The Affordable Care Act and You

1. Sheldon Weisgrau
Presentation to Via Christi 50+, Wichita
October 23, 2013

2. 
Introduction

Health care and health insurance
◦ Why do we need health reform?

The Affordable Care Act (aka “Obamacare”)

Q&A
◦ What’s really in the law?
◦ The ACA and Medicare
◦ The Health Insurance Marketplace
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3. Health Reform Resource Project
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4. 

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Assist in public education and stakeholder
engagement related to health reform
Provide technical assistance to advocacy
organizations and other stakeholders
Assist Kansas entities in securing grants and
programs available under the Affordable Care
Act (ACA)
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5. 
Supported by Kansas Grantmakers in Health:
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Kansas Health Foundation
Health Care Foundation of Greater Kansas City
REACH Healthcare Foundation
Sunflower Foundation: Health Care for Kansans
United Methodist Health Ministry Fund
Wyandotte Health Foundation
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6. Health Reform Resource Project
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7. Health Reform Resource Project
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8. 
Access
◦ 48 million uninsured in U.S. (18% of pop < age 65)
 360,000 uninsured in Kansas (14% of pop <65)
 67,000 uninsured in Sedgwick Co (15.5% of pop <65)
◦ Millions more underinsured
◦ Employment-based health insurance declining
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9. 
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Access
Quality
◦ Inconsistent
◦ Disparities
◦ Infections, medical errors, patients harmed
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10. 
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
Access
Quality
Cost
◦ Highest in the world
◦ Increasing faster than salaries and inflation
◦ Main driver of long-term budget deficits
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11. 
The uninsured:
◦ Receive less preventive and prenatal care
◦ Go without medical care and prescription drugs due
to cost
◦ Diagnosed at later stage of illness
◦ Hospitalized for avoidable conditions
◦ Less healthy
◦ Earn less (and have less financial protection)
◦ Have higher death rates
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12. 
Communities with high rates of uninsurance
◦ More difficulty recruiting and retaining physicians
◦ ER crowding and diversion
◦ Insured patients have lower access, quality, and
satisfaction
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13. Health Reform Resource Project
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14. 
906 pages, 10 titles
1. Access to private health insurance
2. Expanded Medicaid coverage
3. Medicare reform
4. Wellness and prevention
5. Health care workforce
6. Fraud and abuse
7. Access to drugs and biologics
8. Voluntary long-term care insurance (CLASS)
9. Revenue measures
10. Manager’s amendment and reconciliation
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15. Health Reform Resource Project
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16. 

Make better health insurance coverage more
available and affordable for legal residents
Reform health care delivery and financing to
provide better quality and outcomes, more
cost effective care
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17. 
What it does
◦ Builds on the existing system of coverage
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18. 
What it does
◦ Builds on the existing system of coverage
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What it does not do
◦ Does not create “government-controlled” or
“socialized” health care
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19. 
What it does
◦ Builds on the existing system of coverage

What it does not do
◦ Does not create “government-controlled” or
“socialized” health care
◦ Does not create “death panels”
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20. 
What it does
◦ Builds on the existing system of coverage

What it does not do
◦ Does not create “government-controlled” or
“socialized” health care
◦ Does not create “death panels”
◦ Does not eliminate (or make big changes to)
Medicare
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21. 
Extends health insurance coverage to
25-30 million uninsured
◦ Expands the Medicaid program
◦ Authorizes Medicare financing and delivery reform
◦ Restructures markets for individual and small group
insurance
 Health Insurance Marketplace
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22. 
Extends health insurance coverage to
25-30 million uninsured
◦ Prohibits insurers from denying coverage to those
with pre-existing conditions (guaranteed issue) or
charging them more (community rating)
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23. 
Extends health insurance coverage to
25-30 million uninsured
◦ Prohibits insurers from denying coverage to those
with pre-existing conditions (guaranteed issue) or
charging them more (community rating)
◦ Mandates that most people maintain insurance
coverage
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24. 
Extends health insurance coverage to
25-30 million uninsured
◦ Prohibits insurers from denying coverage to those
with pre-existing conditions (guaranteed issue) or
charging them more (community rating)
◦ Mandates that most people maintain insurance
coverage
◦ Provides tax credits to help individuals and small
businesses purchase insurance
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26. 
Enhances benefit package
◦ Covers annual wellness visit
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27. 
Enhances benefit package
◦ Covers annual wellness visit
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Reduces out-of-pocket costs
◦ No deductibles or coinsurance for preventive
services
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28. 
Enhances benefit package
◦ Covers annual wellness visit

