Tips & Tricks for Effectively Communicating What’s
in the Health Care Law
Health Action 2014
The U.S. Census Bureau reported
that 49.9 million residents,
16.3% of the population, were
uninsured in 2010 (up from 49.0
million residents, 16.1% of the
population, in 2009).
Thanks to Chris Lilienthal at Pennsylvania
Budget and Policy Center
This is about what reform would
mean for the mother with breast
cancer whose insurance company
will finally have to pay for her
chemotherapy. … This is about
what reform would mean for
middle-class families who will be
able to afford health insurance for
the very first time in their lives …
and have some security about
their children if they get sick
Thanks to Chris Lilienthal at Pennsylvania
Budget and Policy Center
Making Connections
Persuasive
communications
speaks to our
deeply held
values and beliefs
as Americans.
Thanks to Chris Lilienthal at Pennsylvania Budget
and Policy Center
Rules of Good Communications
Thanks to Chris Lilienthal at Pennsylvania Budget
and Policy Center
Rules of Good Communications
Thanks to Chris Lilienthal at Pennsylvania Budget
and Policy Center
Rules of Good Communication
Thanks to Chris Lilienthal at Pennsylvania Budget
and Policy Center
In every presentation
 Cover: Insurance Reforms, Medicare & Medicare Advantage,
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the Marketplace, and Medicaid Expansion
Expand if appropriate and if you’re comfortable
Keep facts to a minimum
Leave LOTS of times for questions
Don’t worry about being an ‘expert’
Build trust with your audience
The Affordable Care Act in Pennsylvania
Tips and Tricks
 National data is helpful, but trust your field experiences
 You can be YOU - even with a topic like this
 Opposition interruptions are rare, but great opportunity to
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respond to room
Intro slide to build trust, show off that you’re non-partisan
Background terms: explain co-pay, co-insurance, deductible,
premiums. (In our long version we have a slide for that).
Take a step back to look at life before reform
Explain reform doesn’t just expand access – introduce topics
you’re covering
About us..
 Pennsylvania Health Access Network (PHAN) is a broad,
non-partisan coalition that works to ensure all Pennsylvanians
have access to quality, affordable health coverage.
 Represent approximately 60 organizations and a million
consumers across the state.
 Recognized by media, lawmakers (R and D), state and federal
officials, and consumer advocacy organizations as a credible
source of information.
 Work to monitor implementation and push for reforms to be
as consumer friendly as possible.
 Also known as Obamacare, the Health Care
Law, ACA, Patient Protection and
Affordable Care Act, PPACA
 Signed into law on March 23rd, 2010
 Upheld by the Supreme Court as
The
Affordable
Care Act
Constitutional
 Subject of attacks and misinformation
campaign launched by opponents still
fighting for repeal
Before health care reform..
 For the decade leading up to reform,
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premiums were rising much faster than
wages.
Medical bills leading cause of family
bankruptcy
Rx drug costs were hurting seniors on fixed incomes
Small businesses were paying 18% more than large
companies for similar coverage
People with pre-existing conditions had no protections
Tips & Tricks: Insurance Reforms
 Always start with reforms
 Cover all reforms, even if you’re talking to seniors or only
have 20 minutes
 Use stories or anecdotes to explain key provisions
 Save essential health benefits for marketplace
Insurance Reforms
 Say goodbye to pre-existing conditions
 No more lifetime limits and annual limits
 Pulling coverage when you get sick now illegal
 Streamlined appeals process
 Children can stay on parent’s plan until 26
Insurance Reforms Continued
 ER access
 Direct access to OBGYN
 Medical Loss Ratio
 Justify rate hikes.
 Gender discrimination illegal. Age rating
capped.
