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Tips & Tricks for Effectively Communicating Whats in the Health Care LawHealth Action 2014

PHAN runs a program to certify our volunteers as PHAN Certified Health Reform Trainers.

This slideshow is the short version presentation our trainers use (although we recommend only more advanced folks try to give a presentation in under an hour) mixed in with slides for the Families USA conference. I have left the note section designed for trainers in here to give you a sense of what our instructions to them are.

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The U.S. Census Bureau reported that 49.9 million residents, 16.3% of the population, were uninsured in 2010 (up from 49.0 million residents, 16.1% of the population, in 2009).Thanks to Chris Lilienthal at Pennsylvania Budget and Policy CenterThis is about what reform would mean for the mother with breast cancer whose insurance company will finally have to pay for her chemotherapy. This is about what reform would mean for middle-class families who will be able to afford health insurance for the very first time in their lives and have some security about their children if they get sickThanks to Chris Lilienthal at Pennsylvania Budget and Policy CenterMaking Connections

Persuasive communications speaks to our deeply held values and beliefs as Americans.Thanks to Chris Lilienthal at Pennsylvania Budget and Policy CenterRules of Good Communications

Thanks to Chris Lilienthal at Pennsylvania Budget and Policy CenterRules of Good Communications

Thanks to Chris Lilienthal at Pennsylvania Budget and Policy CenterRules of Good Communication

Thanks to Chris Lilienthal at Pennsylvania Budget and Policy CenterIn every presentationCover: Insurance Reforms, Medicare & Medicare Advantage, the Marketplace, and Medicaid ExpansionExpand if appropriate and if youre comfortableKeep facts to a minimumLeave LOTS of times for questionsDont worry about being an expertBuild trust with your audience

9The Affordable Care Act in Pennsylvania

This is the 17/25 minute presentation. It is recommended that you have given a few presentations at 45 minutes before attempting this, or that you at least talk with Athena first and practice with her or another trainer who has done the mini-version. These are actually harder to do than the full-length, but nothing our certified trainers cant handle.

If you just talk straight, you CAN get through all of this in 17-20 minutes and save 5-8 minutes for questions.

Please note: I put times on here youll see, for example, (20 seconds). Thats not meant to make you nervous, or like you need to watch your time on that slide. Its just to let you know that if I say whats recommended thats about how long it takes. When I first started doing this, I thought it took longer than it actually does, so I thought it would be helpful to include for guidance. If you find it stresses you out, ignore em.

Heres how it breaks down:Slides 1-4: 1-2 minutesInsurance Reforms: 5-6 minutesMedicare: 3-4 minutesMarketplace: 3-4 minutesMedicaid expansion: 4 minutesMandate, call to action, sign-in sheet pitch: 2 minutes

Yes, if youre at the higher end of things then youre going to find this takes you 20 minutes to say all this. Most experienced presenters can get through it in 17 minutes.

10Tips and Tricks National data is helpful, but trust your field experiencesYou can be YOU - even with a topic like thisOpposition interruptions are rare, but great opportunity to respond to roomIntro slide to build trust, show off that youre non-partisanBackground terms: explain co-pay, co-insurance, deductible, premiums. (In our long version we have a slide for that).Take a step back to look at life before reformExplain reform doesnt just expand access introduce topics youre coveringAbout us..Pennsylvania Health Access Network (PHAN) is a broad, non-partisan coalition that works to ensure all Pennsylvanians have access to quality, affordable health coverage.Represent approximately 60 organizations and a million consumers across the state.Recognized by media, lawmakers (R and D), state and federal officials, and consumer advocacy organizations as a credible source of information.Work to monitor implementation and push for reforms to be as consumer friendly as possible.

Heres where youre building trust as a PHAN Certified Trainer.

In 25 minute version just mention were awesome while this is in the background and leave it at that.12The Affordable Care ActAlso known as Obamacare, the Health Care Law, ACA, Patient Protection and Affordable Care Act, PPACA

Signed into law on March 23rd, 2010

Upheld by the Supreme Court as Constitutional

Subject of attacks and misinformation campaign launched by opponents still fighting for repeal

Feel free to still mention Jimmy Kimmel Obamacare v Affordable Care Act thing here. It always gets a giggle and will help the audience get to like you. Dont skip that just because were moving through this quickly. (OR use some other joke or personal way to help folks relate to you).

