The Affordable Care Act of 2010: What is Happening Next What You Need to Know

Training Sections 1.Recent History of Health Care Reform 2.Overview of Changes in Affordable Care Act (ACA) 3.Timeline of Major Changes 4.Resources

Training Section 1: Recent History of Health Care Reform

4 Recent History March 2010 U.S. Congress passed: Patient Protection and Affordable Care Act (HR 3590) Health Care and Education Reconciliation Act of 2010 (HR 4872)

5 Recent History March 2010 President Obama signed into law, creating: Patient Protection and Affordable Care Act (Public Law ) Health Care and Education Reconciliation Act of 2010 (Public Law ) Together, commonly known as The Affordable Care Act (ACA) of 2010

Training Section 2: Overview of Changes in Affordable Care Act (ACA)

7 Overview The Affordable Care Act (ACA) of 2010: Impacts many areas of health care Result of many compromises Does not go into effect all at once Relies heavily on state and local implementation

Overview Affordable Care Act makes major changes in 4 basic areas: 1.Insurance company accountability 2.Lowering costs and improving quality 3.Increasing access and choice 4.Patient rights and consumer protections 8

Overview: HealthCare.Gov

Training Section 3: Timeline of Major Changes

11 Explaining the Timeline How Timeline Works: Changes take effect over many years, through 2020 Timeline shows when major reforms go into effect Designed to give more detailed information about changes coming soon, summarizes changes down the road

12 Explaining Timeline: [Date] [Type of Reform] Who: Population reform impacts Why: Need or problem reform is addressing What: Specifics of what reform does When: When reform goes into effect How: Details of how reform will be implemented or accessed

TIMELINE: IN PROGRESS NOW 13

14 Timeline: In Progress Now High-Risk Pools Who: People who can’t get insurance because of pre-existing medical conditions, including mental health conditions Why: Before ACA, people with pre-existing conditions often couldn’t get any insurance

15 Timeline: In Progress Now High-Risk Pools What: People who can’t get insurance because of pre-existing medical conditions can apply for a Pre-Existing Condition Insurance Plan (PCIP) Law limits premiums to “standard rates” - the average amount private insurers in the state charge for premiums for similar coverage Limits out-of-pocket expenses ($5,950/year for individual)

16 Timeline: In Progress Now High-Risk Pools What: States can run PCIPs, with federal funding, or use federal PCIP –29 states chose to run plans themselves –21 states chose to let the federal government run them 35 states already ran high-risk pools before ACA –Could continue to run these if they meet the law’s standards, or could set up new plans PCIPs in each state operate under ACA standards –But plans may vary from state to state

17 Timeline: In Progress Now High-Risk Pools When: States letting the federal government run their PCIP: –Can apply online now and get coverage within a month States running their own PCIP: –Different application and enrollment dates –PCIPs are up and running in 47 states –Will be in all states by end of September

18 Timeline: In Progress Now High-Risk Pools When: PCIPs are meant to be temporary: –End on January 1, 2014, when insurance companies won’t be allowed to deny people coverage because of pre- existing conditions –By this date, government-regulated, state-run insurance exchanges also start operating

19 Timeline: In Progress Now High-Risk Pools How: To apply for a PCIP you must: – Be a U.S. citizen or lawfully present in the United States – Have had no health coverage for the last 6 months –Have a pre-existing condition, as defined by each PCIP –You can apply no matter what your income is To find details for your state:

20 Timeline: In Progress Now Money Follows the Person Grants Who: People on Medicaid who need long-term care services Why: In the past, Medicaid’s Money Follows the Person grants have provided flexible funding that lets a person who needs long- term care services get services that are most appropriate to what they need and want MFP funding gives flexibility to move from institutional to community-based services and keep funding

21 Timeline: In Progress Now Money Follows the Person Grants What: ACA extends these grants and adds $2.25 billion in funding Broadens eligibility standards Helps states pay for the costs of moving someone from institution to home When: MFP grants have been extended until September 2016 How: The program will continue operating as before

22 Timeline: In Progress Now Donut Hole Rebates Who: People on Medicare Part D who fall into gap in prescription drug coverage called the donut hole

23 Timeline: In Progress Now Donut Hole Rebates Why: Under Medicare Part D, when person’s prescription drug costs reach a certain amount ($3,520 in 2010): –Medicare stops paying for any prescription drug costs –They have to pay for 100% of their drugs out-of-pocket, until they reach the maximum out-of-pocket amount –Once they reach this maximum, they are out of the donut hole - Catastrophic Coverage begins, and Medicare starts to help cover the costs again

24 Timeline: In Progress Now Donut Hole Rebates What: Under ACA, people who fall into donut hole this year will get one-time, tax-free $250 rebate –Over 1 million people so far! When: Rebates started June 10, 2010, continuing throughout the year

25 Timeline: In Progress Now Donut Hole Rebates How: People get rebate as soon as they reach the donut hole No application necessary, rebate checks are mailed automatically People getting Medicaid Extra Help (Low Income Subsidy) will not get rebate Call MEDICARE to report suspected fraud, or with questions

