The Patient Protection & Affordable Coverage Act of 2010 as Amended

(by the Health Care and Education Affordability Reconciliation Act)

How Its Provisions Address Our Principles

Spring, 2010

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

Network

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

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

Myths About Health Reform

Source: 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%.

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).

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).

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.

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).

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).

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).

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).

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).

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).

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).

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.

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.