the affordable care act of 2010: what is happening next what you need to know
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The Affordable Care Act of 2010: What is Happening Next What You Need to Know. Training Sections Recent History of Health Care Reform Overview of Changes in Affordable Care Act (ACA) Timeline of Major Changes Resources. Training Section 1: Recent History of Health Care Reform. - PowerPoint PPT PresentationTRANSCRIPT
The Affordable Care Act of 2010: What is Happening NextWhat You Need to Know
Training Sections
1. Recent History of Health Care Reform
2. Overview of Changes in Affordable Care Act (ACA)
3. Timeline of Major Changes
4. Resources
Training Section 1:Recent History of Health Care
Reform
4
Recent History
March 2010
U.S. Congress passed:
• Patient Protection and Affordable Care Act (HR 3590)
• Health Care and Education Reconciliation Act of 2010 (HR 4872)
5
Recent History
March 2010
President Obama signed into law, creating: • Patient Protection and Affordable Care Act
(Public Law 111-148)
• Health Care and Education Reconciliation Act of 2010 (Public Law 111-152 )
• Together, commonly known as The Affordable Care Act (ACA) of 2010
Training Section 2:Overview of Changes in
Affordable Care Act (ACA)
7
Overview
The Affordable Care Act (ACA) of 2010:
• Impacts many areas of health care
• Result of many compromises
• Does not go into effect all at once
• Relies heavily on state and local implementation
Overview
Affordable Care Act makes major changes in 4 basic areas:
1. Insurance company accountability
2. Lowering costs and improving quality
3. Increasing access and choice
4. Patient rights and consumer protections8
Overview: HealthCare.Gov
Training Section 3:Timeline of Major Changes
11
Explaining the Timeline
How Timeline Works:• Changes take effect over many years, through 2020
• Timeline shows when major reforms go into effect
• Designed to give more detailed information about changes coming soon, summarizes changes down the road
12
Explaining Timeline: [Date] [Type of Reform]
Who: Population reform impacts
Why: Need or problem reform is addressing
What: Specifics of what reform does
When: When reform goes into effect
How: Details of how reform will be implemented or accessed
TIMELINE: IN PROGRESS NOW
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Timeline: In Progress Now High-Risk Pools
Who: • People who can’t get insurance because of pre-
existing medical conditions, including mental health conditions
Why: • Before ACA, people with pre-existing conditions
often couldn’t get any insurance
15
Timeline: In Progress Now High-Risk Pools
What:• People who can’t get insurance because of pre-
existing medical conditions can apply for a Pre-Existing Condition Insurance Plan (PCIP)
• Law limits premiums to “standard rates” - the average amount private insurers in the state charge for premiums for similar coverage
• Limits out-of-pocket expenses ($5,950/year for
individual)
16
Timeline: In Progress Now High-Risk Pools
What:• States can run PCIPs, with federal funding, or use federal
PCIP– 29 states chose to run plans themselves– 21 states chose to let the federal government run them
• 35 states already ran high-risk pools before ACA– Could continue to run these if they meet the law’s
standards, or could set up new plans
• PCIPs in each state operate under ACA standards– But plans may vary from state to state
17
Timeline: In Progress Now High-Risk Pools
When:• States letting the federal government run their PCIP:
– Can apply online now and get coverage within a month
• States running their own PCIP: – Different application and enrollment dates– PCIPs are up and running in 47 states– Will be in all states by end of September
18
Timeline: In Progress Now High-Risk Pools
When:• PCIPs are meant to be temporary:
– End on January 1, 2014, when insurance companies won’t be allowed to deny people coverage because of pre-existing conditions
– By this date, government-regulated, state-run insurance exchanges also start operating
19
Timeline: In Progress Now High-Risk Pools
How:• To apply for a PCIP you must:
– Be a U.S. citizen or lawfully present in the United States
– Have had no health coverage for the last 6 months – Have a pre-existing condition, as defined by each
PCIP
– You can apply no matter what your income is • To find details for your state:
www.HealthCare.Gov/law/about/provisions/pcip/index.html
20
Timeline: In Progress Now Money Follows the Person Grants
Who:• People on Medicaid who need long-term care services
Why:• In the past, Medicaid’s Money Follows the Person
