Look at all these changes:
New benefits and protections for people with insurance under the ACA, this act:
insurance plans to cover wellness checks and preventative services and immunizations without co-pays or fees.
Protects people with pre-existing conditions- no discrimination due to health status.
Ends all lifetime limits on insurance coverage and ends annual coverage limits for essential benefits.
Allows for family coverage for students until age 26.
Ensures coverage for individuals regardless of pre-existing health conditions.
Caps out-of pocket expenses.
· Changes employer-based
Insurance (subsidized by tax credits for small businesses):
o Required coverage for all
full-time employees by 2015 (for businesses with more than 50 employees).
o Cannot inflate costs due
to sick employees (with pre-existing conditions)
· Creates exchanges
for insurance marketplace- competing on a level playing field with requirements to make the insurance plans understandable.
*Plus- Insurance companies may
not spend more than 20% of your premiums on their administration costs (insurance company executives cannot take out the outrageous
Edward Hanway, the CEO of Cigna made $14.6 million in 2009. Ronald Williams, Aetna's CEO made over $18 million in 2009.
Angela Braly, the CEO of Wellpoint, made $13.1 million in 2009. According to Neil Wagner at the website "The doctor will
see you now" and based on 2009 national averages, Mr. Hanway's salary could have paid for:
- Health insurance for 3,000 individuals ($4,824 each) or 1,100 families ($13,375
- 241 full-time nurses ($60,000 per year each)
- 209,000 additional prescriptions filled ($70 each)
Most people in most states will see
a reduction in health insurance plan costs.
Doesn’t the affordable care act cover everyone now?
No. There are many who still fall through the cracks. Our philosophy of charity
care is to provide for those who don't have other options. Family Health Care's focus is the uninsured poor.
Was the ACA poorly designed?
The Supreme Court disconnected the portion of the Affordable Care Act
(ACA) covering very poor adults from the rest of the plan. Part of the plan was that the ACA would cover these individuals
through expanded Medicaid. After the decision by the court, the majority of states chose to expand medicaid to cover people
with incomes under 100% of poverty. The states of Kansas and Missouri chose not to expand Medicaid services to cover
very poor adults. There are many possible reasons for this decision. Perhaps the policymakers really believed private charities
could make up the difference. However, the result five years later is that about 160,000 Kansans and about 240,000 Missourians
who have very low incomes do not qualify for coverage through the ACA. Those with incomes over 100% of poverty qualify for
ACA subsidies and assistance paying for private insurance, but those with incomes under the poverty level have no assistance
(remember they were meant to be covered by expanded Medicaid.) That leaves only charitable care for these vulnerable people.
Family Health Care provides charitable care with the help of donors and foundations here in Kansas City. We are beholden to
those that have the ability and are willing to help as we have maintained our commitment to the uninsured poor.
Will Family Health Care have any operational changes based on the ACA?
Family Health Care operates as a non-profit charitable medical
practice both in name and in activity. We choose to serve a very vulnerable patient population. Many of our low-income patients
have social situations or secondary diagnoses (such as mental illness) that impact their health care and their ability to
navigate through services. We provide added value services such as: social services, literacy, peer education, legal,
and other supports meant to help patients optimize their health (these services are not covered through health insurance).
Will there be changes in the revenue streams for Family Health Care?
The most important
income source is from donations and grants- this accounts for half of our income and will continue to be important as our
revenue from fees for services is projected to worsen. Our current revenue streams include fees-for-services from public and
private insurance, as well as self-pay fees on a sliding scale. We have actually seen an increase
in the proportion of self-pay patients (with a resulting decrease in payments). Our choice is to
provide for the uninsured and refer those who gain insurance. We refer many insured patients (including those insured by Medicaid)
to other practices in order to open our schedule and provide more services for a growing proportion of uninsured patients.
Other clinics are focusing on the Medicaid or newly insured population rather than opening their schedules for the