth over $27,5000 for
families ($10,200 for individuals). Dental and
vision plans are exempt and not counted in
total cost of a family’s plan.
HealthCare.gov

17. Families with Children
• Exception: Until
2014,
“grandfathered”
group plans do not
have to offer
dependent
coverage up to age
26, if a young adult
is eligible for group
coverage outside
their parent’s plan.
HealthCare.gov

18. “Grandfathered” Plans
• If you have health care coverage from a
plan that existed on March 23, 2010.
This has covered at least one person
continuously from that day forward—
the plan is considered to be
“grandfathered”.
• This provision prohibits lifetime dollar
limits to key health benefits.
HealthCare.gov

19. “Grandfathered” Plans
• These plans are not permitted to cancel
insurance coverage solely because of
an honest mistake made on your
insurance application.
• Must extend dependent coverage to an
enrollee’s adult children until they turn
26 years.
• These protections are added to your
plans on or after September 23, 2010.
HelathCare.gov

20. Seniors/Retirees
• Medicare covers some
preventive care without
charging the Part B
deductibles and
coinsurance.
• Free annual wellness
examination
• Medicare benefits are
not being reduced or
taken away.
• Can choose your own
physicians
HealthCare.gov

21. Seniors/Retirees
• Law creates CLASS (Community Living
Assistance Services & Support for
people needing help with activities of
daily living, after 2012.
• CLASS is a voluntary, enrollment-
based insurance program to provide
resources for activities of daily living in
the home.
• Patients will get a cash allowance to
help pay for this in-home support.
HealthCare.gov

22. Seniors/Retirees
• CLASS will be an
alternative to
nursing home
placement.
• People with
Disabilities
regardless of age
will be able to
participate in
CLASS.
HealthCare.gov

23. Medicare Part D “Donut Hole”
• Medicare Part D prescription
plans have a coverage gap
called the ”donut hole.” After
you spend a certain amount
of money for covered drugs,
you have to pay all costs
out-of-pocket for your
prescriptions up to a yearly
limit. Once you have spent
up to the yearly limit, your
coverage gap end and your
drug plan helps pay for
covered drugs again.
HealthCare.gov

24. Medicare Part D “Donut Hole
• Starting January 1,
2011, if you reach the
coverage gap, you will
automatically get a 50%
discount on covered
brand name drugs.
• You get this discount at
the pharmacy or
through mail order, until
you reach catastrophic
covered phase.
HealthCare.gov

25. Medicare Part D “Donut Hole
• You will get a 7%
discount on generic
drugs while in this
coverage gap.
• Expect additional
savings on your
covered brand-name &
generic drugs while in
the gap over the next
10 years until the gap is
closed in 2020.
HealthCare.gov

26. Medicare Part D “Donut Hole
Requirements
• Must be enrolled in a
Medicare Prescription
Drug Plan or a
Medicare Advantage
plan.
• This program is to help
those with limited
resources.
• Must reach the
coverage gap
• Entire drug cost will
count toward the
amount you need for
catastrophic coverage
HealthCare.gov

27. Early Retirees
• Law provides
resources to
employer-based
retiree health plans
for those people
that retire before
age 65.
HealthCare.gov

28. Military/Veterans
• New law does not effect
current plans from
Veteran Health
Administration
• New does not effect
TRICARE or TRICARE
for Life benefits your
family currently
receives
• You will be able to
purchase additional
coverage if you want
through the new health
insurance Exchanges,
which open in 2014
HealthCare.gov

29. Military/Veterans
• You will benefit from
new consumer
protections, if you have
private insurance
coverage
• If you are a veteran that
is not eligible for VA
health care or other
coverage, you and your
family may be eligible
to receive tax credits for
insurance you buy in
the exchanges
HealthCare.gov

30. Uninsured
• Coverage in high-
risk pool if you have
a pre-existing
condition
• Discrimination ban
extends to all adults
in 2014 after
Exchanges are
created & high risk
pools are phased
out.
www.HealthCare.gov

31. Privately Insured
• No discrimination against children with
pre-existing conditions
• Ban on lifetime coverage limits
• Ban on insurance plans dropping you if
you get sick
• Free preventive care
• Regulate annual limits on coverage
under new plans
www.HealthCare.gov

32. Privately Insured
• Regulate annual limits on coverage
under new plans
• New, independent appeals process
• Requirement that plans put more of
your premiums into care, less into
insurance company profits
• Restrict CEO pay depending on market
size
www.HealthCare.gov

33. Small Employers
• Small Business Tax
Credits- 35% premiums
in 2010 and 50% in
2014
• Employers with fewer
than 50 employees are
exempt from new
employer responsibility
policies
• In 2014, small
businesses with fewer
than 100 employees
can shop for insurance
within the Exchanges.
www.HealthCare.gov

34. Large Employers
• Employers with more
than 50 employees is
considered a large
employer.
• Must provide health
insurance for
employees or pay a fine
of $2000 per worker
each year, if any worker
receives federal
subsidies to purchase
insurance.
www.HealthCare.gov

35. Rural Communities
• Limited access to
health services
• Travel longer distance
to get health care
• Greater access to
primary care providers-
16,000 new providers
over next 5 years
• Capping out-of-pocket
expenses
www.HealthCare.gov

36. Rural Communities
• Prevention & wellness
benefits for free
• More Community
Health Centers will get
more funding to see
more patients
• National Health Service
Corps will be expanded
in order to provide
loans & scholarships to
primary care providers
in rural areas
HealthCare.gov

37. Health Care Providers
• Investments in
electronic health
record adoption
• Patients will get new
rights to choose
their primary care
professionals
• Reduce paperwork
and administrative
hassles
HealthCare.gov

38. Health Care Providers
• New investment in training for more
primary care doctors
• Paying Physicians based on value not
volume to increase quality care (2015)
• Lower the burden of uncompensated
care on physicians and other health
facilities
www.HealthCare.gov

39. Pros of Health Care Reform
• Needed because of higher costs
• Provides cheaper prescriptions for seniors
• Reducing costs, fraud, abuse and paying for quality
over quantity
• More coverage & preventive care for all legal U.S.
residents
• Insurance companies must cover everyone-No pre-
existing conditions or exclusions
Business Pundit

40. Cons of Health Care Reform
• Adds $940 Billion to the Federal deficit over
next ten years
• Higher Medicare taxes for businesses and
families earning more than $250,000
• Cuts in Medicare benefits of $500 Billion
before 72 Million “Baby Boomers” become
eligible for benefits
Business Pundit

41. Current Challenges to Health Care
Reforms
• Possible “de-funding” of
the Health Care Reform
bill in Congress
• Legal suits to determine
constitutionality of the
reform by 26 states &
National Federation of
Independent
Business—ultimately
will go to the Supreme
Court
• Waivers given to
unions, states and
some employers
Orange County Register

42. Key Takeaways
• Reform and changes
are needed to reduce
costs and increase
access.
• Changes are varied by
customer segment—
elderly, families,
companies, etc.
• Changes are phased in
over several years
(2010-2018).
• Emphasis on quality
and prevention will also
lead to less costs.

43. Questions

44. References and Resources
• Health Reform- www.healthreform.gov
• Health Care Statistics in U.S. –
www.healthpaonline.net/health-care-
statistics-in-the-united-states.htm
• Health Care- www.HealthCare.gov