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									Welcome to CheckPoint HR’s Educational Forum on
Health Care Reform in America - Overview of Proposals and Related Issues

Congressman Rush D. Holt – Honored guest
Patrick Carragher – V.P. Benefits, CheckPoint HR
Rachel Smith – Corporate Communications, Martin Financial Group

                                                                           PAY R O LL


   Key Points
    • Legislative Process
    • Comparison of the Leading Proposals
    • Funding
    • Existing Plans – “Keep If You’re Happy”
    • Public Option
    • Summary

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   Overview of the Proposals

          House Bill, H.R. 3200 (Dingell)

          Senate Health, Education, Labor and
           Pensions (HELP) Committee Bill (Kennedy)

          Future Consideration
             Senate Finance Committee Bill (Baucus)
             H.R. 676 – Single Payer Bill (Conyers/Kucinich)

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                    Legislative Process
         House of Representatives                                      Senate

       7/14/09: Bill Introduced                         June/July 2009: Senate drafting separate version
              Bill Introduced                              Senate Introduces Bill –OR-
       7/15/09: Referred to Committee                         Sen. Baucus(Finance): in progress
       7/17/09: Report from Congressional
                                                                     Consideration of House
                                                            SenateKennedy(Health): passed July 15
       BudgetAssignment and the staff of the
               Office (CBO)                                 Bill
                                                        Future: Finance Committee Reviews and Markups
              Hearing Session
       Joint Committee on Taxation                         Committee Assignments
              Markup Session
       ONGOING: Revisions from Committees                  Hearing Session
             Committee Vote
            Energy & Commerce (Waxman)                     Markup Session
            Ways & Means (Rangel)
                                                           Committee Vote
            Education & Labor (Miller, Andrews, Holt)
                      HOUSE VOTE                          SENATE VOTE

                                             FINAL BILL

                               PRESIDENT SIGNS INTO LAW
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                       Leading Bills - Comparison
                                       House Bill                  Senate HELP Bill

      Sponsors         Dingell                             Kennedy

      Proposed         94% of Population                   97% of Population

      Pooling          Health Insurance Exchange:          Health Benefit Gateway:
      Mechanism        -Individuals and Small Businesses   Voluntary Participation
                       -Larger Business Later?

      Government       Public Option                       Community Health Insurance Plan

      Cost             Cost: $1.5 Trillion (10-Years)      Cost: $615 Billion (10-Years)

      Proposed         •Income Taxes on Wealthy            •Details Provided by Senate
      Funding          •Businesses Tax Increases            Finance Committee
                       •Cuts to Medicare/Medicaid
                       •Penalties – Indiv./Businesses

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                  Senate Finance Committee
            Proposed Savings and Revenue Options

               Tax Implications
                 Tax Employer and Government Contributions to Health Care
                 Taxes on Lifestyle Items (Soda, Juice, Beer, etc.)
                 Reduce/Discontinue Medical Exp Deductions on Returns

               CDHP Changes
                 HSA: Limit Contribution to Deductible Amount
                 Increase Penalty on Non-Qualified Disbursements
                 HRA, FSA: Tax Part/All Contributions
                 No Reimbursement for OTC Drugs

               Medicare/Medicaid
                 Increase Rebates From Drug Companies
                 Impose Cost-Sharing on Medicare Supplemental Plans
                 Base Medicare Premiums on Income (mainly Part D)
                 Review/Adjust Charity Care Funds/Provider Rates

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                                        Leading Bills - Comparison
                                                 House Bill                  Senate HELP Bill

          Individual Mandate                     2.5% Penalty                $750 Penalty

          Employer Pay or Play                   8% of Annual Payroll*       $750 (FT), $375 (PT)
                                                 72.5% Premium – single      60% Premium
                                                 65% Premium – family

          EXEMPT Employers                       <$250K ($500K) Payroll      25 or Less Employees
                                                 Tax Credits Available       Tax Credits Available
          Premium Subsidies                      Sliding Scale               Sliding Scale

