Sunday, September 30, 2012

Patriots for Change Health Care Reform Committee
SOME AFFORDABLE CARE ACT (ACA) (OBAMACARE) BACKGROUND

IF YOU HAVE PRIVATE INSURANCE:
Your insurance company...
  • Will find it harder to waste your premium on CEO salaries and overhead costs
  • Must use at least 80 percent of your premium for health services and improving care
  • Has to justify any hikes to your premium before an independent panel—helping to keep your rate down
  • Plans are beginning to offer free preventive health services like regular blood pressure and cholesterol checks, mammograms, and screenings for things like colon cancer and diabetes.
  • Insurance companies can no longer put a lifetime cap on the amount of care they’ll cover, or cancel your coverage over a mistake in your paperwork—and by 2014, no one can be denied insurance due to a pre-existing condition.
  • Your children can now stay on your family health insurance plan until they turn 26.
  • Your children can no longer be denied coverage based on a pre-existing condition like asthma or diabetes.
  • Preventive services like checkups and childhood immunizations are covered without a co-pay or deductible.
IF YOU ARE ON MEDICARE:
  • People enrolled in traditional Medicare will save an average of $4,200 in health care expenses over the next 10 years.
  • You now have access to annual wellness visits with your doctor, free of charge.
  • If you fall into Medicare's “donut hole” for prescription drugs, you now get a 50 percent discount on brand-name drugs—and by 2020, the doughnut hole will close for good.
  • Free preventative services, including: Colon cancer screenings, Flu shots, Blood pressure and cholesterol checks, Mammograms, Bone density screenings, Screenings for breast cancer
  • Free annual wellness visits with your doctor
  • Improved care for Seniors after they leave the hospital to reduce avoidable readmissions
  • Lower Medicare costs and premiums
IF YOU HAVE NO INSURANCE:
  • If you have a pre-existing condition you can get coverage through the new Pre-Existing Condition Insurance Plan (PCIP), a bridge to 2014, if uninsured for 6 months
  • A new online insurance finder can help you get information about private plans, public coverage options in your state, and resources to help you find free or discounted care.
  • Can’t be charged more or denied coverage based on a pre-existing condition like heart disease of breast cancer 
  • Starting in 2014, your family will be able to shop for coverage in a new Affordable Insurance Exchange. In this new marketplace, insurance companies won't be able to deny coverage because someone has a pre-existing condition. Insurance companies will have to compete on price and quality, and you'll be able to see all your options in one place to find a plan that works for your family.
  • By 2014, you’ll have access to affordable health coverage, even if you can’t get it through work.
IF YOU ARE ON MEDICAID:
  • The new health care law makes it easier to access the benefits you already have—with new tools to help doctors and nurses better coordinate your care, and streamlined computer systems for better efficiency.
  • Simpler rules to help you qualify for Medicaid by 2014
  • By 2014, if you no longer qualify for Medicaid, you will be able to access affordable coverage through Affordable Insurance Exchanges
OTHER CHANGES:
  • Provides small business health Insurance Tax Credits
  • Allows states to cover more people on Medicaid
  • Tackles health care fraud and waste in Medicare, Medicaid and CHIP
  • Expands coverage for early retirees (55-65)
  • Consumers can compare health insurance coverage options and pick the coverage that works for them at HealthCare.gov
  • Prohibits insurance companies from rescinding coverage 
  • Provides mechanism to appeal coverage determinations or claims to insurance company and establishes an external review process.
  • Eliminates lifetime limits on insurance coverage
  • Annual limits on insurance coverage are regulated and banned after 2014
  • Prohibits denying coverage of children based on pre-existing conditions
  • Provides grants to states that implement program to hold insurance companies accountable for unreasonable rate hikes
  • Rebuilds the primary care workforce  
  • Consumer Assistance Programs in states that apply for federal grants to help set up or expand independent offices
  • Expansion of community health sponsors
  • Increases payment to rural health care providers to help them continue to serve their communities.
  • Brings down premium costs: at least 85% of all premium dollars collected by insurance companies for large employer plans must be spent on health care services and health care quality improvement; for plans sold to individuals, at least 80% of the premium. 
  • The Independent Payment Advisory Board (IPAB) submits proposals to Congress and the President extending the life of the Medicare Trust Fund by focusing on ways to target waste, reduce costs, improve health outcomes, and expand access.
  • Increases access to services at home and in community through state Community First Choice Option (Medicaid) instead of nursing home.
  • Encourages Integrated Health Systems through incentives for “Accountable Care Organizations.” 
  • Reduce health care disparities
MEDICARE CUTS
$716 billion: Where does it come from?
  • 35% from reduction in payments to hospitals and health insurance companies
  • 30%  from reimbursements to private Medicare Advantage plans (was 117% of regular fee-for-service)
  • 30% Other (Disproportionate Share Payments, home health care payment reductions, etc.)
Where does it go?
  • Support of the ACA
Medicare benefits NOT reduced.

FOR MORE DETAILS:




Posted by at

No comments:

Post a Comment