Overview of the Patient Protection and Aff

1. Overview of thePatient Protection and Affordable Care Act of 2010 For CWA Leaders April 2010 This presentation is an overview of the Patient Protection and Affordable Care Act of 2010. We will focus mainly on those issues that impact CWA members and retirees. This presentation is an overview of the Patient Protection and Affordable Care Act of 2010. We will focus mainly on those issues that impact CWA members and retirees.

2. Though this is not the bill CWA would have authored if allowed to do it our way, it is a major step forward. And it was a tough fight. It was a fight against special interest groups like the insurance industry, pharmaceutical companies, and against nay-sayers and obstructionists like the teabaggers. It was a tough fight to protect our members and retirees benefits, to improve the situation at the bargaining table and to pave the way to progress toward health care for all. There are many provisions that will move our nation forward � achieving our key principles for reform. Though this is not the bill CWA would have authored if allowed to do it our way, it is a major step forward. And it was a tough fight. It was a fight against special interest groups like the insurance industry, pharmaceutical companies, and against nay-sayers and obstructionists like the teabaggers. It was a tough fight to protect our members and retirees benefits, to improve the situation at the bargaining table and to pave the way to progress toward health care for all. There are many provisions that will move our nation forward � achieving our key principles for reform.

3. CWA Leads on Issues Critical to Our Members and Retirees Retiree health care Coalitions: reports; print ads; joint visits Result: $5 billion reinsurance trust fund; premium rating limits Tax on high-cost health plans Reports, briefings Labor & Coalition letters, visits & ads Patch thru calls & worksite calls Result: delayed effective date to 2018; reduced tax by 80% CWA lead the way on some of the issues important to our members. Protecting retiree health coverage was a top priority for CWA. CWA founded a coalition, the Bridge Years Health Coalition, that included other organizations like the Alliance for Retired Americans, the National Coalition on Health Care, the Small Business Majority, and employers like Verizon and UPS. The coalition funded reports and print ads in Capitol Hill publications and we held joint lobbying visits. The $5 billion retiree reinsurance trust fund is a result of this effort. We also won limits on premium rating � the additional amounts insurance companies charge on account of age. The limit under the new law will be a 3-to-1 ratio, versus 5-to-1 and even up to 25-to-1 prior to reform. CWA led the way on the excise tax. We commissioned reports, held congressional briefings; participated in joint visits with other labor unions and coalitions; funded television and print ads on the issue. We organized a dental community letter that was sent to members of Congress. We had a strong internal mobilization program. We held worksite actions, had members to write letters and make phone calls. The result: the excise tax has been slashed. The effective date is pushed out to 2018 (from 2013), dental and vision plans are excluded from the calculation, there is an adjustment to account for the age and gender make up of the plan�s covered workforce. In all, the changes we worked for reduced the impact of the tax by 80%.CWA lead the way on some of the issues important to our members. Protecting retiree health coverage was a top priority for CWA. CWA founded a coalition, the Bridge Years Health Coalition, that included other organizations like the Alliance for Retired Americans, the National Coalition on Health Care, the Small Business Majority, and employers like Verizon and UPS. The coalition funded reports and print ads in Capitol Hill publications and we held joint lobbying visits. The $5 billion retiree reinsurance trust fund is a result of this effort. We also won limits on premium rating � the additional amounts insurance companies charge on account of age. The limit under the new law will be a 3-to-1 ratio, versus 5-to-1 and even up to 25-to-1 prior to reform. CWA led the way on the excise tax. We commissioned reports, held congressional briefings; participated in joint visits with other labor unions and coalitions; funded television and print ads on the issue. We organized a dental community letter that was sent to members of Congress. We had a strong internal mobilization program. We held worksite actions, had members to write letters and make phone calls. The result: the excise tax has been slashed. The effective date is pushed out to 2018 (from 2013), dental and vision plans are excluded from the calculation, there is an adjustment to account for the age and gender make up of the plan�s covered workforce. In all, the changes we worked for reduced the impact of the tax by 80%.

4. Learn How Reform Impacts: CWA Negotiated Plans Retirees CWA Employers Excise Tax on High Cost Plans Retiree Drug Subsidy In this presentation we will talk about how reform impacts CWA negotiated health plans, retirees, and our employers. We will talk about the new responsibilities and changes that will happen to employer-sponsored health plans including the excise tax on high cost plans and the retiree drug subsidy.In this presentation we will talk about how reform impacts CWA negotiated health plans, retirees, and our employers. We will talk about the new responsibilities and changes that will happen to employer-sponsored health plans including the excise tax on high cost plans and the retiree drug subsidy.