grants have provided flexible funding that lets a person who needs long-term care services get services that are most appropriate to what they need and want
• MFP funding gives flexibility to move from institutional to community-based services and keep funding
21
Timeline: In Progress Now Money Follows the Person Grants
What:• ACA extends these grants and adds $2.25 billion in
funding• Broadens eligibility standards • Helps states pay for the costs of moving someone from
institution to home
When:• MFP grants have been extended until September 2016
How:• The program will continue operating as before
22
Timeline: In Progress Now Donut Hole Rebates
Who:• People on Medicare Part D who fall into gap in
prescription drug coverage called the donut hole
23
Timeline: In Progress Now Donut Hole Rebates
Why:• Under Medicare Part D, when person’s prescription drug
costs reach a certain amount ($3,520 in 2010): – Medicare stops paying for any prescription drug costs
– They have to pay for 100% of their drugs out-of-pocket, until they reach the maximum out-of-pocket amount
– Once they reach this maximum, they are out of the donut hole - Catastrophic Coverage begins, and Medicare starts to help cover the costs again
24
Timeline: In Progress Now Donut Hole Rebates
What:• Under ACA, people who fall into donut hole this year
will get one-time, tax-free $250 rebate – Over 1 million people so far!
When:• Rebates started June 10, 2010, continuing
throughout the year
25
Timeline: In Progress Now Donut Hole Rebates
How:• People get rebate as soon as they reach the donut
hole
• No application necessary, rebate checks are mailed automatically
• People getting Medicaid Extra Help (Low Income Subsidy) will not get rebate
• Call 1-800-MEDICARE to report suspected fraud, or with questions
26
Timeline: In Progress NowRescission Outlawed
Who:• Anyone who has insurance and might get sick
Why:• Before ACA, when someone with insurance got sick
with an expensive or chronic illness, insurance companies would often go back and search their application for mistakes, looking for reason to drop their coverage
• This is called rescission, and happened to thousands of Americans each year
27
Timeline: In Progress Now Rescission Outlawed
What:• Under ACA, insurance companies won’t be allowed
to drop people’s coverage because they get sick
When:• Rescission is illegal starting September 23, 2010
How:• Department of Health and Human Services is
responsible for regulation and enforcement details
28
Timeline: In Progress Now Ban on Discriminating Against
Kids with PECWho:• Children under 19 with pre-existing conditions
Why:• Before ACA, insurance companies could legally deny
insurance to children because they had a pre-existing condition
What:• Under ACA, it is illegal for insurance companies to
deny or restrict insurance to children because of pre-existing condition
29
Timeline: In Progress Now Ban on Discriminating Against
Kids with PECWhen:• Applies to health plan years starting after
September 23, 2010
How:• As with any group plan, insurance companies may
decide to restrict enrollment to specific enrollment periods
• Department of Health and Human Services is responsible for regulation and enforcement details
30
Timeline: In Progress Now Expanded Coverage for Young
AdultsWho:• Adult children up to age 26
Why:• Before ACA, children were often dropped from
parents’ insurance plans when they turned 18 or finished college
• Many young people have difficulty finding jobs with employer-sponsored coverage and can’t afford to buy individual coverage, so they often would go without insurance
31
Timeline: In Progress Now Expanded Coverage for Young
AdultsWhat:• Children can stay on (or be added to) their parents’
insurance until they turn 26– Applies to plans that offer dependent coverage
When: • Open enrollment for coverage starts on September
23, 2010 and is required by law to continue for at least 30 days
• Finding Insurance Options
32
Timeline: In Progress Now Ban on Lifetime Coverage Limits
Who:• Anyone who has insurance or will ever use insurance
Why:• In the past, insurance companies have used lifetime
coverage limits to limit amount of money they will pay out for a customer’s health care needs
• If someone got sick and reached their lifetime coverage limit during treatment, the insurance company could just stop paying for treatment
33
Timeline: In Progress Now Ban on Lifetime Coverage Limits
What:• Insurance companies not allowed to put caps on
amount they will spend on lifetime coverage costs for essential benefits
• Essential benefits include things like hospital stays, doctor visits, and prescription drugs
34
