The Patient Protection and

Affordable Care ActWhat’s in it for New Mexico Counties?

Life Before PPACA

Nationally, health insurance premiums rose 80% from 2000-2007 while wages rose only 15%.

In 2009, one in six US dollars was spent on health care. It is projected by the CBO that without PPACA by 2016, at least half of all US households will have to spend half of their total income on health care.

In New Mexico, prior to PPACA, 23% of people, or 400,000 New Mexicans, were without health insurance. Texas was the only state with a higher rate of uninsured: 24%.

Prior to PPACA 80 New Mexicans lost their insurance every day.

In the year 2000, the average insurance premium for a family of four was $6,222. By 2006, this rate had nearly doubled to $11,279.

Without PPACA, in 2016, the average family of four in New Mexico is projected to pay $28,533 in premiums.

“Injustice Anywhere is a threat to justice everywhere.” -MLK

Market ReformsWhat death panels?

PPACA prohibits denial of coverage for pre-existing conditions beginning in 2014.

PPACA provides for immediate access to affordable coverage for those with pre-existing conditions. Children with pre-existing conditions are covered immediately. As of July 1, adults uncovered due to a pre-existing condition can be covered through a temporary high risk pool.

Insurers must offer their policies to all people. They may not discriminate against specific genders, ethnicities or individuals suffering from illness. Policies must be renewable.

PPACA prohibits the imposition of annual or lifetime limits. PPACA prohibits recission, the practice of retroactively cancelling coverage

once an illness is diagnosed. Children are now covered under parents’ plans up to the age of 26. All policies must now cover preventive services without a co-pay.

Market ReformsPPACA makes your coverage secure

If you like your current coverage, you can keep it.

PPACA mandates a basic minimum insurance package so that coverage will be effective.

PPACA caps out of pocket expenses. A recent Harvard study showed that more than ½ of all US bankruptcies were caused by medical expenses. More than ¾ of medically related bankruptcies occurred to insured individuals.

PPACA ends egregious industry abuses like the ones discussed above. The industry can earn a profit, but not at the expense of care.

Health Center and Workforce Expansion

A Revolutionary Change for New Mexico

PPACA is one of the largest job creation bills New Mexico has seen

New Mexico ranks last nationally in access to care and use of preventive care. 32 out of 33 New Mexico counties experience a workforce shortage. There is no dental school anywhere in New Mexico. $9.5 billion is allocated nationally for community health and mental health

centers to expand services, infrastructure and hours of service. An additional $230 million is allocated for establishing and expanding primary

care residency programs as Teaching Health Centers. This means that your local primary care clinic can become a teaching center for health professionals.

Increases to both Medicare and Medicaid reimbursement for CHCs makes them more attractive to health professionals.

PPACA creates a federal workforce commission to ask why there is a workforce shortage. Senator Bingaman crafted the 2009 Health Action and Supply Professions Act, which was inserted into PPACA, with NM in mind, so all preferences are given to rural and low-income communities for workforce development funding.

Health Center Expansion

PPACA allocates $1.5 billion into the National Health Service Corps which will place 15,000 new health care professionals in rural and underserved areas.

PPACA increases federal loan assistance for new and current primary care providers.

PPACA will establish graduate nursing education programs. This provision will help nursing students in rural and underserved communities to overcome obstacles that prevent their graduation.

PPACA increases Medicaid payments to primary care physicians and Medicare payments to rural physicians and surgeons, even in Clayton.

PPACA will require one standardized form for payment. A national study found that the average spends 142 hours and $68,274 annually interacting with health plans. This is time that will now be spent on patient care.

Workforce Expansion

School-Based Health Clinic Expansion

Catch ‘em Where They’re At

PPACA authorizes $150 million to support construction and modernization of SBHCs

Other grants available through HRSA/HHS will fund salaries and costs, allowing SBHCs to operate 24-hour call and year round services. SBHCs will be allowed to see parents and will provide mental health services.

