How the Affordable Care Act Helps LGBT Americans

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1 How the Affordable Care Act Helps LGBT Americans

2 Darlene Nipper Deputy Executive Director National Gay and Lesbian Task Force

3

4 Introductions Darlene Nipper, Deputy Executive Director, National Gay and Lesbian Task Force Background on the Affordable Care Act and How It Helps LGBT Americans Mayra Alvarez, Director of Public Health Policy, Office of Health Reform, Department of Health and Human Services Federal LGBT Advocacy Activities Kellan Baker, Health Policy Analyst, Center for American Progress State LGBT Advocacy Activities Brad Clark, Executive Director, One Colorado Question and Answer Period

5 LGBT people experience higher health disparities than the public at large National Transgender Discrimination Survey:50% of transgender respondents indicated that they have to teach their medical providers about transgender care. 19% of transgender people reported being refused medical care outright due to their transgender or gender non-conforming status. Unfortunately, we found even higher numbers among people of color in the survey. Factors such as race, ethnicity, socioeconomic status, geographic location and age further exacerbate these disparities. The Health Reform Law has a greater impact on LGBT people because of disproportionate unemployment, uninsurance, pre-existing conditions, etc. among the LGBT community.

6 Mayra Alvarez Director of Public Health Policy Office of Health Reform Department of Health and Human Services

7 The Health Care Law and

8 The Problem Insurance companies could take advantage of you and discriminate against the 129 million Americans with preexisting conditions. Premiums had more than doubled over the last decade, while insurance company profits were soaring. Fifty million Americans were uninsured, tens of millions more were underinsured, and those that had coverage were often afraid of losing it.

9 The Health Care Law In March 2010, President Obama signed into law the Affordable Care Act.

10 What the Law Means for You: 4 Things to Know Protection from the worst insurance company abuses Makes health care more affordable Better access to care Stronger Medicare

11 The Law Stops Insurance Companies from Taking Advantage of You It is now illegal for insurance companies to: Deny coverage to children because of a pre-existing condition like asthma and diabetes. Put a lifetime cap on how much care they will pay for if you get sick. Cancel your coverage when you get sick by finding a mistake on your paperwork. And more

12 These abuses used to be legal: Low Health Insurance Caps Leave Patients Stranded -- USA Today Newborn Denied Health Insurance Coverage Days After Life Saving Heart Surgery -- ABC News WellPoint Routinely Targets Breast Cancer Victims for Rescission -- The Huffington Post Now they are banned for good.

13 The Law Makes Health Care More Affordable BEFORE, insurance companies spent as much as 40 cents of every premium dollar on overhead, marketing, and CEO salaries. TODAY, we have the new 80/20 rule: insurance companies must spend at least 80 cents of your premium dollar on your health care or improvements to care. If they don t, they must repay the money. 60% / 40% 80% / 20%

14 The Law Makes Health Care More Affordable BEFORE, insurance companies could raise your premiums by double digits without justification. TODAY, insurance companies must publicly justify their actions if they want to raise premiums by 10 percent or more. And states have more power to block them.

15 The Law Makes Health Care More Affordable Blue Shield Cancels Insurance Rate Increase -- Los Angeles Times Anthem Withdraws Rate Increases -- San Francisco Chronicle Connecticut Rejects Insurance Rate Increase -- The New York Times

16 The Law Makes Health Care More Affordable BEFORE, small businesses paid an average of 18 percent more for health insurance than large companies. TODAY, small businesses can get tax credits to help pay for coverage for their employees. In 2010, we paid close to $11,000 for employees health insurance. The tax credit cut our costs by over $2,000. For a small business struggling to keep health coverage, that makes all the difference. We were actually considering dropping our insurance, but the tax credit tipped the balance and helped us maintain coverage. --Matt H. in Montana

17 The Law Increases Your Access to Affordable Care Young adults under the age of 26 can now stay on their parents health plans. I honestly don t know what we would have done. There was no way we could have afforded it. I might not be here right now. --Kylie L., 23, in Illinois, who credits the health care law for enabling a life-saving heart transplant

18 The Law Increases Your Access to Affordable Care In many cases, you can get preventive services for free: Cancer screenings such as mammograms & colonoscopies Vaccinations such as flu, mumps & measles Blood pressure screening Cholesterol screening Tobacco cessation counseling and interventions Birth control Depression screening And more Visit for a full list.

19 The Law Increases Your Access to Affordable Care There are new plans in every state for people who have been locked out of the insurance market because of a pre-existing condition like cancer or heart disease. When I was diagnosed, they told me I had a 60 percent chance of being cured. That's pretty good odds, but I was also terribly worried about finances. Now I don't feel like we can't afford the treatment." --Gail O. in New Hampshire For more, visit

20 The Law Increases Your Access to Affordable Care There are thousands of new doctors and nurses in communities around the country and millions more patients getting care.

21 In 2 years: More Improvements to Come Discriminating against anyone because of a pre-existing condition will be illegal. Insurance companies won't be able to charge women more than men. Tax credits will make buying insurance more affordable. There will be new State-based marketplaces called Affordable Insurance Exchanges where private insurers will compete for your business. Members of Congress will have to buy insurance there, too.

