HDF 322 Lecture 18 Outline of Last Lecture I Insurance Outline of Current Lecture II Statistics Across the Nation III Kaiser Family Foundation IV 2010 2011 What the Law Does V Essential Health Benefits of ACA VI Health Reforms Now VII Traditional Health Insurance Principle VIII Major Medical Plans 60s and 70s Current Lecture I Statistics Across the Nation WE ARE THE HIGHEST and we have the most uninsured people Texas Its not something to brag about at all uninsured in Texas 45 have health insurance through employer 4 individual Medicaid 16 Medicare 9 other public 1 uninsured 25 numbers are higher when you leave elderly out II Kaiser Family Foundation These notes represent a detailed interpretation of the professor s lecture GradeBuddy is best used as a supplement to your own notes not as a substitute video that Cookie Roberts did about Affordable Care Act to let people know what helath insurance is health care reform law is complex 1000 pages very few Americans have actually read it no matter where you stand on this everyone has questions about equal amount like don t like don t know THE PROBLEMS in our current health care system problem 1money most agree that policies are too expensive for family avg premium is 14 000 a year and growing health care costs are fastest growing costs in fed budget HOLES peoples illnesses falling through oles some unaffordable some have lifetime limit and after that out of luck so the ones that need coverage are the ones that don t have it uninsured underinsured SOLUTIONS PHASE 1 what the plan proposes to do to deal with costs insurance will be limited to how they spend our dollars if they spend too much on admin they have to give back in rebate Some services will be free screenings vaccinations medicare will get more help with drug costs young people can save and stay on parents policy until age 26 small business will have to pay health insurance Holes lifetime limits will be gone and will be illegal to turn kids down for pre existing health conditions Asthma or diabetes adultscan enter high risk pool for pre existing condition govt will chip in money to bring down costs PHASE 2 New years Day 2014 Medicaid expanded to cover all low income in every state no matter what you make or lose your job you get health insurance tax credit while most cont to get insurance at work you can still buy insurance at THE EXCHANGE An EXCHANGE is insurance megaball based on where you live you get menu of options to compare plans and exchange insurance companies can compete fairly under rules idea is to give consumers fair playing field competition will keep rates competitive With few exceptions people will be required to buy insurance by a tax and small businesses will have to Credits expanded programs and new rules to make more people have insurance HOW ARE WE PAYING FOR THIS 938 Billion Dollars over next 10 years its 2 of fed budgets and 3 of what we would spend on health care overall Hospitals and insurance companies will have to pay New fed advisory board will deal with increased costs new taxes on higher income and companies that make med devices and more III 2010 2011 What the Law Does 2 months or maybe 3 months of how much problem federal exchanges are having 36 states decided not to have own state health care and went to fed exchange all of the state run programs are having NO problems it s the states that didnt want to have their own plan for own citizensthese are the ones that are forced to go to exchanges and exchange at federal levels that are having problems interesting that federal level is having all the problems started in 2010 and 2011 tanning salon tax one of the first thing adult dependents now up until 26 you can be on parents plan as dependents big benefit for college students 2011 primary care in 2011 people are preventing care is free but the physicians are now limiting what is in included in the preventive careusually a physical was preventive care and now annual physical is not as in depth as it used to be so if you want testing and same type of service you have to pay a co pay bc right now co pays are not required for annual preventive care vaccines for children are free 2012 2013 longterm care for community care can ride off health care savings accounts a diff type of deductible 2014 individual mandate and employers requirements IV Essential Health Benefits of ACA these are now required by ACA these are things that all plans must provide In readings they have to provide outpatient care have to cover ER trips can have co pays but still included inpatient care for treatment in hospital baby is born care for before and after mental health services and substance abuse wasn t covered before good plans had many didn t lab tests equipment for recovery pediatric services etc V Health Reforms Now a what we have NOW they were in the phase 1 you can t be dropped when sick prior to this law you could be they didn t have any guaranteed coverage any pre existing conditions children cant be excluded preventive care is more limited but no co pays tax credits up to 35 to offer employees health insurance doughnut hole for elderly Medicare benefits and they are making it smaller so people don t have as high of pocket costs easy to read policies now must age 26 VI Traditional Health Insurance Principle Kitt supports health insurance for everyone we all need it we never know the loss we will have so now in basic health insurance get the HIGHEST COVERAGE WITH LARGEST DEDUCTIBLE because that keeps PREMIUM DOWN what size deductible can I afford that will guide you into a policy higher deductible lower premium YOU KNOW YOU WILL PAY PREMIUM EVERY YEAR the deductible you ONLY PAY WHEN YOU HAVE A LOSS USE HEALTH CARE ONLY PAY DEDUCTIBLE IF YOU NEED CARE VII Major Medical Plans 60s and 70s in this time period we had major medical plan come out this was a plan that allowed you to not pick and choose took care of 3 components of medical care but had to have 3 diff policies and now we have 1 comprehensive policy Major Medical Care designed to cover high limits had deductible had co insurance some plans call it participation lots of different terms for it and after a deductible was paid you pay a little and company pays a lot up to a LID called it a lid and policies did have limits within think about it maybe you want private room so maybe that extra cost is good some hospitals only have this