The Affordable Care ActMaking health care more secure and

returning control to consumers

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Our Health Care Principles

1. Health Care Freedom must be restored. Medical decisions should be controlled by patients in consultation with their healthcare providers, without interference from insurance companies

2. Everyone should have health security, which means a place to go to purchase quality affordable coverage.

3. Health Care discrimination by insurance companies is a violation of fundamental rights, especially against people with preexisting conditions, and must be outlawed.

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The Affordable Care ActThe new national health care law, achieves

these principles

--Passed March 23, 2010

--Reforms Come in 2 Stages

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Stages of Reform

Stage 1 (in effect now)• Outlaws worst health insurance

abuses including denials based on preexisting conditions for children (adults with preexisting conditions will be covered in 2014).

• Creates new standards for insurance, such as allowing young adults to stay on parents policies until they are 26.

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Stages of Reform

Stage 2 (goes into effect 2014)

• Expand BadgerCare (Medicaid) to almost all low income Wisconsinites.

• Create competitive health marketplace to guarantee coverage to everyone who does not have good insurance at work.

• Require Members of Congress to buy the same plans offered to everyone else in the new marketplace.

• Strengthen Medicare for Seniors.5

Stage 1 Reforms

Insurance Practices Outlawed now under the Affordable Care Act

• Preexisting condition exclusions (kids now/everyone in 2014)

• Lifetime limits • Dropping coverage after a person gets sick• Excessive insurance industry profits and

overhead (80-85% of your premium dollars must be spent on medical care, not profits)

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Stage 1 Reforms

The Affordable Care Act guarantees

• Preventive care coverage (ex:

Mammograms, checkups, etc) with no cost sharing (co-pays, deductibles, etc)

• Young adults can stay on parents policies until age 26

• Preventive care without cost sharing for seniors on Medicare

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The Affordable Care Act Ends Discrimination for Half the State

(2.5 Million Wisconsinites)

• Nearly 1 Million in Wisconsin under age 65 have a preexisting conditions that would definitely cause them to be denied coverage if they bought insurance on their own

• An additional 1.5 million under 65 have preexisting conditions that could cause them to be denied or charged excessive rates for health insurance coverage.

(Source: U.S. Department of Health & Human Services, January 2011)

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Just Some of the Examples of Preexisting Conditions

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The Faces of Reform

How the Affordable Care Act is already helping people across Wisconsin who would otherwise be the victims of health insurance discrimination

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Sami’s Story“My 7-year-old son, Sami, suffers from a

disease that causes tumors to grow all over his body. Sami’s treatments could not continue if we hit our insurance policy’s life time limit. Thanks to the Affordable Care Act, insurance companies can no longer impose lifetime limits or deny health coverage to children like Sami with preexisting conditions. We can’t go back to being on our own against the insurance companies.”

--Tracy, Appleton, Wisconsin.

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Remy’s Story“I own a small café. Over 20 years ago

I beat cancer, but ever since then no insurance company would sell me a policy because my cancer is called a preexisting condition. Starting in 2014 under the Affordable Care Act, no insurance company will be allowed to discriminate against me because I’m a cancer survivor.”

--Remy, Pepin, Wisconsin

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Stage 2: Guaranteed Affordable Health Care (2014)

• Wisconsin, with federal funding, creates a new competitive health marketplace, while keeping what works now in place.

• The new health marketplace options are voluntary. If you have good coverage through your job you can keep it.

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Stabilizes & Expands BadgerCare to low income Wisconsinites

• BadgerCare expanded to include every citizen who meets income requirements

• Wisconsin’s contribution of BadgerCare expansion is reduced.

• Eliminates the risk of BadgerCare cuts.

• Affects 337,000 Wisconsinites Badger- Care (Medicaid) recipients with serious and chronic diseases such as Cancer, Lung Disease, Diabetes & Heart Disease

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Competitive Health Marketplace for Middle Class

• Created by each state to meet unique needs by 2014.

• Access through website, similar to Travelocity or Consumer Reports, chose your own private insurance carrier and standards benefits plan.

• The Marketplace is voluntary: can stay with current health insurance if it works for you.

• Consumers in control, with clear information, clear comparisons, and real competition.

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Competitive Health Marketplace

• Makes coverage more secure by ensuring that people cannot be denied coverage due to preexisting conditions or have coverage dropped when they get sick.

• Members of Congress will be required to get their coverage through the same competitive marketplace

• Makes coverage more affordable, by providing tax credits on a sliding scale to middle class Wisconsinites.

• Bans discriminatory pricing based on medical condition, age, or gender.

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Gender Discrimination

• Currently, women are charged more then men by health insurers.

• This and other kinds of discrimination are outlawed in the new competitive health marketplace.

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Strengthen Medicare

The Affordable Care Act protects Medicare benefits for seniors and strengthens the program for future generations by

• cracking down on waste, fraud, and abuse in Medicare,

• ending handouts to insurance companies, and

• providing free preventive care to decrease costly emergency room visits and reduce health care costs long-term.

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Faces of Reform

The human impact of the new competitive health marketplace . . . .

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John’s Story

"I have a tooth that is in infected and needs to be removed, which normally costs $100, but because I have Hemophilia the drugs are between $50,000 & $100,000 just to stop the bleeding. I have been denied insurance because of my condition, any employer-based care would require me to wait a year. I have no way of dealing with my conditions the way things are now. That is why I am looking forward to the new health marketplace." 

--John, Small Business Owner, Albany, WI

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Steve’s Story"I suffered from a deteriorating spine

problem for about 10 years...We discovered what so many Americans have had the misfortune of discovering-It was impossible to purchase health insurance on the free market if you were considered high risk (had a pre-existing condition)...We applied many times over the years to every health insurance company we could find and were flat out rejected…with little other option I took a 20 hour flight to Malaysia to get treatment. Under the Affordable Care Act, I will have a right to coverage so I can get treatment here in the U.S.”

--Steve, Verona, Wisconsin 21

The Choice

• There will be change: because of skyrocketing health costs everyone agrees we need to change.

• One option is the Affordable Care Act, which is already protecting us from health discrimination and will guarantee greater security and control.

• The second option is Paul Ryan’s plan which passed the U.S. House of Representatives in 2011.

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Paul Ryan’s Plan

1. Repeals the Affordable Care Act, allowing insurance companies to deny coverage to millions of people with preexisting conditions and drop coverage for those who get sick, forcing many into bankruptcy.

2. Ends Medicare as we know it, and gives seniors vouchers that will not keep up with medical inflation, doubling their out-of-pocket costs.

Shepherd-Express, 05-05-2011 “Paul Ryan Takes His Budget Plan to the Public” 23

Paul Ryan’s Plan

3. Cuts $50 billion from Medicaid, including funding for long term care for seniors and people with disabilities, and BadgerCare for children & families.

4. Gives $10 trillion in taxpayer funded subsidies to the health insurance industry over life of the plan.

5. Prevents creation of competitive health marketplace where everyone who needs it will have a choice of good plans and tax credits to afford them.

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The Affordable Care Act is Worth Protecting

1. Guarantees health care freedom. Working families no longer can be denied coverage for preexisting conditions, lose their coverage when they get sick, or have to haggle with insurance companies about claims and crucial medical treatments.

2. Everyone will have the peace of mind of knowing that they and their families have guaranteed access to affordable coverage options, no matter what..

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3. Increased opportunity: families will not be forced into bankruptcy when someone gets sick, and will be free to pursue economic opportunities without being constrained by health insurance access issues.

4. Wisconsin should work to improve the new law by implementing it in a way that works for everyone, not special interests such as the health insurance industry.

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The Affordable Care Act is Worth Protecting

How You Can Help

• We are always looking for people with health stories, especially ones with pre-existing conditions and/or on Badgercare!

• Our speaker’s bureau is always looking for new chances to speak. Let us know any opportunities!

• We need speakers to present this presentation to others, generally only once a month 27

Questions?

• Kevin Kane

Healthcare Organizer

Citizen Action of Wisconsin

414 550 8280 (cell)

kevin.kane@citizenactionwi.org

facebook.com/got.healthcare

citizenactionwi.org

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