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Dan M. Gibson Executive Director, MASI

Dan M. Gibson Executive Director, MASI. Never the Twain Shall Meet?? Health Reform’s Impact on Workers’ Comp. February 8, 2011 A brief history of the Patient Protection and Affordable Care Act. Never the Twain Shall Meet?? Health Reform’s Impact on Workers’ Comp. February 8, 2011

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Dan M. Gibson Executive Director, MASI

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  1. Dan M. Gibson Executive Director, MASI

  2. Never the Twain Shall Meet??Health Reform’s Impact on Workers’ Comp February 8, 2011 • A brief history of the Patient Protection and Affordable Care Act.

  3. Never the Twain Shall Meet??Health Reform’s Impact on Workers’ Comp February 8, 2011 • A brief history of the Patient Protection and Affordable Care Act. • How Health Reform will affect people and businesses.

  4. Never the Twain Shall Meet??Health Reform’s Impact on Workers’ Comp February 8, 2011 • A brief history of the Patient Protection and Affordable Care Act. • How Health Reform will affect people and businesses. • What does this mean for Workers’ Comp?

  5. The Patient Protection and Affordable Care Act…A Brief History. • For years the Rising Cost of Health Insurance has been a popular political issue…

  6. The Patient Protection and Affordable Care Act…A Brief History. • The Inflation Rate in Healthcare has steadily outpaced Regular Inflation… by as much as DOUBLE…

  7. Healthcare Costs Soar Above Overall Inflation John Commins, for HealthLeaders Media, October 22, 2010 The average, per capita cost of providing healthcare services in the United States rose by 7.32% for the past 12 months ending in August, a rate of inflation wildly above the 1.1% overall inflation for the same period, according to new study by Standard & Poor's. The new numbers are consistent with a trend that from August 2000 to August 2010 has seen healthcare inflation rise 48% while overall Consumer Price Index has risen 26% for the same period, U.S. Bureau of Labor Statistics data show.

  8. The Patient Protection and Affordable Care Act…A Brief History. • AS A RESULT, HEALTHCARE BECAME A PIVOTAL ISSUE IN THE 2008 PRESIDENTIAL ELECTION…

  9. President Obama Promised He Would Give Us Healthcare Reform. • President Obama’s electoral platform identified the high cost of health insurance, administrative and overhead costs, and inefficiencies stemming from reliance on a paper-based system as the primary factors making health care unaffordable and inaccessible to many Americans. www.friedfrank.com

  10. President Obama Promised He Would Give Us Healthcare Reform. • In his inaugural address, President Obama stated: “That we are in the midst of a crisis is now well understood . . . . Homes have been lost, jobs shed, businesses shuttered. Our health care is too costly.” www.friedfrank.com

  11. President Obama Promised He Would Give Us Healthcare Reform. • The new President pledged that his administration “will restore science to its rightful place and wield technology’s wonders to raise health care’s quality and lower its costs.” www.friedfrank.com

  12. President Obama Acts on His Promise… • In a joint address to Congress on February 24, 2009, just one month into his presidency, President Obama lays out his agenda for the administration. "We can no longer afford to put health care reform on hold. ... I suffer no illusions that this will be an easy process," he says. U.S. News and World Report

  13. President Obama Acts on His Promise… • On March 5, 2009, President Obama holds a health care summit with lawmakers and health care executives. He warns liberals in his party, such as the liberal lion Sen. Edward Kennedy, that costs must be controlled. "We've got to balance heart and head as we move this process forward," he says. U.S. News and World Report

  14. Industry leaders respond… • By the end of March, 2009, the nation’s health insurers say they would no longer deny coverage to those with pre-existing medical conditions — if everyone were required to buy insurance. It is one of many deals with key health care stakeholders, including hospitals and pharmaceutical companies, in an attempt to reach a lasting consensus. U.S. News and World Report

  15. Congressional leaders get on board… • By the end of October, 2009, House Democratic leaders combine three committee bills into a single piece of health care legislation that would cover 36 million uninsured Americans by 2019. It includes a public option. House Majority Leader Steny Hoyer, D-Md., says, “We are one step further on a long, hard road.” U.S. News and World Report

