Understanding the Health Care Debate Monica Bogucki, BSW, JD 2017 Copyright

Types of Health Care Coverage Private health insurance (clinic and hospital) Private long term care insurance Government programs Medicaid/Medical Assistance TEFRA(Tax Equity and Fiscal Responsibility Act) Medicare CHIPS TEFRA Minnesota Care Veterans health system Indian Health Services

Key to understanding the Health Care Debate Need to understand Categorical eligibility Financial eligibility Understanding the funding streams for these programs.

Medicare 65 years of age and older Those who are found disabled prior to 65 years of age

Medicare Medicare Parts A, B and D (federal program) If a person purchases Medicare, then his premium is deducted from social security retirement Because Medicare does not cover everything, most people purchase a Medicare supplemental insurance plan.

Dual Eligibility for Medicare and Medicaid If a person is receiving Medicare and is low income, they can also apply for Medicaid (Medical Assistance). This will be her supplemental plan and will cover prescriptions.

Medicaid/Medical Assistance This is combined federal and state funded program. It covers low income individuals and families It also covers long term nursing facility care It covers foster children It covers those who are disabled and receiving Supplemental Security Income (SSI) benefits. TEFRA (1982)-allows a child with a disability to be covered by MA by excluding parent(s) income

Affordable Care Act 42 U.S.C. section 18001 (2010) Insurance companies could no longer deny insurance coverage to a person with pre-existing condition. Insurance companies could no longer cap lifetime benefits-unlimited benefits. (Example: Previously, insurance companies may cap lifetime benefits at $1 million.) Summary of ACA by Kaiser Foundation- http://www.kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/

Affordable Care Act It also required insurance companies to provide “essential health benefits.” Ambulatory patient services. [outpatient care] Emergency services. Hospitalization. [inpatient care] Maternity and newborn care Mental health and substance use disorder services, including behavioral health treatment. 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.

Affordable Care Act Set up health insurance exchanges Federal exchange- HealthCare.gov Minnesota has a health insurance exchange (MNSURE) Those whose income is lower can receive subsidies (tax credits) on her health insurance premiums—to reduce the cost.

Stakeholders Individual insured Vulnerable populations Disabled Mental health Elder Those with pre-existing conditions Insurance companies Medical providers

Stakeholders Hospitals-urban and rural Medical clinics-urban and rural Those in community based placements- Home health care Hospice

Medicaid Expansion Each state determines who is eligible for MA (within the parameters of federal law) MA covers individuals up to a certain income level. MA Expansion gave the states options to covers individuals at a higher income level (but yet low income) individuals http://www.kff.org/medicaid/fact-sheet/state-medicaid-expansion-approaches/

Benefits of Medicaid Expansion Access to health care For small businesses that are unable to provide health insurance, employees have access to MA

Insurance Industry Health insurance providers are pulling out of the marketplace because of higher costs of providing coverage for those with pre-existing conditions. How do we stabilize the marketplace and keep premiums lower for individuals?

Long Term Impacts of not providing health insurance coverage Loss of employment Increase in homelessness Lower quality of life Increase in deaths Increase in suffering Increase in mental health Increase in individual bankruptcies Closing of medical clinics and hospitals

A View of Chippewa County, MN % of children in poverty, ages 0-17 17.5 % % of children receiving free/reduced lunches 43.7% % of children without health insurance, ages 0-19, 5.2% Kids Count, Minnesota 2016 Fact Sheet, www.cdf-mn.org

A View of Kandiyohi County, MN % of children living in poverty, ages 0-17, 18.7% % of students receiving free/reduced lunch 52.2% % of children without health insurance 4.4% Kids Count, Minnesota 2016 Fact Sheet, www.cdf-mn.org

A View of Lac Qui Parle County, MN % of children in poverty, age 0-17 14.3% % of children receiving free/reduced lunch 40.3% % of children without health insurance, ages 0-19 4.7% Kids Count, Minnesota 2016 Fact Sheet, www.cdf-mn.org

Proposed health care bills American Health Care Act (AHCA) Better Care Reconciliation Act (BCRA) Both bills propose block grants. “The case of welfare reform illustrates a possible scenario under Medicaid block grants: both federal and state spending drop off, with state spending diverted to other uses. To accommodate these changes, it may not be sufficient to cut enrollees, or benefits, or provider reimbursement---states will likely enact all three.” Medicaid Under Block Grants: Lessons From Welfare Reform, Michelle Ko and Marianne Bitler, (July 7, 2017), www.healthaffairs.org

Impact of Block Grants “Following welfare reform, a number of states pursued a “race to the bottom,” with a shrinking number of families receiving cash or work or child-care related assistance….” Medicaid Under Block Grants: Lessons From Welfare Reform, Michelle Ko and Marianne Bitler, (July 7, 2017), www.healthaffairs.org