 Hi everybody, welcome to Arts Health Day 2013. My name is Jessica Holland. I am the executive director of an arts service organization called C4 Atlanta. This day is made possible by a couple of different efforts from several different groups. So we have C4 Atlanta, Wonder Route and Alternate Roots producing this event for the arts community in Atlanta and a special thanks to the City of Atlanta Office of Cultural Affairs for the Power to Get program which made this whole day possible. We raised funds from individual donors and then got a match from the city and that's how we paid for those biometric screening. So just a thank you to all who gave. We can't do this without support from individuals. I am going to hand it over to Jim Brown of the Actors Fund. I've actually seen Jim talk about this particular topic. He'll be touching on patient protection in the Affordable Health Care Act also known as Obamacare and it's so informative, so important and I invited Jim to come back to Atlanta because I really, really want this information out there. So welcome and without further ado, Jim Brown from the Actors Fund. Thank you Jim. Great. Thank you. I should first say that I don't call it Obamacare. I call it Obamacare's with an S at the end of it. My name is Jim Brown but my real name is James Brown. I say Jim Brown because if I say James Brown I have to go out or I have to make some sort of sound that people want when they hear the name James Brown. I'm the National Director of Health Insurance, Health Insurance Resources at the Actors Fund. The Actors Fund is a national human services organization that works with people in the performing arts and the entertainment industry. We're involved in housing, affordable housing. We're involved in something called an Actors Work Program which attempts to get lucrative jobs for people who are pursuing a career in the performing arts. We do health services. We have a free clinic, the only full-time free clinic in Manhattan and we work in social services. So we have about 20 social workers who give programs in substance abuse, HIV AIDS, anxiety and a number of other areas. My part of it began in 1998, we got a grant from the National Endowment for the Arts to set up a center that would educate artists not just performing artists and people in entertainment but visual artists and craftspeople as well regarding health insurance. The reason for this is the National Endowment for the Arts had done a study in which they found out that if you are an artist in the United States you're more than twice as likely to be uninsured as the general population. So what that means is between 30, 33% of all artists in the United States have absolutely no health insurance at all, another 15 to 20% are under-insured meaning they have very high deductible policies, $5,000, $10,000. So the idea was to bring the information, artists in every state, we set up a website that's AHERC.org and it's gone through about six or seven iterations now but you might want to take a look at that. We began telephone counseling for people around the country, we have an 800 number and all this information you can find out at the AHERC.org site. What else have we done? Seminars in about a little over 100 cities in the United States in the past 12 years. And that's one of these cities, Atlanta, which I absolutely love and saw for the first time when, as Jessica said, I gave a talk at a lovely place called Push Push Theater and it was just a terrific audience and I'm hoping to replicate that experience here in so far is that we had, as I recall Jessica, a very vocal audience, which I like and so there's no point in you keeping your questions to the end, you're going to forget what you wanted to ask. So just raise your hand if some issue comes up that you want to discuss and we'll try to spend a few minutes on that before we get back on in the direction that will get us to the end of what we want to do. I'd like to accomplish two things here today. One is I'd like all of you to have really a good sharp understanding about what the Affordable Care Act is, what's coming with it, and what's coming with it despite local politics. There was a time when I would give talks on this in which I would have to get involved with debates regarding the Affordable Care Act, but that's over. This is the lore of the land now. It's a program the way Medicare is a program or Social Security is a program, so that's over. So what we're interested in now, I believe, is learning how this works. I can guarantee you that after the 30 or 40 minutes that we'll spend on that, you will know more than 98% of Americans about what's actually coming because people just generally don't know what all of this is about. Then the second part of it is I'd like to, for those in the room here who live in the state of Georgia, I'd like to give you some guidelines about getting health insurance and health care in Georgia and sometimes specifically in Atlanta. That's one of the handouts that you have there. There are three handouts. One of them is a booklet we created at the Actors Fund called Every Artist Insured. We decided to go right for a dream wish fulfillment right there on the cover, Every Artist Insured. For anyone who is accessing this on the internet, this booklet is available in PDF form on the first page on the lower right of the