  16. Congressional leaders get on board… • By early 2010, several bills have passed various hurdles, but public opinion continues to be divided. On February 22, 2010 President Obama releases his proposal for a complete reform of healthcare. A summit of Congressional leaders is held at Blair House three days later. U.S. News and World Report

  17. The President makes history on March 23, 2010… Obama signs health-care reform bill By Scott Wilson Washington Post Staff Writer "Today, after almost a century of trying; today, after over a year of debate; today, after all the votes have been tallied -- health insurance reform becomes law in the United States of America," he said. "Today." Minutes later, sitting at a small desk surrounded by congressional leaders and some of the Americans whose problems he highlighted in speeches, Obama turned the most contentious bill in recent memory into law with his left-handed signature. He used 22 pens to do so, adding what his Democratic supporters say is another strand in a widening social safety net designed to protect those living in the world's wealthiest society.

  18. The Patient Protection and Affordable Care Act… It is now law.

  19. How Health Reform Will Affect People and Businesses. • Beginning in 2014 Americans will be required by law to have health insurance and attach proof of insurance to their tax returns. What Does Health Reform Mean for You? - NCPA

  20. How Health Reform Will Affect People and Businesses. • If you fail to insure, you will be fined – with the penalty rising to $695 ($2,085 per family) in 2016 or 2.5% of your adjusted gross income, whichever is greater. What Does Health Reform Mean for You? - NCPA

  21. How Health Reform Will Affect People and Businesses. • If your employer fails to offer you health insurance, your employer can be fined as much as $2,000 per employee per year. What Does Health Reform Mean for You? - NCPA

  22. How Health Reform Will Affect People and Businesses. • The type of insurance you must have – including co-pays, deductibles and the employee’s share of the premium – will all be determined by federal regulations, rather than by you and your employer. What Does Health Reform Mean for You? - NCPA

  23. How Health Reform Will Affect People and Businesses. • If you are not covered by an employer plan, Medicare, Medicaid or other government plan, you will be required to buy insurance in a government-regulated health insurance exchange, where competing insurers will offer the government-mandated health insurance benefit package. What Does Health Reform Mean for You? - NCPA

  24. How Health Reform Will Affect People and Businesses. • How your doctor practices medicine and how you obtain care are likely to substantially change. What Does Health Reform Mean for You? - NCPA

  25. But it’s not all bad… • You may be able to buy insurance you cannot now afford. Beginning in 2014, for example, a couple with an income of twice the poverty level (currently $29,000) will be able to buy insurance for an annual premium no higher than 6.3% of their income ($1,827). What Does Health Reform Mean for You? - NCPA

  26. But it’s not all bad… • If you have a pre-existing condition, you will be able to buy insurance for the same premium as that paid by people in good health. What Does Health Reform Mean for You? - NCPA

  27. But it’s not all bad… • Over the next four years, newly created risk pools will offer subsidized insurance to some of the people who have been turned down by health insurers because of a pre-existing condition. What Does Health Reform Mean for You? - NCPA

  28. But it’s not all bad… • If you have a very expensive and continuing health problem, there will be no lifetime limits on your health insurance coverage. What Does Health Reform Mean for You? - NCPA

  29. UNTIL YOU COUNT UP THE COSTS… CBO: Obamacare Would Cost Over $2 Trillion By JEFFREY H. ANDERSON The Weekly Standard weekly newsletter. The CBO’s most recent analysis is out, and it’s not likely to convince wavering House Democrats to jump to the Obamacare side of the fence.  Even the Democrats are granting that the latest version of their proposed health care overhaul would cost $69 billion more than the previous version.  According to the CBO, this version would siphon even more money out of Medicare, make even further cuts to Medicare Advantage, and levy even higher taxes and fines on the American people. President Obama, Speaker Pelosi, and their allies, are cheerfully citing “ten year” costs of $940,000,000,000.00 — apparently believing this to be a far more palatable figure than $1 trillion.  But even this colossal tally is like the introductory price quoted by a cell phone provider.  It’s the price before you pay for minutes, fees, and overcharges — and before the price balloons after the introductory offer expires. 

