Health System | United States Government | Patient Protection And Affordable Care Act

Health System Reform

families Caregivers and caregiving organizations Community and system(s) supports and technology changes Payers and payment incentives and risk: Medicare leverage . patients.The Basics of Health System Reform Its about: People.

Why Reform? • Increasing Premium Costs • Consumers are Detached from Market • Employers Dropping Insurance • Too Many Uninsured • Ineffective Delivery of Care .

Vision of Reform • Develop a consumer driven health care and insurance market that provides: • Greater choice • Better access • Individual responsibility • Affordability • Higher quality • Improved health .

• Requires insurance companies to cover all takers • Creates minimum coverage and first-dollar preventive care .the individual mandate • Requires those who can afford insurance but don’t buy it or obtain it from an employer to pay a penalty • Employer Mandate • Health Insurance Exchanges • Provides subsidies or Medicaid to individuals who cannot afford health insurance.Seven Significant Features of Health-Care Reform • Requires everyone to have health insurance.

which means health care services must be affordable. claims experience. PPACA substantially addresses these goals: – Affordability – PPACA provides assistance on health insurance costs through subsidies and credits for individuals and families.ANA’s Health System Reform Alignment With PPACA • ANA believes health care is a basic human right that should be provided to all individuals. and expansion of Medicaid. varying based on income. available and acceptable. . and genetic information or disability. – Acceptability – PPACA acknowledges different cultural approaches to health care through workforce provisions promoting cultural competence training of health care professionals and development of a diverse workforce. medical condition or history. • ANA believes that the health care system must ensure access. – Availability – PPACA prohibits insurer discrimination based on factors such as health status.

ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine • • • • • • Safe Effective patient‐centered Timely Efficient Equitable .

Six Areas of Emphasis • Health Insurance Reform • Personal Responsibility • Transparency and Value • Maximizing Tax Advantages • Optimize Public Programs • Modernizing Governance .

Influence Market for Health Insurance • A major goal is to keep the health benefit paid with pre-tax dollars • Federal law places some limits • Employees must not be penalized based on their health status • Employees must have access to the same options (guaranteed issue) • Contributions do not have to be equal. but cannot be discriminatory .

The only decision is how much to contribute • Expand Benefit Offerings – No need to try to make everyone happy with one choice • Predictable future costs – Next year’s cost decision is yours.Influence Market for Health Insurance • Advantages to the Employer • Simple . reducing employer’s FICA costs . not the insurer’s • Tax Advantages – All premium are pre-tax.

Influence Market for Health Insurance • Advantages to the Employee • Individual Control & Choice – The employee chooses the plan that works for them • Pay with Pre-Tax Dollars – Up to 40% off • Expansion – More employees may be able to participate as new employers join • Portability – May be able to keep the same plan as they switch employers • Premium Aggregation – Families can pool contributions from multiple sources • Engagement – Employees are now in control and have the power to effect change .

Influence Market for Health Insurance • Impacts on the health system • Informed choice leads to competition • Plans respond directly to consumers • Consumer involvement leads to better health choices and outcomes .

(n. EBSCO Publishing Service Selection Page. 2012.Ehost2. (n.Reference Health Care Reform.ebscohost. from http://www.). Retrieved December 24.org/MainMenuCategories/PolicyAdvocacy/HealthSystemReform EBSCO Publishing Service Selection Page . from http://web.nursingworld.d. American Nurses Association.d. 2012.). Retrieved December 24.com/ehost/pdfviewer/pdfviewer?sid=f3f d4606-dd98-4e4b-8a4ce92af2363c88%40sessionmgr4&vid=7&hid=16 .

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