Can just leave this in background, tell Jimmy Kimmel thing and move on if you like.13

Before health care reform..For the decade leading up to reform, premiums were rising much faster thanwages.Medical bills leading cause of family bankruptcyRx drug costs were hurting seniors on fixed incomesSmall businesses were paying 18% more than large companies for similar coveragePeople with pre-existing conditions had no protectionsCan move through this very quickly, just pick your favorite point or 2, as soon as you see heads start to nod you can go to next slide. (20 seconds)14Tips & Tricks: Insurance ReformsAlways start with reformsCover all reforms, even if youre talking to seniors or only have 20 minutesUse stories or anecdotes to explain key provisionsSave essential health benefits for marketplace

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Insurance ReformsSay goodbye to pre-existing conditionsNo more lifetime limits and annual limitsPulling coverage when you get sick now illegalStreamlined appeals processChildren can stay on parents plan until 26

(2.5 3.5 minutes for this slide)

EVEN in 25 minute version we take time to do this right. Just cut an anecdote or two. Dont skip any thing important here.

You can go through the Big 3 for pre-existing condition, explain lifetime limits with the bankruptcy example, rescissions with the breast cancer survivor example, explain streamlined appeals, and children age 26 mentioning they can be married, etc, but if they have a baby that baby doesnt have to go on parents plan - in 2.5 minutes.

*Pre-existing conditions. This is still hard for folks to really believe, so please still mention the Big 3: Means insurance companies cant deny you care, charge you more based on pre-existing condition OR say well cover everything except your bad heart (or enter other example).

*No more lifetime limits. Recommend you keep this anecdote most people know the majority of home foreclosures in country tied to medical bankruptcy, most people dont realize those folks actually had health insurance at the time. Problem was they hit their lifetime limit.

*Rescission. If you skip appeals personal stories/anecdotes can still mention insurance company that targeted women with breast cancer whose cancer was in remission, then would pull coverage when they got sick. Thats now illegal.

*Then transition to and if insurance company refuses to cover a procedure your dr thinks you need, for first time, you can appeal that. Any costs associated with appeal, insurance company pays whether or not you win or lose. put in your own words, but you can cut this provision explenation down to just that.

*Children on parents plan doesnt matter if working, married, filed as dependent, etc. have baby, baby doesnt have to go on parents plan. Leave the rest of stuff for Q&A

16Insurance Reforms ContinuedER accessDirect access to OBGYNMedical Loss RatioJustify rate hikes. Gender discrimination illegal. Age rating capped.Preventive care without co-pays

(1.5-2 minutes)

*ER Access I still make the used to be joke here. You can cut it if youre worried about time. Can also cut bit about only having to reimburse what would pay in network, but DO make sure to cover the jist of this quickly, then move on.

*OBGYN BAM, just mention, move on

*MLR Going to need to slow down here now to explain: Fancy way of saying insurance companies have to use your money on actual care. Use 80-85% of premiums you pay on actual care. More than 15-20% on things like advertising, bonuses, marketing, (lobbying against reform?). Issue you rebate check. 1st year 56 million in PA. Cost control measure. Leave the rest for Q&A

*Justify rate hikes: Big deal for PA, one of weakest systems of rate review in country, were deemed unfit so goes to HHS. Move on.

*Cant charge women more, oldest 3:1 youngest, BAM move on.

*Free preventive care cut this down, just explain jist and list off screenings (cancer like mammograms and coloscopies, mental health, std, blood sugar), annual exam, immunizations, birth control, anything that is a preventive care visit. Thats it. Next slide.

