The Affordable Care Act:
Present and Future Opportunities for Coverage
Presented to Alliance for Healthy and Active Communities
quarterly meeting
Kathy Chan, Associate Director and Director of Policy and Advocacy
Illinois Maternal and Child Health Coalition
Thursday, March 28, 2013
Illinois Maternal &
Child Health Coalition
About IMCHC
www.ilmaternal.org/
Healthcarereform
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Our Projects and Initiatives:
• Campaign to Save Our
Mothers and Babies
• Chicago Area Immunization
Campaign
• Cooking Matters, a program
of Share Our Strength
• Illinois Coalition for School
Health Centers
• Illinois Premature Infant
Health Network
• text4baby
Illinois Maternal &
Child Health Coalition
Presentation Overview
• Understand major provisions of the Affordable Care
Act
• Find out which policies/programs are currently in
effect
• Learn about changes that will occur in the near future
• Be aware of pending policy decisions at the state and
federal levels and opportunities for advocacy
• Questions and answers
• Brief demo of Visualizing Health Care Reform
Illinois Maternal &
Child Health Coalition
Affordable Care Act Overview
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Signed into law on March 23, 2010
Establishes a floor, not a ceiling
States are largely responsible for implementation
Phases-in changes to private health insurance coverage and
expands public coverage
Enacts tax credits to help individuals and small businesses
access more affordable insurance options
Reforms Medicare, protects Medicaid and CHIP
Authorization of numerous grant programs and pilot projects
Imposes individual and employer responsibility provisions
Illinois Maternal &
Child Health Coalition
Present Opportunities
for Coverage
• All Kids – comprehensive health insurance coverage for kids
<300% FPL
• FamilyCare – coverage for parents and relative caregivers
<133% FPL
• Moms & Babies – coverage for pregnant women and infants
up to 1 year of age <200% FPL
• Illinois Healthy Women – limited family planning coverage to
women <200% FPL
• Illinois Breast and Cervical Cancer Program – for uninsured
women 35-64 years, no income limit
Visit www.health.illinois.gov for more information
Illinois Maternal &
Child Health Coalition
Present Opportunities for Access
to Affordable Coverage and Care
• Expansion of young adult coverage to 26
years in private insurance plans
• No-cost preventive care in new private
health insurance plans
– Women-specific preventive services went into
effect on August 1, 2012
Illinois Maternal &
Child Health Coalition
Present Opportunities for Access to
Affordable Coverage and Care (cont'd)
• August 2012 – No-cost women’s preventive
health services for new insurance plans
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Well-women visits
Gestational diabetes screenings
HPV DNA testing (separate from pap smear results)
STI counseling, HIV screening and counseling
Contraceptives (i.e. birth control)
Breastfeeding support services and supplies
Domestic violence screenings
Illinois Maternal &
Child Health Coalition
Present Opportunities for Access to
Affordable Coverage and Care (cont'd)
• CountyCare - 1115 “Cook County” Waiver for early
implementation of “new Medicaid”
– Coverage begins January 1, 2013
– Eligibility criteria:
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19-64 years of age
Income less than 133% FPL
Resident of Cook County
Ineligible for existing Medicaid programs or Medicare
US citizen or Legal Permanent Resident for at least five years
– Must use Cook County Health and Hospital Network and/or
contracted providers
– To apply, phone 312-864-8200 or toll free at 855-671-8883
– http://www.cookcountyhhs.org/patient-services/county-care/
Illinois Maternal &
Child Health Coalition
Present Opportunities for Access to
Affordable Coverage and Care (cont'd)
• Elimination of lifetime limits and phasing out of annual limits
• Elimination of pre-existing conditions for children
• Tax credits to help qualifying small businesses and nonprofits
pay for private health insurance for their employees
• Minimum medical loss ration (MLR)
• Justifications of annual increased premium rates above 10%
• New protections for breastfeeding women
• Direct access to OB/GYNs
• Grants for programs and demonstration projects, e.g.
Community Transformation Grants
Visit www.healthcare.gov for more information
Illinois Maternal &
Child Health Coalition
Health Insurance
Landscape in 2014
 New options for coverage
 Competitive health insurance marketplace
 Tax credits – for those with incomes up to 400% FPL
(~$92,000/year for a family of four)
 Cost-sharing subsidies for those at or below 250% FPL
 New Medicaid limits to cover newly eligible - 138% FPL
(~$20,000/year for family of two)
 Medicaid currently only available to those who meet income
requirement AND categorical eligibility (child under 19 years, parent or
relative caregiver, elderly, disabled)
 Most single and childless adults ineligible
Illinois Maternal &
Child Health Coalition
10
Health Insurance Marketplace
Each state will establish a health insurance marketplace where
consumers can find and compare insurance plans
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Health Insurance Marketplace
 Federal-state partnership in 2014
 Intent for state-based Marketplace in 2015 –
requires state legislature to pass authorizing
legislation. Must include:
 Establish governing board
 Financing mechanism – must be self-sufficient
 Additional issues:
 Strong conflict-of-interest provisions
 Prioritize consumers
 Cost-control, quality-assurance, network adequacy
Illinois Maternal &
Child Health Coalition
Health Insurance
Landscape in 2014 (cont'd)
 1.6M Illinois residents will have access to
affordable coverage
 Over 1M will be eligible to use the Exchange
 342,000 newly eligible for Medicaid
• Guaranteed issue – no more pre-existing
condition exclusion or gender rating; limited age
rating
• Benchmark essential health benefits package –
will also determine coverage for "new Medicaid"
– Likely to be identical to present FamilyCare coverage
Illinois Maternal &
Child Health Coalition
What must be included in
the Essential Health Benefits?
