+ An Overview of the. Affordable Care Act. How Illinois Nurses can Educate and Guide Patients, Family, & Friends About Provisions of the Law

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1 + An Overview of the Affordable Care Act How Illinois Nurses can Educate and Guide Patients, Family, & Friends About Provisions of the Law

2 An Overview of the ACA: How Illinois Nurses can Educate & Guide Patients, Family, & Friends About Provisions of the Law Presenters: Illinois Healthcare Action Coalition (IHAC), Pamela S. Robbins, MSN, RN EverThrive (formerly the Illinois Maternal & Child Health Coalition), Kathy Waligora, M.S.W. Shriver Law Center, Andrea Kovach, J.D.

3 An Overview of the ACA: the Role for Nurses: GOALS/OBJECTIVES Goal:The learner will be able to state the essential components of the ACA, describe the nurse s role in guiding individuals to ACA resources, and to refer questions to credible authorities, including navigators and other resources. Objectives: Discuss the ACA Key Provisions-Insurance Market Reforms Explain why nurses should get involved in educating the public about the ACA Explain how nurses can get involved in educating IL citizens about new ACA health insurance opportunities Describe the new health insurance marketplaces: ACA s new coverage opportunities Describe how to enroll in new coverage opportunities Report Medicaid s new eligibility category Summarize resources for IL nurses to use to guide uninsured

4 CE ANNOUNCEMENTS Participation in the entire program and completion of the evaluation is necessary to receive your certificate. The evaluation will be ed to you at the address you provided during registration. Certificates will be ed within 7 days of completion of the evaluation. This program is being presented without bias, conflict of interest or commercial support.

5 Agenda The Uninsured ACA Summary Key ACA Insurance Reform Provisions Nurses Leadership Role in Educating the Public about ACA Medicaid and the Marketplace Cost and Financial Assistance Roadmaps and Resources for Nurses Key Messages Resources

6 1.5 Million Uninsured Non-Elderly Adults in IL

7 ACA 101 The Affordable Care Act puts in place comprehensive reforms that: Protect consumers from insurance industry practices which limited access to coverage for many, and Improve access to affordable health coverage. If you are already insured, you will see are new benefits, better consumer protections, and more value for every dollar you spend on care. If you are uninsured, new pathways to coverage will make it easier to get covered and stay covered. Financial assistance may be available to help pay for coverage.

8 Key Reforms to Insurance Industry Practices 8 Extended dependent coverage to age 26 No pre-existing condition exclusion for children or adults Preventive services without cost sharing No lifetime limits on care No annual limits on care Small business tax credits No insurance rescissions (unless fraud/intentional misrepresentation) All plans must cover Essential Health Benefits No gender rating

9 Nurses Leadership Role The Future of Nursing: Leading Change, Advancing Health - IOM Report (2010) Key Message Recommendation #3: Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States. Leadership styles must change: collaboration & partnership vs giving directions & expecting them to be followed Code of Ethics for Nurses (2001) #8: The nurse collaborates with other health professionals & the public in promoting community, national & international efforts to meet health needs. (Code is part of IL NPA Rules Section b) IL RN Scope of Practice (2007) #11: Participating in development of policies, procedures, and systems to support patient safety. (IL NPA Rules Section 60-35: RN Scope)

10 Nurses Leadership Role Opinion Leaders (Gallup Poll 2009) Rate nurses second among a list of options for trusted information about health care Relatively few opinion leaders say nurses currently have a great deal of influence on increasing access to care including primary care They believe for nurses to take on more of a leadership role they need to make their voices heard and have higher expectations Leadership Competencies Changing Perceptions Nurses as thoughtful strategists, informed decision makers whose independent actions are based on education, evidence and experience Collaboration with other health professions as full partners in a context of mutual respect and collaboration

11 Nurses Leadership Role Leadership at Every Level Nurses must lead in improving work processes on the front lines, creating new integrated practice models; working with others; from organizational policy makers to state legislators, to craft practice policy & legislation that allows nurses to work to their fullest capacity; leading curriculum changes to prepare the nursing workforce to meet community & patient needs; translating & applying research findings into practice & developing functional models of care; and serving on institutional & policy making boards where critical decisions affecting patients are made. IOM (2010) Policy and Politics Answering the Call Those involved in the health care system, nurses, physicians, patients & others play increasingly interdependent roles The successful path to achieving sustainable change rests upon building partnerships and collective action Very little in politics is accomplished without preparation and allies

12 Getting Insurance in 2014

13 New Coverage Pathway: The Marketplace Get information about the law and health insurance Find help enrolling in coverage Enroll in Medicaid or private health insurance Access financial assistance Plans are guaranteed to provide coverage for essential services Can purchase dental coverage

