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					What’s
 Next
in Health Care Reform:
Training for Trainers.
Goals:
1) To provide an overview of the new law.

2) To prepare you to talk about the new law.

3) To introduce you to state and federal
     implementation of the new law.
What it is not:
1) A PhD Program in Health Policy.
2) How the law will affect your Aunt Edna.
3) Scripture via Powerpoint.
4) A Health Care Town Hall Forum,
                    circa August of 2009.
Agenda:
1) Introduction and Overview (10 min)
2) Law Overview (40 min)
3) Presentation Practice (20 min)
4) Presentation Practice Debrief (15 min)
5) Q&A on Law (20 min)
6) Next Steps (10 min)
7) Evaluation (5 min)
Law Overview:
1) What Happened and Why?
2) What Does The New Law Do?
3) What Does the New Law Mean for You and
     Your Fellow Minnesotans?
4) What’s Next?
                                     What Happened…?
In March 2010, President Obama signed the “Patient
Protection and Affordable Care Act” (PPACA) into law.
  What it is…                               What it is NOT…
  Insurance Industry Reform                 “Single-Payer”
  Medicare Improvements                     “Medicare for All”
  Medicaid Expansion                        “Socialized Medicine”
  Delivery System Reform                    “Death Panels”
  New Requirements to Have                  Tea Act of 1773, The October
  Insurance                                 Revolution, Natl Socialism
  Govt Help to Buy Insurance                The Apocalypse
This slide developed from Health Care for
All New York’s Health Reform: What is it
and What Does it Mean for New York?
                          …and Why?
-Since 2000, premiums have more than doubled while wages have
        virtually stood still.
-Since 1987, the cost of the average family health insurance policy has
        risen from 7% of median family income to 17%.
-At least 46 million Americans were uninsured ‐ more than 85% of
        whom are in working families.
-Since the recession began, an estimated 4 million additional Americans
        have lost their health insurance – and were losing coverage at an
         average of 10,680 workers each day.
-In 2009, 53% of Americans say their household cut back on
         health care due to cost concerns.
-Today, only 4 cents of every health care dollar is spent on prevention.
-In 2007, 60% of U.S. bankruptcies were due to medical costs.
         What Does the New Law Do?
1) Expands Health Insurance Coverage
2) Regulates the Health Insurance Industry
3) Makes Health Insurance More Affordable
4) Reforms the Health Care Delivery System
5) Includes Measures to Increase
     Prevention and Decrease Inequality
           What Does the New Law Do?
 Expanding Health Insurance Coverage
 Increases Bargaining Power with Insurers
Individual Market:
Ex. Individual Consumers who purchase for themselves.

Small Group Market:
Ex. Small businesses, non-profits, local government, etc.

Large Group Market:
Ex. Large Corporations, State Government Pools, etc.

Self-Insured:
Ex. Organizations that pool resources to pay own claims.
         What Does the New Law Do?
Expanding Health Insurance Coverage
How people are insured: pre-reform.
         What Does the New Law Do?
Expanding Health Insurance Coverage
How people are insured: post-reform.
          What Does the New Law Do?
 Expanding Health Insurance Coverage
  Expanding Public Coverage
Medicaid
Medicaid will be expanded to all individuals under age 65 with incomes up to
133% of the federal poverty level ($14,404 for an individual and $29,327 for a
family of four in 2009) based on modified adjusted gross income.



Children’s Health Insurance Program
Eligibility for Medicaid and the Children’s Health Insurance Program (CHIP) for
children is extended at their current eligibility levels until 2019.
           What Does the New Law Do?
  Expanding Health Insurance Coverage
  Individual Mandate
All individuals will be required to have health insurance, with some
exceptions, beginning in 2014. Those who do not have coverage will be required
to pay a yearly financial penalty of the greater of $695 per person (up to a
maximum of $2,085 per family), or 2.5% of household income, which will be
phased-in from 2014-2016. Exceptions will be given for…
   …financial hardship
   …religious objections
   …American Indians
   …people who have been uninsured for less than three months
   …those for whom the lowest cost health plan exceeds 8% of income
   …individuals with income below the tax filing threshold ($9,350 for an individual
           and $18,700 for a married couple in 2009).
          What Does the New Law Do?
 Expanding Health Insurance Coverage
  Employer Penalty
There is no employer mandate but employers with 50 or more employees will be
assessed a fee of $2,000 per full-time employee (in excess of 30 employees) if
they do not offer coverage and if they have at least one employee who receives
a premium credit through an Exchange.

Free Choice Voucher: Employers that offer coverage will be required to provide
a voucher to employees with incomes below 400% of the poverty level if their
share of the premium cost is between 8-9.8% of income to enable them to enroll
in a plan in an Exchange. Employers that offer a free choice voucher will not be
subject to penalty.

