1. INNOVATIONS IN PATIENT CARE EHR | PMS | PHR | HIE | MOBILETalking About The Affordable Care Act (ACA)

2. EHR | PMS | HIE | PHRThe Digest This program is accompanied by a seven page digest of thebenefits of the affordable care act that most directly affectindividuals. The Digest is a solidly researched and easy to read tool that willprovide what you need to convince your voters that they shouldsupport the affordable care act and only vote for those who do. The digest has been used in at least two dozen communitymeetings and personally presented to at least 1500 individualschosen at random in public gatherings. The read only digest may be freely copied for free distribution tovolunteers and voters. 2 3. EHR | PMS | HIE | PHRAgendaA.IntroductionB.ACA big pictureD.Medicaid and MedicareE. The new insurance marketF.Cost controls and regulationsG.Subsidies for individuals, retirees and small business.H. Essential Health BenefitsI. Health insurance benefits already in effectJ. Questions3 4. EHR | PMS | HIE | PHRTalking About the Affordable Care ActBig Picture4 5. EHR | PMS | HIE | PHRACA is a law that makes affordable healthcare possible. IN 2009 THE NEED FOR THIS WAS URGENT President Obama was driven to make health care reform his highest priority by the simple fact that the cost of health care is pushing the country and its people rapidly toward bankruptcy. BUT THIS FIGHT STARTED DECADES AGO President Obama, 280 Democratic Representatives and Senators in the 111th Congress passed ACA using help from presidents Truman, Eisenhower, Kennedy, Nixon, Johnson, Reagan, Clinton, and G. W. Bush5 6. EHR | PMS | HIE | PHRIf Implemented As Written CREATES NEW JOBS The healthcare industry, at 14.3 million jobs will generate 3.2 million new American jobs between 2008 and 2018 According to the Bureau of Labor Statistics this is more than any other industry REDUCES THE DEFICIT reduces the 20 year deficit by $1.5 Trillion BRINGS QUALITY, AFFORDABLE HEALTH CARE for 94% of our residents6 7. EHR | PMS | HIE | PHRIf Implemented As WrittenRELIES ON COMPETITION, BUT HOLDS INSURANCE COMPANIESRESPONSIBLE:Starting in 2014, the Act relies on competition: including universal coverage;single Risk pool underwriting; risk adjustment pools to manage premiums;the creation of co-op insurance companies; transparency; state regulationplus federal oversight.Companies with unreasonable premiums can be excluded from exchanges.7 8. EHR | PMS | HIE | PHRBecause we all benefit, we all have a responsibility ACA requires both implementation by the states and the voters ongoing support. Good health comeS from healthy living. Employers and insurance companies can benefit by helping employees. They are authorized to credit us up to 20% of total premiums to encourage healthy behavior. $30,000,000 has been allocated for this year to jump start state consumer assistance offices. 8 9. EHR | PMS | HIE | PHRTalking About the Affordable Care ActMedicaid and Medicare 9 10. EHR | PMS | HIE | PHRPresident Obama strengthened Medicaid andMedicareeven in 2009 2009 RECOVERY ACT REIMBURSEMENT FOR COSTS TO STATE MEDICAID PROGRAMShas saved Minnesota (in 09 -10), $1,673,476,158 thru Sept 30, 2010. THROUGH ACA Medicare coverage was improved and the trust fund strengthened. TODAY, IN 2011medicare is now providing comprehensive and free preventive care10 11. EHR | PMS | HIE | PHRMedicaid and Medicare Continue to Benefit under theAffordable Care Act 2010-2019 ACA EXTENDS THE LIFE OF MEDICARE UNTIL 2029 2010 BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE.Jan 1, 2011 the ACA started a 50% discount off thenegotiated prices of brand name drugs andbiologics in the donut hole and other discounts ongeneric drugs.ACA closes the donut hole by 2020. 2011 ALL MEDICARE INSUREDS WILL PAY THE SAME PREMIUMSto all Medicare insurance providers.The ACA phases out subsidies to private MedicareAdvantage plans over six years. 1 1 12. EHR | PMS | HIE | PHRIn 2010 2010 MEDICAID State Medicaid coverage must equal and may exceed ACA coverage. THE ACA EXPANDS MEDICAID COVERAGE by increasing qualifying income levels to 1.33 times the Federal Poverty Level or less. FOR THOSE THAT CANNOT AFFORDINSURANCE See Medicaid, above. All others left uninsured may use one of the 7.900 Community Health Clinic offices (see below) or they may use emergency Rooms. Undocumented immigrants and others not qualified for ACA programs may also purchase commercial insurance outside of the exchanges. 