health care reform:what does it mean for you?

On August 6 & 7, AccessHealth SC and a variety of partners collaborated to provide FREE medical, vision and dental services at SC Mission 2010 in Greenville

Over 1,200 patients were provided more than $550,000 in care

44% were employed full or part time

56% were unemployed

a sobering success

today’s talk

historical background gaps in coverage goals of health care reform what does it mean for me? new realities post election final thoughts

evolution of u.s. health care policy

Our system is the result of several major policy decisions rather than one, unified health care policy

– Employer-based coverage

– Government-sponsored coverage

– EMTALA

the start of employer-sponsored coverage

During World War II, wage controls administered by the federal government’s Office of Price Administration led employers to offer health insurance as a benefit in lieu of wage increases

the start of medicare & medicaid

To provide coverage for the elderly as well as poor women and children, Congress enacted Medicare & Medicaid in the mid-1960s

emtala Emergency Medical Treatment and

Active Labor Act of 1986 is arguably the largest unfunded mandate ever imposed on private business

The law requires hospitals to screen and stabilize (treat) every patient who comes to the hospital ED, regardless of the patient’s ability to pay and regardless of what it costs the hospital to provide the care

policy decisions have left a gap in coverage for sc

2.2 million have employer-based health insurance

1.2 million rely on a government-sponsored program for coverage

178,000 have coverage purchased in the individual market

760,000 South Carolinians have no coverage

*Source: Kaiser Family and Robert Wood Johnson Foundations

sc’s uninsured: who are they?

552,000 people from working families —Pay taxes to support government coverage for others

422,000 childless adults (do not qualify for Medicaid)

219,500 adults between 139-399% of federal poverty levels

147,500 children *Source: Kaiser Family Foundation

what happens when the uninsured need care? remember emtala?

Last year, SC hospitals provided more than $1 billion worth of care for which they received no direct payment

Those financial losses were passed along to insured patients and their employers

broad goals of reform

increasing coveragewill expand coverage to almost 500,000 of the 760,000 uninsured South Carolinians

payment reformwill change the way hospitals/providers receive payment

broad goals of reform

delivery system reformincludes delivery system reforms that hold great promise for improving care

insurance reformincludes provisions to protect consumers and increase access to health insurance

health reform: what does it mean for you?

grandfather on Medicare brother who is uninsured aunt with pre-existing conditions daughter just out of college friend who is a small business owner

grandfather on medicare

Additional benefits for traditional

Medicare coverage: Free preventive screenings such as

colonoscopies, mammograms A free annual physical or “wellness”

visit prescription assistance for

“doughnut-hole” coverage gap

Note:

Individuals with Medicare Advantage plans may see changes in their benefits depending on how their insurance company responds to reduced funding for this type of plan

grandfather on medicare

prescription assistanceTransitional rebates to help 61,000 SC seniors in the prescription drug “doughnut hole”

A $1,720 gap in Medicare coverage of prescription meds

– Starts when annual drug costs exceed $2,830

– Ends when annual costs exceed $4,550

“Doughnut hole” closed by 2020

First year rebate (2010) = $250

brother who is uninsured

beginning in 2014, all U.S. citizens and legal residents must have coverage or pay a penalty

Low-income individuals & families will have access to subsidies to help buy private health insurance

— For individuals and families between 133-400% of FPL, the bill provides tax credits and cost-sharing assistance to reduce premium costs of insurance purchased through health insurance exchanges

— 477,000 SC citizens will receive the benefit of premium tax credits through reform

insurance exchanges“Small companies and individuals who don’t have insurance through work will be able to purchase insurance through newly created marketplaces, known as insurance exchanges, created and regulated by states.

… Think of it as an Orbitz or Travelocity for health care plans”

- USA Today

brother who is uninsured

brother who is uninsured

medicaid expansion By 2014 states must extend Medicaid

eligibility to all legal residents up to 133% of poverty and under 65 years old

133% FPL is $14,404 for individual and $29,327 for family of 4

From 2014-2016 the federal government will cover 100% of state costs

aunt with pre-existing condition

Establishes a temporary national high-risk insurance pool for individuals with pre-existing conditions and early retirees - those 55 or older but not yet eligible for Medicare

In 2014, no denial of coverage or exorbitant premiums for adults with pre-existing conditions

No higher premium based on gender or medical history in 2014

daughter out of college

Dependent adult children can stay on parent health policy until age 26 (effective Sept. 23, 2010)

In 2014, young adults can purchase health insurance through the exchange—allowing coverage flexibility and

portability when changing jobs

friend who is a small business owner Small businesses are eligible for

subsidies to offer insurance and have access to the exchanges

Employers with 10 or fewer employees who earn, on average, less than $25,000 a year can get a 50% tax credit for providing health insurance

Employers with 25 or fewer employees who earn, on average, less than $50,000 can receive a partial tax credit of up to 35%– 88% of businesses in SC have 25 or fewer

employees

714,000 seniors on Medicare will no longer pay a co-pay for preventive services (2010)

 30,173 Medicare beneficiaries already received a one-time, tax-free $250 rebate (2010)

18,100 young adults have access to insurance coverage through their parents’ health plans (2010)

57,900 small businesses are eligible for a tax credit (2010)

477,000 citizens will receive premium tax credits (2014)

Almost 500,000 of the 760,000 uninsured will be covered (2014)

what reform means to south carolina

new realities post election

repeal, replace, defund? The House voted to repeal HC reform on Jan 19

by a vote of 245 – 189; total repeal of the law is unlikely for now

Republicans will move forward to defund the bill, undo several unpopular provisions and slow implementation

New House committee chairs will hold committee oversight hearings on reform

new realities post election

legal and legislative challenges 28 states have filed suit claiming the individual

mandate is unconstitutional

26 states are included in the FL Medicaid suit

38 state legislatures are considering various forms of legislation that challenge implementation

new realities post election

state medicaid crisis $228 M shortfall from current fiscal year

Additional $663 M requested to maintain program at current rate plus 10% growth

—100,000 people added to Medicaid since December 2007

Services for 970,000 Medicaid beneficiaries are at stake

$2.2 B in healthcare expenditures at risk!

final thoughts

health reform will expand coverage to a lot of people

many details still to come through the regulatory process

challenges exist for full implementation of the law

no matter what, we’re here to provide for the health care needs in our communities!

final thoughts

south carolina hospitals are: working diligently to cut costs, improve quality and

patient safety, and meet advancing technology demands

ranked by the federal government as one of the top five states making improvements in quality and safety

leading the nation in improving healthcare safety and responsiveness

working to improve the health of South Carolinians

Questions?