The Patient Protection and the

Affordable Care Act

Maggie Baxter, Maggie Hatcher, Elizabeth Glisson, Katie Rary, Caroline Romano, and Katherine Whitmore

Obamacare vs. The Affordable Care Act

Jimmy Kimmel Video

What do Auburn students think?

Auburn Interviews

Problems behind U.S. Healthcare

Why are Ameican Healthcare Costs so High?

High Cost of U.S. Healthcare

• U.S. spends more tax money per capita on healthcare than any other country.• In exchange for these taxes we still get no healthcare

• Only 28% of American’s get their health insurance through government programs

• 18% of it’s gross domestic product on healthcare costs• Australia by comparison spends 9%

• Why?• EVERYTHING HERE COST MORE• Examples: surgical procedures and pharmaceuticals

So why are we spending so much money?

• Some may say the obesity epidemic leading to more health complications

• Malpractice and defensive medicine • Ordering unnecessary tests

• Careers• Healthcare providers are paid more in the U.S.

• Insurance and administrative costs• Pharmaceuticals

High Cost of U.S. Healthcare

• In the U.S. we do not have that centralized negotiation or leverage to make decisions with the people providing health care

• Hard to put a price on not dying • We are spending more money to keep people alive

• Not a simple problem and there will not be a simple solution

• What makes healthcare so expensive• Vital that we as NURSES MAKE A CHANGE

Get Ready for Obamacare

The YouToons Get ready for Obamacare

ACA Overview

• The ACA – passed by Congress and signed into law in March 2010

• The most important provision of the ACA• "individual mandate” requires all

Americans who can afford health insurance to purchase a policy or pay a tax penalty for failing to do so.

How will Americans be covered?

• Employer• Government• Buy your own• None

Key Provisions for ACA• The law allows young people to remain on parent’s

insurance until the age of 26• The ACA requires health insurance companies to

provide more comprehensive coverage• The law requires businesses to provide minimum

health coverage to their employees• Finally, the law offers a number of changes

specific to young women. Insurance companies can no longer charge women more because of their gender

Key Provisions for ACA

• Not much will change for seniors on Medicare

• Medicaid is expanding • The Federal government is allowing each state

to choose whether they want to be a part of expanding Medicaid

• You can check out your state’s decision at• State Decisions on Health Insurance Marketpla

ces and the Medicaid Expansion, 2014

Overview of Marketplace

• The government has set up a virtual insurance megamall to purchase your own coverage.

• You will be able to pick out how much coverage you want and how much you want to pay for it

• ALL Plans will cover a comprehensive set of services• Hospital Visits• Doctor visits• Maternity care• Mental health care• Prescription drugs

How is this affecting nurses?

• Nursing role:• Education• Educate patients, family, and friends about

provisions in the law• Encourage uninsured and underinsured

individuals to get acquire health insurance• Consequences

• Guide patients through the process and provide them with necessary resources

Affordable Care Act Provisions• Emphasis on prevention-oriented (and chronic

disease management) model rather than a sick care model

• Hospital-based Nursing• Increase in patients seeking health care

• Increased focus on preventing complications to improve care and prevent readmissions

“The Obama Administration’s Record on Supporting the

Nursing Workforce”• Released in May 2012• Acknowledges the nurse’s role in current health

care and the potential opportunities created by the ACA• National Health Service Corps• Nursing Education Loan Repayment and

Nursing Scholarship Program• Advanced Nursing Education Expansion

• Nurse-Managed Clinic

More Opportunities for Nurses

• Increased funding in certain areas aimed at supporting primary care• Community Health Centers • School-based Health Centers• Home Visiting

• Incentives for RNs and NPs to aide in specific areas of need• Rural areas, geriatric, mental health, and

pediatric specialties• Increased funding for research

• State incentives to create ways to improve how care is delivered

SHOP Marketplace• What is the SHOP marketplace??

• SHOP stands for Small Business Health Options Program

• SHOP is part of the Health Insurance Marketplace created by the Affordable Health Care Act

• If a business has fewer than 50 employers, then it is not required to offer health insurance.

• The SHOP marketplace offers four different plan levels.

