What happens under Health Reform
1. MEDICARE PART D
prescription drug rebate of $250.00 fro people in the doughnut hole.
2. Tax credits for small businesses of 35% of premiums.
3. Health insurancecompanies can no longer;
A. Cap you health care lifetime
B. Deny children coverage because of pre-existing conditions
C. Drop your coverage because you need medical care
D. have annual caps in new policies
4. The Federal Government will set up a special insurance program for adults with pre-existing conditions.
5. Dependents mat stay on their parents' group insurance policy until the age of 26.
6. New policies must cover preventive screenings and testing with no co-pays allowed.
7. New rules govern hospitals' "Charity Care Policies" and BAN certain collection policies.
8. New rules what a hospital can charge an uninsured person.
9. Much more money for community health centers who serve the uninsured.
1. Medicare Part D 50% rebate on on brand name drugs for those in the doughnut hole
2. Insurance companies
A. No co-payments or deductibles for preventative services
B. Spend 80% of the premium dollar on actual medical care.
3. Medicare covers wellness and preventive medicine
4. Increased reimbursement for primary care
5. A long term insurance program begins ( CLASS )
6. It will be easier to file a complaints against nursing homes and to appeal insurance company denials.
1. Reducing avoidable hospital readmissions
2. Providing new, voluntary options for long term care insurance.
3. Linking payments to quality healthcare
4. Transitioning to reform payments in Medicare Advantage.
5. Encouraging Integrated Health Systems:
Implemenmts physcians payment reforms that enhance payments for primary care services, and encourages physcians to join together to form "Accountable Care Organizations" to gain efficiencies and improve the quality of care.
Why are so many people without Health Insurance?
In the state of Ohio alone, more than 1.7 million people were uninsured in 2009.i Some seem to believe that the uninsured are lazy and would rather not work. Others believe that people are uninsured because they would rather use their money to pay for other items. According to a June 2009 report from Families USA, four out of five persons without health insurance are employed or belong to a family in which at least one adult is working. In fact there are many reasons that people go without health insurance. Often, these reasons are not the fault of the individual. For instance, people are not always able to afford coverage that is offered by an employer or their employer cannot afford to offer health coverage to their employees. Also, some people have lost their jobs or earn too much to qualify for Medicaid, but not enough to afford private insurance.ii We Are the Uninsured aims to bust the negative myths that are associated with being uninsured, and advocate that Health Care is a Right, Not a Privilege!
i. Families USA. (June 2009). Paying a premium: The added cost of care for the uninsured. Washington: Author.
What is Advocacy?
Advocacy helps someone to:
Who should advocate for issues important to them?
Types of Advocacy
The Cost of Being Uninsured
Uninsured people rarely receive health care when they need it and approximately half of all uninsured adults with chronic conditions (such as diabetes or asthma) go without the medical care or medication they need because they cannot afford the cost. Uninsured adults are also 3 to 4 times more likely to go without health care services like breast cancer or high blood pressure screening. Each year in the United States the deaths of 18,000 people can be linked to the fact that they did not have health insurance.
When a person's health becomes so bad that they can no longer delay seeing a doctor, who pays for their care? The person pays what they can out of their own pocket. The hospital or clinic also pays by absorbing the cost that a patient cannot pay. This can be done by offering patients care at a reduced cost, or by writing off the payments that are not collected. The state government also has some monies to pay for the health care of the uninsured, yet this is a very small amount compared to the cost of care. These state monies are partially funded by taxpayers. Society pays in other ways as well. Preventative care would allow an individual the chance to maintain a healthy lifestyle, avoiding lengthly hospital stays or worse.
Uninsured adults are four times more likely to use emergency rooms as their regular source of care - the most expensive setting. Part of the cost for this care is shifted to those with insurance, in the form of higher insurance premiums. The rest is absorbed by the clinic or hospital - limiting health care services for everyone.
WHAT DOES THE HEALTH INSURANCE EXCHANGE MEAN TO YOU?
Essential Health Benefits
The Affordable Care Act ensures Americans have access to quality, affordable health insurance. To achieve this goal, the law ensures that health plans offered in the individula and small group markets, both inside and outside the Affordable insurance Exchanges (Exchanges), offer a comprehensive package of the items and services known as:
"essential health benefits".
Essential Health Benefits must include items and services within at least the 10 following catagories:
1. Ambulatory Patient Services
2. Emergency Services
4. Maternity and Newborn Care
5. Mental Health and Substance use disorder services, including behavioral health treatment
6. Prescription Drug Coverage
7. Rehabilitative Services and Devices
8. Laboratory Services
9. Preventative and Wellness Services and Chronic Disease Management
10. Pediatric Services, including Oral and Vision
1998-2011 Consumers Union: Policy and Action Reports
We Are the Uninsured are collaborating with other Advocacy organizations to help ensure the services Ohioans need and deserve are protected.
Northern Ohioians for
Budget Legislation Equality
is one such group
NOBLE's mission is to protect and expand state public health, safety, and welfare services and programs.
For more information contact:
216-771-5077 x 136
3500 Lorain Ave.
Myths And Facts about Health Care Reform
Health Care Reform hurts people on Medicare
The law adds new benefits for people on Medicare including free prevention services such as annual check ups and cancer screenings. It closes the gap in Medicare prescription drug coverage
(the donut whole)
beginning this year with a $250 rebate to those who have reached the donut whole. Bigger reductions in the donut whole will follow in the next subsequent years. The law helps eliminate waste, fraud, and abuse, ensures that Medicare funds go to improving care.
The Law creates a government- run healthcare program
Health care reform builds on our current system of employer-based insurance and maintains private insurance. The law ensures that the government will be a watchdog to prevent insurance companies from spending too much money on administration and profits.
3569 Ridge Road • Rowena Ventura at 216-281-8945 ext. 205