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Affordable Care Act Policy and Implementation Briefing The Retail Alliance July 26, 2012

H EALTH C ARE.GOV. Affordable Care Act Policy and Implementation Briefing The Retail Alliance July 26, 2012. Joanne Corte Grossi, MIPP Regional Director U.S. Department of Health & Human Services, Region III Pennsylvania, Delaware, District of Columbia, Maryland, Virginia, West Virginia.

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Affordable Care Act Policy and Implementation Briefing The Retail Alliance July 26, 2012

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  1. HEALTHCARE.GOV Affordable Care ActPolicy and Implementation Briefing The Retail AllianceJuly 26, 2012 Joanne Corte Grossi, MIPP Regional Director U.S. Department of Health & Human Services, Region III Pennsylvania, Delaware, District of Columbia, Maryland, Virginia, West Virginia

  2. Critical Need for Health Reform 51 million uninsured Americans $2.6 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 tied up in health care

  3. 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

  4. Affordable Care Act Overview • 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 free preventive care • Prohibits plans from imposing lifetime and annual limits on the dollar value of benefits, and from rescinding coverage when you get sick

  5. Affordable Care Act Overview • Expanded Medicaid Coverage • to include individuals with incomes up to 133 percent of the poverty level

  6. Highlights in 2010 • Establishment of State and National Temporary High Risk Pools • HHS running program • Extend coverage to young adults up to age 26 • 66,000 young adults have benefited to date • Provide tax credits to small employers with 25 FTE employees and average annual wages less than $50k that purchase health insurance • 35% for profit; 25% non-profit • 50% in 2014 for profit companies • 127,000 small businesses eligible in VA

  7. Highlights in 2011 • Eliminate cost-sharing for Medicare covered preventive services that are recommended (rated A or B) by the U.S. Preventive Services Task Force • 837,645 Medicare enrollees in VA received free preventive services • Require pharmaceutical manufacturers to provide a 50% discount on brand-name prescriptions and a 14% discount on generic prescriptions for those who hit the Medicare Part D donut hole • 84,977 Medicare enrollees in VA received discounts

  8. Highlights in 2011 • Holds Insurance Companies Accountable for Unreasonable Rate Hikes – Requires health insurance companies to submit justification for all requested premium increases over 10% • Ensures value for premium payments – Requires plans in the individual and small group market to spend 80 percent of premium dollars on medical services, and plans in the large group market to spend 85 percent

  9. Highlights in 2011 • Increases the number of Primary Care Practitioners – Provides new investments to increase the number of primary care practitioners, including doctors, nurses, nurse practitioners, and physician assistants • Projected to place more than 16,000 health professionals over next 5 years • Community Health Centers - Increases funding for Community Health Centers to allow for nearly a doubling of the number of patients seen by the centers over the next 5 years • 147 community health centers in VA eligible for funding • 273,431 patients treated in 2010 at federally supported health centers in VA

  10. Supreme Court Opinion On June 28, 2012, the United States Supreme Court upheld the law as constitutional The Supreme Court ruled that the Medicaid expansion provision is optional for states

  11. Moving Forward • Exchange Implementation • Exchange certified by January 1, 2013 • State partnership model available • HHS will operate exchange for States that do not elect to operate or do not receive approval to do so by January 1, 2013 • Over next few months, HHS is hosting forums with states to provide assistance and address questions

  12. Highlights for Small Businesses Starting in 2014, all individuals will be required to have health insurance More than 96 percent of employers with 50 or more employees already offer their employees health insurance coverage Businesses with fewer than 50 full-time employees are exempt from any requirement to contribute towards employee health coverage

  13. Highlights for Small Businesses • In 2014, small businesses can participate in Exchanges as part of the Small Business Health Options Program (SHOP) • More affordable coverage because of access to larger risk pools • Small businesses will have increased bargaining power and reduced administrative costs—just like large companies • Workers that want to switch jobs or start their own small business will no longer be held back by fear of losing access to affordable coverage

  14. Affordable Care Act website –www.healthcare.gov Health IT website – www.healthit.gov Center for Consumer Information & Insurance Oversight website – http://cciio.cms.gov Affordable Care Act Spanish website – www.cuidadodesalud.gov Resources:

  15. Thank you! Contact: joanne.grossi@hhs.gov

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