Health Care Reform Lawrence Holditch, MD Medical Director Cincinnati Health Department October 27, 2010

Health Care Reform

Universal Health Care - History Theodore Roosevelt – 1912 Franklin Roosevelt – 1933 Harry Truman Lyndon Johnson – Medicare and Medicaid Richard Nixon – 1971 Bill Clinton – 1993 As of 2009, the United States was the only major industrialized nation without any form of Universal Health Care

Uninsured in United States 40 to 50 Million Uninsured Lack of Appropriate Primary Care and Screenings Increased Severity of Health Problems Inappropriate Use of Emergency Rooms “Hidden Tax” on Insured, Medicare, and Medicaid

Health Care Reform – Both Major Democratic Contenders included “Health Care Reform” in their Platforms March 5, 2009: White House Conference May 2009: Congressional Hearings Summer 2009: Town Hall Meetings Rise of Tea Party Movement

Health Care Reform The Patient Protection and Affordable Care Act Health Care and Education Affordability Reconciliation Act Signed into Law March 23, 2010

Health Care Reform Requires Most Americans to Obtain Health Insurance (By 2014) 32 Million Newly Covered in United States Estimated 80,000 in Hamilton County Tax Penalty for Non-Coverage: Individuals Employers Many Aspects Are Not In Effect Until 2014 or Later

Health Care Reform Increases Medicaid Eligible to 133% FPL (Up to $29,327 for Family of 4) Requires Most Employers with >50 Employees to Provide Health Insurance Provides Financial Assistance for Smaller Employers Most Insured Will Be Able To Keep Current Health Insurance Financial Assistance for 133 to 400% FPL (Up to $88,000 Income for Family of 4) Health Insurance Exchanges (2014); Multi-State (2015)

Health Care Reform - Current High Risk Pool (in effect June 2010): Federal or State Run Program Individuals with Pre-Existing Conditions Must Have Been Denied Coverage Limited Participation: High Premiums and Deductibles

Health Care Reform - Current September 23, 2010: Cannot Deny Coverage for Pre-Existing Condition: Age < 19 Coverage for Dependent Children up to Age 26 Prohibits Lifetime Limits on Coverage Prohibits Rescinding Coverage Except for Cases of Fraud (No “You’re Sick, You’re Out”) $250 to Medicare Part D Recipients in “Donut Hole”

Health Care Reform Medicare: Coverage for Preventative Services Without Co-pay (USPSTF A or B) Comprehensive Health Risk Assessment and Personal Prevention Plan Part D: 50% Discount on Brand Name Drugs in “Donut Hole” 10% Increased Payments to Primary Care Create “Innovation Center” in CMS

Health Care Reform CLASS: Community Living Assistance Services and Supports Voluntary Long Term Care Insurance Seniors and Disabled National Prevention, Health Promotion, and Public Health Council Chain Restaurants and Vending Machines: Disclose Nutritional Content Community Health Centers and National Health Service Corps Funding

Health Care Reform Medicaid “Bundling” Demonstration Projects Enhanced Health Disparities Data Collection: Race, Sex, Ethnicity, Rural, Underserved Changes in 1099 Requirements

Health Care Reform Create CO-OP Health Insurance Program Create One Set of Rules for Eligibility Verification and Claims Status Medicaid: Increase Payments to Primary Care Providers to Medicare Levels % Federally Funded Medicare: Begin Phase-In of Subsidies for Part D Drugs (25% in 2013; 50% in 2014)

Health Care Reform Requires All Citizens and Legal Residents to have Qualifying Health Care Insurance Creates Health Benefit Exchanges (State) Multi-State in 2015 Payment Assistance up to 400% FPL (Tax Credits) ($88,000 for Family of 4) Creates “Essential Health Benefits Package”

Health Care Reform Medicare: Continues Phase Out of Part D “Donut Hole”: 50% Subsidy Complete Phase Out By 2020 Medicaid: Increases Eligibility To All < 65 and Up to 133% of FPL ($27,327 for Family of 4) Increases Dental Benefits for <19 100% of Preventative Services 100% of Adult Immunization Costs

Health Care Reform: Public Health Prevention and Public Health Fund $15 Billion Over 10 Years Prevention, Wellness, Public Health Activities Public Health Workforce $190 Million per Year for Loan Repayment $30 Million per Year for Mid-Career Training Health Disparities/Data Collection Epidemiology & Laboratory Capacity Grants

Health Care Reform: Community Health Centers Increased Payments From Medicare and Medicaid (2013 – 2014) PPS Rate From Private Insurances Community Health Centers Trust Fund to Expand Operational Capacity $11 Billion Over 5 Years National Health Service Corps Trust Fund: $1.5 Billion Over 5 Years Community Based Residency Training Programs

Health Care Reform - Nurses School Based Health Clinics Grants $50 Million per Year Nurse Managed Health Centers Provide Primary Care to Underserved $50 Million per Year, Beginning 2010 Graduate Nursing Education Program – Medicare Hospital Based Partner with Community Health Centers $50 Million per Year Nurse-Family Home Visit Partnerships $1.5 Billion over Five Years

Health Care Reform - Nurses Increase Reimbursement Rate for CNMs Loan Repayment Funding for Nurses Public Health Pediatrics Nurse Loan Repayment and Scholarship Program Serve 2 Years on Faculty at Accredited School of Nursing NHSC Funding for APNs

Health Care Reform – What’s Not There No “Public Option” No “Death Panels” End of Life Care Discussion Health Risk Assessment/Prevention Plan No Coverage for Abortions No Coverage for Illegal Immigrants

Health Care Reform – How Do We Pay For It? 10% Tax on Indoor Tanning Services Increased Fees: Pharmaceutical Companies Insurance Companies Excise Tax on “Cadillac” Health Plans Reduced Hospital Payments by Medicaid for “Hospital Acquired” Conditions Excise Tax on Taxable Medical Devices Increased Medicare Taxes on High Income Individuals (> $200,000)

Health Care Reform – Medicare Cost Savings Reduced Payments to Medicare Advantage Programs - $15 Billion per Year for 10 Years Hospital Readmissions Reduction Program 25% Payment Penalty on “Hospital Acquired” Conditions “Fraud and Abuse” Programs Estimated Medicare Savings of $417 Billion Over 10 Years

Health Care Reform – Legal Challenges 20 States Have Filed Legal Challenges: Violation of State Sovereignty “Commerce Clause” of Constitution First Amendment: Freedom of Religion

Health Care Reform: Challenges Access to Special Funds Not, as yet, Determined: “Guidance” Now Being Developed Some Aspects Require Further Federal Funding Increased Demand on Primary Care Sources and Providers – Estimated at 63,000 in 2014 Role of Community Health Centers Role of Mid-Level Providers Some Individuals Will Still Require “Safety Net” Providers

Health Care Reform Thank you. Any Questions?