5. Reform & CWA Negotiated Plans We keep our plans: existing bargained-for plans are exempt from most changes through expiration. Company and union may adopt new coverage requirements prior to contract expiration. Some good reforms apply after contract expiration: No exclusions for pre-existing conditions. No lifetime or annual limits on benefits. Children covered until age 26. Preventive care with no deductible or copay. Waiting period for coverage limited to 90 days. Lets start with what happens to our plans. First, we keep our existing plans. Nothing in the new law requires our employers to change our plans immediately. Collectively bargained plans are exempt from most changes until the expiration of the bargaining agreement that was in effect when the legislation was signed into law (March 23, 2010). But, nothing in the law prevents the union and employer from agreeing to make the changes prior to the expiration of the current agreement. Upon expiration of the existing agreement, (or the dates listed below, whichever comes last) collectively bargained plans will have to conform with some requirements of the law including: Effective 9/23/10 no exclusions for pre-existing conditions are permitted for children under 19. Beginning 2014, plans may not impose pre-existing exclusions on anyone. Eff. 9/23/10, no lifetime dollar limits are permitted. Annual limits are restricted on �essential benefits� as of 9/23/10, but effective 2014 no annual limits are permitted on essential benefits. Eff. 9/23/10 plans that provide dependent coverage must extend coverage to children up to age 26 if they do not have an offer of employer coverage in their own right. Effective 2014, plans that provide dependent coverage must extend coverage to children up to age 26. Effective 9/23/2010 preventive services must be provided with no cost sharing � no deductibles or copays. Effective 2014 plans may not impose waiting periods of more than 90 days. Lets start with what happens to our plans. First, we keep our existing plans. Nothing in the new law requires our employers to change our plans immediately. Collectively bargained plans are exempt from most changes until the expiration of the bargaining agreement that was in effect when the legislation was signed into law (March 23, 2010). But, nothing in the law prevents the union and employer from agreeing to make the changes prior to the expiration of the current agreement. Upon expiration of the existing agreement, (or the dates listed below, whichever comes last) collectively bargained plans will have to conform with some requirements of the law including: Effective 9/23/10 no exclusions for pre-existing conditions are permitted for children under 19. Beginning 2014, plans may not impose pre-existing exclusions on anyone. Eff. 9/23/10, no lifetime dollar limits are permitted. Annual limits are restricted on �essential benefits� as of 9/23/10, but effective 2014 no annual limits are permitted on essential benefits. Eff. 9/23/10 plans that provide dependent coverage must extend coverage to children up to age 26 if they do not have an offer of employer coverage in their own right. Effective 2014, plans that provide dependent coverage must extend coverage to children up to age 26. Effective 9/23/2010 preventive services must be provided with no cost sharing � no deductibles or copays. Effective 2014 plans may not impose waiting periods of more than 90 days.

6. More on Reform & CWA Negotiated Plans Limits pre-tax health FSA contributions to $2,500 per year, indexed for inflation Penalty increased to 20% if HSA funds used for non-medical claims No reimbursement of over-the-counter meds in health accounts unless prescribed The new law makes some changes in various account-based plans. There are three basic kinds of account based plans: flexible spending accounts (which we have negotiated in most of our large agreements), health reimbursement accounts, and health spending accounts (which are associated with high deductible health plans). The changes include: Pre-tax contributions to Flexible Spending Accounts are limited to $2500 per year. The amount is adjusted each year for inflation. Previously the limit was $5,000 per year. The penalty for withdrawal of Health Savings Account funds for non-medical use is increased to 20% from 10%. Over-the-counter medications � such as antacids, cold medications, cough drops, aspirin -- are no longer permitted under any type of account unless prescribed by a physician. The new law makes some changes in various account-based plans. There are three basic kinds of account based plans: flexible spending accounts (which we have negotiated in most of our large agreements), health reimbursement accounts, and health spending accounts (which are associated with high deductible health plans). The changes include: Pre-tax contributions to Flexible Spending Accounts are limited to $2500 per year. The amount is adjusted each year for inflation. Previously the limit was $5,000 per year. The penalty for withdrawal of Health Savings Account funds for non-medical use is increased to 20% from 10%. Over-the-counter medications � such as antacids, cold medications, cough drops, aspirin -- are no longer permitted under any type of account unless prescribed by a physician.

