hc reform

							  Health Reform:
What It Means to Our
   Community
 Health Reform: Key Provisions


o Provides coverage to 32 million uninsured people by 2019.


o Changes insurance rules to protect consumers.


o Builds on existing employer- and government-sponsored
  insurance programs.

o Tests ways to tie payment of hospitals and physicians
  to quality improvement.
    10 Things to Know
 Health Reform:
10 Things to Know
    Health Reform: The Top 10

1. No lifetime benefit limits and no annual limits on coverage.

2. Coverage cannot be denied coverage based on health status.

3. Dependent adult children can stay on parents’ health
   policy until age 26.

4. No insurance coverage exclusions for pre-existing conditions
   beginning in 2014.

5. Mandates coverage of preventive care.
     Health Reform: The Top 10

6. Coverage cannot be cancelled when someone becomes sick.

7. Limits insurers’ ability to set premiums based on health
   status and other factors.

8. Creates a new marketplace called an insurance exchange
   to help people find insurance.

9. Provides subsidies to help people buy insurance
   through the exchanges.

10. Requires all Americans to have health insurance.
Health Reform:
A Deeper Look

  Health Reform: A
    Deeper Look
What Does Reform
 Mean for Me?

   What does reform
     mean for me?
   Employer-sponsored
            or
    Buying coverage on
        your own
       Employer Coverage



Most individuals with coverage through their
employers should not see substantial changes.

The bill includes incentives for your employer
to offer insurance.
          Buying Coverage on Your Own




Individuals who purchase their own insurance
coverage may:

o Be eligible for coverage through the exchanges.


o Qualify for tax credits to help purchase coverage.
What Does Reform
 Mean for Me?



       Medicare
      Beneficiaries
                        Medicare

Individuals with traditional Medicare coverage should not
see substantial changes, but will receive some additional
benefits.

Additional benefits will include:

o Free preventive screenings such as colonoscopies and mammograms.
o A free annual physical or “wellness” visit.
o Discounts for brand-name prescription drugs.
o A 50% discount on brand-name drugs while in the “doughnut-hole” coverage
  gap.

However, individuals with Medicare Advantage plans may
see changes in their benefits depending on how their
insurance company responds to reduced funding for this type
of plan.
What Does Reform
 Mean for Me?

   What does reform
     mean without
   Individualsfor me?
       Insurance
                     Uninsured

Beginning in 2014, all U.S. citizens and legal
residents must have coverage or pay a penalty.

o Uninsured individuals will have access to coverage through
  insurance exchanges.

o Subsidies will be available to help low-income individuals buy
  private health insurance.
                      Uninsured


o Eligibility for Medicaid is expanded to low-income individuals.


o Starting in 2010, a high-risk insurance pool will be available to
  individuals with pre-existing conditions and early retirees --
  those 55 or older but not yet eligible for Medicare.

    ◦ Every state must set up an exchange by 2014.
    ◦ The high-risk pool expires in 2014 when exchanges and
     rules to prevent insurers from excluding individuals with
     pre-existing conditions are in place.
            Insurance Exchanges

     “Small companies and
  individuals who don’t have
insurance through work will be
  able to purchase insurance
     through newly created
    marketplaces, known as
 insurance exchanges, created
    and regulated by states.

 … Think of it as an Orbitz or
 Travelocity for health care
           plans.”

                 - USA Today
What Does Reform
 Mean for Me?

   What does reform
    Large Employers
     mean for me?
           or
       Small Businesses
   Note: Employers are not required to
           provide coverage.
            Large Employers



Large employers – businesses with 50 or more
employees – will be fined if their employees
purchase health care coverage through the new
exchanges and receive federal help to pay their
premiums.
              Small Employers

Small businesses are eligible for subsidies to offer
insurance and have access to the exchanges.

o Employers with 10 or fewer employees who earn, on average,
  less than $25,000 a year can get a 50% tax credit for
  providing health insurance.

o Employers with 25 or fewer employees who earn, on average,
  less than $50,000 can receive a partial tax credit.
             Health Reform:
            What Happens Next?

                             In 2010
Insurance reforms:
   o No lifetime benefit limits on coverage for all new plans.

   o Appeals process and patient protections for all new plans.

   o Dependent children up to age 26 can remain covered
     under their parents’ plans.

   o Children with pre-existing conditions cannot be denied
     coverage.
            Health Reform:
           What Happens Next?

                             In 2010
Insurance reforms (cont.):

   o New plans cannot cancel coverage for individuals
     if they get sick.

   o No discrimination based on salary for all group
     health plans.

   o Insurers will be required to spend at least 80% of
     all premiums payments on medical services.
             Health Reform:
            What Happens Next?

                               In 2010
Coverage:

   o Establishes a temporary national high-risk insurance pool for
     individuals with pre-existing conditions and early retirees –
     those 55 or older but not yet eligible for Medicare. Once the
     exchanges are in place, this provision will expire.
Quality:

   o Establishes a national strategy to improve the delivery of
     health services and patient health outcomes. Reduction
     of health disparities is a major focus.
             Health Reform:
            What Happens Next?

                                    In 2010

Medicare:

   o Provides a $250 rebate to Medicare beneficiaries who
     reach the prescription drug “doughnut-hole” coverage
     gap in 2010.

   Note: The gap is scheduled to be eliminated by 2020.
              Health Reform:
             What Happens Next?

                           In 2010

Employers:

   o Small businesses can receive tax credits to purchase
     insurance for employees.
             Health Reform:
            What Happens Next?

                           In 2011

Medicare:

   o Beneficiaries receive a 50% discount on brand-name drugs
     while in the “doughnut-hole” coverage gap.

   o Offers a comprehensive health risk assessment.
            Health Reform:
           What Happens Next?

                           In 2013

Families with an annual income above $250,000 will be
required to:

      ◦ Pay an additional 3.8% tax on investment income.

      ◦ Contribute more to the Medicare program
        in payroll taxes.
             Health Reform:
            What Happens Next?

                             In 2014

Most Americans will be required to have insurance coverage or
face a federal penalty:
   o Fine would start at $95 per person, up to $285 per family,
     or 1% of taxable household income, whichever is greater.

Insurance reforms:
Insurers will be prohibited from refusing to sell policies and
there are new limits on their ability to set prices based on health
status.
              Health Reform:
             What Happens Next?

                          In 2014

Employers:

   o Businesses with 50 or more employees must provide
     coverage or pay a penalty.
           Health Reform:
          What Happens Next?


                       In 2016

Penalties would grow to $695 for each family member, up to
$2,085, or 2.5% of taxable income.
               Resources
                  Resources

Kaiser Family Foundation: www.kff.org

Federal government: www.healthreform.gov

AARP: www.aarp.org

Robert Wood Johnson Foundation: www.rwjf.org