Reduces out-of-pocket costs
◦ No deductibles or coinsurance for preventive
services
◦ Phases out Part D donut hole
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29. 
Reduces rate of cost growth
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30. 
Reduces rate of cost growth
◦ Phases out overpayment to Medicare Advantage
plans
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31. 
Reduces rate of cost growth
◦ Phases out overpayment to Medicare Advantage
plans
◦ Enables provider payment and delivery system
reforms
 From “volume-based” to “value-based”
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32. 
Reduces rate of cost growth
◦ Phases out overpayment to Medicare Advantage
plans
◦ Enables provider payment and delivery system
reforms
 From “volume-based” to “value-based”
◦ Expands fraud and abuse prevention
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33. 
Expansion of home and community-based
services
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More funding for Aging and Disability
Resource Centers (ADRCs)
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Programs to enhance quality and patient
safety, reduce readmissions
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Programs to expand primary care, nursing,
geriatric care workforce
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35. 
Established by each state by Oct 1, 2013
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36. 
Established by each state by Oct 1, 2013
◦ Administered by federal govt if state opts out
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37. 
Established by each state by Oct 1, 2013
◦ Administered by federal govt if state opts out

For individual and small group markets
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38. 
Established by each state by Oct 1, 2013
◦ Administered by federal govt if state opts out
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For individual and small group markets
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Provides web-based one-stop shopping
◦ Pooling mechanism for individuals and small
businesses
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39. 
Established by each state by Oct 1, 2013
◦ Administered by federal govt if state opts out
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For individual and small group markets
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Provides web-based one-stop shopping
◦ Pooling mechanism for individuals and small businesses
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Plans must offer “essential health benefits”
package
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40. 1.
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4.
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7.
8.
9.
10.
Ambulatory care services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance abuse services
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease
management
Pediatric services, including oral and vision care
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41. 
Qualify if household income is 100%-400% of Fed Poverty Level and purchase
in Marketplace and no affordable employer offer
Household
Size
2013 Federal Poverty Guidelines
100%
400%
1
$11,490
$45,960
2
$15,510
$62,040
3
$19,530
$78,120
4
$23,550
$94,200
5
$27,570
$110,280
6
$31,590
$126,360
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Businesses qualify if they meet size and salary requirements
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Most Kansans who would have been covered by Medicaid expansion will be
too poor to qualify for tax credits
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43. 
No lifetime or annual coverage limits
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Children up to age 26 on parent’s policy
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Plan standardization
◦ Catastrophic, Bronze, Silver, Gold, Platinum
◦ Limits on out-of-pocket costs
◦ Standard language and definitions
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44. 
Toll-free hotline
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Agents/brokers
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Navigators and Certified Application Counselors
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Kansas Insurance Department
◦ 1-800-318-2596
◦ http://www.healthcare.gov
◦ http://www.cuidadodesalud.gov
◦ Clinics, health departments, Area Agencies on Aging,
community mental health centers, hospitals, etc.
◦ http://www.insureKS.org
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45. 
Senior Health Insurance Counseling For
Kansas (SHICK)
◦ Area Agencies on Aging
◦ 1-800-860-5260
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1-800-MEDICARE
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http://www.medicare.gov
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47. 
Open Enrollment
◦ October 1, 2013 – March 31, 2014
 Future years: Oct 15-Dec 7
◦ Special enrollment periods
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If you want insurance on . . .
◦ January 1, enroll by December 15, 2013
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If you want to avoid the penalty . . .
◦ Enroll by February 15, 2014
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48. 
Marketplace opened October 1, 2013
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Individual mandate – January 1, 2014
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Employer responsibilities
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Medicaid expansion
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OUTREACH / EDUCATION / ENROLLMENT
◦ Coverage begins January 1, 2014
◦ www.healthcare.gov
◦ http://www.cuidadodesalud.gov
◦ Enforcement delayed until 2015
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49. Sheldon Weisgrau, Director
Health Reform Resource Project
1129 S. Kansas Avenue, Suite B
Topeka, KS 66612
(785) 408-8008
HealthReformResource@gmail.com
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