AHRQAHIRC.org site. You can just click on that and this entire booklet that we're looking at here is there and can be printed out in color exactly like this if you'd like to have copies and distribute them if you're representing groups. We'll be referring to that booklet. In addition, we have a handout. I'm about to say the two most frightening words in the English language and I think you'll agree with me. I consider it two words. You might consider it PowerPoint. It's a frightening, terrifying word that generally clears the room. These are PowerPoint slides for a small PowerPoint presentation. Actually, I'll be following this as we go through. For those on the webinar, I'll be reading it out so you'll be able to follow as well. At the end of this, I will give my email address if you would like that PowerPoint to look over at home or to show to any group or use in any legal way that you wish. I'll send it to you and you can do that. Then the third sheet is Georgia. Yes, I have some right here. Thank you. There are three sheets there. Does anybody else not have them? We have one, two, three, four, five, six, seven. There should be plenty there. Let me give you it now. Why wait to the end? It's not a mysterious thing. It's kind of a suspense thing. I try to keep you by waiting. You have to wait for my email address. Obviously, it didn't work. My email address is this. It's the letter J Brown, B-R-O-W-N, at Actors Fund, as one word, A-C-T-O-R-S, F as in Frank, U-N-D, dot org. J Brown at Actors Fund, dot org. You send that to me. I'll get it right out to you. Within 24 hours, you'll have the PowerPoint. Now, I should also mention this to you, my telephone number at the Actors Fund. This is important because I should give you just a little bit of my background. When I graduated from college, I went over to Sardinia to make Spaghetti Westerns. I was an actor in Spaghetti Westerns. The only reason for that is that I was six foot three and weighed 142 pounds. I was the perfect lanky cowboy. But when they brought me over, it turns out that I couldn't act at all and I cannot. But they had me there. In every movie I was in, I was the first person who was killed. I was killed within five minutes. I was the guy who the sheriff walked into the bar. I said back off Lawman and he shot me. Then I would work on other aspects of the film. I taught at NYU, New York University for 15 years in the drama department in the school of the arts. I had some famous students, Alec Baldwin. I had Adam Sandler as a student who I famously told that his humor was infantile. I thought this was a criticism. Apparently, this was his go-ahead to have a long career. I left teaching to work for the American Red Cross, then International Red Cross overseas in disaster areas. I did that for several years. I got back to the United States, was broke, and a friend of mine was working for the Etna Insurance Company. He said, Jim, there is gold in themnar hills in health insurance. I worked in health insurance for 10 years for Etna and Empire Blue Cross Blue Shield. Then I became a regulator for health insurance for the state of New Jersey. I worked for the act, but I go through that to tell you I know a great deal about health insurance, but I may be the only health insurance person you hear talk or you speak to in your life who isn't trying to sell you something. I don't know if any of you are familiar with the singer John Prine, but John Prine has a line in one of his songs, every one of my best friends turned out to be insurance salesmen. I think we've all been through that experience. Let me give you my number at the actor's fund is 212-221-7300 extension 265. If you call me, and this is true for anybody listening this on the webinar over the internet, that's what we're set up to do. We have professional insurance people at the actor's fund. We have social workers who have been trained in health insurance. You call us and we will help you find affordable options. If affordable options exist, the affordable options is a little bit like an oxymoron like Larry King Live or something like that. We will try to help you find those options. Feel free to call us and you are our clients. Again, we're not selling anything at all. All the money for the actor's fund comes from grants, not for profits. Let's begin with the Affordable Care Act. I'm going to have to take off my glasses now because I don't know if any of you have this. I can read perfectly without glasses. I just need glasses to see anything beyond 10 or 15 feet. I almost don't like to do this because people tell me it's quite disturbing when I look at them without my glasses. Since I can't see you at all, I can just see some blurry thing there, but I will see your hand go up. What's already happened since March 2010 in the Affordable Care Act, well, children under the age of 19, and I'm referring now to the PowerPoint here, but again, for the people who are on the webinar, all of this and all of the information that I give you here, unless I lapse into stories about my fascinating childhood in the Bronx and it was a fascinating childhood. Unless I do that, everything I talk about is in this green booklet here that you can download. Children under the age of 19 with pre-existing conditions can't be denied coverage. I don't know why it took us this long to come to that, but that's the