Auto Enrollment: Large employers that offer coverage will be required to
automatically enroll employees into the employer’s lowest cost premium plan if
the employee does not sign up for employer coverage or does not opt out of
coverage.
          What Does the New Law Do?
  Regulates the Health Insurance Industry
Getting Insurance           Benefits Package             Price
-Guaranteed Issue           -Comprehensive Benefits      -Premium Rating
-Pre-Existing Conditions    -Standard Benefit Categories -Rate Review
-Limiting Waiting Periods                                -Medical Loss Ratios
-Dependent Coverage
-Lifetime & Annual Limits
-Prohibiting Rescission
          What Does the New Law Do?
  Regulates the Health Insurance Industry
Getting Insurance           Benefits Package             Price
-Guaranteed Issue           -Comprehensive Benefits      -Premium Rating
-Pre-Existing Conditions    -Standard Benefit Categories -Rate Review
-Limiting Waiting Periods                                -Medical Loss Ratios
-Dependent Coverage
-Lifetime & Annual Limits
-Prohibiting Rescission
Sec. 2702. Guaranteed availability of coverage. Each health insurance
issuer must accept every employer and individual in the State that applies
for coverage, permitting annual and special open enrollment periods for
those with qualifying lifetime events.

Sec. 2703. Guaranteed renewability of coverage. Requires guaranteed
renewability of coverage regardless of health status, utilization of health
services or any other related factor.
          What Does the New Law Do?
  Regulates the Health Insurance Industry
Getting Insurance               Benefits Package             Price
-Guaranteed Issue               -Comprehensive Benefits      -Premium Rating
-Pre-Existing Conditions        -Standard Benefit Categories -Rate Review
-Limiting Waiting Periods                                    -Medical Loss Ratios
-Dependent Coverage
-Lifetime & Annual Limits
-Prohibiting Rescission
Sec. 2704. Prohibition of preexisting condition exclusions or other discrimination based
on health status. No group health plan or insurer offering group or individual coverage
may impose any pre-existing condition exclusion or discriminate against those who have
been sick in the past.

Sec. 2705. Prohibiting discrimination against individual participants and beneficiaries
based on health status. No group health plan or insurer offering group or individual
coverage may set eligibility rules based on health status, medical condition, claims
experience, receipt of health care, medical history, genetic information, evidence of
insurability – including acts of domestic violence or disability.
          What Does the New Law Do?
  Regulates the Health Insurance Industry
Getting Insurance         Benefits Package               Price
-Guaranteed Issue         -Comprehensive Benefits        -Premium Rating
-Pre-Existing Conditions  -Standard Benefit Categories   -Rate Review
-Limiting Waiting Periods                                -Medical Loss Ratios
-Dependent Coverage
-Lifetime & Annual Limits
-Prohibiting Rescission

Sec. 2708. Prohibition on excessive waiting periods. Prohibits any waiting
periods for group coverage that exceeds 90 days.
          What Does the New Law Do?
  Regulates the Health Insurance Industry
Getting Insurance           Benefits Package             Price
-Guaranteed Issue           -Comprehensive Benefits      -Premium Rating
-Pre-Existing Conditions    -Standard Benefit Categories -Rate Review
-Limiting Waiting Periods                                -Medical Loss Ratios
-Dependent Coverage
-Lifetime & Annual Limits
-Prohibiting Rescission

Sec. 2714. Extension of dependent coverage. Requires all plans offering
dependent coverage to allow unmarried individuals until age 26 to remain
on their parents’ health insurance.
          What Does the New Law Do?
  Regulates the Health Insurance Industry
Getting Insurance         Benefits Package               Price
-Guaranteed Issue         -Comprehensive Benefits        -Premium Rating
-Pre-Existing Conditions  -Standard Benefit Categories   -Rate Review
-Limiting Waiting Periods                                -Medical Loss Ratios
-Dependent Coverage
-Lifetime & Annual Limits
-Prohibiting Rescission

Sec. 2711. No lifetime or annual limits. As amended by Section 10101,
prohibits plans from establishing lifetime limits, and annual limits
beginning in 2014, on the dollar value of benefits. Prior to 2014, plans may
only establish restricted annual limits as defined by the Secretary of
Health and Human Services (HHS), ensuring access to needed services
with minimal impact on premiums.
          What Does the New Law Do?
  Regulates the Health Insurance Industry
Getting Insurance           Benefits Package             Price
-Guaranteed Issue           -Comprehensive Benefits      -Premium Rating
-Pre-Existing Conditions    -Standard Benefit Categories -Rate Review
-Limiting Waiting Periods                                -Medical Loss Ratios
-Dependent Coverage
-Lifetime & Annual Limits
-Prohibiting Rescission

Sec. 2712. Prohibition on rescissions. Prohibits all plans from rescinding
coverage except in instances of fraud or misrepresentation.
          What Does the New Law Do?
  Regulates the Health Insurance Industry
Getting Insurance             Benefits Package             Price
-Guaranteed Issue             -Comprehensive Benefits -Premium Rating
-Pre-Existing Conditions      -Standard Benefit Categories -Rate Review
-Limiting Waiting Periods                                  -Medical Loss Ratios
-Dependent Coverage
-Lifetime & Annual Limits
-Prohibiting Rescission
Sec. 2707. Comprehensive health insurance coverage. Requires health insurance
issuers in the small group and individual markets to include coverage which
incorporates defined essential benefits, provides a specified actuarial value, and
requires all health plans to comply with limitations on allowable cost-sharing.

