Health Care Reform: What It Means to Our State, Our Communities and Our Hospitals

1. Health Care Reform:What It Means to Our State, Our Communities and Our Hospitals

2. Health Reform: Key Provisions • Provides coverage to 32 million uninsured people by 2019. • Changes insurance rules to protect consumers. • Builds on existing employer- and government-sponsoredinsurance programs. • Tests ways to tie payment of hospitals and physiciansto quality improvement.

3. Coverage TimelineExpands to 32 Million Individuals by 2019 Through: Medicaid Expansion, Exchanges, Premium Subsidies, and Insurance Reform

4. Health Reform: 10 Things to Know

5. 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.

6. 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.

7. Health Reform: A Deeper Look

8. What Does Reform Mean for Me? Employer-sponsored or Buying coverage on your own

9. Employer Coverage Most individuals with coverage through their employers should not see substantial changes. The bill includes incentives for your employer to offer insurance.

10. Buying Coverage on Your Own • Individuals who purchase their own insurance coverage may: • Be eligible for coverage through the exchanges. • Qualify for tax credits to help purchase coverage.

11. What Does Reform Mean for Me? Medicare Beneficiaries

12. Medicare • Individuals with traditional Medicare coverage should not see substantial changes, but will receive some additional benefits. • Additional benefits will include: • Free preventive screenings such as colonoscopies and mammograms. • A free annual physical or “wellness” visit. • Discounts for brand-name prescription drugs. • 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.

13. What Does Reform Mean for Me? Individuals without Insurance

14. Uninsured • Beginning in 2014, all U.S. citizens and legal residents must have coverage or pay a penalty. • Uninsured individuals will have access to coverage through • insurance exchanges. • Subsidies will be available to help low-income individuals buy • private health insurance.

15. Uninsured • Eligibility for Medicaid is expanded to low-income individuals. • 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.

16. 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

17. What Does Reform Mean for Me? Large Employers or Small Businesses Note: Employers are not required to provide coverage.

18. 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.

19. Small Employers • Small businesses are eligible for subsidies to offer insurance and have access to the exchanges. • 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. • Employers with 25 or fewer employees who earn, on average, • less than $50,000 can receive a partial tax credit.

20. At the Hospital • Hospitals in Iowa will face many challenges with the new health care reform law, but support methods that would provide coverage to people who don’t have it. • Hospitals will be changing the way care is delivered to be more efficient. • Hospitals will be working to continue to find cost-effective ways to provide, high quality health care. • Iowa hospitals are in a good position. Iowa has a relatively low uninsured population at about 10 percent. • Health care in Iowa ranks 2nd best in the nation.

21. Health Reform:Immediate Reforms • Last Year • Insurance reforms: • No lifetime benefit limits on coverage for all new plans. • Appeals process and patient protections for all new plans. • Dependent children up to age 26 can remain covered • under their parents’ plans. • Children with pre-existing conditions cannot be denied • coverage.

22. Health Reform:Immediate Reforms • Last Year • Insurance reforms (cont.): • New plans cannot cancel coverage for individuals • if they get sick. • No discrimination based on salary for all group • health plans. • Insurers will be required to spend at least 80% of • all premiums payments on medical services.

23. Health Reform:Immediate Reforms • Last Year • Coverage: • 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: • Establishes a national strategy to improve the delivery of health services and patient health outcomes. Reduction of health disparities is a major focus.

24. Health Reform:Immediate Reforms • Last Year • Medicare: • 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.

25. Health Reform:Immediate Reforms • Last Year • Employers: • Small businesses can receive tax credits to purchase • insurance for employees.

26. Health Reform:What Happens Next? • In 2011 • Medicare: • Beneficiaries receive a 50% discount on brand-name drugs • while in the “doughnut-hole” coverage gap. • Offers a comprehensive health risk assessment.

27. 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.

28. Health Reform:What Happens Next? • In 2014 • Most Americans will be required to have insurance coverage or face a federal penalty: • 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.

29. Health Reform:What Happens Next? • In 2014 • Employers: • Businesses with 50 or more employees must provide coverage or pay a penalty.

30. 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.

31. Resources Resources Kaiser Family Foundation: www.kff.org Federal government: www.healthreform.gov AARP: www.aarp.org Robert Wood Johnson Foundation: www.rwjf.org

32. IHA Resources • Web – www.ihaonline.org • Blog – blog.iowahosptial.org • Facebook – facebook.com/iowahospital • Twitter – twitter.com/iowahospital