health care reform - 2010 lawrence holditch, md medical director cincinnati health department...
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Health Care Reform - 2010
Lawrence Holditch, MDMedical Director
Cincinnati Health Department
October 27, 2010
Health Care Reform - 2010
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
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
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
Health Care Reform - 2010
The Patient Protection and Affordable Care Act
Health Care and Education Affordability Reconciliation Act
Signed into Law March 23, 2010
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
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)
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
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”
Health Care Reform - 2011
Medicare: Coverage for Preventative Services Without Co-pay
(USPSTF A or B)
Comprehensive Health Risk Assessment and PersonalPrevention Plan
Part D: 50% Discount on Brand Name Drugs in “Donut Hole”
10% Increased Payments to Primary Care
Create “Innovation Center” in CMS
Health Care Reform - 2011
CLASS: Community Living Assistance Services and SupportsVoluntary 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
Health Care Reform - 2012
Medicaid “Bundling” Demonstration Projects
Enhanced Health Disparities Data Collection:
Race, Sex, Ethnicity, Rural, Underserved
Changes in 1099 Requirements
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
2013-2014100% Federally Funded
Medicare: Begin Phase-In of Subsidies forPart D Drugs (25% in 2013; 50% in 2014)
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”
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
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
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
Health Care Reform - Nurses School Based Health Clinics Grants
$50 Million per Year 2010-14
Nurse Managed Health CentersProvide Primary Care to Underserved$50 Million per Year, Beginning 2010
Graduate Nursing Education Program – MedicareHospital BasedPartner with Community Health Centers$50 Million per Year 2012-2015
Nurse-Family Home Visit Partnerships$1.5 Billion over Five Years
Health Care Reform - Nurses
Increase Reimbursement Rate for CNMs
Loan Repayment Funding for NursesPublic HealthPediatrics
Nurse Loan Repayment and Scholarship ProgramServe 2 Years on Faculty at Accredited School of Nursing
NHSC Funding for APNs
Health Care Reform – What’s Not There
No “Public Option”
No “Death Panels”End of Life Care DiscussionHealth Risk Assessment/Prevention
Plan
No Coverage for Abortions
No Coverage for Illegal Immigrants
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)
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
Health Care Reform – Legal Challenges
20 States Have Filed Legal Challenges:
Violation of State Sovereignty
“Commerce Clause” of Constitution
First Amendment: Freedom of Religion
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 CentersRole of Mid-Level Providers
Some Individuals Will Still Require “Safety Net” Providers
Health Care Reform
Thank you. Any Questions?