Post on 19-Aug-2015
Agenda
• Test Thursday - a little bit of every kind of question on it
• Probably not getting to community building as topic today – later in the course
• Flu and meningitis clinics together• 10/9, 10/15, 10/28, 10/29
Ongoing news this week
• Liking Your Neighbors Could Help Prevent You From Having a Stroke (Atlantic – posted on BB Learn)
• 4 million more people would be poor if it weren’t for food stamps (The Washington Post)
• Many states with few insured citizens aren’t expanding Medicaid under Obamacare (Washington Post)
• Analysis: Nearly a Million Fewer Uninsured Children Are Eligible for Public Coverage (RWJF.org)
• Smoking and Diabetes: Does the Increased Risk Ever Go Away? (Amer. J of Epidemiology)
• Plague in the US (NY Times)
Recent US Census snapshot –SNAP issues
• Great deal of discussion in the news about funding SNAP in Congress
Prescription cost issues• http://projects.propublica.org/checkup/. • Medicare Part D in 2010• 28M Beneficiary Claims • 1.1B Prescriptions (Including Refills) • $78B Retail Price of All Prescriptions• 1.7M Number of Prescribers• 40 Average Prescriptions per Beneficiary• $70 Average Retail Price of a Prescription• 3% HC Prescribers That Wrote Half of All Prescriptions
• Note: Include initial prescriptions and refills . • Retail price inc. patients' out-of-pocket costs but not drug maker
rebates.
Health coverage current Medicaid (first in 1965)
• Each state sets its own program standards. • In Idaho –
Criteria for eligibility:• Child <19, pregnant, aged, blind, or disabled
and need nursing home care- limited adults• Income- 133-185% of poverty; • Pass asset test• Need US Citizenship/legal status• Exceptions: i.e. Women diagnosed with
breast or cervical cancer or pre-cancer
Medicare (1965)
• 65 and older• OR severe chronic disabilities- e.g., unemployed
and before age 65• Contributions lifelong through US wages• Consists of:• Part A- mandatory hospital insurance• Part B- Health Care Services-automatically
enrolled, can decline. Deductible and co-pay• Part D- Prescription drug coverage-optional,
monthly premium
State Children’s Health Insurance Plan (SCHIP)• Administered by the states• Started in 1997• Eligible income limit for Idaho SCHIP is
185% of the FPG. = $41,347.50 (family of 4)• Idaho is one of only seven states that have
income limits set below 200% of the FPG.• 1/3 of Idaho children are in SCHIP or
Medicaid – 1/3 more qualify and should not be kept on parent insurance or go uninsured
Put all the pieces together
• Estimated 2/3 of Idaho children qualify for SCHIP • Only 1/3 eligible enrolled• Highest family of 4 income to qualify is
$41,347.50• Last lecture average income in Latah County is
approx. $30,000.• Overall picture of struggle
with health care access
Regardless of the politics…
• 48.6 million in US with no health insurance
• How to advocate health prevention and promotion if you cannot get screened ? • NO coverage to get
screened• How do you rein in
costs ?• Is health care a
human right ?
Income Below Specified Ratio of Poverty Thresholds 1967 to 2011
• Poverty for household of 4 = • $ 22,350 in 2011• 15.7 percent of the
country under poverty line• Very important for
the Affordable Care Act proposals
Affordable Care Act – one attempt
• http://kff.org/health-reform/video/youtoons-obamacare-video/.
• Health Reform video
• Legislation passed by Congress in 2010• Large part takes effect on January 1, 2014• Lots of provisions are phased in over several years
(to 2020)
Key Features of ACA Health Reform
Individual Mandate- “Acceptable health coverage” required of all eligible citizens in 2014• Annual penalties if not covered- varying by
income (phased in)• Exceptions- religious objections, financial
hardship, American Indians, those without coverage < 3 months.• Bottom line – should get better quality
coverage at less cost
Employer/Business requirements
• Employers required to offer insurance if over 50 employees (< 50 exempt)• Business assessed fees of $2000/employee if
not providing insurance.• If >200 employees, employee must enroll in
insurance or use exchange• Premium subsidies to small employers- tax
credits and reinsurance for employees over 55• Walgreens last week will pay employees a
stipend to shop for exchange insurance
Required benefits of ACA health policies• Prescription drug
coverage• Emergency and
hospital care coverage• Doctor visits • Remember the
hallmark of the new care plan is strengthening primary care and access to it
• Kaiserhealthnews.org
• Maternity services• Mental health services• Rehabilitation services• Lab services• Preventive services
must be covered without any out of pocket cost to consumer
• (Routine screening tests)
Expanded public programs
• Expand Medicaid to all individuals under 65 to 133% FPL – 2012 Supreme Court decision• Idaho refuses to do this• All recipients receive “benchmark” benefits
policy- essential services• Increase Medicaid payments to providers to
Medicare rates• CHIP- Increase federal funds to states to cover
increased numbers of children.• Funds from Feds States. Not all state burden
Individual citizen premiums
• Provide policy premium credits and cost sharing subsidies for individuals and families for those between 135-400% FPL• Lowers out of pocket spending limits• Federal subsidies and tax credits will be
offered to individual and families up to 400% FPL
Create state insurance marketplaces
• If earn more than 133% of FPL and no employer provided insurance, states will have insurance exchanges to provide coverage starting 10/1/13• Must be 4 levels of plans – all with the specified
essential health services
• Helps the currently uninsured
Changes for Insurance Companies
• No more lifetime coverage limits on policies• No more waiting periods of > 90 days for coverage• No higher rate for females or poor health• Cannot deny coverage due to health history• Extends dependent coverage to age 26• No cost sharing for preventive services, limits out of
pocket cost to consumer• Consumer has rights before a company now
Higher quality care the goal (Boxes 13.7, 13.10 13.11 in text )
• All policies must :• Cover vaccinations and screenings with no co-pay or
deductible• Hospitals pay a penalty if patient readmitted in a certain
time with common diseases(2012) Cut health care administrative costs (2012) Doctors paid based on quality and not quantity (2015)
• Require chain restaurants and vending machines to disclose nutritional content.• Appropriate funds for prevention research & outreach• In short, higher quality care, prevention and
wellness are emphasized
Adult Female wellness services covered
• Routine wellness and screening services (Pap test, mammogram, etc.)• Gestational diabetes screening• HPV DNA testing• STI counseling• HIV screening and counseling• Breastfeeding support, supplies, and
counseling• Interpersonal and domestic violence screening
and counseling
How to buy health insurance under ACA
• Go to The Henry J. Kaiser Family Foundation home page• http://kff.org/• Click on the Health Reform box at the bottom• Scroll down to the Interactive Health
Insurance Subsidy calculator• Click on the calculator and estimate buying
insurance for the people on the following scenarios in the handout.