Health Care Reform - 2010

1. Health Care Reform -2010 Lawrence Holditch, MD Medical Director Cincinnati Health Department October 27, 2010

2. Health Care Reform - 2010

3. Universal Health Care - History • Theodore Roosevelt – 1912 • Franklin Roosevelt – 1933 • Harry Truman - 1945 • Lyndon Johnson – Medicare and Medicaid - 1965 • Richard Nixon – 1971 • Bill Clinton – 1993 • As of 2009, the United States was the only major industrialized nation without any form of Universal Health Care

4. Uninsured in United States • 40 to 50 Million Uninsured • Lack of Appropriate Primary Care and Screenings • Increased Severity of Health Problems • Inappropriate Use of Emergency Rooms • “Hidden Tax” on Insured, Medicare, and Medicaid

5. Health Care Reform – 2008-09 • Both Major Democratic Contenders included “Health Care Reform” in their Platforms • March 5, 2009: White House Conference • May 2009: Congressional Hearings • Summer 2009: Town Hall Meetings Rise of Tea Party Movement

6. Health Care Reform - 2010 • The Patient Protection and Affordable Care Act • Health Care and Education Affordability Reconciliation Act • Signed into Law March 23, 2010

7. Health Care Reform • Requires Most Americans to Obtain Health Insurance (By 2014) 32 Million Newly Covered in United States Estimated 80,000 in Hamilton County Tax Penalty for Non-Coverage: Individuals Employers Many Aspects Are Not In Effect Until 2014 or Later

8. Health Care Reform • Increases Medicaid Eligible to 133% FPL (Up to $29,327 for Family of 4) • Requires Most Employers with >50 Employees to Provide Health Insurance • Provides Financial Assistance for Smaller Employers • Most Insured Will Be Able To Keep Current Health Insurance • Financial Assistance for 133 to 400% FPL (Up to $88,000 Income for Family of 4) • Health Insurance Exchanges (2014); Multi-State (2015)

9. Health Care Reform - Current • High Risk Pool (in effect June 2010): Federal or State Run Program Individuals with Pre-Existing Conditions Must Have Been Denied Coverage 2010-2014 • Limited Participation: High Premiums and Deductibles

10. Health Care Reform - Current • September 23, 2010: Cannot Deny Coverage for Pre-Existing Condition: Age < 19 Coverage for Dependent Children up to Age 26 Prohibits Lifetime Limits on Coverage Prohibits Rescinding Coverage Except for Cases of Fraud (No “You’re Sick, You’re Out”) $250 to Medicare Part D Recipients in “Donut Hole”

11. Health Care Reform - 2011 • Medicare: Coverage for Preventative Services Without Co-pay (USPSTF A or B) Comprehensive Health Risk Assessment and Personal Prevention Plan Part D: 50% Discount on Brand Name Drugs in “Donut Hole” 10% Increased Payments to Primary Care Create “Innovation Center” in CMS

12. Health Care Reform - 2011 • CLASS: Community Living Assistance Services and Supports Voluntary Long Term Care Insurance Seniors and Disabled • National Prevention, Health Promotion, and Public Health Council • Chain Restaurants and Vending Machines: Disclose Nutritional Content • Community Health Centers and National Health Service Corps Funding

13. Health Care Reform - 2012 • Medicaid “Bundling” Demonstration Projects • Enhanced Health Disparities Data Collection: Race, Sex, Ethnicity, Rural, Underserved • Changes in 1099 Requirements

14. Health Care Reform - 2013 • Create CO-OP Health Insurance Program • Create One Set of Rules for Eligibility Verification and Claims Status • Medicaid: Increase Payments to Primary Care Providers to Medicare Levels 2013-2014 100% Federally Funded • Medicare: Begin Phase-In of Subsidies for Part D Drugs (25% in 2013; 50% in 2014)

15. Health Care Reform - 2014 • Requires All Citizens and Legal Residents to have Qualifying Health Care Insurance • Creates Health Benefit Exchanges (State) Multi-State in 2015 • Payment Assistance up to 400% FPL (Tax Credits) ($88,000 for Family of 4) • Creates “Essential Health Benefits Package”

16. Health Care Reform - 2014 • Medicare: Continues Phase Out of Part D “Donut Hole”: 50% Subsidy Complete Phase Out By 2020 • Medicaid: Increases Eligibility To All < 65 and Up to 133% of FPL ($27,327 for Family of 4) Increases Dental Benefits for <19 100% of Preventative Services 100% of Adult Immunization Costs

17. Health Care Reform: Public Health • Prevention and Public Health Fund $15 Billion Over 10 Years Prevention, Wellness, Public Health Activities • Public Health Workforce $190 Million per Year for Loan Repayment $30 Million per Year for Mid-Career Training • Health Disparities/Data Collection • Epidemiology & Laboratory Capacity Grants

18. Health Care Reform:Community Health Centers • Increased Payments From Medicare and Medicaid (2013 – 2014) • PPS Rate From Private Insurances • Community Health Centers Trust Fund to Expand Operational Capacity $11 Billion Over 5 Years • National Health Service Corps Trust Fund: $1.5 Billion Over 5 Years • Community Based Residency Training Programs

19. Health Care Reform - Nurses • School Based Health Clinics Grants $50 Million per Year 2010-14 • Nurse Managed Health Centers Provide Primary Care to Underserved $50 Million per Year, Beginning 2010 • Graduate Nursing Education Program – Medicare Hospital Based Partner with Community Health Centers $50 Million per Year 2012-2015 • Nurse-Family Home Visit Partnerships $1.5 Billion over Five Years

20. Health Care Reform - Nurses • Increase Reimbursement Rate for CNMs • Loan Repayment Funding for Nurses Public Health Pediatrics • Nurse Loan Repayment and Scholarship Program Serve 2 Years on Faculty at Accredited School of Nursing • NHSC Funding for APNs

21. Health Care Reform – What’s Not There • No “Public Option” • No “Death Panels” End of Life Care Discussion Health Risk Assessment/Prevention Plan • No Coverage for Abortions • No Coverage for Illegal Immigrants

22. Health Care Reform –How Do We Pay For It? • 10% Tax on Indoor Tanning Services • Increased Fees: Pharmaceutical Companies Insurance Companies • Excise Tax on “Cadillac” Health Plans • Reduced Hospital Payments by Medicaid for “Hospital Acquired” Conditions • Excise Tax on Taxable Medical Devices • Increased Medicare Taxes on High Income Individuals (> $200,000)

23. Health Care Reform – Medicare Cost Savings • Reduced Payments to Medicare Advantage Programs - $15 Billion per Year for 10 Years • Hospital Readmissions Reduction Program • 25% Payment Penalty on “Hospital Acquired” Conditions • “Fraud and Abuse” Programs • Estimated Medicare Savings of $417 Billion Over 10 Years

24. Health Care Reform – Legal Challenges • 20 States Have Filed Legal Challenges: Violation of State Sovereignty “Commerce Clause” of Constitution • First Amendment: Freedom of Religion

25. Health Care Reform:Challenges • Access to Special Funds Not, as yet, Determined: “Guidance” Now Being Developed • Some Aspects Require Further Federal Funding • Increased Demand on Primary Care Sources and Providers – Estimated at 63,000 in 2014 Role of Community Health Centers Role of Mid-Level Providers • Some Individuals Will Still Require “Safety Net” Providers

26. Health Care Reform Thank you. Any Questions?