The Affordable Care Act
A Presentation by the Delta Sigma Theta
Sorority, Inc.
National Social Action Commission
Dr. Paulette Walker, National President
Rev. Dr. Gwendolyn Boyd, 22nd National President, Co-Chair, National Social Action Commission
Carla Harris, Co- Chair, National Social Action Commission
Committee-- Dr. Kwamme Anderson, Shavon Arline Bradley, Michelle Barnes Russell
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Presenters
 Dr. Paulette Walker, National President
 National Social Action Commission Co-Chair, 22nd National
President Soror Gwendolyn E. Boyd
 National Social Action Commission Co-Chair, Soror Carla Harris
 Tamia Booker, Chief of Staff, U.S. Department of Health and
Human Services, Region III
 Soror Ashley Allison, Constituency Engagement Director, Enroll
America
 Soror Melanie Campbell, President and CEO National Coalition
of Black Civic Participation
 Soror Shavon Arline Bradley, Senior Director Health Programs,
NAACP
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Presenters
Dr. Paulette C. Walker,
25th National President
Carla Harris,
Co-Chair, National Social
Action Commission
Rev. Dr. Gwendolyn E. Boyd,
22nd National President,
Co-Chair, National Social
Action Commission
Ashley Allison,
Constituency
Engagement Director,
Enroll America
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Melanie Campbell,
President and CEO,
National Coalition on
Black Civic Participation
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Shavon Arline Bradley,
Director of Health Programs
NAACP
Tamia Booker,
Chief of Staff, U.S.
Department of Health and
Human Services region III
3
The Affordable Care Act
2013
Objectives
• Review the Patient Protection and Affordable
Care Act (2010)
• Coverage Accomplishments and Cost Savings
• Health Insurance Marketplace
• Medicaid Expansion
• Engaging in the Enrollment Process
• Next steps for advocacy and action
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The Health Care Law
In March 2010, President Obama signed the
Affordable Care Act into law
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Affordable Care Act –
Coverage Accomplishments
 3.1 million young adults have gained insurance
through their parents’ plans
 6.1 million people with Medicare through 2012
received $5.7 billion in prescription drug discounts
 34 million people with Medicare received a free preventive
service
 71 million privately insured people gained improved
coverage for preventive services
 105 million Americans have had lifetime limits removed
from their insurance
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Critical Need for Health Reform
• 48.6 million uninsured Americans
• $3 trillion spent annually on healthcare
• 17.9 % of our economic output tied up in the
health care system
• Without reform, by 2040, 1/3 of economic
output will be tied up in health care
Affordable Health Care Review
 Provides coverage to young adults up to the age of
26
 Strengthens Medicare benefits with lower
prescription, drug costs for those in the “donut hole”
chronic care and preventive care.
 Prohibits plans from imposing lifetime and annual
limits on the dollar value of benefits, and from
rescinding coverage when you get sick.
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Affordable Care Act Overview
 Rein in insurance premiums rates
 Prevent denials of coverage, including for preexisting conditions
 Make health insurance affordable for middle class
families
 Make health insurance affordable for small
businesses with tax cuts
Affordable Care Act –
Cost Savings
 Slowest sustained national health spending growth in 50
years
• Low growth continuing in 2012 for Medicare and Medicaid
 Rate increases fell from 75% in 2010 to 14% so far in
2013
 $1 billion returned to consumers last summer
• Plans now must spend 80% on healthcare
 $4.2 billion recovered in 2012 from anti-fraud efforts – a
record high – for a total of nearly $15 billion over the last
4 years, double that of the previous 4 years
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What the Affordable Care Act Means to You
 The Affordable Care Act means better coverage for
those who already have health insurance, and more
options for those who don’t, including a new way to
shop for affordable, high-quality coverage.
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Highlights To Date
 Preventive Services for Women
• Historic guidelines for coverage of preventive health care
services
• Contraception and contraceptive counseling
• Domestic Violence Screening and counseling
• Breastfeeding support, supplies and counseling
• HIV screening and counseling
• HPV testing for women over 30
• Well-woman visits
• STD counseling
• Screening for gestational diabetes
The Health Insurance Marketplace
Introduction to the Marketplace
 The Marketplace (or Exchange)
• Place for qualified individuals and employers to directly compare
private health insurance options

Known as Qualified Health Plans (QHPs)
• Comparison on the basis of price, benefits, quality, and other factors
• DHHS that premiums will be about 16% lower than expected
 Each state can choose to
• Create and run its own Marketplace
• Partner with the Federal government to run some Marketplace
functions
• Have a Marketplace established and operated by the Federal
government
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Eligibility and Enrollment in the
Individual Marketplace
 The Marketplace initial open enrollment period began
October 1, 2013, and ends March 31, 2014
 Marketplace eligibility requires you to:
• Live in its service area, and
• Be a U.S. citizen or national, or
• Be a non-citizen who is lawfully present in the U.S. for the entire
period for which enrollment is sought
• Not be incarcerated
 Can apply for Marketplace if pending disposition of charge
 Can apply for Medicaid/CHIP at any time
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10 Essential Benefits
1.
2.
3.
4.
