Long term residential Care week 1
Lola2230
9781284086522_SLID_CH02.pptChapter 2
The Affordable Care Act
Learning Objectives
Discuss how the Affordable Care Act came to be and the factors leading to
its passage.
Discuss the content of the Affordable Care Act of 2010.
Learning Objectives (continued)
Identify and discuss the impact of the Affordable Care Act on long-term care providers and consumers.
4. Identify and discuss the issues still remaining in the Affordable Care Act.
Introduction
The stated aim of the ACA was to:
“Increase the quality, affordability, and rate of health insurance coverage for Americans.”
“Reduce the costs of health care for individuals and the government.”
Key Components of the ACA
Requires individuals to have insurance coverage and businesses to provide coverage or pay fines.
Creates health insurance exchanges to provide a marketplace where individuals and small businesses can buy insurance.
Requires insurance companies to cover all applicants within new minimum standards regardless of pre-existing conditions.
History/Passage of the Law
Passed without a single Republican vote, and 34 Democrats also voted against it.
Attempts to filibuster the bill were defeated by Senate President Harry Reid (D-NV) who used a budgetary process called “reconciliation” to pass the bill with only 51 votes.
Various public polls at the time (and since) showed that more than 60% of Americans did not approve of the law.
Constitutionality of the Law
The constitutionality of the act was challenged, specifically targeting one provision of the act known as the “individual mandate.”
On June 28, 2012, the United States Supreme Court upheld the constitutionality of the Affordable Care Act.
Implementation
Designed to be implemented over several years.
Began with some of the more popular portions.
More controversial regulations (increased taxes, expansion of Medicaid, etc.) were designed to be spread out over later years.
Regulations
The ACA has spawned from 10,000 to 30,000 pages of new regulations.
Only a portion apply to long-term care.
Funding of the ACA
Funded by a combination of taxes and cost offsets (reductions).
Major Medicare taxes include:
A much-broadened tax on mid-level and high-level incomes.
An annual fee on insurance providers.
A 40% excise tax on “Cadillac” insurance policies.
Funding of the ACA (continued)
Cuts in Medicare to finance part of the new spending include reductions in:
Funding for Medicare Advantage policies.
Medicare home healthcare payments.
Certain Medicare hospital payments.
Impact on Long-Term Care
Majority of provisions in the act, including many of the more controversial, are tangential to long-term care.
Originally, it was thought that long-term care would be a potential cost saver because this type of coverage would not be needed immediately.
Impact on Long-Term Care (continued)
Health insurance exchanges
Shifting focus away from institutional care
CLASS Act
Community First Choice Option
Balancing Incentives Payment Program
Money Follows the Person program
Impact on Long-Term Care
(continued)
Spousal impoverishment protections
No Wrong Door system
Aging and disability resource centers
Health homes
Dual-Eligible Initiative
Other Provisions Impacting
Long-Term Care
Improving nursing home quality
Pay-for-performance
Bundling
Accountable care organizations (ACOs)
Medicaid expansion
Other Provisions Impacting
Long-Term Care (continued)
Asset recovery
Readmissions reduction
Medicare Advantage Plans
Medical device tax
Employer mandate
Projected staff shortages
In Summary
The Affordable Care Act (ACA) of 2010 is the most significant health-related piece of legislation since passage of the Medicare and Medicaid amendments of 1965. While many of its provisions do not impact long-term care, others do.
