Prepared for Health Care for America Now! – Michigan By Randy Block, Director, Michigan Unitarian Universalist Social Ju

1. The Patient Protection & Affordable Coverage Act of 2010 as Amended (by the Health Care and Education Affordability Reconciliation Act) How Its Provisions Address Our PrinciplesSpring, 2010 Prepared for Health Care for America Now! – Michigan By Randy Block, Director, Michigan Unitarian Universalist Social Justice Network

2. Objectives • Reveal some health reform myths • Identify health reform principles • Show how new law addresses principles

3. Health Reform Principles • Comprehensive Benefits • Universal Coverage • Affordable • Cost Effective/Adequate Revenues • Acceptable Quality • Equity in Access • Choice of Providers

4. Myths About Health ReformSource: FactCheck.org, March 19, 2010 • MYTH #1: Congress passed “government run health care”. • FACT: New system builds on current health insurance system. • MYTH: #2: Americans premiums will go up. Americans premiums will go down. • FACT: CBO indicates most people’s premiums won’t change significantly. • MYTH #3: The bill cuts Medicare by $500 billion. • FACT: No benefit reductions, but cuts Medicare Advantage overpayments. • MYTH #4: Medical Malpractice is the biggest driver of health care spending. • FACT: CBO reported that total spending could be cut by only about 0.5%.

5. Comprehensive Benefits • No plans can charge for preventive services (2010). • Creates voluntary public, long term care policy (2011). • Medicaid attendant care program for persons with disabilities (2011). • HHS Secretary to define 4 comprehensive benefit packages. Limits cost sharing for low & middle income (2014).

6. Universal Coverage • Lifetime coverage limits prohibited (2010). • No pre-existing condition denials for children (2010). • If 26 or younger, covered on parents’ policies (2010). • High risk pool for people with pre-existing conditions (2010). • Medicare preventive care provided at no charge (2011).

7. Universal Coverage • Health insurance exchanges open for buying insurance (2014). • Adult policies can’t be denied due to health or pre-existing conditions (2014). • Legal immigrants eligible for cost sharing via exchange (2014). • State can offer plan for uninsured up to 200% poverty (2014). • CBO Report: Plan to cover 32 million additional people.

8. Affordability • Small business tax credits (35% of premiums) to purchase insurance (2010). Rises to 50% by 2014. • Temporary employer insurance for employees 55+ (2010). • Close Medicare prescription donut hole (2010 – 2020). • Expand community health centers & school clinics (2011).

9. Affordability • Annual deductibles caps: $2,000/individual & $4,000/family (2014). • Annual out of pocket cost caps for small business plans: $2,000/individual and $4,000/family (2014). • Expand Medicaid to individuals up to 133% of poverty. Fed’s pay 100% of costs 2014-16; phase down to 90% by 2020. • Premium and cost sharing credits for individuals and families between 100% and 400% of poverty. • Cut Medicare Part B premium costs for low-income (2014).

10. Cost Effectiveness/Revenues • Policies must spend 80-85% revenues on medical care (2010). • CBO report: Law projected to cost $960 billion over 10 years and reduce national debt by $138 billion by 2020. To cut $1.2 trillion from national deficit between 2020 & 2030. • Wellness program grants for small employers and Medicare programs create individual prevention plans (2011). • New annual fees on pharmaceutical manufacturers (2011).

11. Cost Effectiveness/Revenues • High income families to pay 3.8% on investment income (2013). • All persons (but lowest income) required to buy health insurance or pay penalties (2014). • Employers with 50+ employees pay fines if don’t cover their employees or provide unaffordable insurance (2014). • Employers pay excise tax on high cost health plans (2018).

12. Acceptable Quality • Establish health insurance ombudsman program (2010). • Begin a national strategy to improve health care quality, patient outcomes and population health (2011). • Link provider payments to quality outcomes (2012). • Require fast food/vending machine nutrition labeling (2012).

13. Equity in Health Care Access • Health professional cultural competence training (dates vary). • Requires data collection by race, sex, primary language, disability and rural status; research to reduce disparities (2012). • Legal immigrants eligible for financial assistance in the exchange (2014). • Prohibits health discrimination by gender (2014). • Abortion payments beyond Hyde amendment not permitted (2014).

14. Choice of Providers • Consumers allowed to choose primary care doctor under new plans (2010). • Medicare to provide more incentives to health professionals to serve low and moderate income people (2010). • Higher reimbursement for primary care doctors and other providers to serve Medicaid populations. (2013 & 2014).

15. Other Insurance Reforms • HHS website with insurance information by state (2011). • Demonstration grants to evaluate tort reform options (2011). • Medicare Advantage plans lose subsidies but could gain bonuses for high quality (2012). • Create non-profit health insurance co-ops in all states by 2013.

16. Concluding Remarks • The 2010 Affordable Health Care for America health reform law is not a government run health system, but regulates and expands existing private and public insurance systems. • The new law has many provisions that address reform principles of making health coverage more comprehensive, affordable, universal, cost-effective, higher quality, allowing more provider choice and enhancing health equity. • The law is projected to expand coverage to 32 million people. • Health advocates need to be informed and vigilant to ensure that reform is wisely implemented at both federal and state levels.