7. Reform & Retirees As of 1/1/11 Medicare covers prevention & screenings with no deductibles or co-pays �Doughnut hole� in Medicare Rx plan closed by 2020 $5 billion trust to help cover high-cost claims of retirees age 55 - 64 Reform does make changes in benefits for retirees, both Medicare-eligible retirees and those who are not yet eligible for Medicare. Medicare is changed to cover preventive services and screenings with no deductibles or copayments. The doughnut hole in the Medicare prescription drug plans is closed over time and eliminated by 2020. A $5 billion trust fund is set up to cover high-cost claims of retirees between the ages of 55 thru 64. The fund will reimburse 80% of claims between $15,000 and $90,000. Reform does make changes in benefits for retirees, both Medicare-eligible retirees and those who are not yet eligible for Medicare. Medicare is changed to cover preventive services and screenings with no deductibles or copayments. The doughnut hole in the Medicare prescription drug plans is closed over time and eliminated by 2020. A $5 billion trust fund is set up to cover high-cost claims of retirees between the ages of 55 thru 64. The fund will reimburse 80% of claims between $15,000 and $90,000.

8. Reform & CWA Employers Must implement new benefit requirements after bargaining agreements in effect on 3/23/10 expire. May agree to adopt prior to expiration. Limit waiting periods for new employees to no more than 90-days. Must report value of health plan on employee W-2s (not taxable.) Small employers can purchase health coverage through exchanges; may qualify for subsidies. CWA employers will have to make some changes to their plans. Changes can be made either after the expiration of the bargaining agreement that was in effect on 3/23/2010 or the union and the employer could agree to implement changes prior to the expiration. Waiting periods for new employees will have to be limited to no more than 90 days. They will have to report the value of the health plan on employees W-2s, but it is just reporting. There is no tax imposed on employees or retirees. Small employers will be able to purchase health coverage through the exchanges once they are established in 2014 and they may qualify for subsidies to help make coverage more affordable. CWA employers will have to make some changes to their plans. Changes can be made either after the expiration of the bargaining agreement that was in effect on 3/23/2010 or the union and the employer could agree to implement changes prior to the expiration. Waiting periods for new employees will have to be limited to no more than 90 days. They will have to report the value of the health plan on employees W-2s, but it is just reporting. There is no tax imposed on employees or retirees. Small employers will be able to purchase health coverage through the exchanges once they are established in 2014 and they may qualify for subsidies to help make coverage more affordable.

9. More on Reform and CWA Employers � Excise Tax on High-Value Plans 40% tax on high-cost plans delayed to 2018 applies to cost above thresholds. 2018 Thresholds: $10,200 for single coverage; $27,500 for family coverage. Thresholds indexed to CPI + 1% in 2019; CPI only beginning in 2020. Adjustments for age and gender and separate threshold for retirees will reduce the tax. Separate vision and dental plans excluded; contributions to savings accounts included. Negotiations between Labor and White House cut tax by 80% � from $149 billion to $32 billion. One of our biggest battles during the health care reform fight was over the attempt to slap a huge tax on high cost health plans. Here is how we were able to beat back the tax: The tax is delayed until 2018. The Senate bill put the effective date at 2013, so we shaved off five years. The tax is applied to amounts above designate thresholds. In 2018, the threshold amounts are $10,200 for single coverage and $27,500 for family coverage. In 2019 the threshold amounts are increased by the Consumer Price Index (or CPI) plus 1%. In following years, the thresholds are increased by the CPI only. The thresholds will be adjusted to account for the age and gender make-up of the covered population. Separate thresholds are established for retirees. These changes will have the effect of reducing the tax payable. Dental and vision plans are not included in the taxable amounts, but contributions to health savings or reimbursement accounts are included. These changes to the excise tax were negotiated in an meeting between labor leaders (including CWA President Cohen) and the White House and were included in the final legislation. The provisions cut the value of the tax by 80%, reducing the revenue it would generate from $149 billion in the Senate bill to $32 billion in the final bill. One of our biggest battles during the health care reform fight was over the attempt to slap a huge tax on high cost health plans. Here is how we were able to beat back the tax: The tax is delayed until 2018. The Senate bill put the effective date at 2013, so we shaved off five years. The tax is applied to amounts above designate thresholds. In 2018, the threshold amounts are $10,200 for single coverage and $27,500 for family coverage. In 2019 the threshold amounts are increased by the Consumer Price Index (or CPI) plus 1%. In following years, the thresholds are increased by the CPI only. The thresholds will be adjusted to account for the age and gender make-up of the covered population. Separate thresholds are established for retirees. These changes will have the effect of reducing the tax payable. Dental and vision plans are not included in the taxable amounts, but contributions to health savings or reimbursement accounts are included. These changes to the excise tax were negotiated in an meeting between labor leaders (including CWA President Cohen) and the White House and were included in the final legislation. The provisions cut the value of the tax by 80%, reducing the revenue it would generate from $149 billion in the Senate bill to $32 billion in the final bill.

