FOCUS: Affordable Care Act
Must Be Heard Reports on Implementation of Health Care Reform
Additional funding to Community Health Centers helps expand coverage, improve care and lower costs. Small businesses now able to provide health insurance because of new tax credits. Stories of patients rescued by Pre-Existing Condition Plan. Breakdown of the Affordable Care Act - impact on health care delivery, federal budget, beneficiaries and the economy.
Impact on Small Businesses:
Up to 4 million small businesses are eligible for tax credits to help them provide insurance benefits to their workers. The first phase of this provision provides a credit worth up to 35% of the employer’s contribution to the employees’ health insurance. Businesses with more than 50 employees will be required to offer health insurance. Watch Must Be Heard reports on ACA's impact on Small Businesses.
Helen Dally, daughter of small business owners in Portland, Oregon, discusses the impact of Small Business Health Care Tax Credits. COMING SOON: Interview with Jamal Lee, of Breasia Studios, LLC, discussing the impact of the tax credits on his business.
Health Care Delivery System Reforms:
U.S. Senator Sheldon Whitehouse's (D-RI) recently released report Health Care Delivery System Reform and The Patient Protection & Affordable Care Act highlights ACA's potential to improve care while reducing costs of health care delivery, initiatives that are essential for solvency of Medicare and controlling federal spending. The report focuses on savings that can be achieved through reforms in payment, primary and preventive care, measuring and reporting quality, administrative simplification, and information technology.
Must Be Heard investigates the impact of these reforms through conversations with CEOs of Community
Health Centers, doctors, nurses and policy analysts.
Tony Lewis, President & CEO of Cobble Hill Health Center in Brooklyn, NY - discusses specific implementation measures of Center for Medicare & Medicaid's Community-based Care Transitions Program (CCTP) - its role in better coordinating transitions between hospitals and other settings, reducing hospital readmissions and lowering costs of health care delivery while improving care. CMS uses consumer satisfaction, readmissions and community-specific root cause analysis data collected by CCTPs to determine trends and facilitate CCTPs' learning collaboratives. The program has potential to save billions of Medicare dollars. "What’s been remarkable about this whole project - while [CMS] had certain criteria for inclusion in the project, they haven’t been proscriptive in the way you have to design this…. They really look for local organizations to work collaboratively to design their own programs…. The CMS, other officials from government see themselves as facilitators ... because I think they’ve recognized its growth needs ... to come from the communities who know the best ways ultimately to care for the people living in the community." - Tony Lewis
Geisinger Health System in northeastern Pennsylvania is a prime example of innovation in payment reforms. It enforced new financial incentives and quality measures that significantly improved care and lowered costs of health care delivery. Medical claims data showed "a total cumulative reduction by 18 percent of inpatient admissions" and a 36% reduction in readmissions (page 14). Geisinger program used payment practices similar to ACA's new Medicare Shared Savings Program that is already in the process of being implemented at 27 newly created Accountable Care Organizations across the country.
Barbara Coufal, Assistant Director of Legislation at American Federation of State, County and Municipal Employees, discusses ACA's demonstration projects that experiment with reforming provider payment methods aimed at improving quality and lowering cost of health care delivery, to be expanded throughout the healthcare system and integrated care organizations already provide evidence of incentives that successfully treat illnesses in their nascent stages.
Dr. Shilpy Setya dicusses health and cost-saving benefits of preventive care.
COMING SOON: Interview with Board members and physicians at Chinese Community Accountable Care Organization re: implementation of 33 quality measures and Medicare Shared Savings Program.
Igor Volsky, Health Care Policy Editor of Center for American Progress, discusses ACA's payment system reforms that reward quality and coordination, aimed at reducing health care spending while improving care.
Beneficiaries:
ACA's Pre-Existing Condition Insurance Plan (PCIP) provides new coverage options to individuals who have a pre-existing condition and who have been unable to obtain affordable health insurance coverage. Young adults are now allowed to stay on their parent’s plan until they turn 26 years old. Insurance companies are prohibited from imposing lifetime dollar limits on essential benefits. Must Be Heard collects stories of beneficiaries of these reforms.
Barbara Kornblau's daughter with history of heart surgery, asthma, fibromyalgia, arthritis and hepatitis C is unable to get insurance coverage, until ACA's Pre-Existing Condition Plan. Spike Dolomite Ward, was living without health insurance, unable to afford $1,500/month individual insurance premiums. She was diagnosed with breast cancer and was rescued by the ACA's Pre-Existing Condition Plan which now covers her chemotherapy. Marjory Ackley's husband, Bill Ackley, having had chronic lymphocytic leukemia, was a victim of lengthy insurance denial appeals process. Bill Ackley had to delay treatment and was not as receptive to the transplant when he received it. The Affordable Care Act now requires that insurance companies give their decision within 72 hours after receiving request appealing the denial of a claim for urgent care.