          Essential Benefits Package             •No Cost Preventative       •No Cost Preventative
                                                 •Dental/Vision (Children)   •Coverage Until Age 26
                                                 •No Caps (Annual/Life)      •No Caps (Annual/Life)
                                                 •No Pre-Ex Cond. Excl.      •No Pre-Ex Cond. Excl.
                                                 •Guaranteed Coverage        •Guaranteed Coverage

          Medicaid Expansion                     Incomes Up To 150% FPL      Incomes Up To 133% FPL

          *Sliding Scale for Smaller Employers

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          House Amendments - Examples
          Small Employer Benefit Arrangements (SEBA)
           1 Million+ Small Businesses Eligible (8.5 Million Workers)
           Small Businesses and Self-Employed:
               Share Resources
               Spread Risk
               Provide Collective Power in the Health Exchange
           Advantages:
               Lower Costs Due to Size/Efficiency
               Information, Expertise, Advocacy Services

           Unity Reform Package and Blue Dogs Amendments
            Reduce Subsidy Levels in Exchange (BD)
              Expand Small Business Exceptions from Pay or Play Requirement (BD)
              Simplify Medicare Admin Procedures, Put Savings to Low-Income Subsidies (U)
              Require All Exchange Plans to Get Approval for Higher Premium Increases
              Negotiate Part D Rx Prices
              Public Option Must Negotiate Provider Rates (Same as Private Plans)
              Public Option Must Use Drug Formulary (Cost Control)

           Source: House Energy and Commerce Committee Amendments

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                                       Current Plans
                “Keep Your Plan If You’re Happy With It”

                     House Bill                            Senate HELP Bill

     No Enrollment Except Dependents           Enroll Dependents and New Employees

      No Change in Cost-Sharing               Does Not Have to Comply With New
      Premiums Can Increase                   Standards
      Conform to Standards:
             Guaranteed Issue/Renewal
             No Health Condition Exclusions
             No Annual/Lifetime Limits
             Rates Based on Only a Few

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           Public Plan - Comparisons
                                         House Bill                       Senate Bill
           Plan Types      Basic, Enhanced, Premium, Premium   At least Basic

           Premium         Based on Area                       Must Be Sufficient to Cover Costs

           Funding          $2 Billion Startup (90 Days        Startup Funds (90 Days
                             Claim Reserves)                     Claim Reserves)
                            10-Year Payback Schedule           10-Year Payback Schedule

           Providers        Medicare Rates                     Negotiated Rates
                            Incentives to Participate

           Enrollment      CBO Projects Only 3% of Americans
                           Will Enroll By 2019

           Other           Ombudsman, Benefits Administrator   Non-profit Entities to Administer

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   CO-OPS: Public Option Alternative
   Sen. Kent Conrad (D-N.D.)

                 Consumer-Owned Nonprofit Cooperatives

               Competitor to Private Insurers

               Initial Government Funding: $3-4 Billion

               Operate Under National Structure With State
                Affiliates, Independent of Government

               Required to Maintain Financial Reserves

               Would Risk Pool Be Large Enough to Compete???

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        GOVERNMENT –
        White House Site:
        House Bill (Full Text):
        House Energy and Commerce Committee:
        House Education and Labor Committee:
        House Ways and Means Committee:
        Senate HELP Bill (Full Text):
        Senate HELP Committee:
        Senate Finance Committee:
        Congressional Budget Office:

        RESEARCH -
        Kaiser Family Foundation:
        Health Reform Legislation Process:

        OTHER –
        Examples of Impact of Health Care Measures:

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               Similarities to NJ Small Group Mandates

               Funding and Ultimate Affordability In Question

               Public Option – Will It Be Included?

               Revisions Still Forthcoming

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                       Thank You.
Recording of Educational Forum and Materials will be available

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