10. Main Revenue Source: Medicare Tax on Wealthy You can see by this chart that the excise tax on high value health plans is no longer the major revenue source of the health care reform legislation. Instead, the main source of financing for the new law is new Medicare taxes on the wealthy. First, a 0.9% tax will be applied to wage over $200,000 per individual. Second, for the first time, Medicare taxes will also be applied to unearned income � such as dividends and interest, rents, capital gains, etc. It will only be applied to those with incomes over $200,000 per person or $250,000 for married couples and families. Those new taxes will raise $210 billion over ten years. Taxes and fees on insurance companies, drug companies and medical device manufacturers will also raise a lot -- $107 billion over ten years. Penalties on employers who don�t provide coverage but who have workers who get subsidies from the government will raise $52 billion over 10 years. The excise tax on high cost health plans is expected to raise $32 billion over ten years. Other revenue raisers include $17 billion from individuals who don�t get coverage; $5 billion from the change in the Medicare Part D subsidy to employers; and $3 billion from the tax on tanning services. You can see by this chart that the excise tax on high value health plans is no longer the major revenue source of the health care reform legislation. Instead, the main source of financing for the new law is new Medicare taxes on the wealthy. First, a 0.9% tax will be applied to wage over $200,000 per individual. Second, for the first time, Medicare taxes will also be applied to unearned income � such as dividends and interest, rents, capital gains, etc. It will only be applied to those with incomes over $200,000 per person or $250,000 for married couples and families. Those new taxes will raise $210 billion over ten years. Taxes and fees on insurance companies, drug companies and medical device manufacturers will also raise a lot -- $107 billion over ten years. Penalties on employers who don�t provide coverage but who have workers who get subsidies from the government will raise $52 billion over 10 years. The excise tax on high cost health plans is expected to raise $32 billion over ten years. Other revenue raisers include $17 billion from individuals who don�t get coverage; $5 billion from the change in the Medicare Part D subsidy to employers; and $3 billion from the tax on tanning services.

11. More on Reform & CWA Employers � Medicare Retiree Drug Subsidy Business deduction for retiree benefit expense remains in effect. Medicare Retiree Drug Subsidy (RDS) for 28% of retiree Rx costs remains in effect. Companies may no longer deduct the cost of benefits for which they have received a subsidy. Provision eliminates windfall but reduces value of subsidy. There was a lot of coverage in the news when several companies announced a charge they were taking to account for the cost of changes required by the health care law. The issue is the reversal of a �windfall� that AT&T, Verizon and Qwest and many other employers enjoyed as part of the Medicare Modernization Act of 2003. That law allowed employers to deduct as a business expense 100% of retiree drug plan costs, even though they received a government subsidy equal for 28% of the expenses. The current Congress considered that double-dipping. The new law will not permit deductibility of benefits that have been subsidized. Companies are required to report the impact of tax law changes immediately, so that is why we heard about so many companies taking the charge. For example, in company filings, AT&T reported that it expected to receive a total subsidy of $1.6 billion between 2010 and 2019 under the terms of the old law. Under the terms of the new health care reform law, AT&T has reduced that estimate by $1 billion. That charge is what is being reported in the media. So, instead of receiving $1.6 billion in a combination of tax-free subsidies from the government and tax deductible retiree benefit expenses, AT&T will have only $600 million in deductible expenses. They can no longer double dip. They lose the windfall, but still get a substantial benefit from the government. This is a non-cash expense, meaning it is an accounting issue, not a cash issue. It should not impact our employers� ability to pay for retiree benefits, but it may put pressure on them to reduce expenses in order to show a better profit. Remember: There are many other changes in the health care legislation which will help contain future cost increases, including a $5 billion reinsurance program for pre-Medicare retirees and a reduction of the number of uninsured which is estimated to cost our plans $1,000 person. So this change should not be assessed in isolation. There was a lot of coverage in the news when several companies announced a charge they were taking to account for the cost of changes required by the health care law. The issue is the reversal of a �windfall� that AT&T, Verizon and Qwest and many other employers enjoyed as part of the Medicare Modernization Act of 2003. That law allowed employers to deduct as a business expense 100% of retiree drug plan costs, even though they received a government subsidy equal for 28% of the expenses. The current Congress considered that double-dipping. The new law will not permit deductibility of benefits that have been subsidized. Companies are required to report the impact of tax law changes immediately, so that is why we heard about so many companies taking the charge. For example, in company filings, AT&T reported that it expected to receive a total subsidy of $1.6 billion between 2010 and 2019 under the terms of the old law. Under the terms of the new health care reform law, AT&T has reduced that estimate by $1 billion. That charge is what is being reported in the media. So, instead of receiving $1.6 billion in a combination of tax-free subsidies from the government and tax deductible retiree benefit expenses, AT&T will have only $600 million in deductible expenses. They can no longer double dip. They lose the windfall, but still get a substantial benefit from the government. This is a non-cash expense, meaning it is an accounting issue, not a cash issue. It should not impact our employers� ability to pay for retiree benefits, but it may put pressure on them to reduce expenses in order to show a better profit. Remember: There are many other changes in the health care legislation which will help contain future cost increases, including a $5 billion reinsurance program for pre-Medicare retirees and a reduction of the number of uninsured which is estimated to cost our plans $1,000 person. So this change should not be assessed in isolation.