 Preventive care without co-pays
Tips & Tricks Medicare
 Stress NO Guaranteed benefits cut
 Responding to the payment advisory board (“death panel”)
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questions
Take your time to explain donut hole, but don’t worry about
exact numbers
Do NOT assume anyone gets the difference between
Medicare and Medicare Advantage, even if you’re talking to a
senior on Medicare Advantage
Don’t skip 5 star rating system
Responding to “billions” cut from Medicare
Health Reform and Medicare
 No guaranteed benefits are cut.
 New Benefits for Seniors
 Free preventive care under
Traditional Medicare
 Went into effect January 1, 2011
 Includes colonoscopies, mammograms,
annual wellness exam, annual flu shot,
screenings for diabetes, and more
Health Reform and Medicare
 Closing the donut hole
 52.5% discount on brand name drugs and 28% on
generic.
 In 2012, 222,703 Pennsylvanians saved over $168
million, an average of $753 per beneficiary.
 Extends life of Medicare Trust Fund by at least 8 years
 Cracking down on waste, fraud, and abuse
 Since 2009, $14.9 billion in fraudulent payments have
been returned to Medicare Trust Fund
Medicare Advantage
 Private insurance
 1997 – Payouts roughly equal to cost of
traditional Medicare
 2003 – Congress votes to increase payouts
 2009 – Medicare pays 14% more per beneficiary
than traditional Medicare
Medicare Advantage and ACA
 Every Medicare Advantage plan is rated on a 1 to 5 star
system.
 Rating of 1 – 3 stars means:
 No more bonus payments
 Must increase rating in 3 years
 Rating of 4-5 star means:
 Bonus payments, but every dollar must to be used to benefit
seniors
 Only for 5 star plans: Seniors can switch into 5 star plan
anytime of year
 Check your rating and compare plans in your area at
www.medicare.gov/find-a-plan or calling 1-800-MEDICARE
Medicare Advantage and ACA
 Medical Loss Ratio
 It’s working
 In 2011: Medicare Advantage enrollment
increased by 10% and premiums fell by an
average of 7%
Tips & Tricks for Marketplace
 Don’t take questions during this section, even for small,
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informal presentations
Break it up: Basics, EHB, Plan types, Tax credits, How you
get it
Stress MOC involvement – use that as transition to QHP
Forget about actuarial value, use low/high
Show what FPL means in annual income and hourly wages
Don’t talk about it as a website
Health Insurance Marketplace
 Uninsured, small business owners, people paying more
than 9.5% of pay on premiums & Members of Congress
 Qualified Health Plan
 Tax credits and cost-sharing subsidies
Essential Health Benefits Package
•Ambulatory patient services
•Emergency services
•Hospitalization
•Maternity and newborn care
•Mental health services
•Prescription drugs
•Habilitative &Rehabilitative services
•Laboratory services
•Preventive and wellness care
•Pediatric services
Level
Monthly
Premium
CoPay or Outof-Pocket
Costs
Platinum
Highest
Lowest
Gold
High
Low
Silver
Middle
Middle
Bronze
Low
High
Catastrophic Plan
 Much lower premiums, but high deductibles
 Available to 30 and under or those who receive financial
hardship exemptions
 Covers 3 primary care visits and free preventive care benefits
 After deductible is met, all essential health benefits are
covered
Premium Tax Credit Eligibility
FPL
100%
400%
Annual – 1
person
Hourly
Full/Part time
– 1 person
Annual – 4
persons
household
Hourly
Full/Part time
– 4 persons
$11, 490
$45,960
$5.52/$11.04
$11.32/$22.64
$23,550
$94,200
$22.09/$44.19
How Tax Credits Work
 Paid directly to insurance company
 Marketplace lets you know how big of a credit you’re
eligible for.
 Based on silver level plan, but you pick the plan you
want.
 Tax credits based on projected income
Help with out of pocket costs
 Folks at or below 250% of FPL
($28,725/yr individual; $58,875/yr family
of 4) eligible for reduced cost sharing
 Must be getting Premium Tax Credit
 Have to be enrolled in a silver-level plan
 Caps on out of pocket expenses
But HOW do I get it?