5.
Hospital care
Doctors’ office visits
Emergency Room visits
Prescription drugs
Maternity & newborn
care
6. Rehabilitative services
& devices
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7. Laboratory services
8. Preventive services
9. Mental health care
10. Pediatric services
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Engaging in the Enrollment Process
How to Apply
In Person
 Easy
 Convenient
 Streamlined
By Phone
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By Mail
Online
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Open Enrollment
 www.Healthcare.gov
 Paper Applications
 National Marketplace Toll-Free Call Center
for Federally Facilitated and State-Partnership Marketplaces
• 1-800-318-2596 (TTY 1-855-889-4325)
• Customer service representatives - 24/7
• English and Spanish
 Language line for 150 additional languages
 In Person Assistance
• Navigators – Virginia Poverty Law Center, Inc & Advanced Patient
Advocacy, LLC*
• Trained Enrollment Assisters
• Agents and Brokers
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CONT.
 Looking for assistance in person? You can find information online and via
text using the Get Covered Locator.
 Text: Consumers without access to the internet can also get access to this
resource by texting "LOCATOR" and their ZIP code to 877877.
Other digital tools that are available for public officials to work with
navigators, in-person assistors and CAC's include:
Online: Visit this page: http://getcoveredamerica.org/locator/ enter your
ZIP code and you will see a list of Navigators, In-Person Assisters,
Community Health Centers, and/or Certified Application Counselors
within 25 miles. A map will display where these assisters are located to
make it easier for consumers to know who is the most convenient local
expert to go to. Consumers will be given a phone number and a website,
when available, to use to get more information and to setup an
appointment. You can also print this list of assisters out, or have it
emailed or texted to them.
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Medicaid Expansion
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Implications
 In 2011, 20% of African Americans were uninsured
 At least 59% of uninsured African Americans with
incomes below the Medicaid expansion limit reside in
states not expanding Medicaid
 African-Americans are at risk of facing coverage gaps due
to states choosing not to expand Medicaid
 State decisions impact people of color, but
disproportionately affect Black Americans
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“She Knows” Campaign
 Research has shown that uninsured Americans are
demographically diverse.
 Certain constituency groups such as young adults,
Latinos, African-Americans, and lower-income
people are more likely to be uninsured.
 Women not only make up 45 percent of the
uninsured, but are overwhelming known as trusted
messengers for advice on health coverage across
consumer groups.
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“She Knows” Campaign
 Enroll America’s Women’s Outreach has launched
the “She Knows” Campaign geared to educate and
engage uninsured women. The “She Knows”
campaign will serve as a call for women to learn
more about their stake in the new health coverage
options, encourage them to recognize their role as
trusted messengers, and gain training on how to
effectively amplify their voice to help spread the
word to other uninsured Americans.
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“She Knows” Campaign
Women’s Stake in Coverage: Key Benefits for Women
under the New Health Care Law
 Women can't be charged more for health coverage
than men and insurance companies can no longer
deny coverage to women due to pre-existing
conditions such as breast cancer or being pregnant.
 Free preventive health care for women means 22
covered preventive benefits are now included in all
plans, like mammograms, well-woman visits, ovarian
cont.
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“She Knows” Campaign
 cancer screening, screening for diabetes, and more.
You will also be able to get your FDA approved birth
control at no out-of-pocket costs, as the full cost will
be covered by your monthly premium.
 Women’s choice of doctors is protected, which
means you can choose any primary care provider,
OB-GYN, or pediatrician in your health plan's
network without a referral.
 Young adults can stay on their parent’s plan until age
26.
cont.
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“She Knows” Campaign
 We know women want to feel secure that they know
the information before they share it. Therefore, this
program will provide key messages, guidance, and
tools to help them lead the conversations with their
families, friends, and communities.
 In order to effectively educate, engage, and enroll
women in health coverage, Enroll America is
partnering with allied organizations to provide key
messages, resources, tools, and support to women
messengers and consumers.
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“She Knows” Campaign
The main goals of the “She Knows” program:
 Educate uninsured/insured women about how they
stand to benefit from the new health coverage
options;
 Engage women as key messengers by providing
ongoing webinar trainings and resources;
 Provide women support by connecting them to
Enroll America staff on the ground and partner
organizations working on outreach and enrollment;
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“She Knows” Campaign
 And, Creatively reach women who can share key
messages within their own communities
The programmatic outreach and support the “She
Knows” campaign will provide:
 Monthly webinars that educate and support women
on their role in the campaign;
 Earned media events to amplify women’s voices as
trusted messengers;
 Storytelling tools and resources for women to share
their stories during the enrollment process.
