what does health care reform mean for you and your family? bringing health reform home april 2010

Download WHAT DOES HEALTH CARE REFORM MEAN FOR YOU AND YOUR FAMILY? Bringing Health Reform Home April 2010

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  • Slide 1
  • WHAT DOES HEALTH CARE REFORM MEAN FOR YOU AND YOUR FAMILY? Bringing Health Reform Home April 2010
  • Slide 2
  • Opening In March Congress passed and the President signed comprehensive health reform legislation As a non-partisan organization PICO worked to give families a voice in the health care debate. We made our voices heard on reform because of the stories affecting our families
  • Slide 3
  • Opening Reform builds on the current system with changes phased in over several years Now that the legislation has passed it is important for us to know what is in it and how it will affect each of us
  • Slide 4
  • Reflection
  • Slide 5
  • What about reform are you hopeful about? What questions or concerns do you have? One-to-Ones
  • Slide 6
  • Pre health care reform blueprint
  • Slide 7
  • Post health reform blueprint (UPDAT
  • Slide 8
  • Key Elements of Health Reform Greater regulation on insurance companies Illegal to deny coverage to people with pre-existing conditions Cannot charge more or terminate your insurance if you are sick No more annual or lifetime limits Greater scrutiny on premium increases and the ability to appeal insurance company denial of care
  • Slide 9
  • Key Elements of Health Reform Expands coverage to 32 million people currently without insurance
  • Slide 10
  • Key Elements of Health Reform Creates state-based Exchanges, a place that uninsured individuals and small businesses can buy coverage The Exchange will also be a safety net for those currently with insurance if they lose a job. Members of Congress will get their insurance through the Exchange.
  • Slide 11
  • Key Elements of Health Reform Measures to Control Health Care Costs for Families 80-85% of premiums have to go to medical care rather than administration costs and profits Limits on out-of-pocket costs ($5,950 for individuals and $11,900 for families in 2010) to prevent medical bankruptcies; applies to plans in the Exchange and incentives for employers to provide this Exchanges make it easier to compare plans and find the best value Cost containment of rising costs of healthcare (subsequent slides)
  • Slide 12
  • Key Elements of Health Reform Tax credits for small businesses to purchase health insurance for employees
  • Slide 13
  • Key Elements of Health Reform Focus on prevention Expands health care work force of doctors and nurses Youth can stay on their parents health insurance plans up to age 26 Everyone must have health insurance unless you have a religious objection or financial hardship An additional $11 billion in funds for Community Health Centers, which is estimated to double the number of people served
  • Slide 14
  • How is it paid for? Starting 2010: cost saving changes in Medicare Greater oversight and enforcement to reduce fraud, waste and abuse; greater efficiency and collaboration among doctors and reduced over-payments to the Medicare Advantage companies. Starting in 2011-2013: increasing penalties on contribution loopholes in Health Saving Accounts Increased penalties on nonqualified distributions from Health Saving Accounts, a lower cap on Flexible Spending Accounts contributions, and a standardization of the definition of qualified medical expenses.
  • Slide 15
  • How is it paid for? Starting in 2013: high-income earners will contribute more to the Medicare fund Individuals earning over $200,000 and families earning over $250,000 will contribute 2.35% for income above the threshold instead of the current 1.45%. They will also pay a 3.8% tax on net investment income (excluding retirement plans). Starting in 2018: insurers will have to pay a 40% excise tax on high cost group plans The tax is on the cost of coverage in excess of $27,500 (family coverage) and $10,200 (individual coverage). There are higher thresholds for retirees and employees in high risk professions.
