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The Affordable Care Act (ACA) and Health Care for People with Disabilities

The Affordable Care Act (ACA) and Health Care for People with Disabilities . Presented by Lisa D. Ekman Director of Federal Policy, Health & Disability Advocates DC Advocacy Partners is the District Class May 9., 2104. What this presentation will cover:. Why was the ACA needed ?

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The Affordable Care Act (ACA) and Health Care for People with Disabilities

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  1. The Affordable Care Act (ACA)and Health Care for People with Disabilities Presented by Lisa D. Ekman Director of Federal Policy, Health & Disability Advocates DC Advocacy Partners is the District Class May 9., 2104

  2. What this presentation will cover: • Why was the ACA needed ? • What was actually in the ACA? • How is implementation going? • What barriers still exist to people with disabilities to getting quality care?

  3. Why was the ACA needed? • 55 million people did not have any health insurance • Individual health insurance policies were not covering what people needed • Health care costs were increasing

  4. 55 million people uninsured Why does that matter? People’s health matters AND • Health care related bankruptcies • No preventative care • Everyone pays more when uninsured get treatment

  5. Private Insurance Problems • Inadequate benefits/insurance policies • Lack of access for people with pre-existing conditions • Not affordable for people with any illness • Caps on what policies would spend • Canceled policies when people need them

  6. Health Care Costs • The United States spends much more per person than other countries on health care but doesn’t get good outcomes • Almost 1 in 5 dollars created by our economy goes toward health care costs • The aging of the baby boomers will cause that share to increase

  7. The ACA Had 2 Main Goals • Expand access to affordable comprehensive coverage AND • Help control health care costs

  8. How the ACA Expands Access to Coverage How do people get health insurance? • Private Insurance • Employer Sponsored • Individual Market • Public Insurance • Medicare • Medicaid

  9. How the ACA Expands Access (cont) • Private insurance problems were mostly in the individual market – no pooling of risk • Some people could not get a policy at all – pre-existing condition ban • For some it was too expensive if had any health issues • Rescission – dropping people when sick

  10. How the ACA Expands Access (cont) • The ACA created new “risk pools” – • To make the individual market more like the employer market • They are called marketplaces – some states have their own and some use the Federal one • Individual and Employer Mandates

  11. How the ACA Expands Access (cont) The ACA reformed private insurance requirements: • Ban on considering pre-existing conditions • Cannot charge people more for premiums because sick • No annual caps/no lifetime caps • Cannot drop people when they get sick • All policies must cover essential health benefits

  12. What Are Essential Health Benefits (EHB)? • ambulatory patient services; • emergency services; • hospitalization; maternity and newborn care; • mental health and substance use disorder services, including behavioral health treatment; • prescription drugs; • rehabilitative and habilitative services and devices; • laboratory services; • preventive and wellness services and chronic disease management; • and pediatric services, including oral and vision care.

  13. Other Private Insurance Reforms • Coverage for dependent children up to age 26 • Community Rating – everybody pays same regardless of health status or gender • Increasing transparency – insurance companies have to do a better job of telling people what is covered under the policies • Online information so people can make apple to apple comparison

  14. How the ACA Makes Coverage Affordable Subsidies and Limits on Costs • People making between 138% of FPL and 400% of FPL can get help paying for their health insurance premiums • There is a cap on the total amount people must spend per year on health care

  15. How the ACA Expands Coverage (cont) Medicaid Expansion • Every state was supposed to offer Medicaid to: • Adults whose income was up to 138% of the federal poverty line • Did not have a limit on resources like other Medicaid eligibility categories • Would include EHB services as required services

  16. How the ACA Expands Care (cont) Access to Home and Community Based Services Under Medicaid • Home and Community-Based Services State Plan Option • Community First Choice • State Balancing Incentive Payments Program • Money Follows the Person (MFP)

  17. How is implementation going? Private Health Insurance • Every state is offering private insurance that meets the new requirements. • Most states are participating in the Federally Facilitated Marketplace or FFM but some states are running their own • DC has its own marketplace • More than 8 million people have insurance through the Marketplaces!

  18. How is implementation going? Medicaid • 27 states have expanded Medicaid • 5 states are still considering it • 19 have said they won’t move forward at this time • About 3.9 million people insured through Medicaid expansion

  19. Barriers for People with Disabilities Some benefits are still not adequate • Can’t have annual spending caps but can have limit on the number visits or number or types of devices • Prescription coverage • Durable medical equipment like wheelchairs • Supplies • Habilitation

  20. Barriers for People with Disabilities (cont) With private insurance there are still: • Some policies that don’t include enough or the right specialists • Some doctors offices that are not accessible • Some insurance policies might discriminate against people with certain conditions

  21. Barriers for People with Disabilities (cont) In Medicaid: • Some people can’t get the long-term services and supports (LTSS) they need • Some programs are expiring or haven’t been taken up: • Money Follows the Person expires in 2016 • Only 8 states took up Community First Choice option

  22. Discussion

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