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Action Items: What Chapters Can Do
 Champion for Coverage
• Opportunities to provide education and outreach
• Linkage to the Health Insurance Marketplace
• Link: http://marketplace.cms.gov/help-us/champion.html
 Certified Application Counselor*
• Receive training to assist people in applying for coverage
through the Health Insurance Marketplace
• Link: http://marketplace.cms.gov/help-us/cac.html
 Direct Legislative Action
• Fall and Winter Legislative Sessions
• Advocate for Medicaid
Expansion
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Action Items: What Chapters Can Do
 Host a forum
 Partner with Libraries, Community Centers and
Churches to host enrollment activities
 Partner with Federal Qualified Health Centers
(FQHCs) to volunteer at enrollment activities
 Canvassing your communities
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The Health Insurance Marketplace
Key Dates
 October 1, 2013 – Open Enrollment
 December 2013 Goal – Website Up Again
 December 23, 2013 – Cut off to receive
coverage by January 1, 2014
 January 1, 2014 – Coverage Begins,
Expanded Medicaid Coverage
 March 31, 2014 – Open Enrollment Closes
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Announcements
•
Special Breakout on the ACA
During Delta Days in the Nation’s Capital
February 1-4, 2014
• Upcoming Webinars throughout 2014



12/11/2013
ACA for entrepreneurs ( how small businesses are affected)
note: small businesses have been given one year delay
Medicare beneficiaries (geared toward Delta Dears)
Caring for your family (spouse, child, parent)
ACA for health professionals
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Need more information?
 Stay Connected
• Sign up to get email and text alerts at
HealthCare.gov/subscribe
• Updates and resources for partner organizations are
available at Marketplace.cms.gov
• Twitter@HealthCareGov
• Facebook.com/Healthcare.gov
• Delta Sigma Theta Web-site Members Only Section,
National Social Action Commission Link
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Delta Sigma Theta Sorority, Inc. Contact
 National Social Action Commission
socialactioncommittee@deltasigmatheta.org
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Glossary
 COBRA: In 1986, the United States Congress passed
the Consolidated Omnibus Budget Reconciliation Act;
(COBRA). This bill requires that most group health
plans to provide a temporary continuation of group
health coverage that otherwise might be terminated.
COBRA also requires continuation coverage to be
offered to covered employees, their spouses, and
their dependent children when group health
coverage would otherwise be lost due to certain
specific events. Those events include the death of a
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CONT.
Covered employee, termination or reduction in the
hours of a covered employee’s employment for reasons
other than gross misconduct, divorce or legal
separation from a dependent status (and therefore
coverage) under the plan.
 Health Insurance Marketplace: Commonly referred
to as “the Marketplace”. Marketplace is sometimes
referred to as ‘Health Insurance Exchanges’, is a new
way to shop for quality heath coverage. Through the
Marketplace or exchange, you can find affordable
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Options for health insurance coverage. Eligibility for
coverage options is determined through submission of
an application (either online, paper, through in-person
assisters/navigators, over the phone) that is incomebased. The marketplace allows you to compare your
coverage options side-by-side and enroll is a plan that
is best for you.
 Medicaid: A national public health insurance
program that is administered by a state but also
funded through the Federal government. Medicaid
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CONT.
Is specifically for low-income families and children,
pregnant women, the elderly, persons with disabilities,
and in some states, other adults. While the Federal
government provides a portion of the funding for
Medicaid and sets program guidelines, states have
flexibility in how they choose to run their individual
programs. Essentially, Medicaid will vary state-by-state
and may be referred to by different names.
 Medicare: The Patient Protection and Affordable
Care Act [P.L. 111-148], commonly referred to as
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CONT.
‘Obama care’ or the ‘Affordable Care Act’ is the health
care law that expands the affordability quality and
availability of private and public health insurance
through consumer protections, regulations. Subsidies,
taxes, insurance exchanges, and other reforms. It is
important to note that this is the unofficial name for
the health care law.
 Premium: Health insurance premium is the amount
the policy-holder or his sponsor (e.g. an employer) is
responsible to pay to the health plan to purchase
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CONT.
health coverage. Health insurance premiums are paid
monthly to a health plan to provide health coverage.
Including paying for health-related services such as
doctor visits, hospitalizations, and medications.
 TRICARE: A national health care program that is
administered by the Defense Health Agency (DHA)
for active-duty and retired uniformed services
members and their families. TRICARE is a major
component of the Military Health System that
provides quality health care services to support
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REFERENCES
Military operations.







Families USA. 2013 Federal Poverty Guidelines. Retrieved December 9, 2013 from:
http://www.familiesusa.org/resources/tools-for-advocates/guides/federal-povertyguidelines.html
Healthcare.gov. Retrieved December 9, 2013 from: https://www.healthcare.gov/
Kaiser Family Foundation (KFF). Interactive Subsidy Calculator: Retrieved December 9, 2013
from: http://kff.org/interactive/subsidy-calculator/
KFF The Requirement to Buy Coverage Under the Affordable Care Act. Retrieved December
9, 2013 from: http://kff.org/infographic/the-requirement-to-buy-coverage-under-theaffordable-care-act/
Obama care Facts. Dispelling the myth. Retrieved from:
http://obamacarefacts.com/obamacare-facts.php
United States Department of Labor. An employees guide to health benefits under COBRA.
Retrieved December 9, 2013 from: http://www.dol.gov/ebsa/pdf/cobraemployee.pdf
Tricare.mil. Retrieved December 9, 2013 from: http://www.tricare.mil/
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Sources
 U.S. Department of Health and Human Services,
Healthcare.gov
 Enroll America