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“Health Reform” The Patient Protection and Affordable Care Act, 2010

“Health Reform” The Patient Protection and Affordable Care Act, 2010. Major Features of The Patient Protection and Affordable Care Act of 2010.

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“Health Reform” The Patient Protection and Affordable Care Act, 2010

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  1. “Health Reform”The Patient Protection and Affordable Care Act, 2010

  2. Major Features of The Patient Protection and Affordable Care Act of 2010 • Individual Mandate: Everyone must have insurance, or face a penalty if they don’t purchase a plan (penalty is $95 in 2014 increasing to $695 in 2016, or 2.5% of income by 2016). • Subsides to households below 250% of FPL • Subject of law suits by Attorneys General of Several States- Constitutionality? Supreme Court will hear the case in March and make a decision by June.

  3. The Patient Protection and Affordable Care Act • Employer Contribution: Penalizes companies with over 50 workers who don’t provide insurance ($2,000 per worker), but exempts paying penalty for first 30 workers. • Tax credits for small employers (<25 workers, average wage < $50K) to pay for insurance

  4. The Patient Protection and Affordable Care Act • Insurance Reform: • “guaranteed issue” – insurance companies cannot exclude people with pre-existing conditions; • no rescission; • no annual or lifetime caps, etc. (Now in Effect) • Covers dependents up to 26 years old (already in effect)

  5. Insurance Reform • Federal Government can regulate insurance company rate increases and unfair practices. (Starts in 2014) • HI companies must spend 80-85% of premiums on health care (medical loss ratio)

  6. The Patient Protection and Affordable Care Act 3a. Creates (Interim) High Risk Pools for those with pre-existing conditions and no HI for six months (run either by states or the federal government). Scheduled to start September 1, 2010. Many states are refusing to take this on due to costs. (Now in effect.)

  7. The Patient Protection and Affordable Care Act • Insurance Exchanges: Individuals and employees of small employers can purchase insurance plans through State Level exchanges. These will all be private plans, there is no “Public Option.” Different levels of coverage: Bronze, Silver, Gold, Platinum and Catastrophic. Starts in 2014

  8. The Patient Protection and Affordable Care Act • Medicaid Expansion: Medicaid will cover everyone under 133% of FPL, including childless adults (12-20 million people). Feds cover 100% of costs for newly eligible (2014-7), then 95% (2018-9), then 90% of costs after 2020. Starts in 2014. • Reauthorizes CHIP until 2019 • Raises Medicaid Rates to Medicare Rates for Primary Care Providers

  9. The Patient Protection and Affordable Care Act • Medicare Changes: No Part D doughnut hole by 2020. Reimbursed $250 last year if you reached the doughnut hole. 50% subsidy on Brand Name Drugs in the doughnut hole started in 2011. • Increases Medicare Payroll Tax to 2.35% from 1.45% for the affluent (over $200K/year per individual ($250k couple). Additional 3.8% tax on unearned income over $200k/year per individual ($250k couple).

  10. The Patient Protection and Affordable Care Act 7. Financing: Medicare increases. Also, starting in 2018, excise tax on high coverage plans (>$27,500 for family). At individual and small group level--Subsidies and tax credits. Individual and employer penalties for not purchasing insurance. Elimination of “excess payments” to Medicare Advantage Programs.

  11. The Patient Protection and Affordable Care Act • Prevention and Public Health. Creates National Prevention, Health Promotion and Public Health Council to coordinate federal wellness programming. Disseminate evidence-based preventive services and community preventive services. $7 Billion allocation from 2010-2015 plus $2 Billion per year after 2015.

  12. The Patient Protection and Affordable Care Act • Long-term Care. “Community Living Assistance Services and Supports” (CLASS). Voluntary payroll deductions for long-term care assistance. After 5-year vesting period, all participants would be eligible for average of at least $50/day for non-medical support services for people with functional disabilities. Increase Medicaid support for home and community-based services programs. Nursing homes required to disclose more information to the public. (This Program has been scrapped by the Obama Administration. Funding method was unsustainable.)

  13. The Patient Protection and Affordable Care Act of 2010 • Workforce. Increased funding for Primary Care residencies and for primary care practitioners. Addresses nursing shortage by increasing capacity for education programs, supporting training programs, etc. Funding for training that employs medical home and disease management models. Also some funding for dental professions. 11. Community Health Centers. $11 billion additional funding over 5 years. School-based health centers, nurse clinics, etc. encouraged.

  14. The Patient Protection and Affordable Care Act • Abortion: No federal financing for abortion • Undocumented workers (“Illegal immigrants”) cannot even purchase HI from an exchange with their own money.

  15. The Patient Protection and Affordable Care Act • Waste, Fraud and Abuse efforts are expanded. • Malpractice Reform: Grants to states to experiment with new approaches to malpractice reform.

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