cal-acp · richard thorp, fap (ano) became ma president and steve larson, fap ( as2) is currently...

15
Cal-ACP News & Views Fall / Winter 2013 Volume 3, Issue 2 A publication of the California Services Chapter of the American College of Physicians 2014 Upcoming Events: February 10, 2014 California Northern Council of Early Career Physicians February 25-26, 2014 Sacramento Leadership Day April 10-12, 2014 Internal Medicine May 21-22, 2014 Washington Leadership Day Rolling Out Covered California Pg. 2 - CalACP announces CovCA Grant 2013 CMA HOD Post-Report Pg. 4 Perspecves from first-year Pg. 6 medical students aending 2013 CMA HOD Advocacy Front Pg. 7 - Introducing Tom Riley, Leg. Consultant Save the Date! Pg. 8 - Early Career Physicians Event Covered California Fact Sheets Pg. 9 - Affordable Insurance a Naonal Priority - The Health Insurance Marketplace - Changes Coming to Healthcare in 2014 - Some Changes for Health Insurance Plans Health Insurance Resource Center Pg. 13 Inside this issue: The American College of Physicians Services California Chapter Teams up with Three Health Care Partners to Increase Understanding of State Health Benefit Exchange. Covered California Educaonal Grant Arcle Featured on Page 2 Pg. 1

Upload: others

Post on 03-Oct-2020

3 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: Cal-ACP · Richard Thorp, FAP (ANO) became MA President and Steve Larson, FAP ( AS2) is currently President of the oard of Trustees of MA and is running for President-Elect in 2015

Cal-ACP

News & Views

Fall / Winter 2013

Volume 3, Issue 2

A publication of the California Services Chapter of the

American College of Physicians

2014 Upcoming Events:

February 10, 2014

California Northern Council of Early Career

Physicians

February 25-26, 2014

Sacramento Leadership Day

April 10-12, 2014

Internal Medicine

May 21-22, 2014

Washington Leadership Day

Rolling Out Covered California Pg. 2

- CalACP announces CovCA Grant

2013 CMA HOD Post-Report Pg. 4

Perspectives from first-year Pg. 6

medical students attending 2013 CMA HOD

Advocacy Front Pg. 7

- Introducing Tom Riley, Leg. Consultant

Save the Date! Pg. 8

- Early Career Physicians Event

Covered California Fact Sheets Pg. 9

- Affordable Insurance a National Priority

- The Health Insurance Marketplace

- Changes Coming to Healthcare in 2014

- Some Changes for Health Insurance Plans

Health Insurance Resource Center Pg. 13

Inside this issue:

The American College of Physicians Services

California Chapter Teams up with Three Health Care

Partners to Increase Understanding of State Health

Benefit Exchange.

Covered California

Educational Grant

Article Featured on Page 2

Pg. 1

Page 2: Cal-ACP · Richard Thorp, FAP (ANO) became MA President and Steve Larson, FAP ( AS2) is currently President of the oard of Trustees of MA and is running for President-Elect in 2015

Earlier this year the California Chapter of the American College of

Physicians Services announced it was awarded an outreach and

education grant from the state health insurance exchange. Covered

California, the insurance exchange, awarded one of four Provider

Education Grants in the amount of $865,000 to CalACP and its partners

in the project, the California Academy of Family Physicians, the

California Academy of Physician Assistants, and the Osteopathic

Physicians and Surgeons of California.

The goal of the grant is to help inform physicians, physician assistants

and their health care teams throughout the state about health care

coverage options available to patients and family members as part of

national health care reform. By educating its 9,272 active members and

encouraging them to educate their patients, CalACP aims to increase

the number of Californians with health care coverage. Collectively, ACP

and its partner organizations include more than 26,000 mostly primary

health care providers who serve millions of patients across the state,

including many culturally and ethnically diverse patients in underserved

communities.

