The Affordable Care Act: Whats In It For You and Tennessee Leader: Nikki Viverette | 11.18.2012.

| Scarritt-Bennett Center
Uninsured in America What do you guys think is the uninsured rate in the U.S.? 15% of N. Americans are uninsured- 53.8 million people (42.8 million, not counting undocumented residents) Typical uninsured person- 46% are white, more than 75% are from working families, people age 19-29 make up 32% Over 900,000 Tennesseans are uninsured, including 80,000 children

U.S. Health Care Costs The U.S. spends way more than other industrialized nations and yet our life expectancy rates are far lower than many other countries (chart) How much do you think the U.S. spent on health care in 2010? The U.S. spent $2.6 trillion on health care, which was over 17.9% of the GDP. Growing health care costs and the huge number of uninsured in the U.S. has driven many administrations to implement some sort of health reform. This administration succeeded and the answer was the Affordable Care Act (ACA). ACA History The culmination of 100 years of bipartisan struggle to achieve health reform A step towards eliminating disparities in health care and health status The law was passed in 2010 and headed to the Supreme Court after some states brought a lawsuit against it. The Supreme Court ruled on June 28, 2012 that all provisions of the ACA, including the much- contested individual mandate, were constitutional. However, they also ruled that states were no longer obligated to expand their Medicaid programs, but could instead choose. What does the ACA basically do? Expands coverage to millions who are currently uninsured o Private insurance reforms Eliminates rescissions Eliminates pre-existing conditions exclusions for children (2010) and adults (2014) Eliminates annual and lifetime limits Must publicly explain premium increases over 10% Must spend 80% of premium dollars on care, if not, they must rebate the extra amount. Did anyone get a rebate? o Exchanges Online marketplace to compare private insurance options Can be state-run, federally-run, or combo Available to everyone, but people with incomes from 100-400% FPL (chart) will be given premium credits to help them buy insurance through the exchanges o Expanding Medicaid- will discuss more below o Individual mandate provision (chart)- cannot control cost or quality without having everyone in the system Slows health care spending costs o The ACA will save money (about $550 billion) by reducing overpayments to Medicare Advantage plans and reducing the rate of growth in provider payments over the next ten years. o It will also bring in money (about $515 billion) from penalty payments, a tax on costly insurance plans, and other budgetary effects during that same time.

Some of the ACAs benefits Young adults can stay on their parents insurance until age 26 Cost protections o It keeps insurance companies from using lifetime limits on essential benefits o Limits the amount people will have to pay out-of-pocket over the course of a year Small business tax credits Exchange Expansion of Medicaid Premium credits and cost-sharing subsidies Discount on meds and help for low income Medicare beneficiaries No annual limit on coverage Community health centers- will help fund 185 community health centers in TN Medicaid Expansion States now have the option to expand Medicaid (TennCare in TN) If states expand, everyone in the state under 133% FPL (138%) could be eligible for Medicaid The federal govt will pay 100% for the cost of expansion for the first three years, then will slightly decrease the federal match to 90%, where it will remain. At no point will the state pay more than 10% for newly eligible people, as the law is written. Medicaid expansion could cover 330,000 additional people in Tennessee, most of them low-wage working adults. Medicaid expansion would also get rid of categorical requirements, as well as expand the income for people to be insured. If TN does not expand, people below 100% FPL will not only have Medicaid (unless they are already eligible), but they also will not be eligible for premium subsidies to buy insurance through the exchange. In other words, if TN does not expand, TNs most vulnerable will be left with no option for insurance. Why Medicaid expansion is good for the state and for Tennesseans Medicaid reform is good for the hundreds of thousands of people across TN It makes good financial sense for TN o Medicaid expansion will provide economic stimulus for TN o Provides $10.5 billion in federal revenues for state government budgets between 20142019. o Reduces state costs for uncompensated care o Stimulates state economies, generating thousands of jobs and state tax revenue- Medicaid expansion would bring over 7,500 jobs to Tennessee in 2014 alone, and 18,000 jobs between 2014-2019. Medicaid reform is crucial for hospitals, especially rural hospitals and communities o More insured people means less uncompensated care for hospitals, and lower premiums for those who do have insurance o The new law will lower state costs for uncompensated care by as much as $1.6 billion between 2014 and 2019 o States will still face reduced reimbursement from the federal govt (DSH payments) for uncompensated care, and if TN does not expand, we will be providing the same amount of uncompensated care And most importantly, Medicaid reform will save thousands of Tennesseans lives- an average of 65 Tennessee deaths per year could be averted by enacting the expansion. Where is TN in this? Questions?