4 Easy Steps

• Create an account from the marketplace • Complete your application• Pick a plan• Enroll

The Marketplace

Navigating the Marketplace

• Healthcare.gov• Before you begin:

• Set-up and clear your cookies application• Try applying in the morning, evening, or

weekends, as times the site is least congested

Navigating the Marketplace

• Applying for coverage: • Create a marketplace account• online, paper, or over-the-phone application

• review and save the email confirmation and information regarding your eligibility to plans • Enter your full name as on your Social Security

Number

Navigating the Marketplace

• Select a plan:• Ex: Catastrophic Health Plan

• if you are under 30yoa, you can have lower monthly premiums but high deductibles

• The expectation is that people under 30yoa have less healthcare problems and will utilize the health care system less often.

• If you apply for Medicaid or Chip, you will get an email stating eligibility or asking for more information

Overview of Plans

• Metal levels generally reflect the plan’s generosity in covering the cost of benefits for an average enrollee

• Plans must offer “essential health benefits” but can differ in other ways, such as in the networks of providers and Rx formularies they offer

Bronze and Silver Plans

• Bronze level • actuarial value of 60%• patient responsible for 40% of the costs of all

coverage benefits

• Silver level • actuarial value of 70%• patient responsible for 30% of the costs of all

coverage benefits.

Gold and Platinum Plans

• Gold level • actuarial value of 80%, so on average• patient responsible for 20% of the costs of all

coverage benefits• Platinum level • actuarial value of 90%• patient responsible for 10% of the costs of all

coverage benefits

Overview of Plans

Essential Health Benefits

The law directs that Essential Health Benefits be equal in scope to the benefits covered by a typical employer plan and cover at least the following 10 general categories.

Final Steps to Applying

• Completing application:• Pay your first premium directly to your

insurance company• Review your plan’s provider directory

and decide who will provide your care.• Contact your insurance company with

any questions• Log on to HealthCare.gov to learn more

about your coverage

Solutions

• Preventative Care• Education

• Schools, Communities, Churches • Patient Treatment Plan• Affordable Care Act

Solutions

• Technology• Case Managers• Decrease Nurse Turnover

Solutions

• Nurse Managed Clinics• Goal: Avoid hospitalization

Solutions

• Talking to Representatives• ANA's Activist Toolkit

Questions

• What is the most important role as a nurse regarding the Affordable Care Act?

EDUCATION

Questions

• In the Affordable Care Act provisions, they are aiming to deliver what type of care?

-Sick Care Model Or

-Prevention-Oriented Model

Questions

• What does S.H.O.P stand for?

Small Business Health Options Program

Questions

• What is the name of the website to sign up for coverage?

The Marketplace- www.healthcare.gov

Questions

• Give two solutions to nurses can be engaged in to better facilitate the Affordable Care Act.

Preventative care, Education, Telemedicine, Nurse managed clinics, and talking to representatives

QUESTIONS?

References • Activist toolkit. (2014). Retrieved from http://www.rnaction.org

/site/PageServer?pagename=nstat_activist_toolkit

• Ford, A., Jones, H., Manibog, C., & Tweeten, L. (2013, February). What makes health care so expensive?. Retrieved from http://healthland.time.com/2013/02/20/what-makes-health- care-so-expensive/

• Haney, C. (2010, June). Health system reform: Nursing's goal of high quality, affordable care for all . Retrieved from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/Issue-Briefs/Health-System-Reform.pdf

• Nurses offer solutions for cost-effective health care. (2009, June). Retrieved from http://www.cna-aiic.ca/~/media/cna/page content/pdf en/ 2013/07/26/11/04roi_solutions_cost_fs_e.pdf

References• Nurse practitioners: The growing solution in health care delivery. (2014).

Retrieved from https://www.aacn.nche.edu/media-relations/fact-sheets/nurse-practitioners

• The obama administration's record on supporting the nursing workforce. Retrieved from http://www.whitehouse.gov/sites/default/files/docs/nurses_report_0.pdf

• The shop marketplace: Health insurance options for small businesses. (2014, January ). Retrieved from http://marketplace.cms.gov/training/get-training.html

• U.S. Centers for Medicare & Medicaid Services. (2013, June). Tips to help you enroll in marketplace coverage. Retrieved from https://www.healthcare.gov/how-to-have-the-best-experience -with-healthcare-gov/