17Tips & Tricks MedicareStress NO Guaranteed benefits cutResponding to the payment advisory board (death panel) questionsTake your time to explain donut hole, but dont worry about exact numbersDo NOT assume anyone gets the difference between Medicare and Medicare Advantage, even if youre talking to a senior on Medicare AdvantageDont skip 5 star rating systemResponding to billions cut from MedicareHealth Reform and MedicareNo guaranteed benefits are cut.New Benefits for SeniorsFree preventive care under Traditional MedicareWent into effect January 1, 2011Includes colonoscopies, mammograms, annual wellness exam, annual flu shot, screenings for diabetes, and more

In 25 minute version you go through this quickly*No guaranteed benefits cut.*All that free preventive care we just talked about seniors started getting it in 2011. used to be a coloscopy could cost $400-$600.Next slide.19Health Reform and MedicareClosing the donut hole52.5% discount on brand name drugs and 28% on generic.In 2012, 222,703 Pennsylvanians saved over $168 million, an average of $753 per beneficiary. Extends life of Medicare Trust Fund by at least 8 years Cracking down on waste, fraud, and abuseSince 2009, $14.9 billion in fraudulent payments have been returned to Medicare Trust Fund

(2minutes)Here you should take time to explain what donut hole is: Medicare Part D is Rx drug part of Medicare. Helps seniors pay for about $3,000 worth of drugs, then next $3-4k seniors pay out of pocket, then Medicare picks up again. Stuck paying out of pocket known as donut hole, when we hear stories of seniors cutting pills in half/choosing between food and medicine.

(Save for Q&A) ONLY if asked: NO such thing as rationed care or death panels. Board to save money in Medicare without cutting any services, just so the life of Medicare trust fund can be extended, it would be a biparistan board, but it still hasnt come into existence because the new health care law saves so much money as is through cracking down on waste, fraud and abuse; free preventive care; etc.

(Save for Q&A) ONLY if asked: Hospitals that have super high readmission rates will have to pay less than 1% base Medicare rate back to fed gov as a penalty. To increase quality of care seniors get.

20Medicare AdvantagePrivate insurance1997 Payouts roughly equal to cost of traditional Medicare2003 Congress votes to increase payouts2009 Medicare pays 14% more per beneficiary than traditional Medicare

Remember this slide is just in the background as you explain Medicare Advantage is actually private health insurance and how it came to be.

Refresher, my style, feel free to put it in yours:

Medicare Advantage is Private health insurance.

Back in the 90s insurance companies went to Congress and said you guys have everyone 65 and older. Thats a huge chunk of the population and wed like to compete for that business. Since were private we can offer the same benefits or better for the same cost or less. So, give seniors the option and if they choose us, pay us what youd pay out for Medicare. Congress took the deal.

In many cases Advantage plans did offer better benefits, in some they werent as good, but they couldnt do it for less cost, they couldnt do it for cost and by 2009..

Takes about 30 seconds to say all that.

21Medicare Advantage and ACAEvery Medicare Advantage plan is rated on a 1 to 5 star system.Rating of 1 3 stars means:No more bonus paymentsMust increase rating in 3 yearsRating of 4-5 star means:Bonus payments, but every dollar must to be used to benefit seniors Only for 5 star plans: Seniors can switch into 5 star plan anytime of yearCheck your rating and compare plans in your area at www.medicare.gov/find-a-plan or calling 1-800-MEDICARE

For the 25 minute presentation youre going to go through this piece more quickly. *CMS rates every plan 1-5 stars. Look at hundreds of categories everything from chronic disease management to if I call the 1-800 number do I get to talk to a human?*Quickly run through 1-3 vs. 4-5 star plans and how to find out how yours is rated

(1 minutes)22Medicare Advantage and ACAMedical Loss RatioIts workingIn 2011: Medicare Advantage enrollment increased by 10% and premiums fell by an average of 7%

Just remind theyre also private so the MLR applies and look, it wasnt a disaster. Move on. (30 seconds max)23Tips & Tricks for Marketplace Dont take questions during this section, even for small, informal presentationsBreak it up: Basics, EHB, Plan types, Tax credits, How you get itStress MOC involvement use that as transition to QHPForget about actuarial value, use low/highShow what FPL means in annual income and hourly wagesDont talk about it as a website

Health Insurance MarketplaceUninsured, small business owners, people paying more than 9.5% of pay on premiums & Members of CongressQualified Health PlanTax credits and cost-sharing subsidies

Remember the rule: If you mention nothing else, mention MOCs go into this.

