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Health Care Reform Bill What it means for Colorado.ppt

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					Health Care Reform Bill:
      A Summary
  (of opportunities!)
       Tom Bost MD
         HCACF
         4/17/10
Health Care Reform Bill Summary:
          Tom’s Menu
• Handout: the details
• Presentation: the highlights
• Focus: on Colorado specifically
  – on the timing/process of implementation
  – What and how much is “plastic”
  – Set up context for Elinor and Jim
• Links: www.KFF.org
        – DPC.SENATE.GOV/DPCDOC-
          SEN_HEALTH_CARE_BILL.CFM
        Health Care Reform Bill:
           The Bottom Line
• “Implementation is forever…”
   – Drew Altman, CEO of Kaiser Family
     Foundation
• “The real solution here is a legislative fix so all
  players in the industry can act according to a
  clear set of rules”
   – Wm Schiffbauer, Lawyer for AHIP
• This is only the beginning…
Health Care Reform Bill Summary
 Title I: Quality, Affordable Health Care for (almost) All
 Title II: Role of Public Programs
 Title III: Improving Quality/Efficiency of Health Care
 Title IV: Prevention of Chronic Disease/Public Health
 Title V: Health Care Workforce
 Title VI: Transparency and Program Integrity
 Title VII: Improving Access to Innovative Therapies
 Title VIII: CLASS Act
 Title IX: Revenue Provisions
 Title X: Reauthorization of Indian Health Act
 Editorial comments in pink…
Health Care Reform Bill Summary:
       Where’s Our Beef?
 Title I: Quality, Affordable Health Care for (almost) All
   *state based exchange options (CO-OP, Basic Plan)
 Title II: Role of Public Programs
   *state based expansion of Medicaid
 Title III: Improving Quality/Efficiency of Health Care
 Title IV: Prevention of Chronic Disease/Public Health
 Title V: Health Care Workforce
 Title VI: Transparency and Program Integrity
   *state oversight/regulation; multi-state options
 Title VII: Improving Access to Innovative Therapies
 Title VIII: CLASS Act
 Title IX: Revenue Provisions
 Title X: Reauthorization of Indian Health Act
Health Care Reform Bill Highlights:
 Title I: Quality, Affordable Care
•   Implications for citizens
•   Implications for employers
•   Implications for states
•   Federal programs with state implications
•   The plans themselves
Health Care Reform Bill Highlights:
 Title I: Quality, Affordable Care
• Implications for citizens:
  – Must buy insurance or pay penalty
  – Sliding scale for premium assistance and out of
    pocket limits based on Fed. Poverty Line
  – FPL=$10k individual; $22k family of 4
  – Deductibles limited to $2k individ/$4k family
  – Can opt out if premium >8% of income
  – Catastrophic only coverage available for <30 and/or
    those who do not meet criteria
  Massachusetts experience
Health Care Reform Bill Highlights:
 Title I: Quality, Affordable Care
  Implications for Individual citizens:
    • <133% FPL get enrolled into Medicaid
    • 133% FPL ($14k) 4% premium $290 + $2000 max
      out of pocket 1/3 HSA limit
    • 200% FPL ($21k) 4% premium $440 + $2000 max
      out of pocket 1/3 HSA limit
    • 300% FPL ($32k) 8% premium $1320 + $3000
      max out of pocket ½ HSA limit
    • 400% FPL ($43k; Colo. Median 50k) 8% premium
      $2090 + $4000 max out of pocket 2/3 HSA limit
96% of uninsured Coloradoans <400% FPL
Health Care Reform Bill Highlights:
 Title I: Quality, Affordable Care
  Implications for citizens: Family of 4:
   • <133% FPL ($29k): get enrolled into Medicaid
   • 133% FPL ($29k): 4% premium $1160 + $4000
     max out of pocket--1/3 HSA limit
   • 200% FPL ($44k) 4% premium $1760 + $4000
     max out of pocket—1/3 HSA limit
   • 300% FPL ($66k) 8% premium $5280 + $6000
     max out of pocket—1/2 HSA limit
   • 400% FPL ($88k) 9.5% premium $8360 + $8000
     max out of pocket—2/3 HSA limit
Health Care Reform Bill Highlights:
 Title I: Quality, Affordable Care
Implications for employers:
• >200 employees: must provide insurance
• <50 employees: need not provide insurance
  (though tax break if they do)
• 50-200 employees: don’t have to provide
  insurance, BUT if even one of their employees
  qualifies for premium subsidies, they pay penalty
