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The Affordable Care Act: Implications for the Health Care Landscape

The Affordable Care Act: Implications for the Health Care Landscape. Presented by Deb Polun Director of Government Affairs/Media Relations Community Health Center Association of Connecticut. First… a bit about Federally-Qualified Health Centers (FQHCs). What is a community health center?

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The Affordable Care Act: Implications for the Health Care Landscape

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  1. The Affordable Care Act:Implications forthe Health Care Landscape Presented by Deb Polun Director of Government Affairs/Media Relations Community Health Center Association of Connecticut

  2. First…a bit about Federally-Qualified Health Centers (FQHCs)

  3. What is a community health center? Also called “federally qualified health centers,” they provide medical, dental and behavioral health services to people regardless of ability to pay. Background

  4. Community health centers also provide “enabling services,” such as transportation, translation and referrals to specialists. They are recognized and partially funded by the federal government. State governments also provide additional funding. Background

  5. Community health centers are located in urban and rural areas across the country. Nationally in 2012: • 1159 community health centers (8500+ sites) • 21 million patients Background

  6. 14 separate health centers Over 200 sites Over 340,000 patients Over 1.6 million visits Background

  7. In Connecticut: • 58% of patients are on Medicaid • 23% are uninsured • About 6% are on Medicare • 29% are best served in a language other than English Background

  8. Why did the federal government think we needed health reform? Patient Protection and Affordable Care Act

  9. Improving the health of Americans • Integrating health care • Controlling health care costs The ACA is aimed at:

  10. Signed into law on March 23, 2010 • Immediately challenged by a number of states and the National Federation of Independent Business Patient Protection and Affordable Care Act

  11. US Supreme Court consolidated cases and ruled most provisions constitutional on June 28, 2012 • Since its enactment, the US House of Representatives has made 42 efforts to repeal its enactment Patient Protection and Affordable Care Act

  12. Highlights of the ACA

  13. All individuals must have a certain level of health insurance coverage or else pay a fee • Effective 2014 • Penalty in 2014 is $95/year or 1% of income, whichever is greater. Individual Mandate

  14. Provisions will be put into place to make the purchase of health insurance easier and more affordable: • Changes to commercial insurance • Help from employers • Expansion of Medicaid

  15. Provisions will be put into place to make the purchase of health insurance easier and more affordable: • Help from the government • Establishment of insurance marketplaces (“Exchanges”)

  16. Young adults up to age 26 can be carried on their parents’ insurance plans (2010). • Individuals with pre-existing conditions will not be denied coverage or charged extra (kids: 2010; adults: 2014). Commercial Insurance Provisions:

  17. Insurance companies cannot cancel coverage just because the enrollee gets sick (2010). • Preventive care, such as vaccinations and screenings, will be covered (2010). • Women cannot be charged more than men (2014). Commercial Insurance Provisions:

  18. 80-85% of premium dollars have to go to health care – or they must refund the extra (2011). • Lifetime limits will be eliminated (started in 2010, full implementation in 2014). Commercial Insurance Provisions:

  19. Large employers will be required to either cover their workers or pay a fine (originally 2014, now delayed to 2015). • Small businesses will not be required to provide coverage to their employees, but if they do, they can receive a tax credit (2010). Impact on Employers:

  20. States can expand Medicaid to all individuals up to 138% of FPL (2010). • CT has decided to expand Medicaid (HUSKY D). For a single adult, annual income limits will go from ~$6093 to ~$15,202. This will capture ~40,000 people. Changes to Medicaid:

  21. Individuals and families may qualify for assistance from the federal government in purchasing health insurance (2014). Help from the Government:

  22. CT is setting up a state health insurance exchange, which will be a marketplace for individuals and families to purchase health insurance (2014). Health Insurance Exchange: OCTOBER 1, 2013

  23. Preventive care is now included, including an annual wellness visit (2011). • Additional help with prescriptions has been added and the donut hole will be closed by 2015. • New initiatives focus on community-based care, transitions from hospitals (2011). Changes to Medicare:

  24. $11 Billion in new health center funding over 5 years • New health centers • Expanded capacity • Infrastructure improvements Impact on Health Centers (Nationally):

  25. $1.5 Billion to National Health Service Corps to help place primary care providers in shortage areas. This includes every federally-qualified health center! Impact on Health Centers:

  26. $150 Million to all 330-funded FQHCs to assist with outreach and enrollment for the Exchanges • Almost $1.6M for CT health centers • 72 Certified Application Counselors (CACs) currently doing enrolling at health centers; 39 additional will be online within a few weeks. Impact on Health Centers:

  27. Credit: http://www.nachc.org

  28. Questions?

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