Post on 22-Feb-2016
description
IMPLEMENTATION OF THE AFFORDABLE CARE ACT: NEXT STEPS FOR TOBACCO CONTROL
The National Perspective
Jennifer SingleterryManager, National Health Policy
American Lung AssociationJennifer.singleterry@lung.org
Agenda
1.What should insurance plans cover?
2.What is covered for different types of insurance?
3.Next steps
Acronyms
• ACA = Affordable Care Act/healthcare reform/Obamacare
• HHS = Department of Health and Human Services
• EHB = Essential Health Benefit
Comprehensive Benefit
• 7 medications– 5 NRTs– Bupropion– Varenicline
• 3 types of counseling– Individual (face-to-face)– Group– Phone
• Easy to access/no limits
Health Insurance
• Employer-sponsored insurance
• Medicare• Medicaid• Uninsured• State exchanges• Individual policies
Medicare
• ACA: new prevention and wellness visit
• Prescription medications provided through Part D– Missing: over-the-counter medications
• Individual counseling provided through Part B– Expanded in 2010 to include all on
Medicare– Missing: group and phone counseling
Essential Health Benefit
ACA: directs HHS Secretary to establish an Essential Health Benefit – a minimum federal standard
– Must include 10 categories of coverage
– Applies to all plans in state exchanges
– Applies to coverage offered to newly eligible Medicaid enrollees
10 categoriesAmbulatory patient servicesEmergency servicesHospitalizationMaternity and newborn careMental health and substance use disorder servicesPrescription drugsRehabilitative servicesLaboratory servicesPreventive and wellness servicesPediatric services
Essential Health Benefit
Medicaid Expansion
State Exchanges
?
Medicaid• ACA: In 2014 will cover everyone up
to 133% of the federal poverty line (approx. $31,000 annual income for family of 4)– Supreme Court decision
• Undergoing a lot of changes right now
• Has a higher smoking rate than the general population
• Joint federal & state program
Medicaid – Federal Requirements
• All preventive services for children through EPSDT
• ACA: tobacco cessation for pregnant women• ACA, 2014: Medicaid expansion must have
coverage for EHB• ACA, 2014: States will no longer be able to
exclude tobacco cessation medications.– Unclear what this means in practice
State Exchanges
• Begin in 2014• All plans in exchanges must
cover EHB• HHS has indicated
implementation approach, but not published a rule
• Hot topic in the states!
State Exchanges – EHB
• Each state picks its own benchmark plan• Benchmark plan’s coverage serves as the
Essential Health Benefit (a minimum state standard)
• Must supplement if benchmark does not cover all 10 categories of care
• Plans in the exchange have a lot of flexibility
Employer-Sponsored Insurance
• ACA: Non-grandfathered plans must cover USPSTF A’s and B’s with no copay– Tobacco cessation is given an ‘A’,
but is not clearly defined• 9 states have tobacco cessation
mandates– Only apply to fully-insured (ie small
employers)– CO, IL, MD, NJ, NM, ND, OR, RI,
VT
Uninsured
• 50 million currently (2010 - Kaiser)• 30 million post-ACA (CBO estimate)• Quitlines• Other state and local programs• Pharmacy & drug company discount programs
Prevention and Public Health Fund
• Quitline funding• Tips from Former Smokers
Campaign (Tips Part 2?)• Community Transformation Grants• In constant danger of being
raided!– Cut by $6.25 billion in the Middle
Class Tax Relief and Job Creation Act in 2012.
– Stay tuned for more shenanigans
Next Steps• Need to know:
– Is your state setting up an exchange?– Has your state chosen an EHB benchmark? – Is your state carrying out the Medicaid expansion?– What are private plans in your state covering for
tobacco cessation?• Make contacts with Medicaid office, Insurance
Commissioner, exchange implementers• Reach out to health plans • Reach out to patient navigator programs• Advocate for better coverage!