Best way to do it: Theres a new health insurance marketplace open to folks who need insurance. Uninsured, small business owners, people paying too much of their paycheck can purchase insurance through this marketplace. Members of Congress and their staff lost their health insurance and went into this. SO or THEREFORE (do the transition from that into QHPs)

SO when they wrote the law they wrote it so that every plan sold is going to have to be a QHP meaning it will have to cover a whole host of benefits they wanted the Essential Health Benefits network with an adequate number of doctors and provide info in clear language.

Majority of folks will get help paying for premiums, many will get help with co-pays.

Next slide25Ambulatory patient servicesEmergency servicesHospitalizationMaternity and newborn careMental health servicesPrescription drugsHabilitative &Rehabilitative servicesLaboratory servicesPreventive and wellness carePediatric services

Essential Health Benefits Package

Every plan sold in the marketplace, but also in the individual and small group market will now have to cover these essential health benefits.

Big deal for Pennsylvania one of last states not to mandate maternity coverage be included in insurance policies, for example.

Leave your cancelled plans/EHB response for Q&A: Yes this is why some plans are being cancelled. They were substandard plans and didnt meet the EHB. Insurance companies (who lobbied hard against health reform) had years to get their policies in line with the EHB and many have decided instead to cancel the polices and send out notices it is because of reform. 26LevelMonthly PremiumCoPay or Out-of-Pocket CostsPlatinumHighestLowestGoldHighLowSilverMiddleMiddleBronzeLowHighSimply explained: Every plan 4 categories. Platinum plans those will be your best plans, will likely have the EHB plus maybe a gym membership or other extras. Those plans will cost the most every month, but the co-pays will be the lowest.

Bronze simply just EHB, no extras, very low monthly premiums but higher co-pays.

Watch out for Bronze, may find more high deductible plans in that category. 27Catastrophic PlanMuch lower premiums, but high deductiblesAvailable to 30 and under or those who receive financial hardship exemptionsCovers 3 primary care visits and free preventive care benefitsAfter deductible is met, all essential health benefits are covered

10-20 seconds For folks struggling to purchase insurance and the 30 or under crowd, there is a catastrophic plan available. That is a high deductible plan, basically just for emergencies, but even that comes with 3 primary care visits and free preventive care.28Premium Tax Credit EligibilityFPL100%400%Annual 1 person$11, 490$45,960

Hourly Full/Part time 1 person$5.52/$11.04$11.32/$22.64Annual 4 persons household$23,550

$94,200 Hourly Full/Part time 4 persons$22.09/$44.19Folks making between 100-400% of the FPL will qualify for tax credits to help pay for the coverage.

What does that mean? Basically an individual making between $11,500 to $46,000 a year will get help paying for the premiums. Or, a family of four that brings in between $23,500 to $94,000 will qualify.

Next slide29How Tax Credits WorkPaid directly to insurance companyMarketplace lets you know how big of a credit youre eligible for.Based on silver level plan, but you pick the plan you want.Tax credits based on projected income

Paid directly to insurance company: so you can just pay your share of the monthly premium every month

Based so that silver level plan is affordable to you, but you pick the plan you want so maybe if you apply your tax credit to bronze it would be free or you could pay a little extra a month to upgrade to gold.

Based on projected income: if your income changes go back to the marketplace (well talk about how to do that in a minute) and let them know otherwise you could end up paying some of it back at the end of the year if your income went up. (In 25 minute version, cant elaborate on this part. Just have to mention that much and move on).30Help with out of pocket costsFolks at or below 250% of FPL ($28,725/yr individual; $58,875/yr family of 4) eligible for reduced cost sharingMust be getting Premium Tax CreditHave to be enrolled in a silver-level planCaps on out of pocket expenses

More help paying for coverage:

Some folks (those making less than 250% of FPL or around $29,000/year) will also get help paying for out of pocket expenses like co-pays. They have to be enrolled in a silver level plan to qualify for that help.

There are also additional caps on out of pocket expenses. These caps are set rather high likely most people will never reach them. They are designed for families or individuals with expensive chronic illnesses so that we no longer see people with health insurance going into significant debt because of out of pocket costs. Weekly chemo or MS treatments, for example, can be very expensive and add up. 31But HOW do I get it? Visit www.healthcare.gov

Call 1-800-318-2596Customer service representatives - 24/7English and SpanishLanguage line for 150 additional languages

But how do you get access to it? You can go to healthcare.gov, call the 1-800 number (reference brochure)32But HOW do I get it? (continued)Talk to a Navigator or a Certified Application CounselorVisit www.localhelp.healthcare.gov to find one near you!Cant find one near you? Call PHAN. We have CACs that can help you: 1-877-570-3642

Or you can get in person help by meeting with a navigator or CAC both can help you enroll in person. Visit local help (if youre in a rural area and there arent a lot of navigators or CACs OR if youre in Philly, Pittsburgh area, mention PHAN has CACs that can help folks, too, so to call or email us).

Move on.33Loss of minimum essential coverageMaterial contract violations by Qualified Health PlansGaining or becoming a dependent Gaining or losing eligibility for premium tax credits or cost-sharing reductionsGaining lawful presenceRelocation resulting in new or different Qualified Health Plan selectionEnrollment errors of the MarketplaceExceptional circumstancesSpecial Enrollment Period Qualifying Events

Must sign up during open enrollment period. Going on now through end of March.

In order to keep premiums reasonable and allow people with pre-existing conditions access the marketplace, had to set up an open enrolment period. Once that ends cannot get access to marketplace unless you meet a special qualify event. Give em a few examples (have a baby, lose your job, move, get married). Then, Next slide.

(you just need them to get the impression that its reasonable. Dont need to read it off and explain it all). 15 seconds.

34Tips & Tricks for Medicaid Explain how Medicaid works in your state pre-ACA firstMost popular messaging point is security, second is uncompensated care savingsExplain savings, but focus on peopleIf youre in a state that hasnt expanded youll need to explain the gap at least twice during presentation.Medicaid Expansion: Supreme Court Ruling Changes the GameText here

ACA envisions everyone making less than 138% of FPL ($15,856 for individual or $32,499 family of 4) will go into an expanded Medicaid programSupreme Court ruling makes Medicaid expansion optional to statesPennsylvania has not yet opted in

Painting by Theresa BrownGold of Art as Social InquiryThe ACA was written as a whole with everyone making between 100-400% of FPL getting those tax credits to help them buy private insurance and everyone making less than 138% of FPL (Or about $16,000/year for individual or $33k/year family of 4) will go into an expanded Medicaid program.

This was HUGE. When we talk tens of millions of Americans getting health insurance through the ACA it was mainly thanks to this measure.

The Supreme court ruled that this piece was actually optional.

Pennsylvania hasnt taken this option and until we do there is no help then for everyone making less than 100% of FPL.36A Common Misconception..

Medical Assistance not available to all low-income folks

1.4 million Pennsylvanians uninsured

Many working low-wage, temporary or part-time jobsThere is a common misconception that if you are a low wage worker or unemployed that you can get Medicaid Assistance. This simply isnt true, in Pennsylvania you need to be VERY low income AND meet another qualifying factor: have a disability, a young child, be pregnant, etc. 37

States receive 100% Federal Match 2014, 2015, and 2016

Slowly goes down, until steadying out at 90%

If Pennsylvania were to accept the Medicaid expansion opportunity, we would get 100 cents on the dollar back for all the money we spend on actual care for these folks until 2016. After that it will slowly go down until it steadies out at 90 cents on the dollar in 2020 and beyond.

