Health Care Reform Overview

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					    Health Care Reform:
       An Overview
Presented by Bonnie Braun, PhD
           Public Health Carousel:
     2nd Annual Public Health Conference
          Wooster County, Maryland
                 April 6, 2011
                 Your Feelings About
              the Health Reform Law

describe your own feelings about the
         health reform law?
     Confusion Most Commonly Expressed Emotion

                                 Describes         Does not describe

              Confused            53%                  47%

                Anxious              39%                  61%

                  Angry               34%                  66%

           Enthusiastic                 27%                  72%

Note: Don’t know/Refused answers not shown.
Source: Kaiser Family Foundation Health Tracking Poll (conducted March 8-13, 2011)
Health Reform Hits Main Street
Henry J. Kaiser Family Foundation Presents
“Six I” Policy Analysis
Organizing Framework




 Health Reform: Information
 Law of the Land
 Provisions
 Dates of provisions
              Public Law
         111-148 &111-152
111-148 and 111-152 are collectively
known as health reform law, the
Patient Protection and Affordable
Care Act or the Affordable Care Act
(ACA).    Signed into law, March 23, 2010;jsessi
   Easy to Use Summary
     Robert Wood Johnson Foundation
1) Present unbiased information about health reform
2) Set forth implementation issues;
3) Help people understand the legislation and its
   implementation; and
4) Help federal and state legislative and public agency
   staff, private organizations and interest groups involved
   in implementation, health policy researchers, and the
The Inside Story of America's
 New Health Care Law and
  What It Means for Us All
  Provisions for Community Decisions--
• Establish a Prevention and Public Health Fund for
  prevention, wellness & public health activities
  including prevention research, and a Education
  and Outreach Campaign for preventive benefits.
• Establish grant program to support delivery of
  evidence-based and community-based
  prevention and wellness services aimed at
  strengthening prevention, reducing chronic
  disease and addressing health disparities
  especially in rural areas.
  Provisions for Community Decisions--
           Wellness Continued
• Provide grants for up to 5 years to small
  employers that establish wellness programs
  beginning FY11 and resources to evaluate.
• Require an effectiveness and impact report.
• Require chain restaurants and food sold from
  vending machines to disclose the nutritional
  content of each item.
   Provisions for Community Decisions—
           Oral Health Campaign
• Public Education Campaign – Requires the HHS
  Secretary to establish a 5-year, evidence-based
  public education campaign to promote
  oral health, including a focus on early childhood
  caries, prevention, oral health of pregnant
  women, and oral health of at-risk populations.
For a complete list of oral health provisions, see Children’s Dental Health Project’s
(CDHP) Senate Health Reform Toolbox available in the in the Health Care Reform
Center on at
 Provisions for Family Decisions
• Citizens and residents carry health insurance
  coverage or pay phased-in tax penalty of
  >$695 / year per family or 1.5% of household
  income beginning in 2014. Some exemptions.
• Expand Medicaid to all under age 65 with
  incomes up to 133% of federal poverty level.
• All newly eligible adults guaranteed a
  benchmark package covering essential health
  benefits.                           (January 1, 2014)
  Provisions for Family Decisions
• Provide refundable premium credits to eligible
  individuals and families with incomes between
  133-400% federal poverty level. (January 1, 2014)
• Exclude costs for over-the-counter drugs not
  prescribed from being reimbursed through a
  Health Savings Account (January 1, 2011); limit
  amount of contributions to flexible spending
  account to $2,500 per year (January 1, 2013)
  Provisions for Family Decisions
• Establish an internet website to help residents
  identify health coverage options (July 1, 2010)

• Develop standards for insurers to use in providing
  information on benefits and coverage.
  (Note: Associated with health literacy).
        What is Health Literacy?

Cultural &
               How easily people can
                    understand Literacy use
                    Oral        and

               information to live well.

