the affordable care act

The Affordable Care Act

A Presentation by the Delta Sigma Theta Sorority, Inc.

National Social Action Commission

12/11/2013 Health Insurance Marketplace 101 1

Dr. Paulette Walker, National PresidentRev. Dr. Gwendolyn Boyd, 22nd National President, Co-Chair, National Social Action Commission

Carla Harris, Co- Chair, National Social Action CommissionCommittee-- Dr. Kwamme Anderson, Shavon Arline Bradley, Michelle Barnes Russell

Presenters

Dr. Paulette Walker, National President National Social Action Commission Co-Chair, 22nd National

President Soror Gwendolyn E. Boyd National Social Action Commission Co-Chair, Soror Carla Harris Tamia Booker, Chief of Staff, U.S. Department of Health and

Human Services, Region III Soror Ashley Allison, Constituency Engagement Director, Enroll

America Soror Melanie Campbell, President and CEO National Coalition of

Black Civic Participation Soror Shavon Arline Bradley, Senior Director Health Programs,

NAACP 12/11/2013 Health Insurance Marketplace 101 2

Presenters

12/11/2013Health Insurance Marketplace 101 3

Dr. Paulette C. Walker, 25th National President

Rev. Dr. Gwendolyn E. Boyd,22nd National President, Co-Chair, National Social Action Commission

Carla Harris, Co-Chair, National Social Action Commission

Shavon Arline Bradley, Director of Health ProgramsNAACP

Melanie Campbell, President and CEO, National Coalition on Black Civic Participation

Ashley Allison, Constituency Engagement Director, Enroll America

Tamia Booker, Chief of Staff, U.S. Department of Health and Human Services region III

The Affordable Care ActThe Affordable Care Act

2013

• Review the Patient Protection and Affordable Care Act (2010)

• Coverage Accomplishments and Cost Savings• Health Insurance Marketplace• Medicaid Expansion• Engaging in the Enrollment Process• Next steps for advocacy and action

ObjectivesObjectives


In March 2010, President Obama signed the Affordable Care Act into law

The Health Care LawThe Health Care Law


3.1 million young adults have gained insurance through their parents’ plans

6.1 million people with Medicare through 2012 received $5.7 billion in prescription drug discounts

34 million people with Medicare received a free preventive service

71 million privately insured people gained improved coverage for preventive services

105 million Americans have had lifetime limits removed from their insurance

Affordable Care Act – Coverage Accomplishments

Affordable Care Act – Coverage Accomplishments


Critical Need for Health ReformCritical Need for Health Reform

• 48.6 million uninsured Americans

• $3 trillion spent annually on healthcare

• 17.9 % of our economic output tied up in the health care system

• Without reform, by 2040, 1/3 of economic output will be tied up in health care

Provides coverage to young adults up to the age of 26

Strengthens Medicare benefits with lower prescription, drug costs for those in the “donut hole” chronic care and preventive care.

Prohibits plans from imposing lifetime and annual limits on the dollar value of benefits, and from rescinding coverage when you get sick.

Affordable Health Care ReviewAffordable Health Care Review


Affordable Care Act Overview

Rein in insurance premiums rates

Prevent denials of coverage, including for pre-existing conditions

Make health insurance affordable for middle class families

Make health insurance affordable for small businesses with tax cuts

Slowest sustained national health spending growth in 50 years• Low growth continuing in 2012 for Medicare and Medicaid

Rate increases fell from 75% in 2010 to 14% so far in 2013

$1 billion returned to consumers last summer • Plans now must spend 80% on healthcare

$4.2 billion recovered in 2012 from anti-fraud efforts – a record high – for a total of nearly $15 billion over the last 4 years, double that of the previous 4 years

Affordable Care Act – Cost Savings

Affordable Care Act – Cost Savings


The Affordable Care Act means better coverage for those who already have health insurance, and more options for those who don’t, including a new way to shop for affordable, high-quality coverage.