case now. So no child under the age of 19 can be denied health insurance. Young adults up to the age of 26 can stay on or enroll in their parents coverage. This is extremely important, particularly in the arts, because what it does is it allows people when they're very, very young, and so you don't have to worry about health insurance, you don't have to worry about your parents don't have to worry about a few. This depends upon whether your parents have health insurance, of course. So the significant thing here is that you're able to go on the parents insurance as just another child. Many states passed laws. By the way, Utah was the first state to pass a law like this that extended insurance to children, not just to children, but to young adults to the age of 26 years old. And the reason for that is that young Mormon men go out and as missionaries. So in the state of Utah, they extended it to age 26. Other states have extended it to age 29. The problem is you would have to pay the full cost for the insurance. Here it's just another child in the family on the insurance. So this is very significant. Insurance can't retroactively cancel the policies of people who are sick. This is called rescission in the insurance business. And what is the time when you're going to need an operation that's going to cost $40,000? The insurance company goes into your file with a fine tooth comb and makes sure that nothing in there is incorrect because if they find something incorrect, for example, if you forgot to put that you had asthma or there's some anomaly that exists in your file, what do they do? They drop your coverage. But notice they have accepted your coverage for those 12 or 14 that your premiums for those 12 or 14 years. And at the moment when there's a high payout, your insurance is dropped. This is a nasty bit of business. And this has been stopped now with the Affordable Care Act. That's what rescission is. Insurance can impose lifetime limits on medical benefits. What this means, all of you who have an insurance policy, that's one of the numbers on the schedule of benefits, okay? The lifetime payout. And usually the lifetime payout, actually not usually. It can be anywhere from $50,000 over the course of your lifetime to $5 million. Or in fact, all HMOs in the United States are required to have no limit on that payout. Now, what does that mean? Well, the average, let's say is $1.5 million. So it'll say the insurer over the course of your lifetime will pay $1.5 million. And you say, that's a lot of money. How could I possibly reach $1.5 million? Okay, well, one of the most famous stories of course, at least in the entertainment world is Christopher Reeve, who had obviously a serious head injury. And his policy was used up I believe in 17 months, the $1.5 million in the policy, okay? Any policy now sold in the United States has no lifetime limit on it. You follow me? Okay? So you cannot be dropped at the point you reach an amount. All new plans must cover certain preventive services, mammograms, tetanus, and that just makes sense, okay? The earlier on that you discover a problem, the better your chances are of being healed and also the less cost it is to treat that problem. So the next one here is 2010, uninsured people with pre-existing conditions may be eligible for coverage through PCIP. Those on the webinar every state has a PCIP plan, okay? Just put the letters PCIP into Google or Bing or whatever you use, okay? And it'll come up either your state's PCIP plan or the federal plan. Georgia does not have its own plan. It uses the federal plan, which is fine, okay? And I'm going to talk about that when we talk about Georgia. I'm going to direct you to where to find that plan. But what I'll tell you now about that PCIP plan is you have to be uninsured for six months in order to get it, and this is part of the Affordable Care Act, and you have to have a pre-existing condition. So weirdly, oppositely, in order to get this, you have to have a pre-existing condition. And I remember I was with a group of about 150 people giving a talk like this, and I had actually given out the sheet of the pre-existing conditions. And there was a fellow up around up in that area there, and he was pouring over the conditions, and then suddenly he went, and I said, what is that? And he says, I've got one, severe psoriasis. And it was an odd moment that someone was pleased to have a pre-existing condition, but he was thrilled because he was able to get the plan, which would have been in his state about $900 less than the previous pre-existing condition risk plan that they had before. So it worked for him. In 2014, the term pre-existing, I always love the term pre-existing condition too, because it sounded like existentialism 101 in college. Today we're going to discuss the pre-existing condition. It's kind of like pre-owned cars instead of used cars. But in any way, it's gone away. You won't be denied insurance anymore for any pre-existing condition. Most people will be mandated to have coverage or pay a penalty. If you look in your booklets here, you'll see the different groups that are exempt from that. I'll tell you a few of them, Native Americans are exempt because they have their own healthcare system. Anyone making less than $8,000 a year is exempt from having health insurance. Anyone who actually makes less than $9,600, they wouldn't have to file taxes. So if you don't have to file taxes, you don't have to have a plan. And that's kind of a tricky one, because how are they going to find out if you have a plan on that? It's through the IRS. Okay, that's how they're mechanism that's going to find out that people have followed the mandate. New insurance marketplaces called Exchanges will offer insurance to those who don't get it elsewhere. In November of the past year, your governor will go the way it doesn't matter, because the federal government is going to set it up for you. I shouldn't say it doesn't matter. It matters greatly. It's an unfortunate thing. In so far as your state will not have a say in how it's set up. And you know who your people are. You know what you need. You know who your people are. Excuse me, you won't have a say in how it's set up. The federal government is simply going to do that. In any event, it'll still be there. The exchange will still be there. And what is the exchange? It's a marketplace where you'll go to get health insurance. And I'm going to describe in a moment in detail the way that is going to work or how it's meant to work. Now, here's something critical. Subsidy, more person households, the amount will go up. But for individuals with income less than 40% of the federal poverty level, that amount now is already over $44,000. It's $43,000 here. It goes up every year. Does everybody know what the federal poverty level is? The FPL. You see it in the newspapers all the time. It's a formula invented in 1964, I believe. And it's really a way to determine whether an individual or a family is living in poverty in the United States. Now, that formula is used everywhere in the 48 contiguous states, the same one. And there's a different formula, slightly different formula, used for Hawaii and Alaska. Now, I used to say this. I'm going to tell you what I used to say and why I don't say it's not a clue. We took geography, but you've seen that New Yorker cartoon, where it's New York, then there's New Jersey, then there's Chicago, then there's Las Vegas, and then there's California for a New Yorker. Well, the federal poverty level, the FPL, as I say, is the same in all 48 states, but it's the same everywhere was some place opposite in some terrible way, I guess, than the center of Manhattan. Well, of course, somebody in the audience raised their hand and they said, by the way, I'm from the backwoods of Arkansas. And it's actually a very nice place. And it's not that cheap to live there, at least if you're an individual. You are officially poor in the United States. If last year you made less than a little under $12,000. So if you made a little under a little less than $12,000, you're officially poor. If you made more than that, welcome to the middle class. Okay. So almost all social programs, almost all social programs in the United States are based on the FPL. And what you'll see is gradations with Medicaid, depending upon you're a pregnant woman or you're blind or what your situation is. But I would say Georgia is somewhere in the area of maybe 60, 63% of the federal poverty level in order to get Medicaid and then going up higher for people in different situations. Okay. So that's what the FPL is $24,000. As of January, I say January 1st, 2014, but this goes into effect really on October 1st of this year because on October 1st, you are going to begin to apply for these insurances. Okay. So premium you're going to have to pay for that insurance, not free. You're going to have to pay a premium for it. Okay. How much copay you'll have to pay at the doctor's office. Okay. What's the limit of your out of pocket costs, what they will be. Okay. And all of these things you will know upfront. This is really one of the first times we've had something like this. You're having a real sense of what your financial liability is going to be with your health insurance. Okay. Now what are you buying? What's the product of the Affordable Care Act? It's an essential set of benefits. I've listed in this next slide here some of them and for those on the webinar what I've listed, all plans have to have the essential benefits, ambulatory care, emergency care and hospitalization, maternity and newborn care, mental health and substance abuse, prescription, getting it on the most popular small business plan sold in that state. Okay. So it's going to be a good plan. So whatever the most popular small business plan, it's going to be a good plan. It's going to be a good plan in Georgia. And what does that mean? That's going to be a good plan. Okay. Under 400% of the federal poverty level who will be paying less for it because of subsidies. You follow me on this. That is on the exchange, if they're going to sell it on the exchange and you get a subsidy, they must include, it'll be comprehensive health insurance. Will you be able to buy a plan that is not comprehensive? Yes you will because insurers will be selling insurance products that are off the exchange. You follow me here? You can buy something else if you want to and who will be buying those? People making over $40,000 a year. You follow me because they're not going to get a subsidy anyway, right? And they'll just this is working. It can be a little bit tricky. Yes. That's a great question. It's the number that's on the line of the first page of your tax, on