We are well on our way with implementing our educational strategy,

which encompasses a multifaceted approach that incorporates regional

meetings, On-demand webinars and videos, focus groups, group

learning sessions, educational print medium, newsletters,

e-communication, and working with hospitals to schedule training and

education sessions in hospital grand rounds. Outreach efforts to deliver

information to patients include educating not only physicians, but also

the office and health care teams that support physician practices. We

will work with registered nurses, medical assistants, nurse practitioners,

physician assistants, office managers and other physician practice staff

so all involved have an opportunity to learn more about Covered

California insurance plans so they can in turn educate patients about

exchange eligibility and enrollment.

...Continued next page Pg. 2

Rolling Out Covered California …

CalACP and partners awarded educational grant

Page 3: Cal-ACP · Richard Thorp, FAP (ANO) became MA President and Steve Larson, FAP ( AS2) is currently President of the oard of Trustees of MA and is running for President-Elect in 2015

Darin Latimore, MD, FACP, President, California Services

Chapter of the American College of Physicians and Covered

California certified instructor has presented the educational

programming to physicians, their health care teams and

medical students at various meetings in recent months. We are

pleased to acknowledge that CalACP members Susan Sprau, MD,

MACP, Roman Maher, MD, MBA, FACP, Alpesh Amin, MD, MACP,

George Meyer, MD, FACP, George Sarka, MD, FACR, FACP and

Michael Matus, MD, serve as Covered California Faculty Members

and have received required training to lead educational

presentations. The funding from this grant is only to be used on

educating clinicians and other health care providers about Covered

California and how to direct their patients to the health exchange,

via web, phone or in person.

In addition to the grant awarded to CalACP and its partners,

Covered California also awarded grants to the California Medical

Association (CMA), California Society of Health-System Pharmacists

and the National Council of Asian Pacific Islander Physicians.

Collectively, grant recipients are expected to reach out to more

than 200,000 health care providers during the grant period, which

runs from September 2013 to December 2014.

We look forward to working together to help providers and their

patients understand the opportunities available through Covered

California.

Dr. Latimore presenting Covered California to UC Davis

undergraduate medical students.

Rolling out Covered California …

UC Davis medical students gather following Covered

California presentation and Q &A session.

We are available to provide in person educational

sessions for your medical office team, including

educational materials specifically for physicians and

their practice staff. We can also provide you with

educational materials to distribute to patients who ask

for information about Covered California.

For questions or additional information on this

opportunity, please contact Ashley Ruby, Executive

Director, CalACP Services: [email protected]

Services at [email protected] — (916) 589-0678.

Pg. 3

Page 4: Cal-ACP · Richard Thorp, FAP (ANO) became MA President and Steve Larson, FAP ( AS2) is currently President of the oard of Trustees of MA and is running for President-Elect in 2015

2013 CMA HOD Post-Report by Susan Sprau, MD, MACP

CalACP Chief Delegate

to CMA House of Delegates

California ACP was well

represented at the 2013 CMA

House of Delegates held at

the Disneyland Hotel, Ana-

heim, CA on October 11-13.

Angie Chen, FACP (CANO),

Chester Choi, MACP (CAS1), Darin Latimore, FACP CANO), Mel Sterling,

MACP (CAS2) and myself (CAS1) were the ACP delegates to the Specialty

Delegation. Ashley Ruby, CA ACP Executive Director, provided support

for our deliberations and was able to meet key ACP members and CMA

staff in person. In addition, there were many ACP members partici-

pating as part of county delegations, and mode of practice forums,

including Gordon Fung, FACP (CANO Governor). Darin Latimore brought

five medical students from UC Davis to observe the deliberations in an

effort to increase medical student awareness of how healthcare policy is

developed.

CA ACP has several members in leadership positions at CMA. Lee Snook,

FACP (CANO) was elected Vice-Speaker in a contested election.

Richard Thorp, FACP (CANO) became CMA President and Steve Larson,

FACP (CAS2) is currently President of the Board of Trustees of CMA and

is running for President-Elect in 2015. They have all expressed interest in

furthering ACP policy/principles through CMA.