What the Affordable Care Act Means to YouWhat the Affordable Care Act Means to You


Highlights To Date

Preventive Services for Women • Historic guidelines for coverage of preventive health care

services• Contraception and contraceptive counseling• Domestic Violence Screening and counseling• Breastfeeding support, supplies and counseling• HIV screening and counseling• HPV testing for women over 30• Well-woman visits• STD counseling• Screening for gestational diabetes

The Health Insurance MarketplaceThe Health Insurance Marketplace

The Marketplace (or Exchange) • Place for qualified individuals and employers to directly compare

private health insurance options Known as Qualified Health Plans (QHPs)

• Comparison on the basis of price, benefits, quality, and other factors• DHHS that premiums will be about 16% lower than expected

Each state can choose to • Create and run its own Marketplace• Partner with the Federal government to run some Marketplace

functions• Have a Marketplace established and operated by the Federal

government

Introduction to the MarketplaceIntroduction to the Marketplace

15Health Insurance Marketplace 10112/11/2013

The Marketplace initial open enrollment period began October 1, 2013, and ends March 31, 2014

Marketplace eligibility requires you to:• Live in its service area, and• Be a U.S. citizen or national, or • Be a non-citizen who is lawfully present in the U.S. for the entire

period for which enrollment is sought• Not be incarcerated

Can apply for Marketplace if pending disposition of charge Can apply for Medicaid/CHIP at any time

Eligibility and Enrollment in the Individual Marketplace

Eligibility and Enrollment in the Individual Marketplace

1612/11/2013 Health Insurance Marketplace 101

10 Essential Benefits10 Essential Benefits


Engaging in the Enrollment ProcessEngaging in the Enrollment Process

Health Insurance Marketplace 10112/11/2013

Easy Convenient Streamlined

In Person

By Mail

By Phone Online

How to ApplyHow to Apply

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www.Healthcare.gov Paper Applications National Marketplace Toll-Free Call Center

for Federally Facilitated and State-Partnership Marketplaces • 1-800-318-2596 (TTY 1-855-889-4325)

• Customer service representatives - 24/7• English and Spanish

Language line for 150 additional languages In Person Assistance

• Navigators – Virginia Poverty Law Center, Inc & Advanced Patient Advocacy, LLC*

• Trained Enrollment Assisters• Agents and Brokers

Open EnrollmentOpen Enrollment


http://www.healthcare.gov/

Looking for assistance in person? You can find information online and via text using the Get Covered Locator.

Text: Consumers without access to the internet can also get access to this resource by texting "LOCATOR" and their ZIP code to 877877.

Other digital tools that are available for public officials to work with navigators, in-person assistors and CAC's include:Online: Visit this page: http://getcoveredamerica.org/locator/ enter your ZIP code and you will see a list of Navigators, In-Person Assisters, Community Health Centers, and/or Certified Application Counselors within 25 miles. A map will display where these assisters are located to make it easier for consumers to know who is the most convenient local expert to go to. Consumers will be given a phone number and a website, when available, to use to get more information and to setup an appointment. You can also print this list of assisters out, or have it emailed or texted to them.

CONT.CONT.


http://getcoveredamerica.org/locator/

Medicaid Expansion

Health Insurance Marketplace 101 22

In 2011, 20% of African Americans were uninsured

At least 59% of uninsured African Americans with incomes below the Medicaid expansion limit reside in states not expanding Medicaid

African-Americans are at risk of facing coverage gaps due to states choosing not to expand Medicaid

State decisions impact people of color, but disproportionately affect Black Americans

ImplicationsImplications


Research has shown that uninsured Americans are demographically diverse.

Certain constituency groups such as young adults, Latinos, African-Americans, and lower-income people are more likely to be uninsured.

Women not only make up 45 percent of the uninsured, but are overwhelming known as trusted messengers for advice on health coverage across consumer groups.