  30. AND CONSIDER THE SURGE IN DEMAND... • Medicare benefits are likely to decrease while the cost of Medicare is likely to increase. • Overwhelmed clinics and doctors are likely to get worse, and the time spent waiting for appointments and procedures is likely to become unreasonably long. • The United States currently leads the world in time spent with the doctor, number of people seeking preventative care, and accessibility of medical care. • An over-utilized system is likely to crush under the demand, and overall healthcare is like to suffer. What Does Health Reform Mean for You? - NCPA

  31. AND FACTOR IN THE COST TO EMPLOYERS DURING A DOWN ECONOMY… • In weighing the costs of complying with Obamacare, some employers are considering laying off workers and automating their workplaces. • The cost of automation is cheaper in some cases than compliance. • This means thousands if not millions of Americans in time may lose their jobs because of Health Reform. MASI Fall Conference, Health Care Symposium, October 1, 2010

  32. So … What Does this Mean for Workers’ Comp?

  33. Health Reform Will Affect Workers’ Comp… • Availability of care will be an issue. With a large number of people having new health coverage, doctors and facilities may be swamped in some areas. The problem will lead to: • (a) delays in appointments for workers compensation-related medical treatments and • (b) less willingness by providers to participate in occupational medical networks and offer discounts off fee schedules. WorkersCompInsider.com

  34. Health Reform Will Affect Workers’ Comp… • There could be a benefit…. For example, one provision of the new law allows health insurers to charge smokers 50 percent more for health insurance coverage. Another provision provides that employees enrolled in a company wellness program or meeting certain health standards may obtain a 30 percent reduction in health insurance premiums. In theory, as a result of these provisions, employee health will improve, which will result in fewer workers’ comp claims. HRHeroOnline.com

  35. An effort to Reform Workers’ Comp Nationally is Already Underway…. Congressman Seeks National Review of State Workers’ Compensation Laws The Insurance Journal.com Congressman Joe Baca, D-Calif., has introduced legislation that would authorize the creation of a National Commission on State Workers’ Compensation Laws. Baca’s National Commission on State Workers’ Compensation Laws Act would establish a separate body to evaluate state workers’ compensation laws in order to determine if they provide an “adequate, prompt and equitable” system for injured workers. “More than 35 years have passed since our government took a serious look at the effectiveness of workers’ compensation laws,” said Rep. Baca. ”Access to proper benefits and medical care after on the job injuries is a right every American worker deserves. I am hopeful this legislation will bring us closer to updating and modernizing our state workers’ compensation laws to ensure they remain effective in this new century.” In 1972, a national commission authorized by the Nixon administration made numerous recommendations and set minimum standards. June 2009

  36. But the law is not set in stone yet…

  37. But the law is not set in stone yet… Judge Rules Health Care Law Is Unconstitutional Published January 31, 2011 FoxNews.com A U.S. district judge on Monday threw out the nation's health care law, declaring it unconstitutional because it violates the Commerce Clause and surely reviving a feud among competing philosophies about the role of government.  Judge Roger Vinson, in Pensacola, Fla., ruled that as a result of the unconstitutionality of the "individual mandate" that requires people to buy insurance, the entire law must be declared void.  "I must reluctantly conclude that Congress exceeded the bounds of its authority in passing the act with the individual mandate.”

  38. One thing is for sure… Obamacare is Confusing!

  39. There is a need among MASI members for help… • Many large employers, who traditionally have looked to MASI for help in workers’ comp, are now struggling to understand the changes now taking place as a result of Health Reform.

  40. There is a need among MASI members for help… • The possible implications of all of this are enormous. Large employers could be greatly impacted by the mandatory changes in healthcare – and costs could escalate considerably.

  41. How MASI will respond… • MASI has decided to increase the focus of its mission. In addition to being an advocate for self-insured Workers’ Comp, MASI will now become an advocate for Self-Insured Health.

  42. Our Mission • The Mississippi Association of Self-Insurers, MASI, is committed to representing the interests of the self-insured workers’ comp and health community by promoting knowledge and providing advocacy in legislative and regulatory arenas.

  43. Stay Tuned… Exciting times are ahead…

  44. Dan M. Gibson Executive Director, MASI

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