22 So no matter your circumstances If you start a new business, change jobs, move to another state, or retire early You ll have access to affordable health insurance.

23 The Law Strengthens Medicare Many free preventive services such as mammograms and colonoscopies and a free annual wellness visit. A 50% discount on covered brand-name medications for those in the prescription drug donut hole an average savings of nearly $600 per person in The donut hole will be closed in Strong anti-fraud measures, including tougher penalties for criminals. Makes sure your doctors can spend more time with you and improve care coordination just like they do at hospitals such as the Mayo Clinic and Cleveland Clinic.

24 Did You Know The law builds on our private health insurance system. The law gives states significant flexibility in implementing the law. If states can identify their own path to accomplish the same goals, they re free to take it. The law does not add to the deficit. According to the independent Congressional Budget Office, the law is paid for.

25 4 Things to Remember About the Law Protection from the worst insurance company abuses Makes health care more affordable Better access to care Stronger Medicare

26 Learn More Social Networks

27 Kellan Baker, MPH, MA Health Policy Analyst Center for American Progress

28 Kellan Baker, MPH, MA Health Policy Analyst Center for American Progress

29

30 When this Administration took office, the health care system wasn t working for a lot of Americans. But it was especially broken for LGBT Americans. That wasn t right. All Americans, regardless of where they live or their age, sex, race, sexual orientation, or gender identity, have a basic right to get the care they need. - HHS Secretary Sebelius at the February 2012 White House Conference on LGBT Health

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33 1. Data collection 2. Patient s Bill of Rights 3. Public coverage expansion 4. Private coverage expansion 5. Preventive care, especially for women Health care workforce 8. HIV/AIDS care 9. Nondiscrimination protections 10. Community-based prevention programs

34 ACA Section 4302: HHS may collect any relevant demographic data on health disparities through federally conducted or supported surveys and programs Required categories: race, ethnicity, primary language, sex, disability status June 2011: HHS announces LGBT Data Progression Plan for collecting sexual orientation and gender identity data through national data collection efforts Goal: sexual orientation question on 2013 National Health Interview Survey (NHIS), gender identity on NHIS or other federally supported surveys

35 Keeps young adults covered up to age 26 Ends lifetime limits on coverage Phases out annual limits on coverage by 2014 Ends pre-existing condition exclusions for children now and for adults in 2014 Ends arbitrary withdrawal of insurance coverage Requires insurers to put 80-85% of each premium dollar toward medical care rather than administrative costs

36 Sets national Medicaid eligibility threshold at 138% of the federal poverty level (up to approximately $15,000 for an individual) starting in 2014 Expands Medicaid eligibility to any adult under age 65 in this income bracket Establishes Medicaid maintenance of effort requirement through 2014

37 Requires every state to have a Health Insurance Exchange starting in 2014 Exchanges will offer subsidized access to private insurance for small employers and people with incomes between 138 and 400% of the federal poverty level (up to $43,000 for an individual) Exchanges may not discriminate on the basis of sexual orientation or gender identity All Exchange plans must offer the ten essential health benefit categories

38 Private insurers must cover certain preventive services without cost These services include HIV and other STI testing, depression screening, vaccinations, tobacco use screening, and cholesterol screening Women s Health Amendment requires comprehensive preventive services for women, including contraception, intimate partner violence screening, and well-woman visits Medicare beneficiaries receive free annual checkups

39 Supports Spanish-language website at Allows consumers to compare insurance options, including a filter for plans offering domestic partner benefits

40 Establishes $11 billion fund to support new community health centers and expansion of existing centers Supports access to essential community providers i.e., community health centers Requires revision of the Medically Underserved Population Designation Triples the National Health Service Corps

41 Eliminates Medicaid disability requirement for people with HIV Eliminates Medicare Part D donut hole by 2020, provided a $250 rebate for donut hole costs in 2010, and requires pharma companies to provide a 50% discount on brandname drugs in the donut hole beginning in 2011 Counts ADAP contributions toward Medicare Part D s True Out of Pocket Spending Limit (TrOOP) starting in 2011 Prohibits pre-existing condition exclusions and higher premiums based on health status starting in 2014 Promotes patient-centered medical homes as a way to improve quality of care for people with chronic conditions

42 ACA Section 1557: extends federal nondiscrimination protections to the health care system Includes the Americans with Disabilities Act and the Rehabilitation Act (HIV/AIDS status) Includes Title IX of the Education Amendments of 1972 (sex) National trend to include gender identity and sex stereotyping under sex protections

43 Creates National Prevention Strategy and $15-billion Prevention and Public Health Fund Fund supports new Community Transformation Grants (CTG) program at CDC In 2011, $102 million was awarded to 59 communities and states to fight leading causes of illness and death for more than 115 million people CTG grantees may include LGBT community as a priority population

44 aca_lgbt.html

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47 Darlene Nipper Mayra Alvarez Kellan Baker Brad Clark

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