  per total # employee - 30
Health Care Reform Bill Highlights:
 Title I: Quality, Affordable Care
Implications for states:
• Greatly expand Medicaid
• May choose to create Basic Health Plan (eg
  Medicaid-like) for citizens 133-200% FPL
• Must create AND administer:
     -Health Exchange for Individuals
     -Exchange for Small Businesses (SHOP)
Health Care Reform Bill Highlights:
 Title I: Quality, Affordable Care
 Fed Programs impacting State Exchanges:
 •2 OPM created multi-state (“national”) plans
     --one must be non-profit
 •CO-OP: consumer operated and oriented plan
     --non-profit, Federal grant sponsored
     --by July 2013; cannot exist now
 •Regulate Health Care Choice Compacts
     --allows plans to be offered in other states but
     subject only to the regulations of the state of origin
Health Care Reform Bill Highlights:
 Title I: Quality, Affordable Care
• The plans themselves
  – Guaranteed issue/renewability
       • no pre-existing conditions/rescissions
  –   Limits on out of pocket expenses/deductibles
  –   Limits on ratings (age 3:1; smoke 1.5:1)
  –   State determined essential package elements
  –   Free preventative services
  –   Limited abortion coverage
  –   Streamlined application form/process
  –   Standardized information
Health Care Reform Bill Highlights:
 Title I: Quality, Affordable Care
The plans themselves:
• Various levels:
  –   Bronze: 60% coverage
  –   Silver: 70%
  –   Gold: 80%
  –   Platinum: 90%
• NO Maximum life time/yearly benefits
• Must cover dependents up to age 26
• Catastrophic only: <30 yr old or exempt
Health Care Reform Bill Highlights:
 Title II: Role of Public Programs
• Changes in Medicaid
• Changes in Medicare
    – Gradual closing of donut hole
    – Create Independent Payment Advisory Board
•   SCHIP
•   High risk pool program
•   Re-insurance program
•   Community Health Center support
Health Care Reform Bill Highlights:
Title III: Improving Quality of Health
                  Care
• Grants to states to develop tort reform
• Community based collaborative care
  network program (for un/underinsured)
• Collection of data on disparities
Health Care Reform Bill Highlights:
 Title IV: Public Health/Prevention
• Grants for evidence- and community-
  based programs
• Employer wellness programs
  – Good idea in theory
  – Possible area for abuse/gouging
Health Care Reform Bill Highlights:
 Title V: Health Care Workforce
• Grants to:
  – enhance primary care/underserved areas
  – Primary care models
• Obvious tie-in to existing Colorado entities
  – San Luis Valley consortium
  – Grand Junction network
Health Care Reform Bill Highlights:
      Title VI: Transparency
• State exchanges
• State ombudsman
  – Consumer protection/advocacy
  – Dispute arbitration
• State regulation of Insurance industry
  – Share reports on claims/denials etc
  – Justify rate hikes
  – prove that 80-85% of premiums go to services
Health Care Reform Bill Highlights:
   Title VIII: Community Living Assistance
       Services, Supports (CLASS Act)
• Medicaid program (therefore state
  determined)
• Encourage community based (vs.
  institutional care) for those at risk
  – Up to $50/day for non-medical expenses to
    maintain community residence
Health Care Reform Bill Highlights:
  Title IX: Revenue Provisions
• Projected cost: $938 billion/ten years
• Projected savings: $124 billion reduction in
  budget over ten years
• PALES IN COMPARISON TO SINGLE
  PAYER (Lewin Group 2008: 1.4 billion/yr
  for Colorado alone)
       Health Care Reform Bill:
         In Summary, then:
• “Americans will always do the right thing… only
  after exhausting all the other possibilities”
   – Winston Churchill
• “If we believe leaders must be just, violence
  muzzled, power accountable and the riches of
  the Earth shared equitably, such a world will
  come to pass. I am not deceived. It is the
  hardest of worlds to make real. Torturous
  advances won over generations can be lost by a
  s single stroke of myopic president’s pen or a
  vainglorious general’s sword” –David Mitchell

				
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posted:10/15/2012
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