The Patient Protection
and the Affordable
Care Act
Maggie Baxter, Maggie Hatcher, Elizabeth Glisson, Katie Rary,
Caroline Romano, and Katherine Whitmore
Obamacare vs. The Affordable
Care Act
Jimmy Kimmel Video
What do Auburn students
think?
Auburn Interviews
Problems behind U.S. Healthcare
Why are Ameican Healthcare Costs so High?
High Cost of U.S. Healthcare
• U.S. spends more tax money per capita on healthcare than
any other country.
• In exchange for these taxes we still get no healthcare
• Only 28% of American’s get their health insurance through
government programs
• 18% of it’s gross domestic product on healthcare costs
• Australia by comparison spends 9%
• Why?
• EVERYTHING HERE COST MORE
• Examples: surgical procedures and pharmaceuticals
So why are we spending so much
money?
• Some may say the obesity epidemic leading to more health
complications
• Malpractice and defensive medicine
• Ordering unnecessary tests
• Careers
• Healthcare providers are paid more
in the U.S.
• Insurance and administrative costs
• Pharmaceuticals
High Cost of U.S. Healthcare
• In the U.S. we do not have that centralized negotiation or
leverage to make decisions with the people providing health
care
• Hard to put a price on not dying
• We are spending more money to keep people alive
• Not a simple problem and there will not be a simple solution
• What makes healthcare so expensive
• Vital that we as NURSES MAKE A CHANGE
Get Ready for Obamacare
The YouToons Get ready for Obamacare
ACA Overview
• The ACA – passed by Congress and signed into
law in March 2010
• The most important provision of the ACA
• "individual mandate” requires all Americans who
can afford health insurance to purchase a policy or
pay a tax penalty for failing to do so.
How will Americans be
covered?
• Employer
• Government
• Buy your own
• None
Key Provisions for ACA
• The law allows young people to remain on parent’s
insurance until the age of 26
• The ACA requires health insurance companies to
provide more comprehensive coverage
• The law requires businesses to provide minimum
health coverage to their employees
• Finally, the law offers a number of changes
specific to young women. Insurance companies
can no longer charge women more because of
their gender
Key Provisions for ACA
• Not much will change for seniors on Medicare
• Medicaid is expanding
• The Federal government is allowing each state to
choose whether they want to be a part of expanding
Medicaid
• You can check out your state’s decision at
• State Decisions on Health Insurance Marketplaces and
the Medicaid Expansion, 2014
Overview of Marketplace
• The government has set up a virtual insurance megamall
to purchase your own coverage.
• You will be able to pick out how much coverage you want
and how much you want to pay for it
• ALL Plans will cover a comprehensive set of services
• Hospital Visits
• Doctor visits
• Maternity care
• Mental health care
• Prescription drugs
How is this affecting nurses?
• Nursing role:
• Education
• Educate patients, family, and friends about provisions in
the law
• Encourage uninsured and underinsured individuals to
get acquire health insurance
• Consequences
• Guide patients through the process and provide them
with necessary resources
Affordable Care Act Provisions
• Emphasis on prevention-oriented (and chronic disease
management) model rather than a sick care model
• Hospital-based Nursing
• Increase in patients seeking health care
• Increased focus on preventing complications to improve
care and prevent readmissions
“The Obama Administration’s Record
on Supporting the Nursing Workforce”
• Released in May 2012
• Acknowledges the nurse’s role in current health care and
the potential opportunities created by the ACA
• National Health Service Corps
• Nursing Education Loan Repayment and Nursing
Scholarship Program
• Advanced Nursing Education Expansion
• Nurse-Managed Clinic
More Opportunities for
Nurses
• Increased funding in certain areas aimed at supporting
primary care
• Community Health Centers
• School-based Health Centers
• Home Visiting
• Incentives for RNs and NPs to aide in specific areas of need
• Rural areas, geriatric, mental health, and pediatric
specialties
• Increased funding for research
• State incentives to create ways to improve how care is delivered
SHOP Marketplace
• What is the SHOP marketplace??
• SHOP stands for Small Business Health Options
Program
• SHOP is part of the Health Insurance Marketplace created
by the Affordable Health Care Act
• If a business has fewer than 50 employers, then it is not
required to offer health insurance.
• The SHOP marketplace offers four different plan levels.