             Listening   Speaking   Writing   Reading
What percentage of Americans feel
   confident making insurance
   25% 45% 65% 85%

       Health Reform: Issues
 Provisions still being converted to
   federal rules and regulations.
 States making decisions on extent
  of adoption of the federal law.
 Courts considering constitutionality.
 Diversity of opinion the value of the
Forget Math and Science, Teach Civics
   (Or Why We Need To Bring Back
        "School House Rock")
• 52% know it is the law of the land
• 22% of the American people think the
  Affordable Care Act has been repealed.
• 26% aren't sure.
  (Kaiser Family Foundation February, 2011 Poll)
      Health Reform: Impacts
 State legislative and executive
   branches responding
 Families and communities
  searching for information
                        Summary of Recommendations
     Summary Of Recommendations

1. Establish basic structure and governance of
   Health Insurance Exchange.
2. Continue development of State’s plan for
   seamless entry into coverage, maximizing
   federal funding.
3. Develop centralized outreach and education
4. Develop state and local strategic plans to
   achieve improved health outcomes.
          Summary Continued
5. Encourage active participation of safety net
   provider in health reform and new insurance
6. Improve coordination of behavioral health
   and somatic ( mind and body) services.
7. Incorporate strategies to address potential
   barriers to care for special population
   wherever possible.
         Summary Continued
8. Institute comprehensive workforce planning.
9. Support education and training.
10. Explore licensure and administrative
11. Explore improvements to liability policy
12. Achieve cost savings and quality.
    improvements through payment reform and
    innovations in health care delivery models.
          Summary Continued
13. Promote improved access to primary care
14. Achieve reduction and elimination of health
    disparities through exploration of financial,
    performance-based incentives and
    incorporation of other strategies.
15. Preserve strong base of employer-sponsored
16. Ensure continued leaders and oversight of
    health reform implementation.
     Health Reform: Implications

   Public Policy Arena
   Private Sector Arena
   Non-profit Sector Arena
   Educational Arena
   Civic Arena
   Personal and Family Arena
    Health Reform: Imperative
 There is a timeline for action.
 People confused about the law
  and insurance.
 Scams and fraud likely.
 Personal, community and other
  public policy decisions must be
   Health Reform: Interventions
 Deepen knowledge of provisions of the law.
 Monitor changes over time as provisions are
   launched or modified.
 Modify existing educational materials on
   health , health care, insurance, etc.
 Incorporate principles of health literacy in
  communications about health reform
    Health Reform: Interventions
 Seek and share grant opportunities.
 Conduct research to monitor impact of law
  on families and communities and assess
  effectiveness of educational programs.
 Find ways to act collectively in a timely manner.
 Your ideas . . . .
               “Six I” Policy Analysis
               Organizing Framework
 What does the federal legislation actually state?
 What actions have the state of Maryland taken to respond to
    federal legislation?

 What modifications of the federal legislation have been,
   are being, or might be made?

 How will our businesses, society, communities, families,
   individuals be affected by the new law?
    “Six I” Policy Analysis Organizing
          Framework Continued
Does Maryland need to pass state-specific legislation?
How can we take advantage of provisions while awaiting
  possible changes in the law? Do we need to better
  educate citizens?

Are there reasons to act now to reduce confusion, improve
   understanding and decision-making; prevent fraud, etc.?

What actions can a community, individuals, families and the
   business sector take now?
What can we do for ourselves without waiting for Congress,
   the Courts and the General Assembly?
               Knowledge Base


     for                        Political
Intervention                     Will
           Want to Learn More?
• Announcing the Availability of Audio and Video
  Recordings of Forum:
  Health Reform, Rural Communities and You
• In December, the University of Maryland Center for
  Health Literacy and University of Maryland Extension
  hosted a statewide forum focused on health reform
  and its impact on rural families and communities.
• You can view and listen to any or all of the sessions by
  going to our website and clicking on
                           Bonnie Braun, PhD
                  Endowed Chair and Director
          University of Maryland--College Park
                        School of Public Health
Herschel S. Horowitz Center for Health Literacy
       Professor and Extension Family Policy
                Department of Family Science

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