The Affordable Care Act (ACA)and Health Care for

People with Disabilities Presented by Lisa D. Ekman

Director of Federal Policy, Health & Disability Advocates

DC Advocacy Partners is the District Class

May 9., 2104

What this presentation will cover:

Why was the ACA needed ?What was actually in the ACA? How is implementation going? What barriers still exist to people with disabilities to getting quality care?

Why was the ACA needed?

55 million people did not have any health insurance

Individual health insurance policies were not covering what people needed

Health care costs were increasing

55 million people uninsured

Why does that matter? People’s health matters AND Health care related bankruptcies No preventative care Everyone pays more when uninsured get treatment

Private Insurance Problems

Inadequate benefits/insurance policies Lack of access for people with pre-existing conditions

Not affordable for people with any illnessCaps on what policies would spend Canceled policies when people need them

Health Care Costs

•The United States spends much more per person than other countries on health care but doesn’t get good outcomes •Almost 1 in 5 dollars created by our economy goes toward health care costs •The aging of the baby boomers will cause that share to increase

The ACA Had 2 Main Goals

1.Expand access to affordable comprehensive coverage AND

2.Help control health care costs

How the ACA Expands Access to Coverage

How do people get health insurance?

• Private Insurance • Employer Sponsored • Individual Market

• Public Insurance • Medicare • Medicaid

How the ACA Expands Access (cont)

• Private insurance problems were mostly in the individual market – no pooling of risk• Some people could not get a policy at all – pre-existing condition ban• For some it was too expensive if had any health issues • Rescission – dropping people when sick

How the ACA Expands Access (cont)

•The ACA created new “risk pools” – •To make the individual market more like the employer market•They are called marketplaces – some states have their own and some use the Federal one

•Individual and Employer Mandates

How the ACA Expands Access (cont)

The ACA reformed private insurance requirements:

• Ban on considering pre-existing conditions

• Cannot charge people more for premiums because sick

• No annual caps/no lifetime caps

• Cannot drop people when they get sick

• All policies must cover essential health benefits

What Are Essential Health Benefits (EHB)?

• ambulatory patient services;

• emergency services;

• hospitalization; maternity and newborn care;

• mental health and substance use disorder services, including behavioral health treatment;

• prescription drugs;

• rehabilitative and habilitative services and devices;

• laboratory services; • preventive and wellness

services and chronic disease management;

• and pediatric services, including oral and vision care.

Other Private Insurance Reforms

• Coverage for dependent children up to age 26• Community Rating – everybody pays same regardless of health status or gender• Increasing transparency – insurance companies have to do a better job of telling people what is covered under the policies • Online information so people can make apple to

apple comparison

How the ACA Makes Coverage Affordable

Subsidies and Limits on Costs • People making between 138% of FPL and 400% of FPL can get help paying for their health insurance premiums • There is a cap on the total amount people must spend per year on health care

How the ACA Expands Coverage (cont)

Medicaid Expansion

• Every state was supposed to offer Medicaid to:• Adults whose income was up to 138% of the

federal poverty line • Did not have a limit on resources like other

Medicaid eligibility categories • Would include EHB services as required

services

How the ACA Expands Care (cont)

Access to Home and Community Based Services Under Medicaid

• Home and Community-Based Services State Plan Option• Community First Choice• State Balancing Incentive Payments Program• Money Follows the Person (MFP)

How is implementation going?

Private Health Insurance • Every state is offering private insurance that meets the new requirements. •Most states are participating in the Federally Facilitated Marketplace or FFM but some states are running their own • DC has its own marketplace

•More than 8 million people have insurance through the Marketplaces!

How is implementation going?

Medicaid • 27 states have expanded Medicaid • 5 states are still considering it • 19 have said they won’t move forward at this time •About 3.9 million people insured through Medicaid expansion

Barriers for People with Disabilities

Some benefits are still not adequate • Can’t have annual spending caps but can have

limit on the number visits or number or types of devices • Prescription coverage • Durable medical equipment like wheelchairs • Supplies • Habilitation

Barriers for People with Disabilities (cont)

With private insurance there are still: • Some policies that don’t include enough or the right specialists • Some doctors offices that are not accessible • Some insurance policies might discriminate against people with certain conditions

Barriers for People with Disabilities (cont)

In Medicaid: • Some people can’t get the long-term services and

supports (LTSS) they need • Some programs are expiring or haven’t been taken

up:• Money Follows the Person expires in 2016• Only 8 states took up Community First Choice option

Discussion