1. The Patient Protection &
Affordable Care Act (ACA)
WHAT DOES
HEALTH REFORM MEAN FOR
OUR FREE CLINIC
& FOR OUR PATIENTS?
2. OUTLINE
๏ถ WHAT IS THE ACA?
๏ถ HOW WILL ACA HELP THE UNINSURED?
๏ถ WHO WILL REMAIN UNINSURED AFTER 2014?
๏ถ HOW WILL ACA AFFECT OUR PATIENTS & OUR
CLINIC?
๏ถ WHAT DO WE NEED TO DO TO PREPARE FOR ACA?
3. ๏ Medicaid eligibility will be expanded to
childless adults and to 133% of FPL
ACA: ๏ Above 133% of FPL, low and middle
income people and small businesses
will get subsidies to make insurance
What ๏
affordable
Children can stay on parentsโ plan until
are some 26 years old
๏ No lifetime or annual caps
of the ๏ No denials based on pre-existing
conditions
Benefits? ๏ No co-pays or deductibles for
preventive care
๏ 80% of premium must be spent on
enrollees
๏ Insurance companies have to justify
rate increases
4. Does ACA help
Free Clinics?
Some free clinics receive liability coverage for their
volunteer health professionals through the
Federal Tort Claims Act (FTCA).
ACA extends that coverage to free clinic board
members, officers, employees,
and individual contractors,
but not to the clinic entity itself.
5. ACA:
๏ Supreme Court Challenge
What are
to the Mandate
some of ๏ Political target for repeal
the ๏ Critical shortage of Primary Care
Barriers? Providers, especially PCPs who
accept Medicaid
๏ The rising cost of health care
6. How will ACA help
the Uninsured?
๏ถ January 1, 2014, 30 million (of 53 million) uninsured will
be eligible for coverage
๏ถ Eligibility for Medicaid will increase from 35% of
Federal Poverty Level in MI to 133% of FPL across the
nation
๏ถ Childless adults will be eligible
This will help many of the patients we serve.
7. 2012 Federal Poverty Levels
2012 FPL Individual Family of 4
100% $11,170 $23,050
MI - 35% $ 3,910 $ 8,068
133% $14,856 $30,656
400% $44,680 $92,200
8. Timeline
for ACA
2010 ๏ President Obama signed ACA into
law. A few changes took effect
immediately; others are being
implemented over the next few
years.
๏ Planning and implementation at
2011-2014
federal and state levels. Numbers of
uninsured continue to grow.
๏ 30 million will become eligible for
2014 coverage, either through Medicaid
or the exchanges.
9. Timeline for
ACA contโd.
๏ Those eligible will be enrolled in
2014-2019
Medicaid and other programs. The
numbers of uninsured will gradually
decline.
๏ The newly insured will try to find a
medical home, but face a critical
shortage of Primary Care Providers,
especially PCPs accepting Medicaid.
๏ The number of uninsured will level
2019 off to those who are not eligible for
coverage through ACA.
10. Who will ๏ Undocumented immigrants
remain ๏ Naturalized citizens here < 5 yrs.
uninsured? ๏ Choose to pay the penalty rather
than acquire insurance
๏ Exempt from the mandate and
choose to remain uninsured, e.g.,
veterans, uninsured <3 mos.,
And where exempt from filing federal tax
will they return, Native American,
incarcerated, religious conscience
find care? reasons.
๏ Citizens without documentation
11. ๏ Many uninsured clients of our
free clinic will be eligible for
ACA: Medicaid
๏ Our clients will need help
Implications through the transition
for ๏ Potential negative impact on our
Free Clinics donors and volunteers?
๏ Potential negative impact on our
relationship to area hospitals?
๏ We need to re-evaluate our
mission and services, and educate
our community on the impact of
ACA.
12. What is the experience
of free clinics in states where
most of the uninsured received coverage?
VT, WI, and MA received federal waivers to expand Medicaid for
uninsured. What happened to free clinics?
๏ถNone closed; in fact volume continued to grow.
๏ถFree Clinics helped enroll and navigate patients through the changes.
๏ถPCP shortage, especially of PCPs who will accept Medicaid, resulted in
free clinics providing care to Medicaid patients but not billing.
๏ถDental Care and Rx Assistance remain huge gaps in service.
13. What Questions Should We Be Asking?
๏ What will be the impact of the ACA on our clinic?
๏ How many of our patients will receive insurance coverage
under ACA? Where will they find care?
๏ Who will remain uninsured in our community?
๏ Will our clinic be needed post-2019? Whom will we serve?
๏ What do we need to do to prepare for ACA changes?
๏ What options are open to us for the future?
๏ Should we consider becoming or partnering with a FQHC?
๏ What if ACA is not implemented?
๏ Other questions?
Editor's Notes
Click on Cabrini Clinic and replace it with your clinic name.
Here is what we are going to coverโฆ
ACA was adopted because the nation has 53M uninsured. It will help many gain coverage, but it also is correcting many abuses in our health care system. Some of these benefits are in effect; others are being phased in over several years.
Our clinic does/doesnโt participate in this program. FTCA extends free liability coverage to free clinicsโthe same coverage that the feds give to employees of FQHCs. The extension of coverage is a great benefit to free clinics.
There are people who are trying to de-rail the ACA. There is a challenge to the mandate which will be heard at the Supreme Court March 26-28. If President Obama does not get re-elected, there probably will be an attempt to repeal the law. And even if the law is enacted as passed, those who receive coverage will find it difficult to find a Primary Care Provider, especially if the coverage is Medicaid. And regardless of ACA, the rising cost of health care in this country has to be addressed.
Eligibility for Medicaid is financial, based on household income. In Michigan, an individual can make no more than 35% of the Federal Poverty Level to be eligible. Childless adults are not eligible. Under ACA this will change.
This chart shows that for an individual in Michigan, income eligibility for Medicaid is less than $3900 per year. Under ACA, this will increase to $15,400. Many of our clients will become eligible.
These charts lay out the timeline for ACAโwhat we can expect.
Will others judge that the uninsured problem has been solved by ACA, and pull their support from free clinics? Our clients will need help applying for Medicaid and finding a new medical home. Throughout this transition, we will need to monitor the impact on our mission and services.
Here are some questions we need to be exploring together.