Sec. 2713. Coverage of preventive health services. Requires all plans to cover
preventive services and immunizations recommended by the U.S. Preventive
Services Task Force and the CDC, certain child preventive services recommended
by the Health Resources and Services Administration (HRSA), and women’s
preventive care and screening recommended by HRSA, without any cost-sharing.
          What Does the New Law Do?
  Regulates the Health Insurance Industry
Getting Insurance                Benefits Package                 Price
-Guaranteed Issue                -Comprehensive Benefits          Premium Rating
-Pre-Existing Conditions         -Standard Benefit Categories     Limit Deductibles
 Sec. Waiting Periods                                             Rate Review
-Limit1302. Essential health benefits requirements. Defines an essential health benefits
 package as Coverage                                              Medical Loss a
-Dependentone that covers essential health benefits, limits cost-sharing, and hasRatios
 specified actuarial
-Lifetime Limits value (pays for a specified percentage of costs), as follows:
-Prohibits Rescission
1. For the individual and small group markets, requires the Secretary to define essential health
benefits, which must be equal in scope to the benefits of a typical employer plan.

2. For all plans in all markets, prohibits out-of-pocket limits that are greater than the limits
for Health Savings Accounts. For the small group market, prohibits deductibles that are
greater than $2,000 for individuals and $4,000 for families. Indexes the limits and deductible
amounts by the percentage increase in average per capita premiums.

3. For the individual and small group markets, requires one of the following levels of coverage,
under which the plan pays for the specified percentage of costs:
Bronze: 60 percent
Silver: 70 percent
Gold: 80 percent
Platinum: 90 percent
          What Does the New Law Do?
  Regulates the Health Insurance Industry
Getting Insurance               Benefits Package             Price
-Guaranteed Issue               -Comprehensive Benefits      -Premium Rating
-Pre-Existing Conditions        -Standard Benefit Categories -Rate Review
-Limiting Waiting Periods                                    -Medical Loss Ratios
-Dependent Coverage
-Lifetime & Annual Limits
-Prohibiting Rescission
Sec. 2701. Fair health insurance premiums. Establishes that premiums in the
individual and small group markets may vary only by family structure, geography,
the actuarial value of the benefit, age (limited to a ratio of 3 to 1), and tobacco use
(limited to a ratio of 1.5 to 1). Section 10103 clarifies that this provision applies to
insured plans in the large group market, not self-insured plans.
          What Does the New Law Do?
  Regulates the Health Insurance Industry
Getting Insurance            Benefits Package             Price
-Guaranteed Issue            -Comprehensive Benefits      -Premium Rating
-Pre-Existing Conditions     -Standard Benefit Categories -Rate Review
-Limiting Waiting Periods                                 -Medical Loss Ratios
-Dependent Coverage
-Lifetime & Annual Limits
-Prohibiting Rescission
Sec. 1003. Ensuring that consumers get value for their dollars. For plan years
beginning in 2010, the Secretary and States will establish a process for the annual
review of increases in premiums for health insurance coverage. Requires States to
make recommendations to their Exchanges about whether health insurance issuers
should be excluded from participation in the Exchanges based on unjustified
premium increases. Provides $250 million in funding to States from 2010 until 2014
to assist States in reviewing and, if appropriate under State law, approving
premium increases for health insurance coverage and in providing information and
recommendations to the Secretary.
          What Does the New Law Do?
  Regulates the Health Insurance Industry
Getting Insurance               Benefits Package             Price
-Guaranteed Issue               -Comprehensive Benefits      -Premium Rating
-Pre-Existing Conditions        -Standard Benefit Categories -Rate Review
-Limiting Waiting Periods                                    -Medical Loss Ratios
-Dependent Coverage
-Lifetime & Annual Limits
-Prohibiting Rescission
Sec. 2718. Bringing down the cost of health care coverage. As amended by Section
10101, requires plans offering coverage in the group and individual markets (including
grandfathered plans but excluding self-insured plans) to report to the Secretary the
amount of premium revenues spent on clinical services, activities to improve quality, and
all other non-claims costs as defined by the National Association of Insurance
Commissioners and certified by the Secretary of HHS. Beginning in 2011, large group
plans that spend less than 85 percent of premium revenue and small group and individual
market plans that spend less than 80 percent of premium revenue on clinical services
and quality must provide a rebate to enrollees. In addition, each hospital operating within
the United States shall publish a list of standard charges for items and services provided
by the hospital.
           What Does the New Law Do?
   Regulates the Health Insurance Industry
Creating a Health Insurance Exchange
What is a Health Insurance Exchange?          The law creates state-based
                                                American Health Benefit
Who Can and Can’t Use the Exchange?     Exchanges and Small Business
                                       Health Options Program (SHOP)
How Can People Use the Exchange?           Exchanges, administered by a
                                       governmental agency or non-profit
Are there Non-Profit Options?                  organization, through which
                                         individuals and small businesses
What benefits will be offered?
                                            with up to 100 employees can
                                             purchase qualified coverage.
           What Does the New Law Do?
   Regulates the Health Insurance Industry
Creating a Health Insurance Exchange
What is a Health Insurance Exchange?              Individuals who are not
                                               incarcerated, are lawfully
Who Can and Can’t Use the Exchange?
                                        residing in a State, and who do
How Can People Use the Exchange?           not have access to affordable
                                       employer coverage are qualified
Are there Non-Profit Options?          to enroll in qualified health plans
                                         through that State’s Exchange.
What benefits will be offered?
           What Does the New Law Do?
   Regulates the Health Insurance Industry
Creating a Health Insurance Exchange
What is a Health Insurance Exchange?     The law requires Exchanges to
                                            certify qualified health plans,
Who Can and Can’t Use the Exchange?        operate a toll-free hotline and
                                          Internet website, rate qualified
How Can People Use the Exchange?                health plans, present plan
                                            options in a standard format,
Are there Non-Profit Options?          inform individuals of eligibility for
                                         Medicaid and CHIP, provide an
What benefits will be offered?
                                        electronic calculator to calculate
                                                     plan costs, and grant
                                         certifications of exemption from
                                              the individual responsibility
                                                              requirement.
           What Does the New Law Do?
   Regulates the Health Insurance Industry
Creating a Health Insurance Exchange
What is a Health Insurance Exchange?    Yes, the law requires the Office of
                                       Personnel Management to contract
Who Can and Can’t Use the Exchange?        with insurers to offer at least two
                                                    multi-state plans in each
How Can People Use the Exchange?                Exchange. At least one plan
                                                        must be offered by a
Are there Non-Profit Options?                                  nonprofit entity.
                                       The law also creates the Consumer
What benefits will be offered?
                                              Operated and Oriented Plan
                                             (CO-OP) program to foster the
                                         creation of non-profit, member-run
                                          health insurance companies in all
                                       50 states and District of Columbia to
                                                 offer qualified health plans.
           What Does the New Law Do?
   Regulates the Health Insurance Industry
Creating a Health Insurance Exchange
What is a Health Insurance Exchange?       The law requires the DHHSSecretary to
                                          define essential health benefits, which
Who Can and Can’t Use the Exchange? must include at least the following general
                                             services: ambulatory patient services,
How Can People Use the Exchange?               emergency services, hospitalization,
                               maternity and newborn care, mental health benefits
Are there Non-Profit Options?
                                and substance use disorder services, prescription
                                 drugs, rehabilitative and habilitative services and
What benefits will be offered?
                                       devices,laboratory services, preventive and
                                            wellness services and chronic disease
                                management, and pediatric services including oral
                                                                     and vision care.
                                                                                    .
           What Does the New Law Do?
   Regulates the Health Insurance Industry
Creating a Health Insurance Exchange
What is a Health Insurance Exchange?The scope of these benefits must be equal
                                     to the scope of benefits provided under a
Who Can and Can’t Use the Exchange?   typical employer plan,. The four levels of
                                      coverage, which vary depending on how
How Can People Use the Exchange?               much the insurer pays, include:
Are there Non-Profit Options?          • Bronze: equivalent to 60% of the full
                                       actuarial value of plan benefits
What benefits will be offered?
                                       • Silver: equivalent to 70% of full value