At the HOD, CA ACP had two resolutions accepted by CMA. Dr. Mel

Sterling authored the resolution to oppose the current Center for

Medicare Services (CMS) outpatient observation (2 night) policy for

hospital stays. National ACP has already sent a letter to CMS requesting

this policy be modified in several ways, including to protect patients

from increased costs when hospital care is considered “outpatient” and

to oppose CMS 3-day rule for a patient to quality for payment for skilled

nursing.

CMA announced significant change to its governance structure so that

all CMA members will be able to submit policy resolutions year round

via the internet and that these resolutions will be reviewed by standing

committees (rather than the current HOD/Reference Committee

process). We have an opportunity to nominate ACP members (who are

also CMA members) to these standing committees. We currently have

representation on the CMA Council on Legislation (Darin Latimore) and

CMA Council on Scientific Affairs (Mel Sterling).

… Continued Pg. 4

L-R: Ashley Ruby, Executive Director, ACP Services,

ACP HOD Delegates Chester Choi, Susan Sprau, Angie Chen,

Darin Latimore, and Mel Sterling

Reference Committee Members in Action

L-R: Darin Latimore, MD, FACP with first-time UC Davis Medical

Students Lucy Ogbu, Jeremy Johnson, Cristina Lee, and John Paul

Aboubechara (Diego Vargas not shown)

Page 5: Cal-ACP · Richard Thorp, FAP (ANO) became MA President and Steve Larson, FAP ( AS2) is currently President of the oard of Trustees of MA and is running for President-Elect in 2015

If you are interested in participating in CMA on standing committees, or as a ACP delegate to the CMA House of

Delegates , please contact me ([email protected]) or Ashley Ruby ([email protected]).

We are also continuing to reach out to medical students and residents/fellows who are interested in participating more in

CMA. If you are not yet a CMA member, membership is free for med students, residents/fellows and can be completed on

the CMA website: cmanet.org. If you have difficulty please contact your medical society or our ACP

Executive Director, Ashley Ruby for assistance.

Report on the CMA 2013 HOD (Continued)

Fred Russo, FACP (CAS1)

CMA HOD Delegation Caucus

Gordon Fung, FACP Governor (CANO)

CMA HOD Delegation Caucus

Marshall Morgan, FACP (CAS1)

CMA HOD Delegation Caucus

Debra Judelson, FACP (CAS1)

CMA HOD Delegation Caucus

Pg. 5

Page 6: Cal-ACP · Richard Thorp, FAP (ANO) became MA President and Steve Larson, FAP ( AS2) is currently President of the oard of Trustees of MA and is running for President-Elect in 2015

It is not often that medical students are exposed to the legislative process of enacting health policy. However, as first year medical students at U.C. Davis School of Medicine, we were given the unique opportunity to attend the California Medical Association (CMA) House of Delegates convention in Anaheim in Anaheim from October 8-11 2013. The CMA is a professional organization representing California physicians with the overall mission of legislative, regulatory, economic and social advocacy. Their comprehen-sive goal is to support their members in navigating the increasingly complex challenges of practicing healthcare in a rapidly evolving society. The CMA House of Delegates (HOD) consists of over 400 physician that meet annually to deliberate resolutions and reports relating to a multitude of issues relating to medical practice, governance, health policy and patient advocacy.

The goal of the House of Delegates consists primarily of resolutions and recommendations submitted by delegations or by individual delegates. We learned that each item of business is assigned to a "reference committee," consisting of six members of the House. Subsequently, each reference committee conducts a hearing or meeting to receive testimony for or against proposed resolutions from other CMA members and delegates. The committee then formulates recommendations for action by the full House, which votes to adopt, reject, amend or refer (for further study or for decision by the Board of Trustees) each recommendation.