Preference will be given to SBHCs that serve high percentages of Medicaid eligible patients.

Expansion of SBHCs strengthens schools. Expansion of SBHCs increases access to mental health

services to New Mexico families.

School-Based Health Clinic Expansion

The FundImproving Public Health

PPACA authorizes and appropriates $11 Billion Fund for Prevention and Public Health

Allocation of funds increases incrementally each year up to 2015. For example, in 2010, $500 million will be spent in 2010, $750 million in 2011, etc., until 2015 when $2 billion will be spent which is the amount funded that year and thereafter.

Many of these prevention grants will require community health coalitions. New Mexico, with its county health councils, stands to benefit, IF we maintain the councils.

In FY10, the HHS Secretary determines how this fund will be allocated. In subsequent years, the Senate and House subcommittee on appropriations will determine how the funds are allocated.

Largest Infusion of Public Health Funds EVER!

FY 2010 Fund AllocationsAre New Mexico’s Counties Prepared

to Participate?

$126 million for Community and Clinical Prevention: supports federal, state and community prevention initiatives along with integration of primary care services into publicly funded community-based behavioral health settings; obesity prevention and fitness; tobacco cessation.

$70 million for Public Health Infrastructure: supports state, local and tribal public health infrastructure; builds state and local capacity to prevent, detect, and respond to infectious disease outbreaks.

$31 million for Research and Tracking: data collection and analysis; to strengthen CDC’s Community Guide by supporting the Task Force on Community Preventive Services; and to improve transparency and public involvement in the Clinical Preventive Services Task Force.

$23 million in Public Health Training: expand CDC’s public health workforce programs and public health training centers.

Creates New Primary Care Residency Slots Supports Physician Assistant training Encourages students to pursue full-time

nursing careers Establishes new Nurse-Practitioner-led

clinics Assists states to plan expansion strategies

for primary care workforce Creates national health council to create

prevention and health promotion strategy

$250 million to Expand Primary Health Workforce

Expansion of Coverage to 95% of

New MexicansWithout unfunded mandates!

Increased CoverageNo unfunded mandates

Expansion of Medicaid eligibility to 133% of FPL will result in coverage to 124,000 additional New Mexicans

Federal government covers 100% of the cost of expansion from 2014 to 2016 and is then phased down to 90% by 2020

Tax credits for low and middle income individuals up to 400% of FPL to ensure affordability of quality coverage

According to CBO, insurance market reforms combined with tax credits will reduce coverage cost on the individual/private market on the average New Mexico family by 56% to 59%.

Expansion of Access Through Subsidies and Private Insurance Reform

2/3 of all New Mexicans will be eligible for tax credits or Medicaid expansion

$3.1-$5.6 billion will be spent by federal government in New Mexico for Medicaid funding

$3.7 billion will be spent in New Mexico for federal subsidies

A total of $6-$9 billion will be spent in New Mexico for this bill

PPACA has already brought $84 million into New Mexico in new grants

How tax credits and Medicaid expansion help New Mexico

Hospitals must define “community benefit” through a coalition-based needs assessment involving other stakeholders (i.e., health councils)

Hospitals must document actual funding for newly defined community benefit

CMS will penalize hospitals with high readmission rates, thus encouraging formation of councils and “ACOs”

Counties and communities with health councils will find it easier to apply for grant-based funding

New IRS Hospital Reporting Requirements Offer Opportunities for Counties

Cost ReductionAn Added Benefit

$143 Billion by 2019 according to the CBO $1 Trillion by 2029 according to the CBO Saves the Medicare Trust Fund from

Bankruptcy

PPACA reduces the federal defict

Incentives for better care, not more care!

Preventive health care, CHC and SBHC funding Creation of Exchanges, Consumer Choice, Market

Competition Insurers must expend between 80% and 85% on

actual medical coverage Advance refundable tax credits

Reduces health care costs while improving quality of care