bcbs health reform nov. 2013 v1
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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Miscellaneous Generic Biologic Drugs Tax on Indoor Tanning Services Nutritional Labeling CLASS Act (repealed) Changes to Tax-Free Savings Accounts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
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