The reference committee meetings presented us with the exciting opportunity to voice our opinions on several issues deliberated in the Medical Student Section. We were particularly impressed by the quality and depth of some of the resolutions championed by other medical students from around the state. One of the more poignant resolutions advocated for California physicians to identify and refer minors at-risk for sexual exploitation to appropriate social services. It was very inspiring to see fellow student delegates from U.C. Davis successfully pass a resolution that will allow California medical schools greater autonomy in setting graduation requirements. Their success has motivated us to author our own resolutions in future conferences.

An important highlight was attending the meetings of the full House of Delegates for the combined group caucus. There were controversial subjects that generated passionate debates, including the topic of single payer healthcare system. Nevertheless, the collegial and respectful atmosphere created a safe environment for all to debate amicably. As the conference proceeded, our familiarity increased as we gained a deeper insight into how physicians can impact health policy and patient care on a broader scale.

One of the best aspects of the weekend was the overwhelm-ing support and warm reception we received from the physicians. Many of them expressed how important our participation as medical students were to the organization and the future of medicine. The networking contacts that we made will serve as a launching pad in our future involvement in health policy and advocacy as we progress through our medical education.

We returned to our school with renewed vigor and enthusiasm in recruiting our fellow classmates to take a more active interest in health policy. Our main objective is to engage and educate our student population about the numerous opportunities to get involved in the AMA and CMA. One of the most resounding lessons that we took away from the conference was the incredible scope of influence that we as medical students can have on policy during our medical and post-graduate education.

We would like to especially thank several individuals and organizations who made this experience possible. They include Dr. Darin Latimore, Dr. Richard Thorpe, Dr. Lee Snook, The CMA Foundation, the Sierra Sacramento Valley Medical Society (SSVMS) and the Office of Student and Resident Diversity at U.C. Davis School of Medicine.

Perspectives from first-year

medical students attending

CMA House of Delegates

By UC Davis first-year Medical Students (pictured at right)

L-R: Diego Vargas, Lucy Ogbu, Jeremy Johnson, CMA Vice-Speaker

Lee Snook, Cristina Lee, John Paul Aboubechara, and Darin Latimore,

MD, FACP

Pg. 6

Page 7: Cal-ACP · Richard Thorp, FAP (ANO) became MA President and Steve Larson, FAP ( AS2) is currently President of the oard of Trustees of MA and is running for President-Elect in 2015

On the advocacy front…

Tom Riley to provide legislative support

The American College of Physicians California Services Chapter (CalACP) is pleased to

announce that Tom Riley, Principal, Cal Capitol Group will be providing legislative support

for the nearly 11,000 members represented by CalACP.

During the legislative session, Tom will closely interface with CalACP’s President,

Darin Latimore, the Board, and Health and Public Policy Committee members on critical

health care legislation that affect ACP members and their patients.

Cal Capitol Group, a professional/government relations consulting firm is based in

Sacramento, has been providing government and public relations consulting services for

over 25 years. Tom has advised and provided management and regulator consulting

services to numerous corporations, foundations and other organizations, including Blue

Shield of California Foundation, American Academy of Pediatrics, District IX, Osteopathic

Physicians, Surgeons of California, California Academy of Family Physicians and many

more.

Tom Riley, Principal

Cal Capitol Group

While a full repeal of SGR is likely to be months away, Congress

passed a three -month patch Thursday that would avert the 24

percent cut due to be imposed on January 1. The Senate is

expected to vote soon on the deferral. The patch includes a

.5 boost in payments to begin at the start of the year.

Meanwhile, two proposals—one in each chamber—that would

permanently recast how Medicare payment would work, continue

to advance forward even though neither is expected to be ready

before the full Congress adjourns next week.

While both proposals would repeal SGR, neither solves how to

offset such a repeal’s budgetary costs. The good news is that the

Congressional Budget Office (CBO) last week reduced the

estimated 10-year cost of such a repeal to $116.5 billion. This is

the second lowering of the estimate by the CBO this year.