  • Slide 16
  • Cost Containment Including: A Medicare Commission to cut through the political gridlock and make decisions on efficiency and reaching spending targets A tax on high cost Cadillac plans as an incentive to buy insurance plans that hold down costs Modernizing Health Care Information Technology (IT) infrastructure (e.g. electronic medical records) Pilot programs such as Medicare bundling to reward coordination and quality over quantity. In bundling Medicare will pay a doctor or hospital for the total care for a person with a certain disease, rather than a payment for every test or procedure; this will start as a pilot program and be expanded if it works
  • Slide 17
  • Cost Containment, continued Gathering and disseminating research on which treatments work, and which dont Investing in preventative care Reducing overpayments to private insurance companies that participate in Medicare Advantage The bill tries out almost every approach that leading health care experts have suggested for cost containment in the hopes that some of the ideas will work well. Successful strategies can be expanded on by the administration - without needing approval from Congress in the face of opposition from providers, suppliers and other interests. The bill is a testing ground of different ideas and we can build on what works.
  • Slide 18
  • What happens in the first year Begin to close the Medicare donut hole for Seniors so prescription drugs are more affordable Donut hole closes completely in 2020.
  • Slide 19
  • What happens in the first year Prohibit insurance companies from denying coverage to children with pre-existing conditions September 23, 2010
  • Slide 20
  • What happens in the first year Insurance companies will be banned from dropping people when they get sick and imposing lifetime limits on coverage - September 23, 2010
  • Slide 21
  • What happens in the first year Holds insurance companies accountable for unreasonable rate hikes
  • Slide 22
  • What happens in the first year Youth can stay on their parents plans up to age of 26 September 23, 2010
  • Slide 23
  • What happens in the first year Small business tax credits to help provide health insurance to employees - right away A high risk pool is created for people with pre-existing conditions, this will be in place until the exchanges are up in 2014 - June 21, 2010 Investments to increase the number of primary care doctors and nurses - October 1, 2010 New consumer assistance offices - September 23, 2010 New plans will have free preventative care and an independent appeals process for insurance company decisions to deny care - September 23, 2010
  • Slide 24
  • What is your current health care situation? Are you insured through work? Through Medicare? Medicaid? Are you uninsured?
  • Slide 25
  • Insured through Employer 2010 No canceling policies when you get sick or setting lifetime limits. Children up to age 26 can stay on your plan. Insurance companies will have to cover children with pre- existing conditions. New plans must provide free preventative services & allow you to appeal denials of coverage. 2010 No canceling policies when you get sick or setting lifetime limits. Children up to age 26 can stay on your plan. Insurance companies will have to cover children with pre- existing conditions. New plans must provide free preventative services & allow you to appeal denials of coverage. 2011 2013 Insurance companies required to spend 80-85% of premium dollars on medical services or else provide rebates to their policyholders. States can require insurance companies to submit justification for premium increases. 2011 2013 Insurance companies required to spend 80-85% of premium dollars on medical services or else provide rebates to their policyholders. States can require insurance companies to submit justification for premium increases. 2014 Insurers will have to cover adults with pre-existing conditions. No annual limits on coverage. Qualified individuals can begin buying subsidized coverage in the Exchange. 2014 Insurers will have to cover adults with pre-existing conditions. No annual limits on coverage. Qualified individuals can begin buying subsidized coverage in the Exchange. 2018 Insurers will have to pay a 40% excise tax on high cost insurance plans. The tax is on the cost of coverage in excess of $27,500 (family coverage) and $10,200 (individual coverage).
  • Slide 26
  • Insured through Medicare 2010 Seniors on traditional Medicare will have no losses in coverage and will add important benefits. Seniors that reach the donut hole will receive a $250 rebate for prescription drugs. 2010 Seniors on traditional Medicare will have no losses in coverage and will add important benefits. Seniors that reach the donut hole will receive a $250 rebate for prescription drugs. 2011 Seniors in the donut hole will receive a 50% discount on brand name drugs. The donut hole will be closed slowly through 2020. Annual checkups and most preventative care and screenings are at no cost. 2011 Seniors in the donut hole will receive a 50% discount on brand name drugs. The donut hole will be closed slowly through 2020. Annual checkups and most preventative care and screenings are at no cost. 2020 The donut hole will fully close. 2013 Government begins to cut subsidies to Medicare Advantage, which costs the government more than traditional Medicare. Se