12. CWA Mobilizes Big Time! 177 Coordinators 7,372 Letters to Members of Congress 31,218 Calls to MOCs from worksites 38,739 Patch thru calls 300+ Visits to MOCs Plus Town Hall meetings, rallies, sit ins, fly ins, etc. CWA mobilized for health care reform big time. We had 177 field coordinators including state and congressional district coordinators. Those coordinators were responsible for activating members in their states and CDs. And they did. We sent 7,372 letters to members of Congress about health care. We generated 31,218 calls to members of Congress during worksite call-in efforts. We generated 38,739 calls through patch-thru call-in programs to members at their homes. We held more than 300 visits with individual members of Congress or their staff. And we attend town hall meetings, rallies, sit ins, and other activities. CWA mobilized for health care reform big time. We had 177 field coordinators including state and congressional district coordinators. Those coordinators were responsible for activating members in their states and CDs. And they did. We sent 7,372 letters to members of Congress about health care. We generated 31,218 calls to members of Congress during worksite call-in efforts. We generated 38,739 calls through patch-thru call-in programs to members at their homes. We held more than 300 visits with individual members of Congress or their staff. And we attend town hall meetings, rallies, sit ins, and other activities.

13. The Principles that Guided Our Work & the Progress We Made Cover All Americans � 32 million uninsured covered; from 83% to 95% of population covered Control Costs �federal deficit reduced $1.3 trillion over 20 years; estimated to cut employer premium trend by 15% to 20% Strong Government Role � rules and standards for insurance companies; health insurance exchanges; cost controls; quality oversight. In addition to the specific changes mentioned before, our concerted efforts helped to make progress toward the principles we have been working for over the past 2-3 years. When we set out on this campaign, we pledged to work for health care reform that would cover all Americans. It is estimated that this new law will cover 95% of the population, up from 83%. That means 32 million Americans who currently do not have coverage, will get it. We pledged to work for reform that would control spiraling health care costs. The non-partisan Congressional Budget Office has estimated that this legislation will reduce the federal deficit by $1.3 trillion over the next two decades and that employer premium trend will be reduced by 15% to 20%. We wanted a strong government role to set standards and serve as a watchdog over the insurance industry. We got that. The health insurance exchanges will be a restructured insurance market where insurers will no longer be able to deny coverage based on pre-existing conditions, or charge women different rates than men. The new legislation also establishes commissions that will provide quality oversight and begin to reimburse providers based on the quality of care and compliance with quality standards, rather than paying them for the volume of services.In addition to the specific changes mentioned before, our concerted efforts helped to make progress toward the principles we have been working for over the past 2-3 years. When we set out on this campaign, we pledged to work for health care reform that would cover all Americans. It is estimated that this new law will cover 95% of the population, up from 83%. That means 32 million Americans who currently do not have coverage, will get it. We pledged to work for reform that would control spiraling health care costs. The non-partisan Congressional Budget Office has estimated that this legislation will reduce the federal deficit by $1.3 trillion over the next two decades and that employer premium trend will be reduced by 15% to 20%. We wanted a strong government role to set standards and serve as a watchdog over the insurance industry. We got that. The health insurance exchanges will be a restructured insurance market where insurers will no longer be able to deny coverage based on pre-existing conditions, or charge women different rates than men. The new legislation also establishes commissions that will provide quality oversight and begin to reimburse providers based on the quality of care and compliance with quality standards, rather than paying them for the volume of services.

