Health Care Reform: An Overview Presented by Bonnie Braun, PhD Public Health Carousel: 2 nd Annual Public Health Conference Wooster County, Maryland April 6, 2011

Your Feelings About the Health Reform Law Does CONFUSED – ANXIOUS – ANGRY - ENTHUSIASTIC describe your own feelings about the health reform law?

Confusion Most Commonly Expressed Emotion Confused Angry Anxious Enthusiastic DescribesDoes not describe Note: Don’t know/Refused answers not shown. Source: Kaiser Family Foundation Health Tracking Poll (conducted March 8-13, 2011)

Health Reform Hits Main Street Henry J. Kaiser Family Foundation Presents Ilc5xK2_E&feature=player_embedded

Information Issues Impacts Implications Imperative Interventions “Six I” Policy Analysis Organizing Framework

Health Reform: Information  Law of the Land  Provisions  Dates of provisions

Public Law & and are collectively known as health reform law, the Patient Protection and Affordable Care Act or the Affordable Care Act (ACA). Signed into law, March 23, 2010

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Easy to Use Summary

1) Present unbiased information about health reform legislation; 2) Set forth implementation issues; 3) Help people understand the legislation and its implementation; and 4) Help federal and state legislative and public agency staff, private organizations and interest groups involved in implementation, health policy researchers, and the press. Robert Wood Johnson Foundation

Landmark: The Inside Story of America's New Health Care Law and What It Means for Us All

Provisions for Community Decisions-- Wellness Establish a Prevention and Public Health Fund for prevention, wellness & public health activities including prevention research, and a Education and Outreach Campaign for preventive benefits. Establish grant program to support delivery of evidence-based and community-based prevention and wellness services aimed at strengthening prevention, reducing chronic disease and addressing health disparities especially in rural areas.

Provisions for Community Decisions-- Wellness Continued Provide grants for up to 5 years to small employers that establish wellness programs beginning FY11 and resources to evaluate. Require an effectiveness and impact report. Require chain restaurants and food sold from vending machines to disclose the nutritional content of each item.

Provisions for Community Decisions— Oral Health Campaign Public Education Campaign – Requires the HHS Secretary to establish a 5-year, evidence-based public education campaign to promote oral health, including a focus on early childhood caries, prevention, oral health of pregnant women, and oral health of at-risk populations. For a complete list of oral health provisions, see Children’s Dental Health Project’s (CDHP) Senate Health Reform Toolbox available in the in the Health Care Reform Center on at

Provisions for Family Decisions Citizens and residents carry health insurance coverage or pay phased-in tax penalty of >$695 / year per family or 1.5% of household income beginning in Some exemptions. Expand Medicaid to all under age 65 with incomes up to 133% of federal poverty level. All newly eligible adults guaranteed a benchmark package covering essential health benefits. (January 1, 2014)

Provisions for Family Decisions Provide refundable premium credits to eligible individuals and families with incomes between % federal poverty level. (January 1, 2014) Exclude costs for over-the-counter drugs not prescribed from being reimbursed through a Health Savings Account (January 1, 2011); limit amount of contributions to flexible spending account to $2,500 per year (January 1, 2013)

Provisions for Family Decisions Establish an internet website to help residents identify health coverage options (July 1, 2010) Develop standards for insurers to use in providing information on benefits and coverage. (Note: Associated with health literacy).

HEALTH LITERACY Cultural & Conceptual Knowledge Oral Literacy Print Literacy Numeracy ListeningSpeakingWritingReading How easily people can get, understand and use information to live well. What is Health Literacy?

What percentage of Americans feel confident making insurance decisions? 25% 45% 65% 85%

Health Reform: Issues  Provisions still being converted to federal rules and regulations. federal rules and regulations.  States making decisions on extent of adoption of the federal law. of adoption of the federal law.  Courts considering constitutionality.  Diversity of opinion the value of the law. law.

Forget Math and Science, Teach Civics (Or Why We Need To Bring Back "School House Rock") 52% know it is the law of the land 22% of the American people think the Affordable Care Act has been repealed. 26% aren't sure. (Kaiser Family Foundation February, 2011 Poll) Math-and-Science-Teach-Civics.cfm

Health Reform: Impacts  State legislative and executive branches responding branches responding  Families and communities searching for information searching for information

Summary of Recommendations

Summary Of Recommendations Summary Of Recommendations ations.pdf ations.pdf 1.Establish basic structure and governance of Health Insurance Exchange. 2.Continue development of State’s plan for seamless entry into coverage, maximizing federal funding. 3.Develop centralized outreach and education strategy 4.Develop state and local strategic plans to achieve improved health outcomes.

Summary Continued 5.Encourage active participation of safety net provider in health reform and new insurance options. 6.Improve coordination of behavioral health and somatic ( mind and body) services. 7.Incorporate strategies to address potential barriers to care for special population wherever possible.

Summary Continued 8.Institute comprehensive workforce planning. 9.Support education and training. 10.Explore licensure and administrative improvements. 11.Explore improvements to liability policy 12.Achieve cost savings and quality. improvements through payment reform and innovations in health care delivery models.

Summary Continued 13.Promote improved access to primary care 14.Achieve reduction and elimination of health disparities through exploration of financial, performance-based incentives and incorporation of other strategies. 15.Preserve strong base of employer-sponsored insurance. 16.Ensure continued leaders and oversight of health reform implementation.

Health Reform: Implications  Public Policy Arena  Private Sector Arena  Non-profit Sector Arena  Educational Arena  Civic Arena  Personal and Family Arena

Health Reform: Imperative  There is a timeline for action.  People confused about the law and insurance. and insurance.  Scams and fraud likely.  Personal, community and other public policy decisions must be public policy decisions must be made. made.

Health Reform: Interventions Deepen knowledge of provisions of the law. Monitor changes over time as provisions are launched or modified. Modify existing educational materials on health, health care, insurance, etc. Incorporate principles of health literacy in communications about health reform

Health Reform: Interventions Seek and share grant opportunities. Conduct research to monitor impact of law on families and communities and assess effectiveness of educational programs. Find ways to act collectively in a timely manner. Your ideas....

“Six I” Policy Analysis Organizing Framework Information: What does the federal legislation actually state? What actions have the state of Maryland taken to respond to federal legislation? Issues: What modifications of the federal legislation have been, are being, or might be made? Impacts: How will our businesses, society, communities, families, individuals be affected by the new law?

“Six I” Policy Analysis Organizing Framework Continued Implications: Does Maryland need to pass state-specific legislation? How can we take advantage of provisions while awaiting possible changes in the law? Do we need to better educate citizens? Imperative: Are there reasons to act now to reduce confusion, improve understanding and decision-making; prevent fraud, etc.? Interventions: What actions can a community, individuals, families and the business sector take now? What can we do for ourselves without waiting for Congress, the Courts and the General Assembly?

Knowledge Base Strategies for Intervention Political Will Effective Impact Achieving Effective Impact

Want to Learn More? Announcing the Availability of Audio and Video Recordings of Forum: Health Reform, Rural Communities and You In December, the University of Maryland Center for Health Literacy and University of Maryland Extension hosted a statewide forum focused on health reform and its impact on rural families and communities. You can view and listen to any or all of the sessions by going to our website and clicking on

Bonnie Braun, PhD Endowed Chair and Director University of Maryland--College Park School of Public Health Herschel S. Horowitz Center for Health Literacy And Professor and Extension Family Policy Specialist Department of Family Science