The Affordable Care Act: Overview & Impact on Adult Immunizations

Transcription

1 The Affordable Care Act: Overview & Impact on Adult Immunizations Adult Immunization Leadership Summit February 1, 2013 Barbara Flye, Senior Health Policy Advisor Office of the Insurance Commissioner 1

2 Goals of today s presentation 1. A community responsibility 2. The basic provisions of the ACA 3. The ACA & adult immunization 4. Innovative efforts to improve immunization rates 5. Q & A 2

3 Immunization matters Next to cleaning water and good nutrition, vaccines have saved more lives than any other public-health intervention in modern history. 3

4 A community responsibility Millions of adults go without routine and recommended vaccinations each year ~40,000 to 50,000 preventable deaths Thousands of preventable illnesses $10 billion in preventable health care costs each year. For some diseases, like pertussis and measles, at least 9 out of 10 of us must have immunity to keep the disease from spreading. Main barrier is lack of coverage for adult immunizations. 4

5 The Affordable Care Act Increase access to health insurance coverage through public and private programs Provide those who are currently insured with comprehensive coverage which includes prevention, and greater financial stability Increased focus on prevention and prescription drug coverage for those on Medicare 5

6 The Affordable Care Act Reduce the uninsured One million Washingtonians are uninsured 80% of uninsured will be eligible for Medicaid or a premium tax credit & cost sharing support Reduce the underinsured Essential Health Benefits (EHBs) requirements No annual or lifetime caps on EHBs Out-of-pocket caps 6

7 ACA: Consumer Protections in place today No lifetime limits on benefits No cost sharing for preventive services No pre-existing exclusions for children Expansion for children to age 26 Access to women s health care services Medical Loss Ratio Standards Benefit & Coverage Documents 7

8 ACA: Consumer protections on the way Guaranteed issue & renewability No annual caps on benefits No pre-existing exclusions for anyone Essential Health Benefits Out-of-pocket spending limits Plus Health Insurance Exchange Advanced Premium Tax Credits & Cost Sharing Support Medicaid Expansion 8

9 Washington s Exchange Washington Healthplanfinder Make apples-to-apples comparison between Qualified Health Plans Help determine eligibility for tax credits or less expensive co-pays and deductibles Receive personal assistance to navigate the process and get the health plan that meets their needs 9

10 2014 ACA Coverage Sources FPL Annual Income: Individual Annual Income: Family of 3 100% $11,170 $19, % $44,680 $76,360 10

11 ACA Premium Tax Credits Income Premium Cap <133% FPL 2% of income % FPL 3-4% % FPL 4-6.3% % FPL % % FPL % % FPL 9.5% Will be adjusted to reflect the growth in premiums. 11

12 ACA Cost Sharing Reductions Income % FPL 94% % FPL 87% % FPL 73% % FPL 70% Native Americans <300% FPL Insurer responsible for: No cost sharing 12

13 Essential Health Benefits 1. Ambulatory patient services 2. Emergency services 3. Hospitalization 4. Maternity and newborn care 5. Mental health & substance use disorder services, including behavioural health treatment 6. Prescription drugs 7. Rehabilitative and habilitative services & devices 8. Laboratory services 9. Preventive and wellness services & chronic disease management 10. Pediatric services, including oral & vision care 13

14 The ACA and Immunization Main barrier to adult immunization is coverage Those without insurance get coverage. Those with coverage are guaranteed preventive care. Under the ACA health plans must cover preventive services and do so with no cost sharing Preventive services includes vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) when delivered in-network Nearly 190 million privately insured people will have access Increases immunization administration fee to Medicare levels for two years 2013 and

15 The ACA and Immunization Expanded and sustained national investment States are permitted to purchase adult vaccines with state funds at CDC-negotiated rates Enhance interoperatability between EMR & immunization information systems Implement strategic plans for billing for immunization services in health department clinics Plan and implement collaborations with employers, pharmacies, & other healthcare entities to expand adult vaccination activities Enhance the sustainability of school-located vaccination 15

16 Preventive care with no cost sharing Immunization for adults (19 years and older) Hepatitis A Hepatitis B Herpes Zoster Quadrivalent Human Papillomavirus vaccine for females Influenza Measles, Mumps, Rubella Meningococcal Pneumococcal Diphtheria, Tetanus, Pertussis Varicella 16

17 Uninsured groups remain Undocumented immigrants Individuals exempt from the mandate who remain uninsured Individuals subject to the mandate who do not enroll Individuals who are eligible for Medicaid but do not enroll 17

18 Delivering immunizations in new ways Washington Vaccine Association Ensuring Funds for Childhood Vaccines Facilitates universal purchase of vaccines for all the children of Washington state: A. By collecting payments from health plans, insurers, and other payers and remitting the funds to the State B. Washington s Department of Health s Childhood Vaccine Program purchases vaccines at favorable rates. Physicians, clinics, hospitals receive state-supplied vaccines at no charge All children have easy access for critical vaccines All payers participate in one of the most efficient, cost-effective systems in the country for purchasing and distributing childhood vaccines. 18

19 Delivering immunizations in new ways Vote & Vax One Person, One Dose Increased access to flu shots and other preventive services through clinics provided at polling places on Election Day Close to 40,000 flu shots have been administered through more than 460 Vote & Vax clinics in 44 states & the DC between 2004 and 2010 About half of the recipients did not usually get flu shots. Among Blacks, Hispanics, and people without health insurance, between 60% & 71% did not usually get flu shots. 19

20 For more information & to get involved: The Affordable Care Act Information on immunizations Office of the Insurance Commissioner Medicaid expansion in Washington state 20