1. The Affordable Care Act: Highlights & Updates Presentation for the Iowa State Association of Counties Meeting November 29, 2012

2. Overview of the Affordable Care Act Title I – Quality, Affordable Health Care for All Americans Title II – Role of Public Programs Title III – Improving the Quality and Efficiency of Health Care Title IV – Prevention of Chronic Disease and Improving Public Health Title V – Health Care Workforce Title VI – Transparency and Program Integrity Title VII – Improving Access to Innovative Medical Therapies Title VIII – CLASS Act Title IX – Revenue Provisions Title X – Strengthening Quality, Affordable Health Care for All Americans

3. Restoring the Partnership for American Health: Counties in a 21 st Century Health System Coverage Public Health, Prevention & Wellness Maintaining a Safety Net Delivery Systems & Access Health Workforce Health IT Long Term Care Jail Health

4. Coverage Expansion Insurance market reforms (many began in the first plan year after 9/23/10) Rescissions forbidden No lifetime caps on essential health benefits No pre-existing condition exclusions for children under 19 Annual limit restrictions Dependent coverage up to age 26 Pre-Existing Condition Insurance Plan (2010) Larger changes in 2014 –Medicaid expansion –Health insurance exchanges –Individual & employer responsibility

5. Public Health: Disease Prevention & Health Promotion National Prevention, Health Promotion and Public Health Council – Strategy & Reports to Congress Prevention and Public Health Fund –Totaling $15B over 10 years –Community Transformation Grants and grants to support other prevention and wellness & public health activities Clinical and Community Preventive Services Task Forces Education and outreach campaigns Preventive services in Medicaid and Medicare

6. Delivery Systems & Access $11B for Community Health Centers $1.5B National Health Service Corps Negotiated rulemaking committee Medicaid = Medicare rate for primary care docs 2013 and 2014 Medicare & Medicaid payment reforms Care coordination efforts –Office in CMS to improve care for dual eligibles –Center for Medicare & Medicaid Innovation

7. Health Workforce National Health Care Workforce Commission Graduate Medical Education Training programs, scholarships and loan repayment National Health Service Corps

8. Health IT Implement secure and interoperable electronic health records HITECH Act Development of standards & protocols to promote the interoperability of systems for enrollment in federal and state health & human services programs

9. Long Term Care Medicaid Money Follows the Person Rebalancing Demo through September 2016 Community First Choice Option in Medicaid

10. Jail Health Persons in custody pending disposition of charges retain eligibility for coverage under plans on the exchanges NACo publication: County Jails and the Affordable Care Act: Enrolling Eligible Individuals in Health Coverage

11. Medicaid & the Safety Net Medicaid coverage for all up to 133% FPL –Though SCOTUS decision affects implementation 100% FMAP in 2014, 90% FMAP in 2020 for expansion population Pass through for counties required to contribute to the non-federal share $14.1 Billion cuts to DSH from 2014 to 2019 New requirements for private non-profit hospitals

12. Supreme Court Decision on the ACA SCOTUS examined four questions: –Is the individual mandate/minimum coverage requirement constitutional? –If the individual mandate/minimum coverage requirement is unconstitutional can it be severed from the ACA? –Does the Anti-Injunction Act bar consideration of the individual mandate/minimum coverage provision? –Are the Medicaid provisions coercive to states?

13. Source: The Advisory Board, as of 11/19/12

14. dd Source: Kaiser Family Foundation

15. Other ACA Implementation Issues Release of additional regulations Changes to the law still possible Fiscal cliff “grand bargain”—possible Medicaid & other changes

16. NACo Health Reform Implementation Activities Member communication Online resources & conference workshops Intergovernmental activities

17. For more information, visit: www.naco.org/healthreformimplement Email healthreforminfo@naco.org to:healthreforminfo@naco.org Sign up for NACo health reform implementation email updates Get answers to your health reform implementation questions For information about NACo’s Healthy Counties Initiative, visit: www.naco.org/healthycountiesinitiative Anita Cardwell Program Manager acardwell@naco.org 202-942-4267