The Affordable Care Act ACA and What It

The Affordable Care Act (ACA) and What It Means for Latinos An Overview by the Kaiser Family Foundation for Univision Affiliates Webinar Briefing June 19, 2013

Today’s Speakers Larry Levitt Claudia Deane Samantha Artiga Associate Director for Director of Senior Vice Public Opinion & Disparities Policy President for Survey Research Project Special Initiatives and Associate Director of Co-Executive the Kaiser Director of the Commission on Program for the Medicaid and the Study of Health Uninsured Reform and Private Insurance Tina Hoff Senior Vice President and Director of Health Communication and Media Partnerships

1. The Basics of the Affordable Care Act (ACA) New and Increased Coverage Options available starting in 2014 • For states that chose to, Medicaid will be expanded to cover adults with incomes up to 138% of the federal poverty level (about $16 K per year for a single person, $21 K for a couple). The Supreme Court ruling on the ACA changed the expansion from a nationwide action to a state option. • New health insurance “marketplaces” (also called “exchanges”) will provide options for individuals buying insurance on their own and for small businesses. Enrollment begins Oct. 1 2013 thru March 31, 2014. Tax credits will be available to persons with incomes from 100% to 400% of the federal poverty level (about $46 K for an individual and $94 K for a family of four) to help offset costs. • Employers with 50+ workers must offer affordable insurance to their workers or pay a penalty. • As of end of 2010, parents are now able to keep children on their insurance up to age 26. Insurance Market Reforms Taking Effect in 2014 • Insurers will be required to provide coverage to everyone regardless of pre-existing health conditions. Variations in premiums limited for age and prohibited for gender and health status. • All insurance plans sold to individuals and small businesses will have to provide a minimum level of coverage, including preventive care, maternity, mental health, and prescription drugs. • To help these reforms work and keep premiums down, most Americans will be required to have insurance or pay a penalty (the “individual mandate”).

2. At Three Years Public Opinion on ACA Remains Divided As you may know, a health reform bill was signed into law in 2010. Given what you know about the health reform law, do you have a generally favorable or generally unfavorable opinion of it? ACA signed into law on March 23, 2010 SOURCE: Kaiser Family Foundation Health Tracking Polls

3. Ongoing Partisan Divide on ACA Percent who say they have a favorable opinion of the health reform law: ACA signed into law on March 23, 2010 SOURCE: Kaiser Family Foundation Health Tracking Polls

4. More Hispanics Lean Favorably Toward ACA As you may know, a health reform bill was signed into law in 2010. Given what you know about the health reform law, do you have a generally favorable or generally unfavorable opinion of it? ACA signed into law on March 23, 2010 SOURCE: Kaiser Family Foundation Health Tracking Polls AMONG HISPANICS

5. Spanish-Dominant Hispanics Most Favorable Views Toward ACA As you may know, a health reform bill was signed into law in 2010. Given what you know about the health reform law, do you have a generally favorable or generally unfavorable opinion of it? Favorable Unfavorable Don't know/Refused Hispanics by Language Preference Spanish dominant English dominant 51% 41% 9% 25% SOURCE: Kaiser Family Foundation Health Tracking Polls (conducted April 15 -20, 2013 and June 4 -9, 2013) 40% 34%

6. Two in Three Hispanics Feel Uninformed About Law Do you feel you have enough information about the health reform law to understand how it will impact you and your family, or not? Hispanics No 65% Whites Blacks No 48% Yes 34% Yes 51% No 45% Yes 53% Dk/Ref 1% SOURCE: Kaiser Family Foundation Health Tracking Poll (conducted April 15 -20, 2013) Dk/Ref 2%

7. Hispanics are at Highest Risk of Being Without Insurance Compared to Other Races/Ethnicities Insurance Coverage of Nonelderly in the U. S. by Race/Ethnicity, 2011: 13% 15% 18% 21% 27% 32% 15% Non- Workers 22% High School 32% 1 or More Full-Time 71% 1 or More 67% Full-Time 62% Less Than 47% White Asian Black 161. 6 M 14. 7 M 33. 5 M High School Uninsured Medicaid /Other Public Employer/Other Private 32% 30% Non-Workers 40% 39% American Indian 1. 9 M Hispanic SOURCE: KCMU/ Urban Institute analysis of 2012 ASEC Supplement to the CPS. 49. 2 M White 26 -34 21% 35 -54 34%

8. Most Uninsured Hispanics are in Working Families; More than Half are under the age of 26 Characteristics of 15. 5 Million Nonelderly Uninsured Hispanics in the U. S. Family Work Status At Least 1 Full-Time Worker 68% Age 19 -25 17% Part. Time Worker 14% Non. Worker 18% Citizenship Status 26 -34 23% 0 -18 19% 45 -64 21% 35 -44 20% Naturalized Citizen 11% U. S. -Born Citizen 43% Non-Citizen >5 Years 42% Non-Citizen <5 Years 4% SOURCE: KCMU/ Urban Institute analysis of 2012 ASEC Supplement to the CPS.

9. ACA Expands Access to Health Insurance Coverage Medicaid/CHIP Plan A Premium Tax Credits Plan B Plan C � � � � � John Doe 123 Main Street 12345 Unsubsidized Marketplace Coverage Eligibility for Multiple Programs Determined in Real Time Information Provided on Available Plans for Comparison Enrollment Into Selected Plan

10. Most Uninsured Hispanics are at Income Levels that Qualify for Medicaid Expansion or Subsidies Health Insurance Status among the 49. 2 Million Non-Elderly Hispanics in the U. S. 15. 5 Million Non Elderly Uninsured Hispanics By Income Level ≥ 400% FPL (5%) Employer-Sponsored Coverage/Other Private 39% Uninsured Medicaid/ Other Public Medicaid* Uninsured 32% 30% SOURCE: KCMU/ Urban Institute analysis of 2012 ASEC Supplement to the CPS. 139 -399% FPL Subsidies (38%) ≤ 138% FPL Medicaid (57%)

11. The ACA Medicaid Expansion Extends Eligibility to Low-Income Adults Medicaid Eligibility Today Extends to Adults ≤ 138% FPL* Medicaid Eligibility in 2014 Pregnant Women Elderly & Persons with Disabilities Children Adults up to Parents 138% FPL

12. Current Status of the Medicaid Expansion Decision as of June 14, 2013 VT WA MT ND NH MN OR ID NV WY WI SD CO CA AZ PA IL KS OK NM TX IN MO OH WV KY AR AL VA MA CT RI NJ DE MD DC NC TN MS AK NY MI IA NE UT ME SC GA LA FL HI Moving Forward at this Time (24 States including DC) Debate Ongoing (7 States) Not Moving Forward at this Time (20 States) SOURCE: Based on KCMU analysis of recent news reports, executive activity and legislative activity in states.

13. Hispanics have High Stakes in State Decisions to Expand Medicaid Distribution of Uninsured Hispanics who are Income Eligible for Medicaid Expansion (8. 9 Million) Debate Ongoing 4% AZ NY 4% 52% in States Moving Forward at this Time (24 States) TX 22% FL 9% 4% GA 3% Other 10% CA 26% Other 18% SOURCE: Based on KCMU analysis of 2011 American Community Survey. 44% in States Not Moving Forward at this Time (20 States)

14. State Health Insurance Marketplace Decisions as of May 28, 2013 VT WA ND MT OR CA AZ CO MI IA NE UT NY WI WY NV NH MN SD ID IL KS OK NM TX HI IN MO PA OH WV KY AR AL VA CT NJ DE MD DC NC TN MS AK ME SC GA LA FL State-based Marketplace (16 states and DC) Partnership Marketplace (7 states) Federally-facilitated Marketplace (27 states) MA RI

15. Outreach and Enrollment Resources for Hispanics • Outreach and education campaigns will ramp up in Summer 2013 – – October 2013: Open enrollment for Marketplace coverage begins January 2014: Start date for Marketplace and Medicaid expansion coverage March 2014: Initial open enrollment period for Marketplace coverage ends Enrollment in Medicaid is not limited to the open enrollment period • Outreach initiatives – HHS/CMS – States – Enroll America and other private initiatives • Resources to direct individuals for more information – Healthcare. gov – National and state call center help lines – Network of certified “assisters” or “navigators” – Community health centers – National Alliance for Hispanic Health Buena Salud Club and Su Familia Provider Database -- Subsidy Calculator from Kaiser Family Foundation: http: //www. kff. org/interactive/subsidy-calculator

16. Key Issues to Watch • How will implementation vary by state? • How many people are signing up for new coverage options? Are the young and healthy getting insured as well as those who are sick? How does gaining insurance impact individuals’ health care and personal lives? • How many states expand Medicaid? What will expansion decisions mean for coverage and costs? For efforts to reduce health care disparities? What happens to poor adults who do not gain a new coverage option in states that do not expand Medicaid? • Are the new marketplace insurance options affordable, taking into account tax credits for low and middle income people? How competitive are the new insurance marketplaces? Are new, local plans entering the market? • What happens to the safety-net for those left out of expanded insurance? • There will be technical glitches in the new marketplaces. Are they widespread or anecdotal? Are they addressed quickly? Are people getting the help they need to understand new coverage options and enroll? • How well do education, outreach, and enrollment efforts meet the language and cultural needs of the community? • How are employers reacting? Are they expanding health benefits or paying the penalty?