On Thursday, both bills were voted out of their committees

—HR 2810 was unanimously passed out of the House Ways and

Means Committee, while the Senate bill moved out of the Senate

Finance Committee on a voice vote.

The bills are not identical, however they share some key features.

Both bills contain:

• .5% pay increases each year from 2014 through 2017;

• a 5% bonus for physicians who particpate in qualifying payment

alternative payments models (such as “medical homes”);

• consolidation of quality improvement incentive programs into

a single Value-Based Performance Incentive Program;

• permanent repeal of SGR.

Any payment increases would represent a large victory for

physician organizations, many of whom pushed heavily to change

the original House proposal that called for a 10-year payment

freeze in exchange for repeal. Indeed, as late as early this week, a

coalition of national physician groups including surgeons and other

specialists came out in opposition to the working bill until the

freeze provision was lifted.

Congress Passes Last-Minute Sustainable Growth Rate (SGR) Fix: Long Term Solution in the making… ACP Policy Update / December 13, 2013

Pg. 7

Page 8: Cal-ACP · Richard Thorp, FAP (ANO) became MA President and Steve Larson, FAP ( AS2) is currently President of the oard of Trustees of MA and is running for President-Elect in 2015

February 10th 2014

SAVE THE DATE!

To join the California Northern Council of Early Career Physicians for

a professional development event, with invited guest speaker

Darin Latimore, MD, FACP President, California Chapter of the American College of Physicians Services (Cal-ACP)

Associate Dean, Office of Student and Resident Diversity, University of California at Davis

WHERE: Sheraton Grand Hotel, 1230 J Street, Sacramento, CA 95814

WHEN: February 10, 2014 – 6:00pm Networking/6:30pm *Dinner/7:00pm Presentation

WHAT: To Discuss Key Points of Covered California

WHY: To Learn About and Engage in ACP as an Early Career Physician

Dr. Darin Latimore is our invited speaker for this professional development event about Covered California

(www.coveredca.com). Come learn about California’s health insurance marketplace and enjoy free dinner and the

company of fellow internists! Also learn about opportunities to engage in ACP as an early career physician, and meet

Northern California chapter leaders during the event.

There is no cost to you for registration & dinner for this event but space is limited.

Please reserve your seat by sending us your RSVP by January 15th to

[email protected] !

Include in your e-mail the following:

1. Your name

2. Practice specialty

3. Questions you may have about Covered California or ACP

4. *Dinner: Please indicate if vegetarian meal preferred

Also, check http://www.acponline.org/about_acp/chapters/ca/cecp_events.htm for details on upcoming events, including professional development events, mixers, and meet-ups locally and at the ACP Annual Meeting in Orlando! Pg. 8

Page 9: Cal-ACP · Richard Thorp, FAP (ANO) became MA President and Steve Larson, FAP ( AS2) is currently President of the oard of Trustees of MA and is running for President-Elect in 2015

FACT SHEET

COVERED CALIFORNIA

Affordable Insurance Is a National Priority

In 2010, the federal government

approved a law — The Patient

Protection and Affordable Care Act

(Affordable Care Act) — to increase

the number of Americans with health

insurance and cut the cost of health

care.

The law is important to Californians

because it provides financial

assistance to help individuals and

small businesses pay for health

insurance. Those who already have

affordable health insurance don’t

need to any action, unless they lose

their coverage for certain reasons,

such as the loss of a job.

To help those without health

insurance get covered, the

Affordable Care Act included a

requirement that states either set up

their own marketplace for

people to buy health insurance or

have one set up by the federal

government. These marketplaces will

offer one-stop shops where

people can compare health

insurance plans and buy the plan

that works best for them, their

family and their budget. California

chose to set up its own marketplace

—Covered California™ — as its

doorway to health coverage.

California also decided to expand its

Medi-Cal program, and Covered

California is the place to go to find

out if you are eligible.

Getting California Covered Covered California was created to

develop an easy-to-use marketplace

where most Californians can get health

coverage that cannot be denied by

health insurance companies or

canceled if they are sick or have a

pre-existing health condition, such as

asthma or diabetes.