Policy:
Must Be Heard recently spoke with Kim Bailey, Senior Health Policy Analyst & Research Director at Families USA, about the impact of the recent Republican budget proposal on healthcare costs, state budgets and the economy. The interview also addresses latest CBO projections regarding Affordable Care Act’s impact on federal budget ($210 billion reduction over ten years) and potential health system savings.
Starting on January 1, 2014, the ACA will establish Affordable Insurance Exchanges, new transparent and competitive insurance marketplaces where individuals and small businesses can buy affordable and qualified health benefit plans. Exchanges will provide significant cost-saving benefits. According to David M. Cutler, exchanges will "group individuals and small firms into larger entities and thus drive down those administrative costs. The exchanges also will minimize marketing costs through more transparent posting of premiums, facilitated enrollment ... and stronger oversight of industry practices." He further projects savings of health expenditures totaling $184 billion over 2010-2019.
David M. Cutler points to current "lack of competition in the health insurance market" and suggests that "creating insurance exchanges that allow individuals and small companies to have the choices that large corporation and their employees already enjoy [would] preserve healthy competition between private insurers."
ACA gives states the option of establishing their own exchanges, tailored to their specific needs, or to choose a federally facilitated exchange. "A 2012 State To-Do List for Exchanges, Private Coverage, and Medicaid" report published by Families USA advocates for "strong public input processes regarding exchange establishment and
operations."
Ron Pollack, the Founding Executive Director of Families USA, discusses state's choice to set up an exchange that allows it to retain power in shaping it. Igor Volsky, Health Care Policy Editor, Center for American Progress, discusses ACA's Exchanges that will offer simplified plans for consumers, will reduce administrative costs, and will give individuals and small businesses the advantage of being part of a larger risk pool.
Affordable Care Act: Full Text
NEWS & ANALYSIS
Obama administration says ACA will save Medicare $200 Billion
The Affordable Care Act creates a new type of non-profit health insurer, called a Consumer Operated and Oriented Plan (CO-OP)
Health Care for a Changing Work Force
Affordable Care Act to support quality improvement and access to primary care for more Americans
Up to 4 million small businesses are eligible for tax credits to help them provide insurance benefits to their workers. The first phase of this provision provides a credit worth up to 35% of the employer’s contribution to the employees’ health insurance. Businesses with more than 50 employees will be required to offer health insurance. Watch Must Be Heard reports on ACA's impact on Small Businesses.
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John Arensmeyer, Founder & CEO of Small Business Majority discusses Small Business Health Care Tax Credits – eligibility, impact and federal implementation, economic advantages of offering health insurance by small businesses, impact on businesses with over 50 employees, economic benefits and history of exchanges that will increase choice and reduce health insurance premiums empowering states to tailor exchanges to their unique marketplaces, job creation, projected impact on federal budget and the mandate which eliminates “hidden tax” and is essential for efficient health care reform. Supported by data and analysis provided by Congressional Budget office, economists Jonathan Gruber, David M. Cutler and others. |
Health Care Delivery System Reforms:
U.S. Senator Sheldon Whitehouse's (D-RI) recently released report Health Care Delivery System Reform and The Patient Protection & Affordable Care Act highlights ACA's potential to improve care while reducing costs of health care delivery, initiatives that are essential for solvency of Medicare and controlling federal spending. The report focuses on savings that can be achieved through reforms in payment, primary and preventive care, measuring and reporting quality, administrative simplification, and information technology.
Must Be Heard investigates the impact of these reforms through conversations with CEOs of Community
Health Centers, doctors, nurses and policy analysts.
Tony Lewis, President & CEO of Cobble Hill Health Center in Brooklyn, NY - discusses specific implementation measures of Center for Medicare & Medicaid's Community-based Care Transitions Program (CCTP) - its role in better coordinating transitions between hospitals and other settings, reducing hospital readmissions and lowering costs of health care delivery while improving care. CMS uses consumer satisfaction, readmissions and community-specific root cause analysis data collected by CCTPs to determine trends and facilitate CCTPs' learning collaboratives. The program has potential to save billions of Medicare dollars. "What’s been remarkable about this whole project - while [CMS] had certain criteria for inclusion in the project, they haven’t been proscriptive in the way you have to design this…. They really look for local organizations to work collaboratively to design their own programs…. The CMS, other officials from government see themselves as facilitators ... because I think they’ve recognized its growth needs ... to come from the communities who know the best ways ultimately to care for the people living in the community." - Tony Lewis
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Rob Rioux, Director of Community Relations and Corporate Development at Cornell Scott-Hill Health Center discusses Center for Medicare and Medicaid's Innovation Challenge and focus on prevention, lowering costs and improving care. Kathy Yacavone, President & CEO of Southwest Community Health Center, discusses the use of ACA's funds to improve infrastructure, increase number of patients served, set up Electronic Health Records and health centers' comprehensive model of “bundled services” - all microcosms of ACA's "bundled payment" initiatives that reward quality and care coordination as well as efforts to establish foundations for Accountable Care Organizations that will reduce waste and improve care. Mark Masselli, President & CEO of Community Health Center, further elaborates on cost-saving benefits of a technologically advanced health care ecosystem and addresses how the health center has benefited from ACA-funded School Based Health Center upgrade initiative and residency for nurse practitioners program.