Timeline: In Progress Now Ban on Lifetime Coverage Limits
When:• Ban starts September 23, 2010, for all new
individual insurance plans and all group plans • Annual limits are restricted in all group plans and
new individual plans, until 2014, when banned completely
How:• The law includes a detailed list of essential benefits
that must be covered without limit
35
Timeline: In Progress Now Free Preventive Services - Private
CoverageWho:• Anyone who has private insurance
Why:• Before ACA, many health plans charged for
preventive services, so people often chose to skip them
• Preventive services can help avoid many costly health problems down the road
36
Timeline: In Progress Now Free Preventive Services - Private
CoverageWhat:• Private insurance plans will have to cover certain
recommended preventive services, like cancer screenings
• Insurance companies will be required to offer these services free to patient - without deductible, coinsurance, or copayment charges
• Law ensures many free preventive health services for children, including many vaccines
37
Timeline: In Progress Now Free Preventive Services - Private
CoverageWhen:• All new individual and group plans after September
23, 2010
How:• Coverage for these services will be offered through
existing private insurance plans
38
Timeline: In Progress Now Improvements to Medicaid HCBS
Who:• People who use Medicaid’s Home and Community-Based
Services (HCBS)
Why:• In 2005, 1915(i) was added to Social Security Act
• Gave state Medicaid programs option to provide HCBS to people with disabilities before they need institutional care
• Many states did not choose to provide these services
39
Timeline: In Progress Now Improvements to Medicaid HCBS
What:• ACA changes and adds to Section 1915(i)
– Removes many barriers to states to offering these services
– Allows states to amend their plans instead of having to apply for waiver
– Improves quality of services and access to HCBS for people with disabilities
• Expands services that state can offer as part of HCBS
• Allows states to extend full Medicaid benefits to people using HCBS
40
Timeline: In Progress Now Improvements to Medicaid HCBS
When:• Changes go into effect on October 1, 2010
How:• As long as people meet a state’s eligibility
requirements, HCBS have to be offered to every eligible person in the state
• States can now provide services to people with incomes up to 300% of the Supplemental Security Income (SSI) Federal Benefit Rate ($2,022 per month in 2010)
TIMELINE: BY 2011
41
42
Timeline: By 2011Drug Discounts for People in
Donut HoleWho:• People who fall in Medicare’s donut hole
Why:• Many people in donut hole can’t afford their
medications
43
Timeline: By 2011Drug Discounts for People in
Donut HoleWhat:• People in donut hole will get 50% discount on brand
name drugs, 7% discount on generics
When:• Discount starts January 1, 2011
– Will grow until 2020, when donut hole is closed completely
How:• Full cost of drugs (rather than discounted amount) will
still count towards person’s out-of-pocket maximum
44
Timeline: By 2011More Preventive Services Under
MedicareWho:• Anyone on Medicare
Why:• Preventive services can help avoid many costly
health problems down the road
45
Timeline: By 2011More Preventive Services Under
MedicareWhat:• People on Medicare will be able to get a free
wellness visit and personalized prevention plan each year
• No copayment, deductible, or coinsurance charges for recommended preventive services
46
Timeline: By 2011More Preventive Services Under
MedicareWhen:• Starting January 1, 2011
How:• Coverage for these services will be offered through
existing Medicare plans
47
Timeline: By 2011Medicaid Community First Choice
OptionWho:• People with disabilities who are on Medicaid
Why:• People with disabilities have the right to choose to
live in and receive services in their homes and communities whenever possible
48
Timeline: By 2011Medicaid Community First Choice
OptionWhat:• People with disabilities who have income below
150% of Federal Poverty Level, and who are eligible for institutional care, can choose community-based services instead
• Allows Medicaid plans to choose HCBS as a rule, rather than the exception
When:• CFC Option starts October 1, 2011
49
Timeline: By 2011Medicaid Community First Choice
Option
How:• ACA provides increased federal Medicaid match for
states that choose the CFC Option
TIMELINE: BY 2012
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Timeline: By 2012CLASS Act
Who:• Everyone
Why:• Paying for long-term care is expensive
– Many people can’t afford it and don’t budget for it
• People need options that give them more choice and flexibility about long-term care