the bottom of the first page. That's the number that you're looking at for all of these things. Okay. There's only one program in the United States that uses an income which is fully adjusted income from, for example, medical course can be taken off, all sorts of other things and that's from their income and then their income can go below the amount that makes them eligible. Okay. Yes. It's what will be defined as poverty for this will be 133, actually 138 percent of the federal poverty level. So it's about $13,000, $14,000 a year because Medicaid, now I do not know if you are going to do that in your study to the extended Medicaid program. Now you guys, I believe, have a Republican governor. The chances are that your governor may not do that. Okay. I know though, Kasek in Ohio, the federal government is going to extend the eligibility for Medicaid and then pay the full course for a number of years. So the states won't have to pay. The federal government is going to have to pay those costs. Okay. So it's, you know, it's crazy not to accept it. It's just crazy. But it's 138 percent. We're looking from that to 400 percent. And I'm going to show you in a detailed way in a moment how that's going to work. Okay. I think you'll get that. And I think there was a question. Right. You're going to be subsidized to be able to do it. And remember, if it's going to cost you more than a percent of your income, you don't have to have it. If you can't find a plan that's less than 8 percent, you follow me? So that's, and of course, what are we talking about here? We're talking about the way we intend this to work. Correct. Do you have a booklet? And now you can call me and say, what a son of a, you know, okay. All right. They've just been so easy. Okay. Yes. That's such a great question. Okay. Part of the law is every state will have something called navigators and assisters. Okay. And there's a huge amount of money for those people. Navigator organizations. And then what are going to be called in-person assisters who will show you how to do about that, how to do that. Okay. We're hoping. No. No. It doesn't affect you at all. I hope you'll stay. I believe been saved something like $7.2 billion since the start of the Affordable Care Act. And where did it come from? It's the donut hole. The point at which pay for a whole slew of preventive medicine testing. Okay. So you'll find the way you are. And Affordable Care Act didn't affect you at all. Okay. Yeah. Okay. For those of you on the webinar and have brought up the booklet, if you did that, it's page five on the booklet that's on our site there. And for those of you who have the green booklet here, we're referring to page four types of plans. Actually, five. And I'll tell you that the fifth one in a moment, but generally four types of plans. A bronze plan, a silver plan, a gold plan, and a platinum plan. And a meeting in Washington when it was first announced. And honestly, I raised my hand and I said, I would like the titanium plan the one way you pay for everything. Okay. But they haven't developed the titanium plan. The insurer pays 70, you pay 30. And the gold, the insurer pays 80, you pay 20%. And the platinum, the insurer pays 90% and you pay 10%. Okay. Which is South Jersey Cultural Council several years ago to give a talk to that organization. And the talk, I agreed to do it. And then they said, the talk is in a casino in Atlantic City. And I'm dreading it talking. It's hard enough for people are pulling the slot machines. And it hits me that Las Vegas is the perfect place to have a talk on health insurance. And why health insurance on our model is gambling. Right. Is gambling. How lucky do you feel this year? Okay. And how well have you calculated? Okay. How much you're going to assess you go through in deciding whether you're going to get the bronze or the platinum plan. How lucky am I this year? How healthy am I? Do I expect to be in the hospital still going to be put and hopefully these are sisters will be able to help you sort of make a decision about that, you know, where you are. The plan that is traditional American health insurance before insurance used to work before the early 90s and HMOs came in. There's a fifth plan. And that's a so called catastrophic or high deductible plan. But you have to be 30 years old. It's going to be $5,990. Okay. That you'll pay out of pocket before your insurance will kick in at 100%. So that's another that. Yeah, because they're just betting on the fact that they don't go they don't go to the hospital anytime they never go to the doctor never go to the hospital. I'm a good example of that. My freshman year of college I was 18 years on tip in those years I always had health insurance. I made almost no use of the American healthcare system. I just didn't I was lucky a couple years I had the flu or something but I was just there was a I was the insurance company's perfect. The cost of health insurance someone 22 years old in Atlanta, Georgia can probably get a decent plan for $155 a month, maybe even less than that. Okay. I'm 63. That plan I can guarantee to the age of 40. And then after the age of 40, they paid less. And they always said the reason was because women can go into childbirth. What do you think the real reason women pay more for men for health insurance for men usage? That's it. Perfect. Who said