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Health Care Reform & The Uninsured in California

Health Care Reform & The Uninsured in California. Presented by: Phil Lebherz, with Ankeny Minoux.

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Health Care Reform & The Uninsured in California

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  1. Health Care Reform & The Uninsured in California Presented by: Phil Lebherz, with Ankeny Minoux All information published herein is gathered from sources which are thought to be reliable, but the reader should not assume that the information is official or final. Reliance on this information or other linked or recommended resources received from LISI shall be at your sole risk, and LISI assumes no responsibility for any errors, omissions, or damages arising. Users of this information are encouraged to confirm with other sources, and to seek qualified advice if embarking on any actions that could carry personal or organizational liabilities.

  2. Agenda • Health Care Reform Legislation Overview • The Uninsured in California – Positive Progress • Keynote: Phil LebherzPerspective on Legislation and the Future of Health Insurance • Q & A

  3. Legislative Timeline March 23rd, 2010: Patient Protection and Affordable Care Act March 30th, 2010: Health Care and Education Reconciliation Act of 2010

  4. Approaches to Expanding Coverage

  5. Individual Mandates and Subsidies

  6. Individual Tax Consequences

  7. Employer Mandates • Employers with 50 or fewer EEs are exempt • Employers with >50 EEs who do notoffer coverage • Employers with >50 EEs who dooffer coverage • Employers with >200 EEs to automatically enroll their employees

  8. Small Business Tax Credits • For employers with up to 25 employees • 2010-2013, up to 35% tax credit • 2014 and beyond, up to 50% tax credit

  9. Insurance Exchanges

  10. Changes to Private Insurance • Temporary High Risk Pool (2010) • Insurance Exchanges (2014) • Carriers’ Medical Loss Ratios • 80% for small group (100 and below) • 85% for large group. • Premium increase review process • Excise tax on “Cadillac” plans

  11. Changes to Private Insurance • No lifetime limits • Dependent coverage to age 26 • No rescinding except in cases of fraud • No pre-existing on children (2010), everyone (2014) • No experience rating

  12. Changes to Private Insurance • Deductibles not to exceed $2,000/$4,000 • Limit waiting periods to 90 days • Allow states to merge IFP & small group • SG definition changes to 2-100

  13. ‘Grandfathering’ Provision Current Plans unaffected by mandates • Only Changes Allowed: • Add or delete new employees/dependents • Part of collective bargaining agreement • Exceptions: • No waiting periods over 90 days • Prohibition on Lifetime Limits • New standard for recissions • Dependent coverage to age 26 • Certain annual limits (group only)

  14. Financing - Taxes • ‘Cadillac Plan’ Tax • Insurer Fees • Health Insurers - $8B (2014) - $14.3B (2018) + • Pharma - $27B • Medical Device - $20B • Medicare Payroll Tax • .9% increase for wages > $200k/$250k • Tax now applies to unearned income • Tanning Services – 10% tax

  15. Timeline for Change - 2010 • Temporary National High Risk pool created • Tax credits for small employers • Dependent coverage increased to age 26 • Remove Lifetime limits & prohibit pre-existing exclusion for children • Minimum Preventive service level w/o cost sharing • Establish premium increase review process • $250 Rebate for Medicare beneficiaries

  16. Timeline for Change - 2011 • Excludes OTC Rx from HSA/HRA/FSA distributions • Increase tax on distributions from HAS/FSA not used for qualified medical expenses to 20%

  17. Timeline for Change - 2013 • CO-OP program for non-profit member run insurance companies • Operating rules for Health Insurance administration • Increase itemized deduction to 10% • Limit FSA contributions to $2500

  18. Timeline for Change - 2014 • Require health coverage • End exclusions for adults with pre-existing conditions • Assess LG employers for not offering coverage • Create State-based Exchanges for IFP and SG • Require GI coverage for SG market and Exchanges • Reduce OOP limits for lower income members • Limit Deductibles to $2000/$4000

  19. Timeline for Change – 2014(cont…) • Limit waiting period to 90 days • Create essential health benefits package • Allow states to merge IFP and SG markets • Require carriers to meet new operating standards and reporting requirements • Expand Medicaid to all individuals under age 65 under 133% FPL • Impose fees on the health insurance sector

  20. Timeline for Change – 2015 and later 2016 • Permit states to form health care choice compacts and allow insurers to sell policies in any state participating in the compact 2018 • Impose an excise tax on insurers of employer-sponsored health plans with high values

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