By Abhinav Gupta Doctors for America What are problems with the access to healthcare for young adults (ages 1929)? What is the Affordable Care Act (ACA)? What does it do for young adults? When do measures in the ACA take effect? Why it is important for you to have insurance? http://www.office.com Young Adults Aged 19-29 (millions) 15.0 Of uninsured, 2/3 receive “no usual source of care” Of uninsured, 1/2 have problems “paying medical bills” 28.6 Uninsured Insured Of uninsured, 2/3 skipped needed care Of uninsured, 1/4 carry medical debt Cost ◦ Expensive, low salaries Ineligible for employer-sponsored health insurance ◦ Part-time, unemployment No insurance after high school/college graduation “Young Invincibles” ◦ Unnecessary care? 1 in 6 suffer from chronic diseases ◦ High blood pressure, cancer, asthma 1 in 10 suffer from a mental health condition 1 in 4 obese Highest rate of injury-related ER visits Examples of Hospitalization Costs: ◦ ◦ ◦ ◦ ◦ Asthma: $12,496 Fractured Rib: $12,000 Torn ACL: $9,220 Diabetes: $24,843 Delivery: $9,542 Goal: Ensure accessible, affordable, quality care for all Americans ◦ Coverage to an additional 32 million Americans by 2019 Strict rules on insurance companies to provide cheaper coverage Reform hospitals and doctors to provide better quality care Funded by various taxes, termination of subsidies http://www.futurity.org Insured as a dependent until age 26 Insurance Regulation Medicaid Expansion Online Insurance Market Exchanges and Insurance Reform Subsidies for use in Insurance Markets Reforms to college insurance plans Coverage for dependents ended after H.S./College Since 2010, child dependents are allowed to remain on their parents’ policies until age 26 ◦ Over 600,000 have already gained insurance ◦ Affect over 1.7 million by 2013 Individual states have expanded insurance dependency laws independently ◦ Ex. NJ: 31, FL: 30, NY: 30 ◦ Some have specific requirements Ex. Unmarried, student, same-state residency Only for fully-insured plans Federal law of age 26 provides uniform minimum regardless of state requirements Ban on discrimination based on pre-existing conditions Ban on rescissions Ban on annual and lifetime limits No discrimination based on sex ◦ Cover maternal and reproductive health Small insurance companies required to spend 80% of premiums on direct medical costs (Large companies: 85%) What’s Medicaid? ◦ Government-sponsored health insurance program Covers over 60 million Americans Based on poverty levels in states Expansion http://www.iamempowered.com ◦ Increases eligibility to 133% of federal poverty level $14,400 for individual; $29,270 for family of four ◦ Will be enacted in 2014 ◦ Effect up to 8 million uninsured young adults http://www.healthcare.gov ACA creates online insurance markets ◦ Ex. Orbitz, Expedia ◦ Compete on price, quality, benefits Offer bronze, silver, gold, platinum plans Uninsured individuals will be able to use markets Businesses with less than 100 employees will be able to use markets ◦ Businesses with less than 25 employees receive tax credits Subsidies for health insurance if no employer insurance and between 133% to 400% FPL ◦ $14,400 -$43,000 per year for individuals ◦ $29,326 - $88,200 per year for family of four Employee will receive federal tax credits based on a sliding scale ◦ Will pay between 2.0 - 9.5% of income on premiums ◦ Difference between this and “silver” plan cost will be paid by government 75% young adults below 400% FPL Insure 5 million young adults 1.6 million young adults (11% of students) enrolled in college health plans Many had low benefits Discriminated on preexisting conditions, age, sex ACA’s effect: ◦ Ban on lifetime limits, rescissions ◦ Offer coverage to all regardless of health status ◦ Provide free preventive care Only for fully-insured plans http://www.office.com The ACA requires all individuals to be insured Negate adverse selection Low-income Americans will be subsidized by tax credits or paid for by Medicaid High-income Americans will be rewarded by lower insurance premiums and better access to care Penalty: ◦ $95 or 1% of annual income ◦ 2016: $695 or 2.5% of annual income http://www.hetemeel.com Sep. 23 2010: ◦ Dependents until age 26 Added 600,000 already; projected 1.7 million by 2013 Jan. 1, 2012: ◦ College health plans reform Jan. 1, 2014: ◦ Expansion of Medicaid Cover an additional 8 million young adults ◦ Insurance exchanges and tax credits implemented Cover an additional 5 million young adults David is a 23-year-old, who just graduated from college in May. He landed a job that does not provide insurance. He recently fractured a rib. 2009: No insurance. Had to pay $9,000 for the emergency room cost. 2014: Eligible to stay on his parent’s insurance. Left hospital with only $1,000 bill for deductible. Savings: $8,000 Mary is a 27-year-old single secretary, making $26,000/ year. She does not receive insurance from her employer. She wants to buy insurance because she has asthma. 2009: Estimated health insurance premium: $3,391 2014: With same premium ($3,391), only responsible to pay $1,874 (7.5% income) and receive $1,516 subsidy. Savings: $1,516 (45% of premium) Catastrophic plans ◦ Offer minimal benefits and deductible of $6,000 Unaffordable, inadequate preventive and primary care Some College plans still not reformed ◦ Self-insured plans Rising Healthcare Costs ◦ Stay aware of unnecessary testing, increased costs ◦ Utilize primary care to stay healthy instead of visiting emergency rooms GET INSURED, STAY INFORMED, AND STAY HEALTHY! Check out www.gettingcovered.com for more information. www.office.com We need your help to spread the message about healthcare reform! To learn more about reform or to get involved, please visit: www.drsforamerica.org Contact us: Doctors for America [email protected] 202-481-8219 “Young Adults.” http://www.healthcare.gov/foryou/youngadults/top5/index.html, 18 July 2011. “Reform Explained.” http://www.younginvincibles.org/HealthCare/reformExplained.html, 15 July 2011. “What Healthcare Reform Means for Young Adults.” http://www.nclnet.org/health/70-health-care-reform-/426-what-health-carereform-means-for-young-adults, 15 July 2011. “Young Adults.” http://www.healthreform.gov/reports/youngadults/index.html, 14 July 2011. “Focus on Health Reform, May 2010.” http://www.kff.org/healthreform/upload/8065.pdf, 15 July 2011. “Realizing Health Reform’s Potential, May 2011.” http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/20 11/May/1508_Collins_how_ACA_is_helping_young_adults_reform_brief_v5_CORRE CTED.pdf, 15 July 20 “Healthcare Reform, The Details.” Presentation by Dr. Howard Forman, Yale University School of Medicine.