that usage? That's right. Completely. Okay. Women women go to the doctor so much often than men do and some so that that's the reason for it. Okay. So anyway, you get a sense of this looking at and hopefully those of you on the webinar can take a look at that that item as well. Sharing plans must limit enrollees out of pocket expenses. This is so significant that it's astonishing really that this is in the law. Plans must limit enrollees out of pocket expenses including the deduct. Why is that significant? It means this no one no one in the United States will any longer have bills of 80,000. Okay. That is gone because your liability will be and it's still high obviously, right? $5,990 and 11,000. But that's it. 2008. The definition of the middle class in the United States is you have people or places to borrow money from. That's it. Okay. You can borrow money is where 47% of all bankruptcies in the United States, the major debt was medical. The thing that they didn't point out in that study is 70% of those people had health insurance. They just had bad health insurance. Okay. That ran out that didn't that didn't cover the it does include a deductible. Okay. Okay. I want to say something to you now about these costs. Okay. I'm going to put my glasses off of this and working in health insurance. I would negotiate rates with large doctors groups in Manhattan. And there was one gastroenterological group. There was about 12 doctors in it. And some of you know that every procedure that takes place has what's called a CPT code. It's a code that spilled on. Okay. And I went into talk to the head doctor thing we do in this office. Okay. So I said, what's the code? And he gives it to me and I look down and I see that we're paying $892 for this code. And I have a feeling it's pretty low. And I'm not going to get this guy to join his group. But I say to him, can you just tell me what you charge for that? And he says, we charge $7,530. And I say to him, we charge 800. We give $892 for that. And he said to me, you know, that's not bad. Now what's happening there? The charge is an illusion. It's just some wild crazy thing. Right? That's been brought up. Okay. The uninsured pay that amount. Nobody else does. The insurers have negotiated rates, Medicaid, Medicare has a negotiated rate. So understand that, okay, when you're confronted with these types of things, particularly if you're uninsured. Well, I don't have that much time, do I? And I have so much to say, I didn't realize and I've gone on like this. And so I'm going to go just quickly through this here. And then what I'm going to do is you have that second sheet on Georgia. Is it possible for people to come up and what I'm going to do is I'm going to switch over to page six in this booklet. Okay, in this green booklet page six. And there it shows you, okay, there's a chart there. So it has the person can pay out of pocket is 2% of their income. 133 to 150% 3 to 4% 150 to 200% 4 points. You see how this works? It's a sliding scale. So you're making $21,000 a year and the limit you're going to 200% of the federal poverty level. Okay, so you're making between 14 and 28 and 14 and let's say 13 $26,000 for a person, your limit will be $1,983 income. So that subsidized. And the second way is you're out of pocket costs because once you reach those out of pocket costs, the insurance kicks in at 100% and there's no more out of that any questions you're going to ask me. We went we already went through the Medicaid and the final thing I want to talk about is the small business tax credit. Okay, if any of you, any of you run a theater, a dance, the definition in order to get that subsidy and if you look on page, excuse me, nine of the booklet businesses with fewer than 25 full-time equivalent now to receive the credit the employer must offer a group health plan and pay at least 50% of the premium. The credit is equal to a percentage of what the employer pays for 2010 to 2013 as a check from the government. If you pay taxes, you're going to get it as a credit beginning in 2014 for a not for profit. It's going to be 35% for a profit. It's going to be 50%. This is almost no arts groups in the United States use it. And I would estimate in the past year or two, the Actors Fund has reached out to dance organizations around the country, asked me about that call me and in the next to last slide is the small business tax credit. It's the place to go to get the form that 99T, which your tax person will be able to fill that out for you. Okay, best questions and yes, a small business for this. Okay, there will be other plans on in the exchange with all these exchanges will have something called a shop SHOP. That's where you're going to look for your health insurance as a okay and sole proprietor. I don't know what it is to be a sole proprietor in Georgia, but you probably file a schedule, see with your taxes as a statement of profit and loss. And then maybe some other elements as well for you to do that. You know better than I do here. Questions. Yes, I remember we're talking about an average amount here. And I said full time employees, I shouldn't have said that it's full time equivalent employees. So you could have 38 employees, but some of them are part time. It just has to come to those number of hours that comes on the internet on the webinar. Thank you. Thanks. Thank you.