14 Essential Health Benefits

15 Get Covered Illinois: The Health Insurance Marketplace Who should enroll: Any Illinois resident who does not currently have health insurance should visit Get Covered Illinois to see their coverage options. Young people the invincibles who assume they can take a chance and not be covered because they are young and healthy Employees full or part time of businesses that do not offer health insurance People who have lost coverage for any reason People with pre-existing conditions who have been denied coverage in the past People who have not been able to afford coverage

16 Three ways to get connected: 1. On the web 2. On the phone In Person Work with a Navigator to get support and advice

17 New Coverage Pathway: New Medicaid Eligibility Category The ACA expands Medicaid to cover all people under 138% of the federal poverty level Must be U.S. Citizen or Legal Permanent Resident of 5 years or more to qualify Coverage begins January 1, 2014 Apply using GetCoveredIllinois.gov

18 Open Enrollment Period 18 Enrollment Date/Period Effective Coverage Begins Oct. 1 Dec. 23, 2013 Jan. 1, st 15 th of month (Jan. March) 16 th last day of month (Dec. March) 1 st of following month 1 st of second following month Initial Open Enrollment Ends March 31, 2014 Changes can be made within 30 or 60 days of triggering event (marriage, birth, move) that allows for a change ***Those who are eligible for Medicaid can apply for coverage any day of the year!

19 +Cost & Financial Assistance

20 Cost of Health Insurance There are three factors that can determine an individual s premium: Age Up to 3x more for older adults Tobacco Use Up to 1.5 times for tobacco users Where you live

21 Financial Assistance Premium Tax Credits Helps you pay the monthly cost to have a plan Cost- Sharing Reductions Decrease the charges (e.g., copays, deductibles) you must pay when receiving health care services covered by the plan

22 Cost: Who is eligible for financial assistance Ineligible for government insurance (eg: Medicaid, Medicare, CHIP) Household Income: Tax credit: % * Cost Sharing: up to 250% Not offered affordable or minimum value employer-sponsored coverage Enrolled in a QHP in the Marketplace Be a part of tax filing unit * * Immigrants w/incomes below 100% FPL who are lawfully present and ineligible for Medicaid may be eligible for the tax credit, though they will be treated as if their income is 100% FPL

23 IMPORTANT: Not offered affordable or minimum value employer-sponsored coverage. What is considered affordable employersponsored coverage? If person is required to contribute 9.5% or less toward the self-only plan even in cases where employee wishes to obtain family coverage. What is considered minimum value employer-sponsored coverage? If job based insurance pays for 60% (or more) of the benefits covered by the plan.

24 Cost Sharing Reduction Subsidies: CSRS Families and Individuals are eligible to receive cost-sharing reductions to help with out-of-pocket costs (not premiums) if their income is between less than 250% FPL Payments are made directly to issuers. The amount of help provided by a CSR depends on a person s income more substantial help is available to people at lower income levels. The CSR is only available if you purchase a silver plan through the marketplace

25 Putting it all together Healthcare.gov GetCoveredAmerica.org Kaiser Family Foundation: kff.org

26 Guiding Patients, Family, & Friends Towards ACA Insurance Opportunities The Role of the Nurse: Answer the call to lead transformation of health care, focus on preventive and wellness care Recognize the value of the Affordable Care Act Be able to discuss the 10 essential ACA health benefits Guide friends, family, neighbors, patients to ACA resources Facilitate access to resources such as the GetCoveredIllinois.gov website, certified Navigators Collaborate with local community associations to continue to increase enrollment, maintain ACA benefits Connect to larger campaigns to elevate messages or even volunteer to canvass your community, host/participate in phone banks, and support events

27 Key Messages 27 All insurance plans will have to cover doctor visits, hospitalizations, maternity care, emergency room care, and prescriptions. You might be able to get financial help to pay for a health insurance plan. If you have a pre-existing condition, insurance plans cannot deny you coverage. All insurance plans will have to show the costs and what is covered in simple language with no fine print.

28 Major Campaigns 28 Get Covered Illinois Get Covered America BeCovered Illinois There are many other campaigns and organizations offering resources, so pick your favorite! Connecting Communities to Coverage 2013

29 Resources Illinois Healthcare Action Coalition Illinois Health Matters EverThrive Illinois ACA The Shriver Center on Poverty Law Kaiser Family Foundation healthreform.kff.org/

30 Resources ANA Code of Ethics for Nurses RWJF: Future of Nursing, Leading Change, Advancing Health: IOM 2010 Report: ANA-Illinois: 3 Step Call to Action for Illinois Nurses: Events/News/3-STEP-Call-to-Action-for-Illinois-Nurses.html Illinois Department of Financial and Professional Regulation: Nursing Act: RN Scope: Section

31 + Questions? Kathy Waligora, M.S.W. EverThrive Illinois Andrea Kovach, J.D. Shriver Center Pam Robbins, RN Illinois Healthcare Action Coalition

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