                                       • Gold: equivalent to 80% full value

                                       • Platinum: equivalent to 90% of full value
          What Does the New Law Do?
  Makes Health Insurance More Affordable
     Caps on Out of Pocket Costs
 Before              After                                Annual Out-
                                               Annual
                              Income as a                  of-Pocket
                                                salary
                             percent of the                 Cap for
                                                (for a
                                Federal                   Those Who
                                              family of
                             Poverty Level                 Qualify for
                                                three)
                                                           Subsidies
                                 150%         $27,465        $3,867
                                 200%         $36,620        $3,867
                                 300%         $54,930        $5,800
No Federal Caps on               400%         $73,240        $7,733
Out-of-Pocket Costs for
non-HSA plans
         What Does the New Law Do?
 Makes Health Insurance More Affordable
   Subsidies for Low Income
                  -The availability of premium credits and cost-sharing
Eligibility       subsidies through the Exchanges is limited to
                  U.S. citizens and legal immigrants who meet
                  income limits.

                  -Employees who are offered coverage by an
Premium Credits   employer are not eligible for premium credits unless
                  the employer plan does not have an actuarial value
                  of at least 60% or if the employee share of the
                  premium exceeds 9.5% of income.
Cost Sharing
Subsidies         -Legal immigrants who are barred from enrolling in
                  Medicaid during their first five years in the U.S. will
                  be eligible for premium credits.
         What Does the New Law Do?
 Makes Health Insurance More Affordable
   Subsidies for Low Income
                   The law provides refundable and advanceable
Eligibility        premium credits to eligible individuals and families
                   with incomes between 133-400% FPL to purchase
                   insurance through the Exchanges. The premium
                   contributions are limited to the following percentages
                   of income for specified income levels:
Premium Credits Up to 133% FPL: 2% of income
                   133-150% FPL: 3 – 4% of income
                   150-200% FPL: 4 – 6.3% of income
Cost Sharing       200-250% FPL: 6.3 – 8.05% of income
Subsidies          250-300% FPL: 8.05 – 9.5% of income
                   300-400% FPL: 9.5% of income
           What Does the New Law Do?
   Makes Health Insurance More Affordable
      Subsidies for Low Income
 What is Actuarial Value?
   Plan                 Premium      Benefits             Cost-sharing
1) Total Tonsils Plan   $4/Month     Tonsillectomies only 100% on Tonsillectomies
2) Every Inch Plan      $50/Month    All Doctor Visits    98% You / 2% Insurance
3) Worse Plan           $200/Month Limited Doctor Visits $2500 Deductible
                                                         $35 Co-Pays
                                                         80% You / 20% Insurance
                                                            on Everything
4) Better Plan          $300/Month All Doctor Visits     $500 Deductible
                                                         $5 Co-Pays
                                                         80% / 20% Some Electives
                                                         100% on Everything Else
        What Does the New Law Do?
Makes Health Insurance More Affordable
   Subsidies for Low Income
What is Actuarial Value?
A measure of the average value of benefits in a health insurance plan.