By 2014, about 2.6 million Californians

will be able to access financial

assistance through Covered California

to pay for their health insurance, and

1.4 million will be newly eligible for

Medi-Cal. An additional 2.7 million will

benefit from coverage that is

guaranteed whether they buy an

insurance plan through Covered

California or on their own. All health

insurance plans purchased through

Covered California must cover certain

services called essential health

benefits. These include doctor visits,

hospital stays, emergency care,

maternity care, children’s care,

prescriptions, medical tests and

mental health care. Health insurance

plans also must cover preventive care

services, like mammograms and

colonoscopies, for free. All plans

being sold in the Covered California

marketplace, as well as those sold

outside it, will be required to include

these benefits.

Pg. 9

Page 10: Cal-ACP · Richard Thorp, FAP (ANO) became MA President and Steve Larson, FAP ( AS2) is currently President of the oard of Trustees of MA and is running for President-Elect in 2015

A Short History, an Ambitious Future California has an important role to play in ensuring that

Covered California is successful. Working together with

federal, state and community partners, Covered California

wants millions of Californians to get affordable health care

coverage. With more Californians covered, the state, our

neighbors and our families will all be able to make healthy

choices that benefit us all.

A Commitment to Californians Covered California is committed to making

sure that everyone is aware of their health

insurance coverage options and can easily

compare health insurance plans and choose

the right one.

We know that choosing health insurance

can be confusing, and we are here to help.

We will be providing support in person, by

phone and online. We are training people in

local communities across the state who will

help Californians learn about the new

health insurance options available. These

trained professionals will be able to offer

help in many difference languages.

The Health Insurance

Marketplace On Oct. 1, 2013, Covered California

will begin enrolling eligible

Californians for health insurance

coverage that will begin in January 2014.

Residents who do not have health

insurance from their employer or another

government program, or for whom that

insurance is not affordable, may qualify

for help with premiums.

Covered California is the only place where

Californians can use premium assistance

from the federal government to reduce

their health care costs. Covered California

is also the place to go to see if you are

eligible for Medi-Cal.

Californians will be able to buy the same

health insurance plan in the private mar-

ket that will be offered through Covered

California. One advantage of purchasing

insurance through Covered California is

that it is easy to compare different

plans. For the first time ever, it is

possible to make apples-to-apples

comparisons across different health

insurance plans, thanks to new

standard benefits that were designed to

work for consumers — not for health

insurance companies. Covered

California also will help small businesses

provide affordable health coverage to

their employees. Through Covered

California, businesses with one to 50 eligi-

ble employees will be able to purchase

health insurance. Businesses with fewer

than 25 equivalent full-time employees

could qualify for tax credits. Starting

in 2016, Covered California will be

open for larger employers with 100

For more information, visit

www.CoveredCA.com or call

(800) 300-1506.

CoveredCA. Com Covered California is the new online

“marketplace” that will make it simple

and affordable to purchase quality

health insurance and get financial

assistance to help pay for it. If your

income is limited, you may be eligible for

free coverage through Medi-Cal.

Pg. 10

For the first time ever, it

is possible to make

apples-to-apples

comparison across

different health

insurance plans.

Page 11: Cal-ACP · Richard Thorp, FAP (ANO) became MA President and Steve Larson, FAP ( AS2) is currently President of the oard of Trustees of MA and is running for President-Elect in 2015

FACT SHEET

Changes Coming to Health Care in 2014

New Improvements in the Health Insurance Market

The Patient Protection and Affordable Care Act (Affordable Care Act) is the federal law passed in 2010 that provides affordable health insurance to more Americans. The historic law will change the way health insurance companies provide coverage, as well as the way consumers get coverage. The fact sheet describes a few of the changes happening in health insurance.

Important Changes for Consumers

More Health Insurance Options.

