The New Health Reform Law: What’s Really In There?

1. The New Health Reform Law:What’s Really In There? www.drsforamerica.org

2. What Is This?

3. Skyrocketing Costs • Health care for the average American family $16,771 per year = a second house payment • Costs are rising 200-300% faster than wages or inflation

4. Uninsured/Underinsured Americans • 49 million Americans uninsured • 14,000 more lose health insurance coverage every day • 72 million Americans have coverage too flimsy to provide protection from major expenses 54,000,000 lives 47,000,000 lives

5. Economic Drag • 5 businesses drop health benefits for employees every hour • 50% of bankruptcies related to medical expenses • Looming Medicare bankruptcy in 2019

6. Legislative Action - America Divided by Fear and Politics • March 2009: Federal legislators make health care reform a top priority • August 2009: Raucous legislative town halls, divisive messaging begins • Spring 2009-Spring 2010: Twisted legislative path in the media/public spotlight • March 2010: Final health care reform legislation passes the US House and Senate, signed into law

7. The Patient Protection and Affordable Care Act of 2010

8. What’s Really In The New Law? • Expanded coverage • Improved affordability of insurance • Improved/increased insurance regulation • Shared responsibility • Efforts to control long-term costs • Emphasis on prevention/primary care • Efforts to improve effectiveness/value of medical care delivered • Support to expand training for the medical professional workforce we need

9. Expanding Coverage 30 million more Americans insured • Expansion of Medicaid eligibility to 133% of poverty – approx $29K for a family of four • Financed 100% by federal money for first two years, then 90% match for all states • Subsidies/Tax Credits for individuals/small businesses to buy insurance in a new “regulated market-place” or “Exchange”

10. State Health Insurance Exchanges Regulated Marketplaces or “Supermarkets for health insurance” • Private insurers offer plans to American consumers – same as members of Congress • Insurance companies compete for business on more level playing field - market principles work better • Government regulates participating insurers, sets up a “minimum benefit” package • Open to individuals without health insurance/small business employees/some employees who can’t afford insurance offered by their employer • Begins in 2014 – or sooner in some states

11. Affordability Exchange “affordability” subsidies • Sliding scale tax credits to help make premiums more affordable (max. approx. 2-9.5% of income) • Additional subsidies to lower out-of-pocket spending • Eligibility up to 400% of Federal Poverty Level ($43,320 for individuals; $88,200 for family of four)

12. InsuranceRegulation • Prohibits pre-existing condition exclusions/rescissions • Prohibits price discrimination based on gender • Prohibits lifetime limits on $ amounts of coverage, limits annual out-of-pocket costs • Requires that at least 85% of premiums go towards medical care (small group/individual markets – 80%) • Full implementation by 2014

13. Real Stories, Real People: “Irene” • Middle-aged working mother with husband and 3 children • Put off coming to see family doctor despite concerning symptoms – knew about “pre-existing condition exclusions” • Thought she could wait the 6-month “probation period” at her new job • Her cancer caught her first

14. Shared Responsibility What is the “Individual mandate?” Financial penalty/tax, for not having health insurance coverage Is that fair? • Helps eliminate “hidden tax” insured pay when uninsured seek their care in the ER and can’t pay the bill • Difficult to incentivize young/healthy people to buy insurance – like car insurance mandates • “Everyone In” drives down the costs of insurance through larger risk pool - ”wholesale” approach Subsidies should help Americans keep care and coverage affordable when they need that assistance.

15. Shared Responsibility Employer responsibility • Employers not offering coverage pay financial penalty if employees receive public $ for Exchange subsidies or Medicaid coverage • Small businesses have exemptions/subsidies to pool purchasing power – should help keep insurance for owners and their workers more affordable

16. Real Stories, Real People: “Gerald” • Small business owner – 8 employees • Offers health benefits - puts him at competitive disadvantage • Believes healthy employees are essential, employers should play a role • Has to cut benefits every year to turn a profit • Looks forward to this year’s tax credits • Hopes further changes will let him keep benefits affordable and help keep employees healthy

17. Control Long Term CostsGetting More Value For Our Dollar • Invest in Primary Care – the right care at the right time saves lives and money • Pilot projects to innovate in payment/health care delivery - reorient incentives to produce better care Patient-Centered Primary Care Prevention We Are Here

18. Prevention and Wellness Incentivizing prevention and healthy choices • First dollar coverage for preventive care – includes Medicare, all new plans • Insurance premium discounts for participation in wellness programs • Requires chain restaurants to publish calorie/RDA information so consumers can make informed choices. • Breastfeeding accommodations for new mothers Expansion of Public Health

19. Will There Be A Doctor or Nurse to See You? • More doctors in the places that need it most • Increased funding for National Health Service Corps • Community Health Centers funding expanded • Increased funding/space for primary care training • Incentives for nursing instructors/training MORE NEEDED!

20. How Are We Paying For This? New Income • High cost insurance plans (over $27K) will be taxed starting in 2018 • Fees on tanning salons, certain device manufacturers, insurers • Tax on unearned income over $250K • Increased high income earners’ current Medicare tax/premium Cutting payments to insurance companies • Restructures wasteful payments to Medicare Advantage HMOs (saving ~$150 Billion)

21. Cost Analysis By The Non-partisan CBO • Reduce deficit $124 billion over 10 years • Average premiums unchanged for majority of Americans who have employer-based health insurance • Costs should go down for those who buy in the Exchange and who qualify for subsidies

22. Where Do We Go From Here? Fixing the Root of the Problem: COST ≠ VALUE

23. Our Journey Has Just Begun

24. We Hold Our Future In Our Hands

25. What You Can DO • Listen and Learn - Educate yourself • Advocate for affordable health care that prevents illness and delivers better health • Pass it On - Talk with others in your family and community • Become a Health Care Voter - Your voice and your vote are important! Please visit www.drsforamerica.org to get more information

26. Thank you! For more information, visit: www.drsforamerica.org Many thanks to Dr. Evan Saulino who contributed greatly to creating this presentation Most of the photos in this presentation were collected from 123rf.com