It is calculated as the percentage of benefit costs a health insurance plan
expects to pay for a standard population, using standard assumptions and
taking into account cost-sharing provisions.

Placing an average value on health plan benefits allows different health plans
to be compared.
         What Does the New Law Do?
 Makes Health Insurance More Affordable
   Subsidies for Low Income
                  The law provides cost-sharing subsidies to eligible
Eligibility       individuals and families. The cost-sharing credits
                  reduce the cost-sharing amounts and annual cost-
                  sharing limits and have the effect of increasing the
                  actuarial value of the basic benefit plan to the
                  following percentages of the full value of the plan for
Premium Credits   the specified income level:
                  100-150% FPL: 94%
Cost Sharing      150-200% FPL: 87%
Subsidies         200-250% FPL: 73%
                  250-400% FPL: 70%
        What Does the New Law Do?
Makes Health Insurance More Affordable
  Medicaid Expansion
Sec. 2001. Medicaid coverage for the lowest income populations.

Eligibility. Creates a new State option to provide Medicaid coverage
through a State plan amendment beginning on April 1, 2010, as
amended by Section 10201. Eligible individuals include: all non-elderly,
non-pregnant individuals who are not entitled to Medicare (e.g., childless
adults and certain parents).

Creates a new mandatory Medicaid eligibility category for all such
“newly-eligible” individuals with income at or below 133 percent of
the Federal Poverty Level (FPL) beginning January 1, 2014.
          What Does the New Law Do?
  Makes Health Insurance More Affordable
    Medicaid Expansion
Medicaid is usually paid 50% by the federal government and 50%
by the state government.
To finance the coverage for the newly eligible, states will receive:
100% federal funding for 2014 through 2016,
95% federal financing in 2017
94% federal financing in 2018
93% federal financing in 2019
90% federal financing for 2020 and years after.
Medicaid payments to primary care doctors for primary care
services will be increased to 100% of Medicare payment rates in
2013 and 2014 with 100% federal financing.
         What Does the New Law Do?
Reforms the Health Care Delivery System

“Turn to page 621 of the Senate version, the
section entitled “Transforming the Health Care
Delivery System,” and start reading. Does the bill
end medicine’s destructive piecemeal payment
system? Does it replace paying for quantity with
paying for quality? Does it institute nationwide
structural changes that curb costs and raise
quality? It does not.
Instead, what it offers is . . . pilot programs.”