26 Timeline: In Progress Now Rescission Outlawed Who: Anyone who has insurance and might get sick Why: Before ACA, when someone with insurance got sick with an expensive or chronic illness, insurance companies would often go back and search their application for mistakes, looking for reason to drop their coverage This is called rescission, and happened to thousands of Americans each year

27 Timeline: In Progress Now Rescission Outlawed What: Under ACA, insurance companies won’t be allowed to drop people’s coverage because they get sick When: Rescission is illegal starting September 23, 2010 How: Department of Health and Human Services is responsible for regulation and enforcement details

28 Timeline: In Progress Now Ban on Discriminating Against Kids with PEC Who: Children under 19 with pre-existing conditions Why: Before ACA, insurance companies could legally deny insurance to children because they had a pre-existing condition What: Under ACA, it is illegal for insurance companies to deny or restrict insurance to children because of pre-existing condition

29 Timeline: In Progress Now Ban on Discriminating Against Kids with PEC When: Applies to health plan years starting after September 23, 2010 How: As with any group plan, insurance companies may decide to restrict enrollment to specific enrollment periods Department of Health and Human Services is responsible for regulation and enforcement details

30 Timeline: In Progress Now Expanded Coverage for Young Adults Who: Adult children up to age 26 Why: Before ACA, children were often dropped from parents’ insurance plans when they turned 18 or finished college Many young people have difficulty finding jobs with employer- sponsored coverage and can’t afford to buy individual coverage, so they often would go without insurance

31 Timeline: In Progress Now Expanded Coverage for Young Adults What: Children can stay on (or be added to) their parents’ insurance until they turn 26 –Applies to plans that offer dependent coverage When: Open enrollment for coverage starts on September 23, 2010 and is required by law to continue for at least 30 days Finding Insurance Options

32 Timeline: In Progress Now Ban on Lifetime Coverage Limits Who: Anyone who has insurance or will ever use insurance Why: In the past, insurance companies have used lifetime coverage limits to limit amount of money they will pay out for a customer’s health care needs If someone got sick and reached their lifetime coverage limit during treatment, the insurance company could just stop paying for treatment

33 Timeline: In Progress Now Ban on Lifetime Coverage Limits What: Insurance companies not allowed to put caps on amount they will spend on lifetime coverage costs for essential benefits Essential benefits include things like hospital stays, doctor visits, and prescription drugs

34 Timeline: In Progress Now Ban on Lifetime Coverage Limits When: Ban starts September 23, 2010, for all new individual insurance plans and all group plans Annual limits are restricted in all group plans and new individual plans, until 2014, when banned completely How: The law includes a detailed list of essential benefits that must be covered without limit

35 Timeline: In Progress Now Free Preventive Services - Private Coverage Who: Anyone who has private insurance Why: Before ACA, many health plans charged for preventive services, so people often chose to skip them Preventive services can help avoid many costly health problems down the road

36 Timeline: In Progress Now Free Preventive Services - Private Coverage What: Private insurance plans will have to cover certain recommended preventive services, like cancer screenings Insurance companies will be required to offer these services free to patient - without deductible, coinsurance, or copayment charges Law ensures many free preventive health services for children, including many vaccines

37 Timeline: In Progress Now Free Preventive Services - Private Coverage When: All new individual and group plans after September 23, 2010 How: Coverage for these services will be offered through existing private insurance plans

38 Timeline: In Progress Now Improvements to Medicaid HCBS Who: People who use Medicaid’s Home and Community-Based Services (HCBS) Why: In 2005, 1915(i) was added to Social Security Act Gave state Medicaid programs option to provide HCBS to people with disabilities before they need institutional care Many states did not choose to provide these services

39 Timeline: In Progress Now Improvements to Medicaid HCBS What: ACA changes and adds to Section 1915(i) –Removes many barriers to states to offering these services –Allows states to amend their plans instead of having to apply for waiver –Improves quality of services and access to HCBS for people with disabilities Expands services that state can offer as part of HCBS Allows states to extend full Medicaid benefits to people using HCBS

40 Timeline: In Progress Now Improvements to Medicaid HCBS When: Changes go into effect on October 1, 2010 How: As long as people meet a state’s eligibility requirements, HCBS have to be offered to every eligible person in the state States can now provide services to people with incomes up to 300% of the Supplemental Security Income (SSI) Federal Benefit Rate ($2,022 per month in 2010)

TIMELINE: BY

42 Timeline: By 2011 Drug Discounts for People in Donut Hole Who: People who fall in Medicare’s donut hole Why: Many people in donut hole can’t afford their medications

43 Timeline: By 2011 Drug Discounts for People in Donut Hole What: People in donut hole will get 50% discount on brand name drugs, 7% discount on generics When: Discount starts January 1, 2011 –Will grow until 2020, when donut hole is closed completely How: Full cost of drugs (rather than discounted amount) will still count towards person’s out-of-pocket maximum