(ONLY if asked: How do we know the fed gov wont cut that? Fed gov has never cut medicaid reimbursement rates since the establishment of the program. Sometimes they have temporarily gone up in times of crisis and then gone back down to where they always were, but have never been cutting. Plus the 100% match rate is paid for and guaranteed so the smartest thing to do would be to expand now while were getting this. Some states have implemented a just in case trigger where if the match rate ever falls below the promised rate the program goes away._38

Whatever county youre in you can use this to show the percentage of uninsured there that will qualify for Medicaid expansion. White counties mean we dont have the data.

For 25 minute version we cut the work slides so when youre here mention:

Census data tells us that 75% of folks who will qualify for ME have Atleast 1 fulltiem worker in household. These are folks working as hairdressers, child care workers, home health aides, server, etc.

(20 sec)39Fiscal Benefits for PennsylvaniaPennsylvanias own Independent Fiscal Office study: Economic WIN for PASave taxpayers hundreds of millions to over a billion dollars on money otherwise going to treat uninsured in ERCreates 35,000 new, good-paying jobs plus generates billions in new tax revenue(20 sec)40States all around PA have taken Medicaid expansion

From the Center on Budget and Policy Priorities report on the state of Medicaid expansion, Oct. 2013Lead in from other slide overwhelming fiscal benefits reason why all the states around us have decided to take Medicaid expansion.

(10 sec)41Whats at stake400,000 Pennsylvanians will be left with no options for coverage.PA hospitals will lose $8.1 billion in federal hospital payments between 2013-2022 while continuing to face annual uncompensated care costs of $1 billion.

Dont have time to get into DSH payments. Just explain 400,000 falling into gap

PA hospitals are set to lose billions to treat uninsured, but will still have hundreds of thousands of uninsured showing up at their doors.

(Can come back if there are questions during Q&A)42Whats Healthy PA?Not traditional Medicaid expansionMoves people into private insuranceElderly, Medically fragile, and people with disabilities will get Medicaid coverage.Significant benefit cuts and limitationsIncludes work requirements and premiumsLengthy waiver processTell lawmakers and Governor Corbett you want Medicaid expansion in 2014.We rushed through the rest of Medicaid expansion in 2 minutes so that you can take a full 2 minutes to explain problems with Healthy PA.

Moving ppl currently on Medicaid and new eligibles to private insurance.More expensive for state.Drastic cuts to benefits and limits to care will mean seniors difficult time getting access to wheelchairs and catheters, limits to mental health treatments and more.Premiums how will someone making 5,000 a year pay it dont have bank account. Are we going to hire people to collect $1, will cost taxpayers moreWork requirements also expensive, extra bureaucracy, when we KNOW majority of folks already working(remember, dont use jump through hoops language)

Need to expand NOW while have 100% federal match.43Individual MandateThose who choose not to get coverage will pay a penalty:2014 $95 or 1% of income, whichever is higher2015 $325 or 2%2016 $695 or 2.5% Exemptions:Health sharing ministries (Amish)Uninsured for less than 3 monthsCant find coverage that costs less than 8% of incomeFolks that would qualify for Medicaid expansion but live in states that arent expanding

Ok, back to moving through things quickly: Everyone who is able to purchase insurance will have to or pay a fine. There are exemptions, if you cant afford it, if you belong to a health insurance ministry like the Amish, if you qualify for Medicaid expansion, youre exempt.44Next stepsSign up for PHAN emails www.pahealthaccess.org to receive info on: Policy calls, free webinars, Action Alerts, and More!Call or write your state legislators in Harrisburg. Tell them to expand Medicaid today!Look for PHAN on Facebook and Twitter www.facebook.com/pahealthaccess.org @pahealthaccessTell your friends and family what youve learned!

Athena Fordaford@pahealthaccess.org

Please make pitch for folks to sign sign-in sheets!

Please also remember to email Athena at aford@pahealthaccess.org the basic details of the presentation. Let me know how it went.

Did something go really well for you? Share with the google group, too.

Thanks!45Questions/Comments to expectWill there be enough doctors?How is this paid for?Are Medicare Advantage plans sold on marketplace?My plan was cancelled, because..Abortion coverage in marketplaceDoes the chip get put in my brain or in my hand?