                        -Dr. Atul Gawande
          What Does the New Law Do?
 Reforms the Health Care Delivery System
    “Getting our medical communities, town by town, to improve care and
control costs isn’t a task that we’ve asked government to take on before.
                 But we have no choice. At this point, we can’t afford any
                 illusions: the system won’t fix itself, and there’s no piece
                     of legislation that will have all the answers, either. The
                           task will require dedicated and talented people in
                           government agencies and in communities who
                            recognize that the country’s future depends their
                           sidestepping the ideological battles, encouraging
                           local change, and following the results. But if
                           we’re willing to accept an arduous, messy, and
                            continuous process we can come to grips with a
                                              problem even of this immensity.”
                               - Dr. Atul Guwande
                What Does the New Law Do?
       Reforms the Health Care Delivery System
       Examples of Demonstrations, Pilots, and Studies
Sec. 1254. Study of large group market.                                        Sec. 3512. GAO study and report on causes of action.
Sec. 1416. Study of geographic variation in application of FPL.                           Oral healthcare
                                                                               Sec. 4102. Oral healthcare prevention activities.
Sec. 1562. GAO study regarding the rate of denial of coverage and enrollment   Sec. 4202. Healthy aging, living well; evaluation of community-based
            by health insurance issuers and group health plans.                            prevention and wellness programs for Medicare beneficiaries.
Sec. 2403. Money Follows the Person Rebalancing Demonstration.                 Sec. 4204. Immunizations.
Sec. 2704. Demonstration project to evaluate integrated care around a          Sec. 4206. Demonstration project concerning individualized wellness plan.
            hospitalization.                                                   Sec. 4306. Funding for childhood obesity demonstration project.
Sec. 2705. Medicaid global payment system demonstration project.               Sec. 5304. Alternative dental health care provider demonstration project.
Sec. 2705. Prohibiting discrimination against individual participants and                                             family nurse practitioner training
                                                                               Sec. 5317. Demonstration grants for family nurse practitioner training
            beneficiaries based on health status.                                          programs.
Sec. 2706. Pediatric Accountable Care Organization demonstration project.      Sec. 5507. Demonstration project to address health professions workforce
Sec. 2707. Medicaid emergency psychiatric demonstration project.                           needs; extension of family-to-family health information centers.
Sec. 3023. National pilot program on payment bundling.                         Sec. 5509. Graduate nurse education demonstration program.
Sec. 3024. Independence at home demonstration program.                         Sec. 6112. National independent monitor demonstration project.
Sec. 3113. Treatment of certain complex diagnostic laboratory tests.           Sec. 6114. National demonstration projects on culture change and use of
                              Rural Community Hospital
Sec. 3123. Extension of the Rural Community Hospital Demonstration Program.                information technology in nursing homes.
Sec. 3126. Improvements to the demonstration project on community health       Sec. 6107. GAO study and report on Five-Star Quality Rating System.
            integration models in certain rural counties.                      Sec. 7103. GAO study to make recommendations on improving the 340B
Sec. 3127. MedPAC study on adequacy of Medicare payments for health care                  program.
            providers serving in rural areas. Medicare                         Sec. 9011. Study and report of effect on veterans health care.
Sec. 3138. Treatment of certain cancer hospitals.                              Sec. 10336. GAO study and report on Medicare beneficiary access to high-
Sec. 3140. Medicare hospice concurrent care demonstration program.                           quality dialysis services.
Sec. 3142. HHS study on urban Medicare-dependent hospitals.                    Sec. 10326. Pilot testing pay-for-performance programs for certain Medicare
Sec. 3208. Making senior housing facility demonstration permanent.                           providers.
Sec. 3313. Office of the Inspector General studies and reports.                Sec. 10504. Demonstration project to provide access to affordable care.
Sec. 3504. Design and implementation of regionalized systems for emergency     Sec. 10607. State demonstration programs to evaluate alternatives to current
            care.                                                                                    tort litigation.
                                                                                            medicaltort litigation
Sec. 3508. Demonstration program to integrate quality
            improvement and patient safety training into
            clinical education of health professionals.
Sec. 3510. Patient navigator program.
          What Does the New Law Do?
 Reforms the Health Care Delivery System
Sec. 3011. National strategy. Requires the Secretary to establish and update
annually a national strategy to improve the delivery of health care services,
patient health outcomes, and population health.
Sec. 3015. Data Collection; Public Reporting. Requires the Secretary to
collect and aggregate consistent data on quality and resource use measures
from information systems used to support health care delivery to implement the
public reporting of performance information.

Sec. 6301. Patient-Centered Outcomes
Research. Establishes a private, nonprofit
entity (the Patient-Centered Outcomes
Research Institute) governed by a public-
private sector board appointed by the
Comptroller General to identify priorities for
and provide for the conduct of comparative
outcomes research.
          What Does the New Law Do?
Includes Measures to Increase
     Prevention and Decrease Inequity
Measures to
                1) Workforce Development
Decrease
Racial Health   2) Data Collection and Reporting
Disparities     3) Community Health Center Funding
                4) Indian Health Care Improvement

                5) Quality Improvements
                6) Community Health Needs Assessment
           What Does the New Law Do?
 Includes Measures to Increase
      Prevention and Decrease Inequity
1) Workforce Development
Workforce Development & Training
Section 5102 State Healthcare Workforce Development Grants
Section 5301 Primary Care Training and Enhancement
Section 5303 Training in General, Pediatric, and Public Health Dentistry
Section 5307 Cultural Competency, Prevention, and Public Health and Individuals with Disability Training
Section 5313 Grants to Promote the Community Health Workforce
Section 5507 Demonstration Projects to Address Health Professions Workforce Needs
Section 5405 Primary Care Extension Program
Loan Repayments
Section 5203 Healthcare Workforce Loan Repayment Programs
Section 5207 Funding for National Health Services Corps
Workforce Recruitment
Section 5401 Centers of Excellence
Section 5402 Health Professions Training for Diversity
Section 5404 Workforce Diversity Grants
Section 5606 State Grants to Health Care Providers Who Provide Services to a High
            Percentage of Medically Underserved Population or Other Special Population
Section 10501 Rural Physician Training Grants
Section 5403 Interdisciplinary, community-based linkages
          What Does the New Law Do?
Includes Measures to Increase
     Prevention and Decrease Inequity
               2) Data Collection and Reporting
               Section 6301 Patient-Centered Outcomes Research Institute
               Section 4302 Understanding Health Disparities: Data Collection and Analysis

               3) Community Health Center Funding
               Section 2303 Community Health Centers.

               4) Indian Health Care Improvement Act
               Section 10221 Indian Healthcare Improvement

               5) Quality Improvements
               Section 1311 Rewarding Quality Through Market Based Incentives
               Section 3501 Quality Improvement Technical Assistance and Implementation
               Section 2951Maternal, Infant and Early Childhood Home Visiting Programs
               Section 3502 Establishing Community Health Teams to Support the Patient-
               Centered Medical Home
               Section 1331 To provide for transparency in coverage.

