presented by deb polun director of government affairs/media relations community health center...

The Affordable Care Act:Implications for the

Health Care Landscape

Presented by Deb PolunDirector of Government Affairs/Media Relations

Community Health Center Association of Connecticut

First…a bit about

Federally-Qualified Health Centers (FQHCs)

BackgroundWhat is a community health center?

Also called “federally qualified health centers,” they provide medical, dental and behavioral health

services to people regardless of ability to pay.

BackgroundCommunity health centers also provide “enabling services,” such as transportation,translation and referrals to specialists.

They are recognized and partially funded by the federal government. State governments also provide additional funding.

BackgroundCommunity health centers are located in urban and rural areas across the country.

Nationally in 2012:» 1159 community health centers (8500+ sites)» 21 million patients

Background

14 separate health centers

Over 200 sites

Over 340,000 patients

Over 1.6 million visits

BackgroundIn Connecticut:

» 58% of patients are on Medicaid» 23% are uninsured» About 6% are on Medicare» 29% are best served in a language other

than English

»Why did the federal government think we needed health reform?

Patient Protection and Affordable Care Act

The ACA is aimed at:

» Improving the health of Americans» Integrating health care» Controlling health care costs

» Signed into law on March 23, 2010» Immediately challenged by a number of

states and the National Federation of Independent Business

Patient Protection and Affordable Care Act

Patient Protection and Affordable Care Act» US Supreme Court consolidated cases

and ruled most provisions constitutional on June 28, 2012

» Since its enactment, the US House of Representatives has made 42 efforts to repeal its enactment

Highlights of the ACA

Individual Mandate » All individuals must have a certain level

of health insurance coverage or else pay a fee˃Effective 2014˃Penalty in 2014 is $95/year or 1% of

income, whichever is greater.

Provisions will be put into place to make the purchase of health insurance easier and more affordable:» Changes to commercial insurance» Help from employers » Expansion of Medicaid

Provisions will be put into place to make the purchase of health insurance easier and more affordable:» Help from the government» Establishment of insurance marketplaces

(“Exchanges”)

Commercial Insurance Provisions:» Young adults up to age 26 can be

carried on their parents’ insurance plans (2010).

» Individuals with pre-existing conditions will not be denied coverage or charged extra (kids: 2010; adults: 2014).

Commercial Insurance Provisions:» Insurance companies cannot cancel

coverage just because the enrollee gets sick (2010).

» Preventive care, such as vaccinations and screenings, will be covered (2010).

»Women cannot be charged more than men (2014).

Commercial Insurance Provisions:» 80-85% of premium dollars have to go

to health care – or they must refund the extra (2011).

» Lifetime limits will be eliminated (started in 2010, full implementation in 2014).

Impact on Employers:» Large employers will be required to

either cover their workers or pay a fine (originally 2014, now delayed to 2015).

» Small businesses will not be required to provide coverage to their employees, but if they do, they can receive a tax credit (2010).

Changes to Medicaid:» States can expand

Medicaid to all individuals up to 138% of FPL (2010).

» CT has decided to expand Medicaid (HUSKY D).

For a single adult,

annual income

limits will go from

~$6093 to

~$15,202. This

will capture

~40,000 people.

Help from the Government:

» Individuals and families may qualify for assistance from the federal government in purchasing health insurance (2014).

Health Insurance Exchange:» CT is setting up a state health insurance

exchange, which will be a marketplace for individuals and families to purchase health insurance (2014).

OCTOBER 1, 2013

Changes to Medicare: » Preventive care is now included, including

an annual wellness visit (2011). » Additional help with prescriptions has

been added and the donut hole will be closed by 2015.

» New initiatives focus on community-based care, transitions from hospitals (2011).

Impact on Health Centers (Nationally):$11 Billion in new health center funding over 5 years» New health centers» Expanded capacity» Infrastructure improvements

Impact on Health Centers:

$1.5 Billion to National Health Service Corps to help place primary care providers in shortage areas. This includes every federally-qualified health center!

Impact on Health Centers:$150 Million to all 330-funded FQHCs to assist with outreach and enrollment for the Exchanges» Almost $1.6M for CT health centers» 72 Certified Application Counselors

(CACs) currently doing enrolling at health centers; 39 additional will be online within a few weeks.

Credit: http://www.nachc.org

Questions?