14. The Principles that Guided Our Work & the Progress We Made Fair Financing � relies on wealthy, employers and health industry to pay their share Improve Health Quality � 100% coverage of prevention; provider payments based on quality & outcomes. We also wanted a health care system that was financed fairly. The financing included in this legislation makes progress toward that goal. As shown in a previous slide, the largest source of financing will be applying Medicare tax to unearned income of the wealthiest Americans. And health industry stakeholders will also be required to pay fees and taxes to keep the system affordable. Finally, we wanted a health care system that focused on quality care. The new law will require health plans to cover preventive care without a deductible or copays in order to encourage those services which will lead to improved health status. The new law will develop quality standards and processes for reimbursing providers based on their compliance with those standards. So we made good progress toward our five principles for reform. We also wanted a health care system that was financed fairly. The financing included in this legislation makes progress toward that goal. As shown in a previous slide, the largest source of financing will be applying Medicare tax to unearned income of the wealthiest Americans. And health industry stakeholders will also be required to pay fees and taxes to keep the system affordable. Finally, we wanted a health care system that focused on quality care. The new law will require health plans to cover preventive care without a deductible or copays in order to encourage those services which will lead to improved health status. The new law will develop quality standards and processes for reimbursing providers based on their compliance with those standards. So we made good progress toward our five principles for reform.

15. Reform Addresses CWA Members� Concerns Janet of Virginia Beach is concerned about her cousin, a self-employed, single dad who cannot afford the $400 a month needed for insurance coverage. He goes without, betting and hoping that he and his daughter do not become ill or get in an accident. Janet�s cousin will be able to buy affordable coverage through the health insurance exchanges at much lower rates. Individuals and small employers will band together to create a large insurance pool, and insurers will not be able to underwrite and charge more for small groups. The government will provide subsidies and tax credits for individuals and small businesses who have a hard time finding affordable coverage. During our campaign, we asked members to write letters to members of Congress on the need for reform, and many of our members included personal stories to express the need. Often our members said they had good coverage and were only worried about the increasing cost of that coverage. But many wrote about other concerns. Here Janet of Virginia Beach is concerned about her cousin. [Read the slide out loud]During our campaign, we asked members to write letters to members of Congress on the need for reform, and many of our members included personal stories to express the need. Often our members said they had good coverage and were only worried about the increasing cost of that coverage. But many wrote about other concerns. Here Janet of Virginia Beach is concerned about her cousin. [Read the slide out loud]

16. Reform Addresses CWA Members� Concerns Veronica of Arkansas worried about her father who worked all of his life, but when he had a massive stroke, got shunted from hospital to hospital because he had no health insurance. Now, with the health care reform legislation, Veronica�s dad will be able to get coverage through the health insurance exchanges. No one will be denied coverage for a pre-existing condition. Subsidies are available to keep coverage affordable. Veronica of Arkansas is concerned about her dad. [Read the slide.]Veronica of Arkansas is concerned about her dad. [Read the slide.]

17. Reform Addresses CWA Members� Concerns Pamela of Brooklyn worries about her grandmother who finds it hard to pay her Medicare deductible and prescription costs. Health care reform will benefit Pam�s grandmother by closing the Medicare prescription drug �doughnut hole� over time, making prescription drugs more affordable. Pamela of Brooklyn is concerned about her grandmother. [Read the slide.] Pamela of Brooklyn is concerned about her grandmother. [Read the slide.]

18. Key Implementation Dates Note: Bargained-for plans exempt from most new rules until expiration of the agreement that was in effect on 3/23/10 when the health care reform bill was signed into law. The next few slides run through a timeline of implementation dates. Remember that bargained plans are exempt from many of the insurance reforms until the expiration of the agreements that were in effect on the day the bill was signed into law � March 23, 2010.The next few slides run through a timeline of implementation dates. Remember that bargained plans are exempt from many of the insurance reforms until the expiration of the agreements that were in effect on the day the bill was signed into law � March 23, 2010.

