The ACA’s Impact Upon Insurers, Providers,

and People

BCBR PULSE EVENTNOVEMBER 12, 2013

SPEAKERS:Susan Levy, Women’s Health

Julia Hutchins, ColoradoHealthOpSharon Caulfield, Caplan and Earnest LLC

The Affordable Care Act

Passed in March 2010◦ Labeled “Obamacare”

Market-based health care reform with additional public support◦ Heritage Foundation Model◦ Massachusetts experience◦ Private insurance companies sell standardized products through

state or federal marketplace “exchange” ◦ Support for premium payments for those at low end of Federal

Poverty Level multipliers◦ Expansion of state Medicaid programs

Many elements of the ACA

Research, Commissions, New FundingConsumer Website (www.healthcare.gov) Medicaid and CHIP Payment Advisory Commission Health Care Workforce CommissionComparative Effectiveness Research New Prevention Council Health Centers & National Health Service Corps Expansion of Drug Discount ProgramPrevention and Public Health Fund Federal Coordination of Care OfficeReinsurance Program for Retiree Coverage Chronic Disease Prevention in Medicaid

Center for Medicare and Medicaid Innovation Grants to Establish Wellness Programs Teaching Health Centers Medical Malpractice Grants Funding for Health Insurance Exchanges Graduate Medical Education National Quality Strategy

Rebates and Tax CreditsMedicare Beneficiary Drug RebatesSmall Business Tax Credits Medicaid Drug Rebate New Requirements on Non-profit Hospitals

More elements of the ACA

Medicare / Medicaid Reform Closing the Medicare Drug Coverage Gap Medicare Payments for Primary Care Medicare Prevention Benefits Medicare Premiums for Higher-Income Beneficiaries Medicare Advantage Payment Changes Medicaid Health Homes Medicaid Payments for Hospital-Acquired Infections Medicaid Long-Term Care Services Medicaid Community-Based Services

Medicaid Coverage for Childless Adults (State Option)

Miscellaneous Generic Biologic Drugs Tax on Indoor Tanning Services Nutritional Labeling CLASS Act (repealed) Changes to Tax-Free Savings Accounts

ACA Elements already in place

Insurance Reform Pre-existing Condition Insurance Plan (phasing out) Adult Dependent Coverage to Age 26 Consumer Protections in Insurance Insurance Plan Appeals Process Coverage of Preventive Benefits Minimum Medical Loss Ratio for Insurers

Source: The Washington Post

Who gets insurance – and how?

Health Exchange OptionsSource: http://www.foxbusiness.com/personal-finance/2013/10/16/why-state-run-health-exchanges-are-faring-better/?intcmp=obinsite

The Goals: The Triple Aim

Better care for Individuals

Better Care for Populations

Lower Per Capita Costs

Reaching the Goals --

PatiencePersistence

The #1 Goal: Healthy People