The Affordable Care Act

1. The Affordable Care Act A Presentation by the Delta Sigma Theta Sorority, Inc. National Social Action Commission Dr. Paulette Walker, National President Rev. Dr. Gwendolyn Boyd, 22nd National President, Co-Chair, National Social Action Commission Carla Harris, Co- Chair, National Social Action Commission Committee-- Dr. Kwamme Anderson, Shavon Arline Bradley, Michelle Barnes Russell Health Insurance Marketplace 101

2. 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 Health Insurance Marketplace 101

3. Presenters Dr. Paulette C. Walker, 25th National President Carla Harris, Co-Chair, National Social Action Commission Rev. Dr. Gwendolyn E. Boyd, 22nd National President, Co-Chair, National Social Action Commission Melanie Campbell, President and CEO, National Coalition on Black Civic Participation Tamia Booker, Chief of Staff, U.S. Department of Health and Human Services region III Ashley Allison, Constituency Engagement Director, Enroll America Shavon Arline Bradley, Director of Health Programs NAACP Health Insurance Marketplace 101

4. The Affordable Care Act 2013

5. Objectives • 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 Health Insurance Marketplace 101

6. The Health Care Law In March 2010, President Obama signed the Affordable Care Act into law Health Insurance Marketplace 101

7. Affordable Care Act – Coverage Accomplishments • 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 Health Insurance Marketplace 101

8. Critical 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

9. Affordable Health Care Review • 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. Health Insurance Marketplace 101

10. 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

11. Affordable Care Act – Cost Savings • 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 Health Insurance Marketplace 101

12. What the Affordable Care Act Means to You • 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. Health Insurance Marketplace 101

13. 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

14. The Health Insurance Marketplace

15. Introduction to the 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 Health Insurance Marketplace 101

16. Eligibility and Enrollment in the Individual Marketplace • 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 Health Insurance Marketplace 101

17. 10 Essential Benefits • Hospital care • Doctors’ office visits • Emergency Room visits • Prescription drugs • Maternity & newborn care • Rehabilitative services & devices • Laboratory services • Preventive services • Mental health care • Pediatric services Health Insurance Marketplace 101

18. Engaging in the Enrollment Process

19. How to Apply • Easy • Convenient • Streamlined By Mail In Person By Phone Online Health Insurance Marketplace 101

20. Open Enrollment • www.Healthcare.gov • Paper Applications • National Marketplace Toll-Free Call Centerfor 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 Health Insurance Marketplace 101

21. CONT. • 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. Health Insurance Marketplace 101

22. Medicaid Expansion Health Insurance Marketplace 101

24. Implications • 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 Health Insurance Marketplace 101

25. “She Knows” Campaign • 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. Health Insurance Marketplace 101

26. “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. Health Insurance Marketplace 101

27. “She Knows” Campaign 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. Health Insurance Marketplace 101

28. “She Knows” Campaign • 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. Health Insurance Marketplace 101

29. “She Knows” Campaign • 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. Health Insurance Marketplace 101

30. “She Knows” Campaign 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; Health Insurance Marketplace 101

31. “She Knows” Campaign • 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. Health Insurance Marketplace 101

32. How can Delta Sigma Theta Sorority, Inc. Chapters assist? Health Insurance Marketplace 101

33. Action Items: What Chapters Can Do • 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 Health Insurance Marketplace 101

34. Action Items: What Chapters Can Do • 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 Health Insurance Marketplace 101

35. The Health Insurance Marketplace Key Dates • 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 Health Insurance Marketplace 101

36. Announcements • 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 Health Insurance Marketplace 101

37. Need more information? • 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 Health Insurance Marketplace 101

38. Delta Sigma Theta Sorority, Inc. Contact • National Social Action Commission socialactioncommittee@deltasigmatheta.org Health Insurance Marketplace 101

39. Glossary • 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 Health Insurance Marketplace 101

40. CONT. 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 Health Insurance Marketplace 101

41. 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. Medicaid Health Insurance Marketplace 101

42. CONT. 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 Health Insurance Marketplace 101

43. 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 Health Insurance Marketplace 101

44. 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 Health Insurance Marketplace 101

45. REFERENCES 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.html • Healthcare.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.php • United States Department of Labor. An employees guide to health benefits under COBRA. Retrieved December 9, 2013 from: http://www.dol.gov/ebsa/pdf/cobraemployee.pdf • Tricare.mil. Retrieved December 9, 2013 from: http://www.tricare.mil/ Health Insurance Marketplace 101

46. Sources • U.S. Department of Health and Human Services, Healthcare.gov • Enroll America