               6) Community Health Needs Assessment
               Section 4959 Additional Requirements for Non-Profit Tax-Exempt Hospitals
          What Does the New Law Do?
Includes Measures to Increase
     Prevention and Decrease Inequity
                 Sec. 4001. National Prevention, Health
                 Promotion and Public Health Council.
                 Creates an interagency council dedicated to promoting healthy policies at
                 the Federal level. The Council shall consist of representatives of Federal
                 agencies that interact with Federal health and safety policy, including the
                 departments of HHS, Agriculture, Education, Labor, Transportation, and
                 others.

                 Sec. 4002. Prevention and Public Health Fund.
                 Establishes a Prevention and Public Health Investment Fund. This will
                 involve a dedicated, stable funding stream for prevention, wellness and
                 public health activities authorized by the Public Health Service Act.


                 Sec. 4004. Education and outreach campaign
                 regarding preventive benefits.
                 Directs the Secretary to convene a national public/private partnership for
                 the purposes of conducting a national prevention and health promotion
                 outreach and education campaign.
           What Does the New Law Do?
 Includes Measures to Increase
      Prevention and Decrease Inequity
Increasing Access to Clinical Preventive Services
Sec. 4101. School-based health centers.
                                                                  Increasing
Sec. 4102. Oral healthcare prevention activities.                 Prevention
Sec. 4103. Medicare coverage of annual wellness visit providing
         a personalized prevention plan.
Sec. 4104. Removal of barriers to preventive services in
         Medicare.
Sec. 4105. Evidence-based coverage of preventive services in
         Medicare.
Sec. 4106. Improving access to preventive services for eligible
         adults in Medicaid.
Sec. 4107. Coverage of comprehensive tobacco cessation
         services for pregnant women in Medicaid.
Sec. 4108. Incentives for prevention of chronic diseases in
         Medicaid.
           What Does the New Law Do?
 Includes Measures to Increase
      Prevention and Decrease Inequity
Creating Healthier Communities
Sec. 4201. Community transformation grants.
                                                                  Increasing
Sec. 4202. Healthy aging, living well; evaluation of community-   Prevention
         based prevention and wellness programs for Medicare
         beneficiaries.
Sec. 4203. Removing barriers and improving access to
         wellness for individuals with disabilities.
Sec. 4204. Immunizations.
Sec. 4205. Nutrition labeling of standard menu items at
         chain restaurants.
Sec. 4206. Demonstration project concerning individualized
         wellness plan.
Sec. 4207. Reasonable break time for nursing mothers.
           What Does the New Law Do?
 Includes Measures to Increase
      Prevention and Decrease Inequity
Support for Prevention and Public Health Innovation
Sec. 4301. Research on optimizing the delivery of public health
                                                                   Increasing
         services.                                                 Prevention
Sec. 4302. Understanding health disparities; data collection and
         analysis.
Sec. 4303. CDC and employer-based wellness programs.
Sec. 4304. Epidemiology-Laboratory Capacity Grants.
Sec. 4305. Advancing research and treatment for pain care
         management.
Sec. 4306. Funding for childhood obesity demonstration project.
       What Does the New Law Mean for
       You and Your Fellow Minnesotans?
What is your current health care situation?

Are you insured through work?

Through Medicare? Medicaid?

Are you uninsured?
                       What Does the New Law Mean for
                       You and Your Fellow Minnesotans?
  If you are insured through an employer
2010                                       2011 – 2013               2014                    2018
No canceling policies when                 Insurance companies       Insurers will have to   Insurers will have
you get sick or setting lifetime           required to spend         cover adults with       to pay a 40%
limits.                                    80-85% of premium         pre-existing            excise tax on
Children up to age 26 can                  dollars on medical        conditions.             high cost
stay on your plan.                         services or else          No annual limits on     insurance plans.
                                           provide rebates to        coverage.               The tax is on the
Insurance companies will have
                                           their policyholders.                              cost of coverage
to cover children with pre-                                          Qualified individuals
                                                                                             in excess of
existing conditions.                                                 can begin buying
                                           States can require                                $27,500 (family
No lifetime limits on coverage.                                      subsidized coverage
                                           insurance companies                               coverage) and
                                                                     in the Exchange.
New plans must provide free                to submit justification                           $10,200
preventative services & allow              for premium               Begin employer          (individual
you to appeal denials of                   increases.                requirement and         coverage).
coverage.                                                            standards.

 This slide developed from PICO National
 Network’s Bringing Health Reform Home
                      What Does the New Law Mean for
                      You and Your Fellow Minnesotans?
 If you are insured through Medicare
2010                               2011                       2013                          2020
Seniors on traditional             Seniors in the “donut      Government begins to cut      The donut
Medicare will have no              hole” will receive a 50%   subsidies to Medicare         hole will
losses in coverage and             discount on brand name     Advantage, which costs the    fully close.
will add important                 drugs. The “donut hole”    government more than
benefits.                          will be closed slowly      traditional Medicare.
                                   through 2020.              Seniors on these plans may
Seniors that reach the                                        face reduced benefits or
                                   Annual checkups and        higher costs. Seniors have
“donut hole” will
                                   most preventative care     the option of transitioning
receive a $250 rebate
                                   and screenings are at no   to traditional Medicare
for prescription drugs.
                                   cost.                      during the first 45 days of
                                                              the year.