44 Timeline: By 2011 More Preventive Services Under Medicare Who: Anyone on Medicare Why: Preventive services can help avoid many costly health problems down the road

45 Timeline: By 2011 More Preventive Services Under Medicare What: People on Medicare will be able to get a free wellness visit and personalized prevention plan each year No copayment, deductible, or coinsurance charges for recommended preventive services

46 Timeline: By 2011 More Preventive Services Under Medicare When: Starting January 1, 2011 How: Coverage for these services will be offered through existing Medicare plans

47 Timeline: By 2011 Medicaid Community First Choice Option Who: People with disabilities who are on Medicaid Why: People with disabilities have the right to choose to live in and receive services in their homes and communities whenever possible

48 Timeline: By 2011 Medicaid Community First Choice Option What: People with disabilities who have income below 150% of Federal Poverty Level, and who are eligible for institutional care, can choose community-based services instead Allows Medicaid plans to choose HCBS as a rule, rather than the exception When: CFC Option starts October 1, 2011

49 Timeline: By 2011 Medicaid Community First Choice Option How: ACA provides increased federal Medicaid match for states that choose the CFC Option

TIMELINE: BY

51 Timeline: By 2012 CLASS Act Who: Everyone Why: Paying for long-term care is expensive –Many people can’t afford it and don’t budget for it People need options that give them more choice and flexibility about long-term care

52 Timeline: By 2012 CLASS Act What: The Community Living Assistance Services and Support Act (CLASS Act) provides for voluntary, self-funded, long-term care insurance through the workplace Insurance will help pay for long-term care costs for people with disabilities and elderly people People will be able to use cash benefit to pay for their choice of variety of long-term care services, including home health care workers, assistive technology, adult day care, transportation, or assisted living

53 Timeline: By 2012 CLASS Act When: Departments of Health and Human Services (HHS) will write rules about how much premiums will cost and what disabilities qualify for the insurance benefits Rules must be written by October 1, 2012

54 Timeline: By 2012 CLASS Act How: Employers decide whether they want to participate If employer participates, people are auto-enrolled, can opt out Premiums taken through payroll deductions –Employers can pay premiums, not required Will be way for self-employed and employees of companies that don’t participate to choose to enroll

55 Timeline: By 2012 CLASS Act How: People pay premiums for five years before they can collect benefits, which will be a minimum average of $50 a day –Amount of benefit depends on assessment of disability No income or asset limit There are eligibility criteria, but no screening for pre-existing conditions No lifetime benefit limit

TIMELINE: BY

57 Timeline: By End of 2014 Ban on PEC Discrimination Who: Anyone with a pre-existing condition Why: Before ACA, insurance companies could legally deny insurance to people because they had a pre-existing condition What: Under ACA, will be illegal for insurance companies to deny or limit insurance to anyone because of a pre-existing condition

58 Timeline: By End of 2014 Ban on PEC Discrimination When: Starting on January 1, 2014 How: Department of Health and Human Services is responsible for regulation and enforcement details

59 Timeline: By End of 2014 Expansion of Medicaid Eligibility Who: Low-income people who have previously made too much money to qualify for Medicaid Low-income adults without children Low-income adults without a disability Why: Many people who did not qualify for Medicaid still did not make enough to be able to pay for private insurance

60 Timeline: By End of 2014 Expansion of Medicaid Eligibility What: Medicaid will expand to cover more low-income people including adults without children, and adults without a disability People with disabilities won’t have to go through complicated disability determination process anymore to become eligible for Medicaid Will also help people with disabilities who did not meet old Medicaid definition of disability

61 Timeline: By End of 2014 Expansion of Medicaid Eligibility When: Starting January 1, 2014 How: Expansion will include people with incomes up to 133% of Federal Poverty Level (about $28,000 for family of 4)

62 Timeline: By End of 2014 State Health Insurance Exchanges Who: Everyone in private insurance market Why: In the past, it has been complicated for people to compare private insurance plans People buying individual plans have not been able to negotiate for better prices, the way people buying group coverage can

63 Timeline: By End of 2014 State Health Insurance Exchanges What: States will create exchanges, a marketplace where people can comparison shop for standardized health packages Exchanges will provide way for individuals and small businesses to buy more affordable coverage People will also be able to join together in groups to negotiate more affordable group insurance Provides subsidies for low-income people on a sliding scale

64 Timeline: By End of 2014 State Health Insurance Exchanges What: The exchanges inspect policies to make sure they meet standards –Can ask companies to justify rate hikes When: Starts January 1, 2014

65 Timeline: By End of 2014 State Health Insurance Exchanges How: Exchange packages will include essential health benefits: Outpatient care Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services Prescription drugs (Re)habilitative services and devices Laboratory services Preventive services and chronic disease management Pediatric services

Training Section 4: Resources

67 HealthCare.Gov Finding Insurance Options Timeline Information for Specific Situations Comparing Quality of Facilities Information about Implementation