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 Kathy Yacavone
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Barbara Coufal, Assistant Director of Legislation at American Federation of State, County and Municipal Employees, discusses ACA's demonstration projects that experiment with reforming provider payment methods aimed at improving quality and lowering cost of health care delivery, to be expanded throughout the healthcare system and integrated care organizations already provide evidence of incentives that successfully treat illnesses in their nascent stages.
Dr. Shilpy Setya dicusses health and cost-saving benefits of preventive care.
COMING SOON: Interview with Board members and physicians at Chinese Community Accountable Care Organization re: implementation of 33 quality measures and Medicare Shared Savings Program.
Igor Volsky, Health Care Policy Editor of Center for American Progress, discusses ACA's payment system reforms that reward quality and coordination, aimed at reducing health care spending while improving care.
Beneficiaries:
ACA's Pre-Existing Condition Insurance Plan (PCIP) provides new coverage options to individuals who have a pre-existing condition and who have been unable to obtain affordable health insurance coverage. Young adults are now allowed to stay on their parent’s plan until they turn 26 years old. Insurance companies are prohibited from imposing lifetime dollar limits on essential benefits. Must Be Heard collects stories of beneficiaries of these reforms.
Barbara Kornblau's daughter with history of heart surgery, asthma, fibromyalgia, arthritis and hepatitis C is unable to get insurance coverage, until ACA's Pre-Existing Condition Plan. Spike Dolomite Ward, was living without health insurance, unable to afford $1,500/month individual insurance premiums. She was diagnosed with breast cancer and was rescued by the ACA's Pre-Existing Condition Plan which now covers her chemotherapy. Marjory Ackley's husband, Bill Ackley, having had chronic lymphocytic leukemia, was a victim of lengthy insurance denial appeals process. Bill Ackley had to delay treatment and was not as receptive to the transplant when he received it. The Affordable Care Act now requires that insurance companies give their decision within 72 hours after receiving request appealing the denial of a claim for urgent care.
Policy:
Must Be Heard recently spoke with Kim Bailey, Senior Health Policy Analyst & Research Director at Families USA, about the impact of the recent Republican budget proposal on healthcare costs, state budgets and the economy. The interview also addresses latest CBO projections regarding Affordable Care Act’s impact on federal budget ($210 billion reduction over ten years) and potential health system savings.
Starting on January 1, 2014, the ACA will establish Affordable Insurance Exchanges, new transparent and competitive insurance marketplaces where individuals and small businesses can buy affordable and qualified health benefit plans. Exchanges will provide significant cost-saving benefits. According to David M. Cutler, exchanges will "group individuals and small firms into larger entities and thus drive down those administrative costs. The exchanges also will minimize marketing costs through more transparent posting of premiums, facilitated enrollment ... and stronger oversight of industry practices." He further projects savings of health expenditures totaling $184 billion over 2010-2019.
David M. Cutler points to current "lack of competition in the health insurance market" and suggests that "creating insurance exchanges that allow individuals and small companies to have the choices that large corporation and their employees already enjoy [would] preserve healthy competition between private insurers."
ACA gives states the option of establishing their own exchanges, tailored to their specific needs, or to choose a federally facilitated exchange. "A 2012 State To-Do List for Exchanges, Private Coverage, and Medicaid" report published by Families USA advocates for "strong public input processes regarding exchange establishment and
operations."
 Elizabeth B. Wydra |
States clearly have a say in the process. According to Essential Health Benefits Bulletin released by CMS "HHS held a series of sessions with stakeholders, including consumers, providers, employers, plans, and State representatives, in both Washington, D.C. and around the nation to gather public input" about defining Essential Health Benefits that will be required to be covered by the insurance plans participating in the exchanges. CMS finally selected an approach that would allow states to "select a single benchmark to serve as the standard for qualified health plans inside the Exchange operating in their State and plans offered in the individual and small group markets in their State." Must Be Heard asked Elizabeth B. Wydra, Chief Counsel at Constitutional Accountability Center, to elaborate on State and Federal roles in implementing the exchanges. |
Ron Pollack, the Founding Executive Director of Families USA, discusses state's choice to set up an exchange that allows it to retain power in shaping it. Igor Volsky, Health Care Policy Editor, Center for American Progress, discusses ACA's Exchanges that will offer simplified plans for consumers, will reduce administrative costs, and will give individuals and small businesses the advantage of being part of a larger risk pool.
Affordable Care Act: Full Text
NEWS & ANALYSIS
Obama administration says ACA will save Medicare $200 Billion
The Affordable Care Act creates a new type of non-profit health insurer, called a Consumer Operated and Oriented Plan (CO-OP)
Health Care for a Changing Work Force
Affordable Care Act to support quality improvement and access to primary care for more Americans