4 Easy Steps
• Create an account from the marketplace
• Complete your application
• Pick a plan
• Enroll
The Marketplace
Navigating the
Marketplace
• Healthcare.gov
• Before you begin:
• Set-up and clear your cookies application
• Try applying in the morning, evening, or
weekends, as times the site is least congested
Navigating the
Marketplace
• Applying for coverage:
• Create a marketplace account
• online, paper, or over-the-phone application
• review and save the email confirmation and information
regarding your eligibility to plans
• Enter your full name as on your Social Security Number
Navigating the
Marketplace
• Select a plan:
• Ex: Catastrophic Health Plan
• if you are under 30yoa, you can have lower monthly
premiums but high deductibles
• The expectation is that people under 30yoa have less
healthcare problems and will utilize the health care
system less often.
• If you apply for Medicaid or Chip, you will get an email
stating eligibility or asking for more information
Overview of Plans
• Metal levels generally reflect the plan’s generosity in
covering the cost of benefits for an average enrollee
• Plans must offer “essential health benefits” but can
differ in other ways, such as in the networks of
providers and Rx formularies they offer
Bronze and Silver Plans
• Bronze level
• actuarial value of 60%
• patient responsible for 40% of the costs of all coverage
benefits
• Silver level
• actuarial value of 70%
• patient responsible for 30% of the costs of all coverage
benefits.
Gold and Platinum Plans
• Gold level
• actuarial value of 80%, so on average
• patient responsible for 20% of the costs of all coverage
benefits
• Platinum level
• actuarial value of 90%
• patient responsible for 10% of the costs of all coverage
benefits
Overview of Plans
Essential Health Benefits
The law directs that Essential Health Benefits be equal in scope to the benefits covered
by a typical employer plan and cover at least the following 10 general categories.
Final Steps to Applying
• Completing application:
• Pay your first premium directly to your insurance
company
• Review your plan’s provider directory and decide
who will provide your care.
• Contact your insurance company with any
questions
• Log on to HealthCare.gov to learn more about
your coverage
Solutions
• Preventative Care
• Education
• Schools, Communities, Churches
• Patient Treatment Plan
• Affordable Care Act
Solutions
• Technology
• Case Managers
• Decrease Nurse Turnover
Solutions
• Nurse Managed Clinics
• Goal: Avoid hospitalization
Solutions
• Talking to Representatives
• ANA's Activist Toolkit
Questions
• What is the most important role as a nurse regarding
the Affordable Care Act?
 EDUCATION
Questions
• In the Affordable Care Act provisions, they are
aiming to deliver what type of care?
-Sick Care Model
Or
-Prevention-Oriented Model
Questions
• What does S.H.O.P stand for?
 Small Business Health Options Program
Questions
• What is the name of the website to sign up for
coverage?
The Marketplace- www.healthcare.gov
Questions
• Give two solutions to nurses can be engaged in to
better facilitate the Affordable Care Act.
 Preventative care, Education, Telemedicine, Nurse
managed clinics, and talking to representatives
QUESTIONS?
References
•
Activist toolkit. (2014). Retrieved from
http://www.rnaction.org/site/PageServer?pagename=nstat_activist_toolkit
•
Ford, A., Jones, H., Manibog, C., & Tweeten, L. (2013, February). What makes
health care so expensive?. Retrieved from
http://healthland.time.com/2013/02/20/what-makes-health- care-so-expensive/
•
Haney, C. (2010, June). Health system reform: Nursing's goal of high quality, affordable
care for all . Retrieved from
http://www.nursingworld.org/MainMenuCategories/PolicyAdvocacy/Positions-and-Resolutions/Issue-Briefs/Health-System-Reform.pdf
•
Nurses offer solutions for cost-effective health care. (2009, June). Retrieved from
http://www.cna-aiic.ca/~/media/cna/page content/pdf en/
2013/07/26/11/04roi_solutions_cost_fs_e.pdf
References
•
Nurse practitioners: The growing solution in health care delivery. (2014). Retrieved
from https://
www.aacn.nche.edu/mediarelations/fact-sheets/nurse-practitioners
•
The obama administration's record on supporting the nursing workforce. Retrieved
from
http://www.whitehouse.gov/sites/default/files/docs/nurses_report_0.p
df
•
The shop marketplace: Health insurance options for small businesses. (2014, January
). Retrieved from
http://marketplace.cms.gov/training/gettraining.html
•
U.S. Centers for Medicare & Medicaid Services. (2013, June). Tips to help you
enroll in marketplace coverage. Retrieved from https://www.healthcare.gov/howto-have-the-best-experience -with-healthcare-gov/