 Visit www.healthcare.gov
 Call 1-800-318-2596
• Customer service representatives - 24/7
• English and Spanish
•
Language line for 150 additional languages
But HOW do I get it? (continued)
 Talk to a Navigator or a Certified Application
Counselor
 Visit www.localhelp.healthcare.gov to find one
near you!
 Can’t find one near you? Call PHAN. We have
CAC’s that can help you: 1-877-570-3642
Special Enrollment Period Qualifying Events
Loss of minimum essential
coverage
Material contract violations by Qualified Health Plans
Gaining or becoming a dependent
Gaining or losing eligibility for premium tax credits or
cost-sharing reductions
Gaining lawful presence
Relocation resulting in new or different Qualified
Health Plan selection
Enrollment errors of the
Marketplace
Exceptional circumstances
Tips & Tricks for Medicaid
 Explain how Medicaid works in your state pre-ACA first
 Most popular messaging point is security, second is
uncompensated care savings
 Explain savings, but focus on people
 If you’re in a state that hasn’t expanded you’ll need to explain
the gap at least twice during presentation.
 Text here
Medicaid Expansion:
Supreme Court Ruling
Changes the Game
 ACA envisions everyone making less than 138% of FPL
($15,856 for individual or $32,499 family of 4) will go into
an expanded Medicaid program
 Supreme Court ruling makes Medicaid expansion “optional”
to states
 Pennsylvania has not yet opted in
Painting by Theresa BrownGold of Art as
Social Inquiry
A Common Misconception..
• Medical
Assistance not
available to all
low-income
folks
•1.4 million
Pennsylvanians
uninsured
•Many working
low-wage,
temporary or
part-time jobs
•States receive
100% Federal
Match 2014, 2015,
and 2016
•Slowly goes down,
until steadying out
at 90%
Fiscal Benefits for Pennsylvania
 Pennsylvania’s own Independent Fiscal
Office study: Economic WIN for PA
 Save taxpayers hundreds of millions to over a
billion dollars on money otherwise going to treat
uninsured in ER
 Creates 35,000 new, good-paying jobs plus
generates billions in new tax revenue
States all around PA have taken
Medicaid expansion
From the Center on Budget and Policy Priorities report on the state of Medicaid expansion, Oct. 2013
What’s at stake
 400,000 Pennsylvanians will be left with no options for
coverage.
 PA hospitals will lose $8.1 billion in federal hospital
payments between 2013-2022 while continuing to face
annual uncompensated care costs of $1 billion.
What’s Healthy PA?
 Not traditional Medicaid expansion
 Moves people into private insurance
 Elderly, “Medically fragile,” and people with disabilities will
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get Medicaid coverage.
Significant benefit cuts and limitations
Includes work requirements and premiums
Lengthy waiver process
Tell lawmakers and Governor Corbett you want Medicaid
expansion in 2014.
Individual Mandate
 Those who choose not to get coverage will pay a penalty:
 2014 $95 or 1% of income, whichever is higher
 2015 $325 or 2%
 2016 $695 or 2.5%
 Exemptions:
 Health sharing ministries (Amish)
 Uninsured for less than 3 months
 Can’t find coverage that costs less than 8% of income
 Folks that would qualify for Medicaid expansion but live in
states that aren’t expanding
Next steps
 Sign up for PHAN emails www.pahealthaccess.org
to receive info on: Policy calls, free webinars, Action
Alerts, and More!
 Call or write your state legislators in Harrisburg. Tell them to
expand Medicaid today!
 Look for PHAN on Facebook and Twitter
www.facebook.com/pahealthaccess.org @pahealthaccess
 Tell your friends and family what you’ve learned!
 Athena Ford
 aford@pahealthaccess.org
Questions/Comments to expect
 Will there be enough doctors?
 How is this paid for?
 Are Medicare Advantage plans sold on marketplace?
 My plan was cancelled, because..
 Abortion coverage in marketplace
 Does the chip get put in my brain or in my hand?