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Michigan Association of Health Plans

Today's Objective. Understand Why Health Reform Is Important to Michigan (The Need)Discussion on Federal Health Reform (Today's Response)Our Political and Administrative Environment Future Actions and Challenges Next Steps. 2. HEALTH PLANS: WHO WE ARE. The Michigan Association of Healt

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Michigan Association of Health Plans

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    2. Today’s Objective Understand Why Health Reform Is Important to Michigan (The Need) Discussion on Federal Health Reform (Today’s Response) Our Political and Administrative Environment Future Actions and Challenges Next Steps 2

    3. HEALTH PLANS: WHO WE ARE The Michigan Association of Health Plans (MAHP) is an industry voice for 17 health care plans Members cover over 2.4 million Michigan residents Commercial, Medicaid and Medicare Product lines Our mission: Advocate for health care that is High quality Affordable Accessible 3

    4. Who we are Aetna CareSource Michigan Grand Valley Health Plan Great Lakes Health Plan/United Health Care Health Alliance Plan Health Plan of Michigan, Inc. HealthPlus of Michigan McLaren Health Plan Midwest Health Plan Molina Healthcare of Michigan OmniCare Health Plan Paramount Care of Michigan Physicians Health Plan-Mid-Michigan Priority Health ProCare Health Plan Total Health Care, Inc. Upper Peninsula Health Plan 4

    5. HEALTH PLANS: WHO WE ARE National leaders in excellence U.S. News & World Report/NCQA rankings show Michigan's health plans among the best in the country 5 of the nation's top 50 commercial plans 4 of the nation's top 25 Medicaid plans (and 11 in the nation’s top 50 Medicaid Plans) 2 of the nation's top 25 Medicare plans 5

    6. Our Need for Reform   About 1.1 million uninsured (number growing) Drives up health care cost for all Still get health care Often at expensive emergency rooms Uncompensated care = Cost shifting Average family paying $1,000/year due to uncompensated care Providing more affordable coverage can mean lower costs for all 6

    7. ABOUT 1.1 MILLION UNINSURED IN MICHIGAN 7

    8. Today’s response: federal reform act Access & Coverage Changes Essential Benefit Design (2014) Health Insurance Exchange (2014) Dependent Coverage (2010) Employer Responsibility (2014) Guaranteed Issue (2014) High Risk Pool (2010) 8

    9. Today’s response: federal reform act Access & Coverage Changes (continued) Individual Mandate (2014) Medicaid Expansion (2014) Pilot for Uninsured (2010) & State Subsidy Program (2014) 1st Dollar coverage for prevention & Wellness(2010) Coverage of Emergency Services (2010) CHIP Expansion (2016) Clinical Trials (2015) 9

    10. Today’s response: federal reform act CONSUMER PROTECTION Ban on Lifetime caps (2010) Restrict annual Caps (2010) ban (2014) Prohibit Rescissions (2010) Provision of premium subsidies/tax credit (2014) Insurance Ombudsman (2010) Web Based Portal (2010) 10

    11. Today’s response: federal reform act INSURANCE ISSUES Group Size Redefined (2010) Temporary Reinsurance for high risk (2014) Temporary reinsurance for >55 not eligible for Medicare (2010-2014) Risk Adjustment (equalization) (2010) Medical Loss Ratios (2010) Permitted Rating Factors (2014) Rate Reviews 11

    12. Today’s response: federal reform act TAXES/CREDITS Excise Tax on “Cadillac Plans) (2018) