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, – the ability to purchase quality coverage at a fair and affordable price.

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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What guides the work we do:

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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This presentation covers what happens in Wisconsin because of Health Reform, and what Walker has done to

threaten it: aka Walkercare

Happy 2nd

Birthday ACA!

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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2.5 million young adults now have coverage that didn’t before!

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

Just So We’re Clear:

All the provisions, changes and benefits that we mentioned and will mention will be taken away from you if this law is repealed or blocked in some way.

Walker has worked to block the Affordable Care Act at every turn, and has told the Attorney General to challenge the law in court 6

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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Walkercare: 2011

Walker’s Insurance Commissioner, who has been investigated for illegal campaign contributions, has sought to stop this cap on excessive insurance industry profits and overhead (80-85% of your premium dollars on medical care, not profits)

This “request”, which would have cost consumers ~$14 million in higher insurance premiums, was blocked by the Federal Government

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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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Get care soonerPrevention saves Money & lives!

The Affordable Care Act Ends Discrimination for 2.5 Million

Wisconsinites Under 65

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

• An additional 1.5 million non-elderly Wisconsinites have preexisting conditions that could cause them to be denied coverage or charged excessive rates.

(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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To name a few…

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.

13Without the Affordable Care Act’s protections,What would this family do?

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 (in 2014)

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

• Walker returned $38 million for the creation of this marketplace, closed the “Office of Free Market Healthcare”, and allowed the legislature to end 2012 session with no competitive health marketplace

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Walkercare Strikes Again!

• Wisconsin will still get a Competitive Health Marketplace, the Federal Government will create one for us at some future date.

• Meaning we have to wait longer for all of the following benefits…

Competitive Health Marketplace for Middle Class

• Created by (or, for us, for) 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.

• System voluntary: can stay with current health insurance if it works for you.

• Consumers in control, with clear information, clear comparisons, and real competition. 17

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

19National Women's Law Center, "Turning to Fairness".Based on comparable insurance plans for 25 year old women and men living capitol cities.http://www.nwlc.org/resource/report-turning-fairness-insurance-discrimination=against-women-today-and-affordable-care-act

Stabilizes & Expands BadgerCare to low income Wisconsinites

• BadgerCare expanded to include every citizen who meets income requirements

• Wisconsin’s contribution of BadgerCare expansion is substantially 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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Walkercare vsBadgercare

• Walker’s original plan involved removing over 60,000 people, including 29,000 children from Badgercare to save money

• The Affordable Care Act requires states to seek a waiver to change their Medicaid programs (like Badgercare)

• The Obama Administration did not allow them to remove that many people

• Walker is still trying, this time removing 22,000 individuals

• Kicker: financially, there is now no need to kick this many people off anymore

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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 25

The Choice

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

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

• What we’re left with is “Walkercare”, before reform and with cuts to Wisconsin’s safety net.

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Walkercare

1. Joins other states in challenging the Affordable Care Act in court, allowing insurance companies to deny coverage to millions of people with preexisting conditions & drop coverage for those who get sick, forcing many into bankruptcy if successful.

2. Ends Badgercare for tens of thousands. Cutting off or pricing out families from a moderate cost insurance alternative, leaving few alternatives

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They have no argument for this It is not fiscallynecessary

3. Scheduled over $500 million in cuts for Medicaid, despite no fiscal need for doing so.

4. Allows insurance companies to raise rates uncontrolled & charge excessive rates

5. Returns $38 million for the creation of the Competitive Health Marketplace, protecting consumers with preexisting conditions & giving individuals more options 28

Walkercare

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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Affordable Care Act is Worth Protecting

3. Increased opportunity: families will not be forced into bankruptcy when someone gets sick, and will be free to pursue economic opportunities without concern with how they will get health coverage

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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Groups that struggleto get coverage now:-Entrepreneurs-Small biz owners-Farmers-Contractors-Nonprofits-Churchesto name a few

One More Time…

The 4 Most Important Points When “Talking Healthcare”…

1. Discrimination based on “preexisting conditions” will soon be outlawed, and now is for children under 18.

2. Preventive care will save money and keep us healthier.

3. Members of Congress will get the same insurance we get access to.

4. When someone says they “don’t like Obamacare”, ask them what they don’t like about (insert favorite new benefit here!)

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How You Can Help

• Real Stories change hearts & minds, share your health care stories with us!

• Hold a house party to learn how to “Talk Health Reform” during the Recalls

• Our speaker’s bureau is always looking for new chances to speak.

• We need speakers to present this presentation to others, generally only once a month 32

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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