52
Timeline: By 2012CLASS Act
What:• The Community Living Assistance Services and Support
Act (CLASS Act) provides for voluntary, self-funded, long-term care insurance through the workplace
• Insurance will help pay for long-term care costs for people with disabilities and elderly people
• People will be able to use cash benefit to pay for their choice of variety of long-term care services, including home health care workers, assistive technology, adult day care, transportation, or assisted living
53
Timeline: By 2012CLASS Act
When:• Departments of Health and Human Services (HHS)
will write rules about how much premiums will cost and what disabilities qualify for the insurance benefits
• Rules must be written by October 1, 2012
54
Timeline: By 2012CLASS Act
How:• Employers decide whether they want to participate
• If employer participates, people are auto-enrolled, can opt out
• Premiums taken through payroll deductions– Employers can pay premiums, not required
• Will be way for self-employed and employees of companies that don’t participate to choose to enroll
55
Timeline: By 2012CLASS Act
How:• People pay premiums for five years before they can
collect benefits, which will be a minimum average of $50 a day– Amount of benefit depends on assessment of disability
• No income or asset limit
• There are eligibility criteria, but no screening for pre-existing conditions
• No lifetime benefit limit
TIMELINE: BY 2014
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Timeline: By End of 2014Ban on PEC Discrimination
Who:• Anyone with a pre-existing condition
Why:• Before ACA, insurance companies could legally deny
insurance to people because they had a pre-existing condition
What:• Under ACA, will be illegal for insurance companies to
deny or limit insurance to anyone because of a pre-existing condition
58
Timeline: By End of 2014 Ban on PEC Discrimination
When:• Starting on January 1, 2014
How:• Department of Health and Human Services is
responsible for regulation and enforcement details
59
Timeline: By End of 2014Expansion of Medicaid Eligibility
Who:• Low-income people who have previously made too
much money to qualify for Medicaid
• Low-income adults without children
• Low-income adults without a disability
Why:• Many people who did not qualify for Medicaid still did
not make enough to be able to pay for private insurance
60
Timeline: By End of 2014Expansion of Medicaid Eligibility
What:• Medicaid will expand to cover more low-income
people including adults without children, and adults without a disability
• People with disabilities won’t have to go through complicated disability determination process anymore to become eligible for Medicaid
• Will also help people with disabilities who did not meet old Medicaid definition of disability
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Timeline: By End of 2014Expansion of Medicaid Eligibility
When:• Starting January 1, 2014
How:• Expansion will include people with incomes up to
133% of Federal Poverty Level (about $28,000 for family of 4)
62
Timeline: By End of 2014State Health Insurance Exchanges
Who:• Everyone in private insurance market
Why:• In the past, it has been complicated for people to
compare private insurance plans
• People buying individual plans have not been able to negotiate for better prices, the way people buying group coverage can
63
Timeline: By End of 2014State Health Insurance Exchanges
What:• States will create exchanges, a marketplace where people
can comparison shop for standardized health packages
• Exchanges will provide way for individuals and small businesses to buy more affordable coverage
• People will also be able to join together in groups to negotiate more affordable group insurance
• Provides subsidies for low-income people on a sliding scale
64
Timeline: By End of 2014State Health Insurance Exchanges
What:• The exchanges inspect policies to make sure they
meet standards– Can ask companies to justify rate hikes
When:• Starts January 1, 2014
65
Timeline: By End of 2014State Health Insurance Exchanges
How:• Exchange packages will include essential health
benefits:• Outpatient care• Emergency services• Hospitalization• Maternity and newborn care• Mental health and substance use disorder services• Prescription drugs• (Re)habilitative services and devices• Laboratory services• Preventive services and chronic disease management• Pediatric services
Training Section 4:Resources
67
HealthCare.Gov
• Finding Insurance Options
• Timeline
• Information for Specific Situations
• Comparing Quality of Facilities
• Information about Implementation