19. Health Care Reform Timeline � 2010 Companies must report impact of change in taxability of Retiree Drug Subsidy payments Reinsurance trust for retiree medical coverage established $250 rebate for seniors who hit Medicare Part D �doughnut hole� Some major changes will take place this year. [Read the slide]Some major changes will take place this year. [Read the slide]

20. Health Care Reform Timeline � 2011 Children covered to age 26 No lifetime and restricted annual limits No pre-existing condition exclusions for children 18 and younger Employers report health plan value on employee W-2s (no tax) Above reforms subject to collective bargaining exemption Health Savings Account withdrawal penalty of 20% No over-the-counter drugs from account-based plans Long-term care benefit available Begin phase out of Medicare D doughnut hole In 2011 some insurance market reforms and other changes will take place. [read the slide]In 2011 some insurance market reforms and other changes will take place. [read the slide]

21. Health Care Reform Timeline � 2013 Deduction for employer Medicare Part D Retiree Drug Subsidy eliminated Medicare payroll tax increased for high wage employees (over $200,000 single/$250,000 joint filers) Medicare tax applied to unearned income (dividends, sale of stock, etc) of the wealthiest taxpayers (over $200,000 single/$250,000 joint filers) $2500 cap on health FSA contributions The next major set of changes happens in 2013 [read the slide]The next major set of changes happens in 2013 [read the slide]

22. Health Care Reform Timeline � 2014 Individuals must have health coverage or pay a penalty Health Insurance Exchanges operational Premium and cost-sharing subsidies for low and middle income individuals available Medicaid eligibility expanded Insurance market reforms: guaranteed issue, premium rating restrictions, waiting period limits, no annual dollar limits, etc. In 2014 key pieces of the legislation go into effect: [read the slide]In 2014 key pieces of the legislation go into effect: [read the slide]

23. Health Care Reform Timeline � 2016 & 2018 2016 -- Sales of health insurance allowed across state lines 2018 � Excise tax on high-cost health plans kicks in In later years, the final pieces of the legislation go into effect: [read the slide]In later years, the final pieces of the legislation go into effect: [read the slide]

24. Summary We keep our plans. Primarily financed by taxing the rich. Really good for family, friends, or laid off members without insurance, and small businesses. New insurance regulations will create a fairer system. Some improvements in the bill (e.g., covering children to age 26, elimination of lifetime maximums) may raise plan costs initially, but� The hidden cost of 32 million uninsured in our plans will be removed, and... Cost controls will moderate cost trends long term and lower the pressure we face at the bargaining table. Overall impact will be positive. It is clear that the health care reform legislation recently signed into law will be a major change, building on the current system, but putting some important reforms in place. [Briefly summarize the points already made. Read through the list on the slide]It is clear that the health care reform legislation recently signed into law will be a major change, building on the current system, but putting some important reforms in place. [Briefly summarize the points already made. Read through the list on the slide]

25. Next Steps for CWA Inform members about facts of health care reform and safeguards in it. Develop bargaining agendas for the new health care environment. Work with regulatory bodies on implementation of new law. Work with Congress to fix unintended consequences. Engage with employers about impact of the legislation on our plans and on our members. The health care reform bill has been signed into law, but work doesn�t end there. We need to make sure our own members understand what�s in reform and how it will impact them. We need to understand how the change in the law will impact our bargaining, and make adjustments to our bargaining agendas. We need to keep on top of the changes and the regulatory and rule-making process that will implement the new law. We need to make sure the law is implemented in ways that will not harm our members and retirees. We will continue to work with Congress in order to fix any unintended consequences of the legislation. We will continue to work with our employers to understand the full impact of the legislation on our plans and on our members. Thank you for your attention. The health care reform bill has been signed into law, but work doesn�t end there. We need to make sure our own members understand what�s in reform and how it will impact them. We need to understand how the change in the law will impact our bargaining, and make adjustments to our bargaining agendas. We need to keep on top of the changes and the regulatory and rule-making process that will implement the new law. We need to make sure the law is implemented in ways that will not harm our members and retirees. We will continue to work with Congress in order to fix any unintended consequences of the legislation. We will continue to work with our employers to understand the full impact of the legislation on our plans and on our members. Thank you for your attention.