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Healthcare Reform and Young Adults

Healthcare Reform and Young Adults . By Abhinav Gupta Doctors for America. Overview. 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?

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Healthcare Reform and Young Adults

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  1. Healthcare Reform and Young Adults By Abhinav Gupta Doctors for America

  2. Overview • 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 itis important for you to have insurance? http://www.office.com

  3. Current Problems: Statistics Of uninsured, 1/2 have problems “paying medical bills” Of uninsured, 2/3 receive “no usual source of care” Of uninsured, 1/4 carry medical debt Of uninsured, 2/3 skipped needed care

  4. Reasons for Lack of Health Insurance • Cost • Expensive, low salaries • Ineligible for employer-sponsored health insurance • Part-time, unemployment • No insurance after high school/college graduation • “Young Invincibles” • Unnecessary care?

  5. Young Invincibles: Myth or Fact? • 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

  6. The Affordable Care Act of 2010 • 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

  7. What’s It Do For Us? http://www.futurity.org

  8. Provisions for Young Adults • 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

  9. Insurance Reform and Expansion Until Age 26 • 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

  10. Insurance Regulation • 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%)

  11. Medicaid Expansion • 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 http://www.iamempowered.com http://www.healthcare.gov

  12. Changes in Insurance Markets • 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

  13. Subsidized Individual Private Insurance • 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

  14. Changes in College Plans • 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 http://www.office.com

  15. Individual Mandate • 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 http://www.hetemeel.com

  16. Timeline • 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

  17. Examples: 2009 vs. 2014 Mary 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) 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

  18. So Is Everything Fixed? • 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

  19. What Can You Do? GET INSURED, STAY INFORMED, AND STAY HEALTHY! Check out www.gettingcovered.com for more information. www.office.com

  20. Spread the Word! We need your help to spread the message about healthcare reform! To learn more about reform or to get involved, please visit: www.drsforamerica.org Contact us: Doctors for America info@drsforamerica.org 202-481-8219

  21. References • “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.

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