Healthcare Reform and Young Adults

By Abhinav GuptaDoctors for America

What are problems with the access to healthcare for young adults (ages 19-29)?

What is the Affordable Care Act (ACA)?

What does it do for young adults?

When do measures in the ACA take effect?

Why it is important for you to have insurance?

Overview

http://www.office.com

Current Problems: Statistics

15.0

28.6

Young Adults Aged 19-29 (millions)

Uninsured Insured

Of uninsured, 2/3 receive “no usual source of care”

Of uninsured, 2/3 skipped needed care

Of uninsured, 1/2 have problems “paying medical

bills”

Of uninsured, 1/4 carry medical debt

Cost◦ Expensive, low salaries

Ineligible for employer-sponsored health insurance ◦ Part-time, unemployment

No insurance after high school/college graduation

“Young Invincibles”◦ Unnecessary care?

Reasons for Lack of Health Insurance

1 in 6 suffer from chronic diseases◦ High blood pressure, cancer, asthma

1 in 10 suffer from a mental health condition 1 in 4 obese Highest rate of injury-related ER visits Examples of Hospitalization Costs:

◦ Asthma: $12,496◦ Fractured Rib: $12,000◦ Torn ACL: $9,220◦ Diabetes: $24,843◦ Delivery: $9,542

Young Invincibles: Myth or Fact?

Goal: Ensure accessible, affordable, quality care for all Americans◦ Coverage to an additional 32 million Americans by

2019 Strict rules on insurance companies to

provide cheaper coverage Reform hospitals and doctors to provide

better quality care Funded by various taxes, termination of

subsidies

The Affordable Care Act of 2010

What’s It Do For Us?

http://www.futurity.org

Insured as a dependent until age 26 Insurance Regulation Medicaid Expansion Online Insurance Market Exchanges and

Insurance Reform Subsidies for use in Insurance Markets Reforms to college insurance plans

Provisions for Young Adults

Coverage for dependents ended after H.S./College Since 2010, child dependents are allowed to remain

on their parents’ policies until age 26◦ Over 600,000 have already gained insurance ◦ Affect over 1.7 million by 2013

Individual states have expanded insurance dependency laws independently ◦ Ex. NJ: 31, FL: 30, NY: 30 ◦ Some have specific requirements

Ex. Unmarried, student, same-state residency Only for fully-insured plans

Federal law of age 26 provides uniform minimum regardless of state requirements

Insurance Reform and Expansion Until Age 26

Ban on discrimination based on pre-existing conditions

Ban on rescissions Ban on annual and lifetime

limits No discrimination based on

sex ◦ Cover maternal and reproductive

health Small insurance companies

required to spend 80% of premiums on direct medical costs (Large companies: 85%)

Insurance Regulation

What’s Medicaid?◦ Government-sponsored health

insurance program Covers over 60 million

Americans Based on poverty levels in

states Expansion

◦ Increases eligibility to 133% of federal poverty level $14,400 for individual; $29,270

for family of four◦ Will be enacted in 2014◦ Effect up to 8 million

uninsured young adults

Medicaid Expansion

http://www.healthcare.gov

http://www.iamempowered.com

ACA creates online insurance markets ◦ Ex. Orbitz, Expedia◦ Compete on price, quality, benefits

Offer bronze, silver, gold, platinum plans Uninsured individuals will be able to use

markets Businesses with less than 100 employees

will be able to use markets◦ Businesses with less than 25 employees receive

tax credits

Changes in Insurance Markets

Subsidies for health insurance if no employer insurance and between 133% to 400% FPL◦ $14,400 -$43,000 per year for individuals ◦ $29,326 - $88,200 per year for family of four

Employee will receive federal tax credits based on a sliding scale ◦ Will pay between 2.0 - 9.5% of income on premiums◦ Difference between this and “silver” plan cost will be paid by

government 75% young adults below 400% FPL Insure 5 million young adults

Subsidized Individual Private Insurance

1.6 million young adults (11% of students) enrolled in college health plans

Many had low benefits Discriminated on pre-

existing conditions, age, sex ACA’s effect:

◦ Ban on lifetime limits, rescissions

◦ Offer coverage to all regardless of health status

◦ Provide free preventive care Only for fully-insured plans

Changes in College Plans

http://www.office.com

The ACA requires all individuals to be insured

Negate adverse selection Low-income Americans will

be subsidized by tax credits or paid for by Medicaid

High-income Americans will be rewarded by lower insurance premiums and better access to care

Penalty: ◦ $95 or 1% of annual income◦ 2016: $695 or 2.5% of annual

income

Individual Mandate

http://www.hetemeel.com

Sep. 23 2010: ◦ Dependents until age 26

Added 600,000 already; projected 1.7 million by 2013 Jan. 1, 2012:

◦ College health plans reform Jan. 1, 2014:

◦ Expansion of Medicaid Cover an additional 8 million young adults

◦ Insurance exchanges and tax credits implemented Cover an additional 5 million young adults

Timeline

David is a 23-year-old, who just graduated from college in May. He landed a job that does not provide insurance. He recently fractured a rib.

2009: No insurance. Had to pay $9,000 for the emergency room cost.

2014: Eligible to stay on his parent’s insurance. Left hospital with only $1,000 bill for deductible.

Savings: $8,000

Examples: 2009 vs. 2014Mary is a 27-year-old single secretary, making $26,000/ year. She does not receive insurance from her employer. She wants to buy insurance because she has asthma. 2009: Estimated health insurance premium: $3,391

2014: With same premium ($3,391), only responsible to pay $1,874 (7.5% income) and receive $1,516 subsidy. Savings: $1,516 (45% of premium)

Catastrophic plans◦ Offer minimal benefits and

deductible of $6,000 Unaffordable, inadequate

preventive and primary care Some College plans still not

reformed◦ Self-insured plans

Rising Healthcare Costs ◦ Stay aware of unnecessary

testing, increased costs◦ Utilize primary care to stay

healthy instead of visiting emergency rooms

So Is Everything Fixed?

GET INSURED, STAY INFORMED, AND STAY HEALTHY!

Check out www.gettingcovered.com for more information.

What Can You Do?

www.office.com

We need your help to spread the message about healthcare reform! To learn more about reform or to get involved, please visit:www.drsforamerica.orgContact us: Doctors for Americainfo@drsforamerica.org202-481-8219

Spread the Word!

“Young Adults.” http://www.healthcare.gov/foryou/youngadults/top5/index.html, 18 July 2011.

“Reform Explained.” http://www.younginvincibles.org/HealthCare/reformExplained.html, 15 July 2011.

“What Healthcare Reform Means for Young Adults.” http://www.nclnet.org/health/70-health-care-reform-/426-what-health-care-reform-means-for-young-adults, 15 July 2011.

“Young Adults.” http://www.healthreform.gov/reports/youngadults/index.html, 14 July 2011.

“Focus on Health Reform, May 2010.” http://www.kff.org/healthreform/upload/8065.pdf, 15 July 2011.

“Realizing Health Reform’s Potential, May 2011.” http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/May/1508_Collins_how_ACA_is_helping_young_adults_reform_brief_v5_CORRECTED.pdf, 15 July 20

“Healthcare Reform, The Details.” Presentation by Dr. Howard Forman, Yale University School of Medicine.

References