The Affordable Care Act establishes state

marketplaces, where individuals and

small businesses can shop for health

insurance on the internet, in person or

by phone. These marketplaces will help

make health insurance much more

reasonably priced and easier to get.

California’s marketplace, named

Covered California, will offer millions of

Californians a variety of health insurance

plans available for purchase.

Affordable Coverage and Financial

Assistance. Covered California will help

individuals and families determine

whether they may get federal financial

assistance that will cut the cost of health

insurance or whether they qualify for

free health insurance through Medi-Cal.

Many small businesses also will be able

to provide employee health insurance,

using federal tax credits to reduce

premium costs.

Protections for Consumers. All health

insurance plans (not counting most plans

sold before March 10, 2010) must

provide health insurance for individuals

and their families even if someone has a

health condition such as diabetes or

asthma. That health insurance cannot be

dropped if someone gets sick.

Consumers also cannot be denied a

health insurance plan if they make an

honest mistake when filling out the

application.

Increased Coverage. The Affordable

Care Act strengthens Medicare,

Medicaid (Medi-Cal in California) and

other very important programs for

millions. In addition, those who have not

yet turned 26 and whose parents have

health insurance can now be included in

their parents’ health insurance plan.

Fines for No Coverage. Starting in

January 2014, most adults will be

required to have public — such as

Medi-Cal or Medicare — or private

health insurance or pay a fine. The fine

becomes more costly over a three-year

period. In 2014, the fine will be

1 percent of yearly income or $95 per

person, whichever is greater. For adults

with children, the fine for lack of

coverage for the child is $47.50. By 2016,

the fine will be 2.5 percent of income or

$695 for an individual, $2085 for a

family, whichever is greater.

What Businesses Will Need to Do.

Employers with 50 or more full-time

employees that do not offer health

insurance that employees can afford, or

that offer a health insurance plan that

does not meet certain requirements,

may receive a fine starting in 2015.

Pg. 11

Page 12: Cal-ACP · Richard Thorp, FAP (ANO) became MA President and Steve Larson, FAP ( AS2) is currently President of the oard of Trustees of MA and is running for President-Elect in 2015

Some Changes for Health Insurance Plans The Affordable Care Act required that health insurance

companies change some of their practices. At the same time,

it protects the consumers’ rights to keep the coverage they

already had before the law was passed.

Under the Affordable Care Act, all health

insurance plans must follow certain rules.

Rate Increases. Health insurance

companies must give a reason for any

increase in premiums. Insurance

companies must spend 80 percent of the

money they receive from premiums on

delivering quality health care, not on

costs such as salaries and advertising.

No Limits to Health Care an Individual

Receives in His or Her Lifetime. Health

insurance companies cannot set a dollar

amount limit for key health benefits

during a person’s lifetime.

Preventive Care. All new health

insurance plans must cover preventive

care and medical screenings, like

mammograms and colonoscopies, as

well as women’s services such as

breast-feeding support, contraception

and domestic violence screening. Health

insurance companies cannot charge

copayments, coinsurance or deductibles

for such services.

Essential Health Benefits. Newly sold

health insurance plans must over ser-

vices that fall into these 10 categories of

essential health benefits:

ambulatory patient care

emergency services

hospitalization

maternity and newborn care

mental health and substance abuse

disorder treatment

prescription drugs

Rehabilitation and habilitation

services and devices

lab services

preventive and wellness services and

chronic disease support

children’s services, including dental and

vision care

New Tools to Choose. Covered

California insurance plans will be

grouped by cost and value, using

consistent information so that

Californians can make apples-to-apples

comparisons among plans, see expected

costs more easily and get the coverage

they need.

There will be four basic levels of

coverage: Platinum, Gold, Silver and

Bronze. As the coverage increases, so

does the monthly premium payment,

but the cost when a person receives

medical care is usually lower.

Californians an choose to pay a higher

monthly cost so that when they need

medical care, they pay less. Or they can

choose to pay a lower monthly cost,

which means that when they need

medical care, they pay more. Each per-

son has the choice. Families can also

seek insurance through Medi-Cal.