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Ambulatory Patient Services
Emergency Services
Hospitalization
Maternity and Newborn Care
Mental Health and Substance Abuse Services (including
Behavioral Health Treatment)
Prescription Drug Coverage
Rehabilitative and Habilitative Services and Devices
Laboratory Services
Preventive and Wellness Services
Chronic Disease Management
Pediatric Services, Including Oral and Vision Care
Illinois Maternal &
Child Health Coalition
Individual and Employer
Responsibility Provisions
• Nearly everyone will be required to purchase health
insurance starting 2014 or face a penalty
– Exceptions:
• Individuals who would have to pay more than 9.5% of their annual
income for health care, even with tax credits and subsidies
• Undocumented individuals
• Employers with >50FTEs will be required to provide
affordable and adequate health insurance (many already
do)
– New tax credits for small businesses to help offset costs
– Employers will only pay a shared responsibility fee if their
uninsured employees receive tax credits or subsidies
Illinois Maternal &
Child Health Coalition
ACA and Immigrants
 Immigrants “lawfully present” in U.S.
 May buy health insurance in state exchanges
 May apply for tax credits for premiums & costsharing reductions
• Are eligible for the Illinois Pre-existing Condition Plan
• Must buy health insurance under the individual mandate
(unless unaffordable or exempt)
 Undocumented Immigrants:
 Unable to buy private health insurance in exchange
(& ineligible for tax credits or cost-sharing
reductions)
 Exempt from individual mandate
Illinois Maternal &
Child Health Coalition
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Pending Illinois
Policy Decisions
• Benchmark EHB selection – BCBS Blue Advantage
• Establishment of a Health Insurance Marketplace in Illinois
(aka “the Exchange”)
– Single-entry point, simplified screening/application
process
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Developing a Navigator/In-Person Assistor program
Ensure Illinois covers all of the newly eligible in Medicaid
Implementation of Medicaid reform legislation
State budget challenges - ongoing need to preserve
Medicaid and related programs
Illinois Maternal &
Child Health Coalition
Pending Federal
Policy Decisions
• Pending rules and regulations
Illinois Maternal &
Child Health Coalition
Planning Questions
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Existing patient payer-mix?
Capacity?
Medicaid delivery system changes?
Partnership opportunities?
Community/patient education?
Illinois Maternal &
Child Health Coalition
Advocacy Opportunities
• SB26/HB106 – Medicaid Financing Act
– www.ilmaternal.org/action.htm
– AARP toll-free hotline: 1-888-616-3322
• Governor’s Health Care Reform Implementation
Council: www.healthcarereform.illinois.gov
• Illinois Department of Healthcare and Family
Services: www.hfs.illinois.gov
– Public Involvement – Boards and Commissions
• Medicaid Advisory Council:
http://www2.illinois.gov/hfs/PublicInvolvement/BoardsandCom
misions/MAC/Pages/default.aspx
Illinois Maternal &
Child Health Coalition
What You Can Do!
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Connect with your legislators!
Spread the word
Consider becoming an ACA Ambassador
Subscribe to IMCHC’s newsletter and action
alert, Facebook, Twitter (@ILMaternal)
Download and share our factsheets and toolkit
Subscribe to our podcast
Invite us to present and suggest future topics
Bookmark www.illinoishealthmatters.org
Illinois Maternal &
Child Health Coalition
Additional Resources
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www.ilmaternal.org
www.illinoishealthmatters.org
www.healthcare.gov
www.familiesusa.org
www.heathreform.kff.org
Illinois Maternal &
Child Health Coalition
Questions?
Kathy Chan
kchan@ilmaternal.org
312-491-8161x24
www.ilmaternal.org
Illinois Maternal &
Child Health Coalition
Visualizing Health Care Reform in 2014
Local Interactive Health Insurance
Data by Community Area
so you can answer the following
questions:
• Who will be eligible for Medicaid
in the community my pharmacy
serves?
• Who will be eligible for subsidies
in the Exchange in 2014 in the
community we serve?
www.illinoishealthmatters.org
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Grant Proposals
Education & Outreach
Advocacy
Board Education
Operational Decisions
Data Example
Illinois Maternal &
Child Health Coalition
Data Example
Lyons and Stickney – Cook County
In 2014, 20,022 people (13% of the population) will have affordable
health insurance available to them. Below are the types of coverage that
will be available to them based on their income:
• 5,512: Newly eligible for Medicaid (income up to 138% FPL,
$15,400/year for a single person)
• 9,565: Eligible for tax credits to help pay for private coverage on the
Health Insurance Exchange (income ranging from139 - 400% FPL,
between $32,000 - $92,000/year for a family of four)
• 4,945 Ineligible for tax credits, but will have access to Exchange
(incomes above 400% FPL, above $92,000/year for a family of four)
Illinois Maternal &
Child Health Coalition
Data Example
Cook County
In 2014, 855,413 people (16.4% of the population) will have affordable
health insurance available to them. Below are the types of coverage that
will be available to them based on their income:
• 330,923: Newly eligible for Medicaid (income up to 138% FPL,
$15,400/year for a single person)
• 394,135: Eligible for tax credits to help pay for private coverage on
the Health Insurance Exchange (income ranging from139 - 400% FPL,
between $32,000 - $92,000/year for a family of four)
• 130,355: Ineligible for tax credits, but will have access to Exchange
(incomes above 400% FPL, above $92,000/year for a family of four)
Illinois Maternal &
Child Health Coalition
Resources
Illinois Maternal &
Child Health Coalition