TheAffordableCareAct intheInland Empire,CaliforniaandtheNation
LomaLindaUniversityInstituteforHealthPolicyandLeadership
April8,2014
AffordableCareAct(ACA)
InMarch2010,PresidentObamasignedintolawthe
AffordableCareAct.
NationalHealthReform– AReality
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• CommunityResource
• California-Based,extensivetraveltoNV,AZ,andHIandsignificantworkwiththePacific
• Day-to-day,week-to-week,month-to-month
• Educatethepubliconthebenefitsofhealthcarereform
• TroubleshootingwithinHHSandotherFederalagencies/departments
OfficeoftheRegionalDirector
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– ExpandingAccessandCoverage
– ImprovingQualityandLoweringCosts
– ConsumerProtections
FrameworkofHealthCareReform
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• SinceOct.1st morethan7.1millionpeoplehaveenrolledinprivateinsurancethroughtheMarketplace.
• BetweenOctoberandFebruary,3millionadditionalpeopleenrolledMedicaidorCHIPand11.7millionweredeterminedeligibleforMedicaidorCHIP.
AffordableCareAct–ExpandingCoverage
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• Slowestsustainednationalhealthspendinggrowthin50years– Lowgrowthcontinuedin2013forMedicareandMedicaid
– ResultinginNoIncreasein2014MedicarePartBPremium
• $1.6billionreturnedtoconsumersin2011and2012– Plansmustspend80%nowonhealthcare
• Rateincreasesfellfrom75%in2010to14%in2013• Over$15billionrecoveredfromanti-fraudefforts– arecordlevelwhichaddedyearstoMedicareTrustFund
AffordableCareAct–Accomplishments:QualityandCost
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• The85percentofAmericanswhohaveinsurancehavemorechoicesandstrongercoveragethaneverbefore– 71MillionPeoplew/PrivateInsuranceGainedImprovedCoverageforPreventiveServices
– 105MillionAmericansNoLongerHaveLifetimeLimitsonTheirInsurance
• 3.1millionyoungadultswereabletostayontheirparents’healthinsuranceplansuntilage26
AffordableCareAct–Accomplishments:ConsumerProtection
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• 1.2millionCalifornianshaveenrolledforhealthinsuranceandselectedplansthroughtheMarketplacethroughtheendofMarchandover1.9millionhavebeenfoundlikelyeligibleandenrolledforexpandedMedi- CalcoveragethroughMarch
• 435,000youngadultshavegainedinsurancethroughtheirparents’plans
• 358,862peoplewithMedicarethrough2013received$333millioninprescriptiondrugdiscounts
• 3.6millionpeoplewithMedicarereceivedafreepreventiveservice• 8millionprivatelyinsuredpeoplegainedimprovedcoveragefor
preventiveservices• 12millionCaliforniaresidentshavehadlifetimelimitsremovedfrom
theirinsurance
AffordableCareAct–CoverageAccomplishmentsinCalifornia
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• FromOctoberThruFebruary72,340enrolledinInlandEmpirecountiesforsubsidizedandnon-subsidizedCoveredCaliforniahealthinsuranceplans.– 89%SubsidyEligible
• 110,721havebeendeterminedlikelyeligibleforMedi-Calinthetwo-countyarea.
InlandEmpireEnrollment
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6. Prescriptiondrugs
7. Rehabilitativeandhabilitativeservicesanddevices
8. Laboratoryservices
9. Preventiveandwellnessservicesandchronicdiseasemanagement
10. Pediatricservices,includingoralandvisioncare
1. Ambulatorypatientservices
2. Emergencyservices
3. Hospitalization
4. Maternityandnewborncare
5. Mentalhealthandsubstanceusedisorderservices,includingbehavioralhealthtreatment
AllQualifiedHealthPlansWillCoverTheseEssentialHealthBenefits
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• ElectedOfficials• Governments– Federal,State,Local,Tribal,Territorial,Pacific• Community-BasedOrganizations• Business/Employers• Labor• Providers• HealthPlans/Issuers• Faith-BasedOrganizations• Agents/Brokers• Academia• Philanthropy• Others
PartnershipsforImplementation
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• YouCannotSeparatePolicyfromPolitics• RelationshipswithElectedOfficialsareMultifaceted• YouCannotTellSomeoneHowtoFeel• KnowYourRole:CoordinationandCollaborationvs.LeadingtheCharge
• TranslationofTechnicalInformation:It’sAllAboutCommunitiesEducatingCommunities
• ConnectivityandTroubleshooting:DoNotAssumeEveryoneKnowstheBasicsofGovernmentortheACA
PartnershipsforImplementation:LessonsLearned
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AClearPathForward
NationalHealthReform– AReality
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StevenWiener(AZ,NV)[email protected]
BonniePreston(CA,HI)[email protected]
Thankyou!
HerbK.SchultzRegionalDirector,RegionIX(415)437-8500– Main(415)437-8502– Direct(415)265-7049– [email protected]
HHSWebsites:hhs.govHealthcare.govCuidadodesalud.gov
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