For more information,

visit www.CoveredCA.com

or call (800) 300-1506.

CoveredCA.com

Covered California is the new online

“marketplace” that will make it simple and

affordable to purchase quality health insurance

and get financial assistance to help pay for it, if

your income is limited, you may be eligible for

free coverage through Medi-Cal.

Pg. 12

Page 13: Cal-ACP · Richard Thorp, FAP (ANO) became MA President and Steve Larson, FAP ( AS2) is currently President of the oard of Trustees of MA and is running for President-Elect in 2015

Help Your Patients Enroll in Health Insurance Marketplaces

One of the principal ways that the Affordable Care Act (ACA) will expand coverage to millions of uninsured persons is through state-by-state health insurance marketplaces. These marketplaces will help eligible patients buy individual health insurance plans that they can afford. They will provide a web-based platform that will enable patients to effectively comparison shop and select the best plan for them and their families. Eligible persons will also be able to get tax subsidies to help them afford the plans offered by the marketplaces.

Health insurance marketplaces are launching this fall and patients who need coverage will be able to begin using them in October. To help you help your patients determine health insurance choices, as well as to answer questions that you might have, the American College of Physicians has put together a series of documents to address questions about the changes in healthcare coverage brought about by the new marketplaces.

The following documents include general information on resources that are available to you and your patients, and answers to frequently asked questions about insurance enrollment. In addition, ACP has also assembled state-specific resources to tell you more about what is happening in your area and help you provide your patients with accurate contact information.

...Continued on next page Pg. 13

Resource center launched to be “Trusted Source of Information for

Internists and Their Patients” American College of Physicians members recognized as trusted sources of information for getting

coverage through health insurance marketplaces

September 9, 2013

(Washington) – A resource center featuring a series of documents to address questions about the changes in healthcare coverage by new marketplaces that will be available in each state starting Oct. 1 was unveiled today by the American College of Physicians (ACP). ACP’s resource center, “Help Your Patients Enroll in Health Insurance Marketplaces,” is deemed critical because recent public opinion polls show that doctors are especially trusted sources of information for the implementation of the Affordable Care Act (ACA).

Page 14: Cal-ACP · Richard Thorp, FAP (ANO) became MA President and Steve Larson, FAP ( AS2) is currently President of the oard of Trustees of MA and is running for President-Elect in 2015

ACP’s State-by-state Guides to Helping Patients Enroll Find information about how the insurance marketplace will operate in your state and a resource guide you can give to your patients to help them find the appropriate people to answer their questions about health insurance. Questions and Answers about Health Insurance Marketplaces and the Affordable Care Act

ACP’s Frequently Asked Questions about Patient Enrollment in Health Insurance Marketplaces ACP’s Questions & Answers About Physician Concerns on the ACA

ACP Health Insurance Enrollment Comment Center

Have questions or comments about ACA health insurance marketplaces and enrollment? Contact ACP staff at [email protected] to share your thoughts.

Other Resources

From ACP: An Internist’s Practical Guide to Understanding Health System Reform HHS Info about Marketplaces: For Professionals | For Patients (English) |For Patients (Spanish)

HHS State-by-State Fact Sheets

Web MD: Health Insurance Checklist

AARP Health Law Answers Tool, Health Care Reform Guide

Kaiser Family Foundation

Consumers Union

The Commonwealth Fund

Health Insurance Marketplace

National Partnership for Women and Families

Additional resources available at healthcare.gov

HHS Report: Health Insurance Marketplace Premiums for 2014

HHS Info: Current Health Insurance Marketplace Premiums Data for 2014 Pg. 14

Continued

Resources Available to you and your patients ...

Page 15: Cal-ACP · Richard Thorp, FAP (ANO) became MA President and Steve Larson, FAP ( AS2) is currently President of the oard of Trustees of MA and is running for President-Elect in 2015