1 2 13. EHR | PMS | HIE | PHREldercare Locator (2010) www.eldercare.gov Or call 1-800-677-1116 for community based services and benefits, counseling, transportation, meals, home care and caregiver support services.13 14. EHR | PMS | HIE | PHRStopping Fraud 2010 ACA IS AGGRESSIVE ABOUT STOPPING FRAUD. Fraud costs Medicare millions of dollars every year. Fraud schemes may be carried out by individuals, companies, or groups of individuals. We can help stop it. 1 4 15. EHR | PMS | HIE | PHRTalking About the Affordable Care ActThe New Insurance Market15 16. EHR | PMS | HIE | PHRThe Affordable Care act creates a new insurance market In 2010: EXISTING GROUP HEALTH PLANS Are "grandfathered" with respect to certain reforms, until they change benefits or increase out of pocket costs beyond limits. INSURANCE EXCHANGES in 2014 Will create transparency and competition and therefore lower rates. AFFORDABLE HEALTH INSURANCE IS MANDATED in 2014Without universal insurance costs will be uncontrollable. PENALTIES in 2014 Monthly for the non-exempt individual who fails to insure themselves and their dependents. 1 6 17. EHR | PMS | HIE | PHRTalking About the Affordable Care ActCost Controls and Regulations17 18. EHR | PMS | HIE | PHRThe Affordable Care Act Is Called Affordable For AReason SUBSIDIES FOR THOSE UNDER 400% OF THE FPLlimit premiums to between 2% to 9.5%of income.limit out of pocket costs to 30% of contract costs. PREMIUM INCREASESare limited in 26 states that can rejectincreases.The Federal government does not havethe authority to limit premiums. 1 8 19. EHR | PMS | HIE | PHRACA has many components to control costs, most of which willcome into effect in 2014 along with the exchange BANS PRICE DISCRIMINATION OF ANY KINDExcept age and smoking. EXCHANGE BUYING To lower insurance premiums from what they would become under past practices, insurers are required to include everyone in a single risk pool. insurance will be sold through state operated exchanges accessible by both individuals, and small businesses . OUT OF POCKET LIMITS To qualify for the exchanges, insurers in the non-group market must limit out of pocket costs to $5,950/yr in 2010 dollars for an individual, $2,000/yr per individual in the small group market and twice these for a family. 1 9 20. EHR | PMS | HIE | PHRThe Affordable Care Act Is Called Affordable For AReason 2010 THE LAW REQUIRES IMMEDIATE RESTRAINT OF UNREASONABLEPREMIUMS.The HHS Secretary has directed the states to have the legislation andregulations needed to approve or disapprove rates and has granted $51million to 45 states to assist this process. 2010 EMPLOYERS ARE RECEIVING HELP FOR EARLY RETIREES. 2 0 21. EHR | PMS | HIE | PHRThe Affordable Care Act also helps our economy by aidingSmall BusinessesSMALL BUSINESS WILL RECEIVE 35% TAX CREDITS NOW (IN 2010) SMALL BUSINESS WILL RECEIVE 50% TAX CREDITS IN 2014 KEY POLITICAL QUESTIONS ARE ANSWERED IN A SHORT PAPER from the Center of Budget and Policy Priorities at http://www.cbpp.org/files/5-17-10health.pdf.21 22. EHR | PMS | HIE | PHRTalking About the Affordable Care ActEssential Health Benefits are defined in the Exchange22 23. EHR | PMS | HIE | PHREssential Health Benefits (2014)All new plans and all plans sold on an exchange must meet these requirements. Insurers may offer a low cost catastrophic plan for those under 30 and four plans varyingcoverage at 60%, 70%, 80% and 90% of the cost of benefits. The requirements will be defined by HHS and must include at least the following benefitcoverage plus the items and services covered within the categories: Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health, substance abuse and behavioral health treatments Prescription drugs Rehabilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral and vision care23 24. EHR | PMS | HIE | PHRTalking About the Affordable Care ActHealth Benefits Already Activated24 25. EHR | PMS | HIE | PHRProvisions that went into effect in 2010 include 1) 2010 CHILDREN: THREE PROVISIONS TOOK EFFECT IN 2010. Coverage denial for pre-existing conditions is banned if less than age 19, AND FOREVERY INSURED ON Jan 1, 2014.Children must be accepted as insured under parents plan up to age 26 if the planinlcudes children in its available coverage.States must not reduce income eligibility for Medicaid and the Childrens HealthInsurance Program (CHIP) until 2019. 2) 2010 ACA CREATED A FEDERAL HIGH RISK INSURANCE PROGRAM FOR THOSE WITH PREEXISTING CONDITIONSand without insurance for six monthsMany states also offer high risk poolsas alternatives to the federal program. 2 5 26. EHR | PMS | HIE | PHROther Provisions that went into effect in 2010: Lifetime limits on benefits are banned. Unreasonable annual benefit limits are restrained until banned. Protecting your choice of physicians. Insurance companies must provide free preventive services. 2 6 27. EHR | PMS | HIE | PHRMore Provisions! 2010 MUST PROVIDE EMERGENCY SERVICES without prior authorization whether in or out of network49 2010 ENDS RESCISSIONS except for fraud 2010 BANS DISCRIMINATION BASED ON INCOME unless self insured. 2010 BANS DUMPING 2010 ENSURES QUALITY OF CARE 2010 MUST PROVIDE AN INDEPENDENT APPEALS PROCESS 2 7 28. EHR | PMS | HIE | PHRTalking About the Affordable Care ActQuestions?Blog:http://my.barackobama.com/page/community/blog/patkittler 2 8 29. O NE W O O DBRI DG E CE NTE R, S UI TE 8 1 2W O O DBRI DG E , NJ 0 7 0 9 5P HO NE : 8 0 0 -7 4 1 -0 981HT T P : / / I PAT I E NTCA RE . CO M