Walkercare Vs The Affordable Care Act

1

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.

2

What has guided Citizen Action’s work on Healthcare over the years

The Affordable Care Act

The national health care law, achieves these principles

--Passed March 23, 2010

--Reforms Come in 2 Stages

3

WalkercareWisconsin’s progress on Healthcare in 2011-12Fails to live up to these

principals

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.

4

Affordable Care Act

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

Affordable Care Act

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)

6

Affordable Care Act

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

7

Affordable Care Act

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)

8

Affordable Care Act

Just Some of the Examples of Preexisting Conditions

9

Affordable Care Act

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

10

Affordable Care Act

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.

11

Affordable Care Act

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

12

Affordable Care Act

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.

13

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.

14

Affordable Care Act

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.

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

• Consumers in control, with clear information, clear comparisons, and real competition. 15

Affordable Care Act

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.

16

Affordable Care Act

Gender Discrimination

• In one of the most glaring inequities, women are charged more then men by health insurers.

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

17

Affordable Care Act

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.

18

Affordable Care Act

Faces of Reform

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

19

Affordable Care Act

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

20

Affordable Care Act

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

Affordable Care Act

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.

• Instead, Wisconsin is implementing “Walkercare” to reduce the amount of coverage we help provide and leave no alternative against rising costs

22

Affordable Care Act

Walkercare

• Legal: Walkercare attacks the Affordable Care Act legally

• Hiding info: Walker has hidden the benefits of the Affordable Care Act on Wisconsin from the public

• Badgercare: Slashing the award-winning nationally recognized health program

• Familycare: creating waiting lines for long term care for seniors & peoples with disabilities.

• Insurance Profits: Allowed insurance companies to decide unchecked how much they will inflate rates

• Competitive Marketplaces: Returning $38 million designated for these Marketplaces

23

Slashes to Badgercare

24

• Walkercare will cut between 53,000- 65,000 individuals off of Badgercare

• 29,100+ are children• 33,750+ are parents• 480+ are pregnant mothers and newborns

• For every $1 we spend on Badgercare in WI we receive $1.50 coming into the state

• Federal Funds Wisconsin loses with Walker’s cuts: =$135.5 Million• Badgercare funds WI hospitals $50 million they

would otherwise lose in emergency room visits & unpaid medical costs. Without BC these costs are pushed on us

• Wisconsin gave 4x as much money in tax breaks for corporations than would be required to keep families on Badgercare.

Insurance Companies

25

• Under Walkercare, insurance companies• Do NOT need to follow the requirement that they spend

80% of YOUR premium dollars on actual healthcare, not profits or overhead (Wisconsin is the ONLY state that has tried to stop this requirement and not stopped yet)

• Do NOT need to post online whenever they increase their costs, why they needed to increase their costs, & there is no watchdog to ensure they are reasonable

• Companies do NOT need to compete at an easy to see, consumer friendly competitive health marketplace, where they cannot deny or drop individuals, and where families and small businesses can get tax credits to afford coverage

• Namely, Insurance Companies are back in the driver’s seat under Walkercare

The Affordable Care Act > Walkercare

1. The ACA 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..

26

Affordable Care Act

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 worry of how they’ll get 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.

27

Affordable Care Act

28

Under Walkercare

1. People with preexisting conditions lose the protections from discrimination. Families can once again be dropped from coverage when they get sick.

2. You’re choice of a nationally recognized public moderate cost health insurance, Badgercare, is taken from you. Leaving you with little options in the face of rising costs

29

Under Walkercare

3. Removes your control: from choosing from affordable insurance options. Insurance Companies will once again decide coverage, cost increases, and plan by a separate set of rules

4. Walkercare moves Wisconsin backwards, not forwards. Even “conservative” states like Alabama, Idaho, Mississippi etc have moved forward with reform, yet WI won’t

So, Which Do You Choose?

30

How You Can Help

• This presentation is available online, forward it to others! Invite them to watch the next Virtual Town Hall! (will email to you)

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

31

Affordable Care Act

Questions?

• Kevin Kane

Healthcare Organizer

Citizen Action of Wisconsin

414 550 8280 (cell)

kevin.kane@citizenactionwi.org

facebook.com/got.healthcare

citizenactionwi.org

32