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Status of Health Reform Spring 2013

Status of Health Reform Spring 2013. Mt. Sinai Hospital John Bouman President Shriver Center Chicago, IL April 26, 2013. Remember: Current system a big problem. Cost ever-increasing, but access to care decreasing Little choice or control or guarantee of quality

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Status of Health Reform Spring 2013

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  1. Status of Health ReformSpring 2013 Mt. Sinai Hospital John Bouman President Shriver Center Chicago, IL April 26, 2013

  2. Remember: Current system a big problem • Cost ever-increasing, but access to care decreasing • Little choice or control or guarantee of quality • No peace of mind: what if you lose coverage and never get it back? • 50 million uninsured – decreasing employer-based coverage, cost-shift to everyone else • Billions of uncompensated care

  3. Illinois – layers of change • Affordable Care Act (ACA) (2010) Market Reforms Subsidized ins. individuals and small business Fill the Medicaid gap System reforms • Medicaid Reform Act (2011) Care coordination (50% by 2015) Long term care re-balancing Lots of health IT • SMART Act (2012) Cuts

  4. Illinois Status -- general • Quinn Administration committed, supportive, competent specialists but stretched very thin • DHFS leads; DOI, human services agencies • Democrats – strong champions; others timid • Republicans – opposed, but… • Insurance industry strong with both parties • Strong politics around children • Dramatic changes everywhere, and so … Lots of denial Lots of opportunity

  5. ACA Status – market reforms • Pre-existing condition discrimination banned • Lifetime and annual limits • Discriminatory pricing for pre-ex, women • Young adult coverage • “Medical Loss Ratio” • Tax credits for small business • “individual mandate” – penalty if uninsured • “shared responsibility” tax – larger businesses that don’t insure employees

  6. ACA Status: Healthcare Marketplace • Web portal for policies, common language • All plans good insurance • Plans being filed and evaluated now • “Co-op” option – Land of Lincoln • Subsidies for premiums: 100-400% FPL • Subsidies for out of pocket costs • IL will do hybrid federal-state in 2014 • Enrollment October, live January -- DOI will regulate policies sold -- Feds manage subsidies and website

  7. ACA Status – Marketplace Issues Plan: Illinois Marketplace 2015, but… • Wait and see re: hybrid • SB 34 is pending bill -- maybe • Board composition: how much industry? • Powers – how much actual regulation of insurance prices (Mass-Colorado-Utah) • Financing – fees and assessments, not GRF

  8. ACA status: Medicaid Completion • Medicaid gap: 19-64, not disabled or parent • 350,000 at least: young adults, empty nesters, unofficially disabled, veterans • NFIBS.Ct. decision hands it to state politics • SB26: passed Senate, pending House • IHA, Chamber, strong coalition • Republicans? Speaker? • October enrollment; January 2014 “on” date • BIG deal

  9. ACA Status – Cook County Waiver • One year early Medicaid eligibility • Up to 114,000 • Live in Cook County • Age 19-64, not eligible for current Medicaid • Income below 133% FPL ($14,856) • Citizen or 5-year LPR • Have SSN or applied for one • Phone: (855) 671-8883, (312) 864-8200 • But paper application (with assistance) • 2014 folds into statewide expanded Medicaid

  10. Illinois Status – Care Coordination • Medicaid Reform Act of 2011: 50% by 2015 • Lots: 90% in 2014. ITS HERE • Integrated Care Pilot: 40,000 senior and people with disabilities in suburbs • Innovations RFP: Six projects selected, all aimed at “high user” populations -- Medical homes plus network of specialists -- Some include housing and social services • Medical Home Network (parents and kids) • Managed Care contracts to handle “duals”

  11. Illinois Status – Innovations RFP winners • Be Well Partners in Health (organized around long term care) • Healthcare Consortium of IL (community based networks, south suburbs) • Macon County Care Coordination (downstate, features mental health providers) • Precedence Care Coordination (downstate) • Together4Health (Heartland, hard to reach populations, housing and social determinants)

  12. Illinois Status – Long-term Care • Medicaid Reform Act of 2011 emphasis • More community based options • Transition from nursing and institutional care • Three court orders • Capital budget includes funds • Need to build sites • Need to build workforce

  13. Illinois status – Budget cuts • FY 13 budget (now), SMART Act • FamilyCare to 133% from 185% (26,000) • Illinois Cares RX eliminated • DON score and other limits to in-home care • Adult dental eliminated • Some provider rate cuts • Maximus contract – redetermination project • 4 prescription limit (not kids for now)

  14. Illinois Status – food for thought • Make managed care work • Re-define relationships and networks Social services, Case management Housing Legal and advocacy • Prevention: medical home=prevention and wellness and smart use of IT=cost savings • Health IT • Immigration reform

  15. Information Federal: www.healthcare.gov National: www.kff.org, www.familiesusa.org Kids: www.ccf.georgetown.edu Legal: www.healthlaw.org Seniors: www.nsclc.org State: http://insurance.illinois.gov/hiric/ http://www2.illinois.gov/gov/healthcarereform/Pages/default.aspx State NGOs: www.illinoishealthmatters.org Shriver Brief: www.theshriverbrief.org

  16. John Bouman Shriver Center 50 E. Washington, Suite 500 Chicago, IL 60602 (312) 368-2671 johnbouman@povertylaw.org www.povertylaw.org

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