Health Care Reform:Health Care Reform:An OverviewAn Overview

Presented by Bonnie Braun, PhDPresented by Bonnie Braun, PhD

Public Health Carousel:2nd Annual Public Health Conference

Wooster County, MarylandApril 6, 2011

Your Feelings About the Health Reform Law

Does CONFUSED – ANXIOUS – ANGRY -

ENTHUSIASTICdescribe your own feelings about the

health reform law?

72%

66%

61%

47%

27%

34%

39%

53%

Confusion Most Commonly Expressed Emotion

Confused

Angry

Anxious

Enthusiastic

Describes Does 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

http://www.youtube.com/watch?v=3-Ilc5xK2_E&feature=player_embedded

Information

Issues

Impacts

Implications

Imperative

Interventions

“Six I” Policy Analysis Organizing Framework

Health Reform: InformationHealth Reform: Information

Law of the LandLaw of the Land ProvisionsProvisions Dates of provisionsDates of provisions

http://healthreform.kff.org/timeline.aspx

Public Law 111-148 &111-152

111-148 and 111-152 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

http://bookstore.gpo.gov/actions/GetPublication.do;jsessionid=90F8EEB212C12ED6BE7B1A8FD341BDA4?stocknumber=069-000-00183-1

http://thomas.loc.gov/cgi-in/query/D?c111:7:./temp/~c1112

http://www.kff.org/healthreform/8060.cfm

Easy to Use SummaryEasy 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; and4) 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

http://www.healthreformgps.org/

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 ReformCenter on at www.cdhp.org.

Provisions for Family DecisionsProvisions 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 2014. 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 DecisionsProvisions for Family Decisions

• Provide refundable premium credits to eligible individuals and families with incomes between 133-400% 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 DecisionsProvisions for Family Decisions

• Establish an internet website to help residents identify health coverage options (July 1, 2010)

http://www.healthcare.gov/• 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

Listening Speaking Writing Reading

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%

http://www.naic.org/

Health Reform: IssuesHealth Reform: Issues Provisions still being converted toProvisions still being converted to

federal rules and regulations.federal rules and regulations. States making decisions on extentStates making decisions on extent

of adoption of the federal law.of adoption of the federal law. Courts considering constitutionality.Courts considering constitutionality. Diversity of opinion the value of the Diversity of opinion the value of the

law.law.

Forget Math and Science, Teach Civics Forget Math and Science, Teach Civics (Or Why We Need To Bring Back (Or Why We Need To Bring Back

"School House Rock")"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)

http://www.kff.org/pullingittogether/Forget-Math-and-Science-Teach-Civics.cfm

Health Reform: ImpactsHealth Reform: Impacts

State legislative and executive State legislative and executive

branches respondingbranches responding Families and communities Families and communities

searching for informationsearching for information

Summary of Recommendations http://www.healthreform.maryland.gov/documents/101116staffrecommendations.pdf

Summary Of RecommendationsSummary Of Recommendationshttp://www.healthreform.maryland.gov/documents/101116staffrecommend

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 policy12. Achieve cost savings and quality.

improvements through payment reform and innovations in health care delivery models.

Summary Continued13. Promote improved access to primary care14. 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: ImplicationsHealth Reform: Implications

Public Policy ArenaPublic Policy Arena Private Sector ArenaPrivate Sector Arena Non-profit Sector ArenaNon-profit Sector Arena Educational ArenaEducational Arena Civic ArenaCivic Arena Personal and Family ArenaPersonal and Family Arena

Health Reform: ImperativeHealth Reform: Imperative There is a timeline for action.There is a timeline for action. People confused about the law People confused about the law

and insurance.and insurance. Scams and fraud likely.Scams and fraud likely. Personal, community and other 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: InterventionsHealth 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

http://www.sph.umd.edu/fmsc/fis/documents/6IsPolicyAnalysisOrganizingTool.pdf

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

InterventionPolitical

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 http://sph.umd.edu/fmsc/fis/current.html

Bonnie Braun, PhD Endowed Chair and Director

University of Maryland--College Park School of Public Health

Herschel S. Horowitz Center for Health LiteracyAnd

Professor and Extension Family Policy Specialist

Department of Family Sciencebbraun@umd.edu

301-335-4335