“She Knows” Campaign“She Knows” Campaign


Enroll America’s Women’s Outreach has launched the “She Knows” Campaign geared to educate and engage uninsured women. The “She Knows” campaign will serve as a call for women to learn more about their stake in the new health coverage options, encourage them to recognize their role as trusted messengers, and gain training on how to effectively amplify their voice to help spread the word to other uninsured Americans.



Women’s Stake in Coverage: Key Benefits for Women under the New Health Care Law Women can't be charged more for health coverage than men and insurance companies can no longer deny coverage to women due to pre-existing conditions such as breast cancer or being pregnant. Free preventive health care for women means 22 covered preventive benefits are now included in all plans, like mammograms, well-woman visits, ovarian

cont.



cancer screening, screening for diabetes, and more. You will also be able to get your FDA approved birth control at no out-of-pocket costs, as the full cost will be covered by your monthly premium.

Women’s choice of doctors is protected, which means you can choose any primary care provider, OB-GYN, or pediatrician in your health plan's network without a referral.

Young adults can stay on their parent’s plan until age 26. cont.



We know women want to feel secure that they know the information before they share it. Therefore, this program will provide key messages, guidance, and tools to help them lead the conversations with their families, friends, and communities.

In order to effectively educate, engage, and enroll women in health coverage, Enroll America is partnering with allied organizations to provide key messages, resources, tools, and support to women messengers and consumers.



The main goals of the “She Knows” program: Educate uninsured/insured women about how they stand to benefit from the new health coverage options; Engage women as key messengers by providing ongoing webinar trainings and resources; Provide women support by connecting them to Enroll America staff on the ground and partner organizations working on outreach and enrollment;



And, Creatively reach women who can share key messages within their own communities

The programmatic outreach and support the “She Knows” campaign will provide:

Monthly webinars that educate and support women on their role in the campaign;

Earned media events to amplify women’s voices as trusted messengers;

Storytelling tools and resources for women to share their stories during the enrollment process.



Champion for Coverage• Opportunities to provide education and outreach• Linkage to the Health Insurance Marketplace• Link: http://marketplace.cms.gov/help-us/champion.html

Certified Application Counselor*• Receive training to assist people in applying for coverage through

the Health Insurance Marketplace• Link: http://marketplace.cms.gov/help-us/cac.html

Direct Legislative Action• Fall and Winter Legislative Sessions• Advocate for Medicaid Expansion

Action Items: What Chapters Can DoAction Items: What Chapters Can Do


http://marketplace.cms.gov/help-us/champion.html

http://marketplace.cms.gov/help-us/cac.html

Host a forum

Partner with Libraries, Community Centers and Churches to host enrollment activities

Partner with Federal Qualified Health Centers (FQHCs) to volunteer at enrollment activities

Canvassing your communities

Action Items: What Chapters Can DoAction Items: What Chapters Can Do



October 1, 2013 – Open Enrollment December 2013 Goal – Website Up Again December 23, 2013 – Cut off to receive

coverage by January 1, 2014 January 1, 2014 – Coverage Begins,

Expanded Medicaid Coverage March 31, 2014 – Open Enrollment Closes

The Health Insurance Marketplace Key Dates

The Health Insurance Marketplace Key Dates

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AnnouncementsAnnouncements


• Special Breakout on the ACA During Delta Days in the Nation’s Capital February 1-4, 2014

• Upcoming Webinars throughout 2014 ACA for entrepreneurs ( how small businesses are

affected) note: small businesses have been given one year delay

Medicare beneficiaries (geared toward Delta Dears) Caring for your family (spouse, child, parent)

ACA for health professionals


Stay Connected• Sign up to get email and text alerts at

HealthCare.gov/subscribe• Updates and resources for partner organizations are

available at Marketplace.cms.gov• Twitter@HealthCareGov • Facebook.com/Healthcare.gov• Delta Sigma Theta Web-site Members Only Section,

National Social Action Commission Link

Need more information? Need more information?