This slide developed from PICO National
Network’s Bringing Health Reform Home
                        What Does the New Law Mean for
                        You and Your Fellow Minnesotans?
   If you are uninsured
2010                                        2014
Temporary high-risk pool for people         Individuals and families will be able to purchase health insurance in
with pre-existing conditions                state-based Exchanges. Those earning up to 400% FPL ($88,200
uninsured for at least 6 months             for a family of 4) will have access to subsidies on a sliding scale.
For early retirees, age 55-64, a            Cap on out-of-pocket costs of $5,950 for individuals and $11,900
temporary re-insurance program is           for families, with lower caps for lower-income families.
created until the Exchange is               Individuals and families under 133% FPL will be eligible for
running.                                    Medicaid.
A large expansion in funds to               Most Americans will be required to buy health insurance or pay a
Community Health Centers. This is           penalty. Undocumented immigrants will not be able to purchase
expected to double the number of            insurance in the Exchange.
patients that clinics serve. This will      Those who are exempt, or under 30, can buy a catastrophic policy
help millions of undocumented               (must also allow for 3 primary care visits a year).
immigrants.
                                            Members of Congress will get their health insurance through the
If you are under age 26, you can            Exchange.
join your parent’s plan.
  This slide developed from PICO National
  Network’s Bringing Health Reform Home
                      What Does the New Law Mean for
                      You and Your Fellow Minnesotans?
 If you are insured by Medicaid
 2010                                          2014
 All children currently receiving Medicaid     Medicaid’s physician reimbursement levels
 and CHIP can continue to receive coverage.    for specific primary care services will be
 States cannot cut children from Medicaid or   increased, leading more doctors to accept
 CHIP until 2019, at which point some          Medicaid.
 children may transition into the Exchange.
                                               Anyone with an income below 133% FPL,
 All adults under 133% of the Federal          about $29,327 in 2009 for a family of
 Poverty Level can continue to receive         four, will be eligible for Medicaid.
 coverage. States cannot cut adults that
 make under 133% FPL from Medicaid.            When the Exchange is operating, states can
                                               decide to keep adults on Medicaid that are
 Many preventive services will be offered      over 133% FPL or transition them into the
 without cost.                                 Exchange.


This slide developed from PICO National
Network’s Bringing Health Reform Home
                      What Does the New Law Mean for
                      You and Your Fellow Minnesotans?
 How is it paid for?
Starting 2010:             Starting in 2011-2013:    Starting in 2013: High-      Starting in 2018:
Cost saving                Increasing penalties      income earners will          insurers will have
changes in                 on contribution           contribute more to the       to pay a 40%
Medicare                   loopholes in Health       Medicare fund                excise tax on high
Greater oversight          Saving Accounts           Individuals earning over     cost group plans
and enforcement to         Increased penalties on    $200,000 and families        The tax is on the cost
reduce fraud,              nonqualified              earning over $250,000 will   of coverage in
waste and abuse;           distributions from        contribute 2.35% for         excess of $27,500
greater efficiency         Health Saving Accounts,   income above the threshold   (family coverage)
and collaboration          a lower cap on Flexible   instead of the current       and $10,200
among doctors and          Spending Accounts         1.45%. They will also pay    (individual
reduced over-              contributions, and a      a 3.8% tax on net            coverage). There are
payments to the            standardization of the    investment income            higher thresholds for
Medicare                   definition of qualified   (excluding retirement        retirees and
Advantage                  medical expenses.         plans).                      employees in high
companies.                                                                        risk professions.

This slide developed from PICO National
Network’s Bringing Health Reform Home
             What’s Next?
1) Building Public Support and Implementing Early Reforms

2) Defending Existing Programs and Current Levels of Coverage

3) Developing Policy and Regulations at the National and State
       Levels

4) Enrolling People in New Programs and Monitoring Impact of
       Reform

5) Ensuring the Sustainability of Reform through Health Care
       Delivery System Reforms
               What’s Next?
1) Early Expansion of Medicaid
  Signable by Governor till January 15, 2011

2) Preparing our Health Insurance Exchange
  Health Care Access Commission vs. Governor’s, Benefit Set

3) Insurance Regulation
  Natl Assoc of Insurance Commissioners, Early Adoption of Insurance Regulations

4) Appropriations for Health Equity Provisions
  Indian Health Services, Community Transformation Grants

5) The 2011 Legislative Session
  $5.8 Billion Dollar Deficit
What’s Next?




+              =
                Thanks and Resources
Community Catalyst: www.communitycatalyst.org
Health Care for America Now!: www.healthcareforamericanow.org
Health Rights Organizing Project: www.healthrightsproject.org
PICO National Network: www.piconetwork.org
Kaiser Family Foundation: www.kff.org
Families USA: www.familiesusa.org
Robert Wood Johnson Foundation: www.rwjf.org
Urban Institute: www.urban.org
Health Reform GPS: www.healthreformgps.org

United States Government: www.healthcare.gov
Democratic Policy Committee: www.dpc.senate.gov
National Association of Insurance Commissioners: www.naic.org

National Academy for State Health Policy: www.nashp.org
Georgetown Center for Children and Families: www.ccf.georgetown.edu

				
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