Welcome!The Topic For Today Is…

Health Care Reform!Topic 1 The LAW Itself

Topic 2 Populations Impacted

Topic 3 Women

Topic 4 Definitions

Topic 5 Random Things You Should Know By Now

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Bonus Question: 5000 pts

Topic 1: 200• Question:• What are the exemptions for the individual

mandate required by ACA?• Answer• 1) People are exempt for religious reasons; or

2) financial hardship

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Topic 1: 400• Question:• Will the health reform law allow a government

panel to make decisions about end-of-life care for people on Medicare?

• Answer• No such panels exist. While early versions of the law

did contain provisions that would allow Medicare to reimburse physicians for voluntary discussions with patients about end-of-life, these provisions were dropped from the final legislationBack

Topic 1: 600• Question:• What services are free because of the ACA

under Medicare?• Answer• Includes full coverage for preventive health

services and an annual exam

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Topic 1: 800• Question• How does the ACA help with limits for what

insurers will pay for claims?• Answer• Health insurance reform eliminated lifetime

limits (2010) and annual limits (2014) on how much insurance companies cover when an individual is sick.

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Topic 1: 1000• Question:• How does the ACA help with out-of-pocket

spending?• Answer• Health insurance reform will limit what

insurance companies can force an individual to pay in out-of-pocket expenses such as deductibles and copayments

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Topic 2: 200• Question:• Which group will Medicaid cover who rarely

gets covered now?• Answer• Adults w/out Dependent Children under 138%

of FPL

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Topic 2: 400• Question:• What major health insurance reform will help

children get access to private health insurance?• Answer• As of Sept 2010, insurance plans can no longer

discriminate against children under age 19 with pre-existing conditions, including babies born with health problems.

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Topic 2: 600• Question:• How does the ACA impact young adults?• Answer• The new law provides that as of Sept. 2010,

adult children up to age 26 may remain on or go back on to their parent’s insurance coverage, if they do not already have access to health insurance through their employer.

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Topic 2: 800• Question:• Are undocumented immigrants eligible to purchase

a qualified health plan (QHP) within the Exchange?• Answer• Unfortunately, the law does allow undocumented

immigrants to purchase insurance for themselves within the exchanges, though they are able to purchase independent individual plans within the private market

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Topic 2: 1000• Question:• I’m hungry - So what’s all this chatter about a

donut hole?• Answer• Eligible seniors who are in the coverage gap

known as the “donut hole” automatically receive a discount on prescription drugs in 2011 and beyond

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Topic 3: 200• Question:• How does the ACA help women get access to

private health insurance and afford it?• Answer• Women will not be able to denied insurance

because of their pre-existing conditions. It also prohibits gender rating by insurers.

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Topic 3: 400• Question:• How does the ACA help women get access to

services they need? (Two parts)• Answer• Part one: Already requires coverage of

preventive services, many of which are specific to women

• Part two: Requires coverage of women’s services as of August 2012Back

Topic 3: 600• Question:• What are some preventative services offered

to women thanks to the ACA?• Answer• FDA-approved contraception methods,

contraceptive counseling, well-woman visits, screening for gestational diabetes, breastfeeding, support, supplies, & counseling

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Topic 3: 800• Question:• What issue could effect women and other high

needs users of health care when insurers participate in health exchanges?

• Answer• Adverse selection

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Topic 3: 1000• Question:• Approximately how many women will gain

coverage when ACA is fully implemented in 2014?

• Answer• 17 million women will gain coverage thanks to

the Affordable Care Act

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Topic 4: 200• Question:• What is a QHP?• Answer• A qualified health plan in Exchanges. They

have to be certified, provide essential health benefits, follow established limits on cost-sharing and meets other requirements.

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Topic 4: 400• Question: • Who can be Navigators?• Answer• Community Based Organizations and Brokers.

Navigators are a consumer-assistance role written into the original language of the ACA to ensure that people can reach the Exchange to purchase individual coverage

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Topic 4: 600• Question:• What is the rate increase generally not

acceptable according to the ACA? (PERCENTAGE)

• Answer• 10 PERCENT. The state or federal government

will examine the health insurer's data on each rate increase and determine whether it is reasonable or not.Back

Topic 4: 800• Question:• What is Medical Loss Ratio (MLR) and what are

the ratios?• Answer• Refers to the amount of insurance premiums

that an insurer spends on health care and activities that improve health care quality. 80% for the individual and small group markets, 85% in large group market.Back

Topic 4: 1000• Question:• What four things can insurers still rate people

for?• Answer• Age (limited to 3:1), geography, tobacco use,

family size.

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Topic 5: 200• Question:• How will the ACA help people cover the costs

of health insurance (above 138% of FPL)?• Answer• Tax credits for people who do not qualify for

Medicare or Medicaid, and under 400% FPL (known as premium subsidies)

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Topic 5: 400• Question:• Do the ACA insurance requirements apply to

self-insured health plans?• Answer• No they are regulated under ERISA, but there

is still legal debate about this

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Topic 5: 600• Question:• Name three of the Essential Health Benefits that must

be covered by insurance after 2014• Answer• Ambulatory, emergency, hospitalization, maternity,

mental health and substance abuse disorder treatment, prescription drugs, rehabilitative and habilitative services, laboratory services, preventive and wellness service and chronic disease management, pediatric services including oral and vision care

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Daily Double

The Winner Of The Last RoundWrite Down How Much Money

You Are Willing To RiskIf You get the Question write you win that money

If you get it wrong you Loss the money!

Topic 5: 800 DAILY DOUBLE!!• Question:• Who is allowed to purchase catastrophic plans

to meet the individual mandate after 2014 other than people under 30?

• Answer• People who qualify for the financial hardship

exemption

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Topic 5: 1000• Question:• What was recently determined by HHS for the

Medical Loss Ratio (MLR) and administrative services?

• Answer• That brokers fees will be calculated into the

MLR ratio

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Bonus Question: 5000 pts.

• Question:• What is required of restaurant chains with

over 20 locations under the ACA?• Answer• List calorie content information for standard

menu items, including drive-thrus and and menu boards

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