37

mailto:Twitter@HealthCareGov

National Social Action Commission [email protected]

Delta Sigma Theta Sorority, Inc. ContactDelta Sigma Theta Sorority, Inc. Contact


COBRA: In 1986, the United States Congress passed the Consolidated Omnibus Budget Reconciliation Act; (COBRA). This bill requires that most group health plans to provide a temporary continuation of group health coverage that otherwise might be terminated. COBRA also requires continuation coverage to be offered to covered employees, their spouses, and their dependent children when group health coverage would otherwise be lost due to certain specific events. Those events include the death of a

Glossary Glossary


Covered employee, termination or reduction in the hours of a covered employee’s employment for reasons other than gross misconduct, divorce or legal separation from a dependent status (and therefore coverage) under the plan.Health Insurance Marketplace: Commonly referred to as “the Marketplace”. Marketplace is sometimes referred to as ‘Health Insurance Exchanges’, is a new way to shop for quality heath coverage. Through the Marketplace or exchange, you can find affordable

CONT.CONT.


Options for health insurance coverage. Eligibility for coverage options is determined through submission of an application (either online, paper, through in-person assisters/navigators, over the phone) that is income-based. The marketplace allows you to compare your coverage options side-by-side and enroll is a plan that is best for you.Medicaid: A national public health insurance program that is administered by a state but also funded through the Federal government. Medicaid12/11/2013 Health Insurance Marketplace 101 41

Is specifically for low-income families and children, pregnant women, the elderly, persons with disabilities, and in some states, other adults. While the Federal government provides a portion of the funding for Medicaid and sets program guidelines, states have flexibility in how they choose to run their individual programs. Essentially, Medicaid will vary state-by-state and may be referred to by different names.Medicare: The Patient Protection and Affordable Care Act [P.L. 111-148], commonly referred to as

CONT.CONT.


‘Obama care’ or the ‘Affordable Care Act’ is the health care law that expands the affordability quality and availability of private and public health insurance through consumer protections, regulations. Subsidies, taxes, insurance exchanges, and other reforms. It is important to note that this is the unofficial name for the health care law.Premium: Health insurance premium is the amount the policy-holder or his sponsor (e.g. an employer) is responsible to pay to the health plan to purchase

CONT.CONT.


health coverage. Health insurance premiums are paid monthly to a health plan to provide health coverage. Including paying for health-related services such as doctor visits, hospitalizations, and medications.TRICARE: A national health care program that is administered by the Defense Health Agency (DHA) for active-duty and retired uniformed services members and their families. TRICARE is a major component of the Military Health System that provides quality health care services to support

CONT.CONT.


Military operations.Families USA. 2013 Federal Poverty Guidelines. Retrieved December 9, 2013 from: http://www.familiesusa.org/resources/tools-for-advocates/guides/federal-poverty-guidelines.htmlHealthcare.gov. Retrieved December 9, 2013 from: https://www.healthcare.gov/Kaiser Family Foundation (KFF). Interactive Subsidy Calculator: Retrieved December 9, 2013 from: http://kff.org/interactive/subsidy-calculator/KFF The Requirement to Buy Coverage Under the Affordable Care Act. Retrieved December 9, 2013 from: http://kff.org/infographic/the-requirement-to-buy-coverage-under-the-affordable-care-act/Obama care Facts. Dispelling the myth. Retrieved from: http://obamacarefacts.com/obamacare-facts.phpUnited States Department of Labor. An employees guide to health benefits under COBRA. Retrieved December 9, 2013 from: http://www.dol.gov/ebsa/pdf/cobraemployee.pdfTricare.mil. Retrieved December 9, 2013 from: http://www.tricare.mil/

REFERENCES REFERENCES


http://www.familiesusa.org/resources/tools-for-advocates/guides/federal-poverty-guidelines.html

Sources

U.S. Department of Health and Human Services, Healthcare.gov

Enroll America

the affordable care act

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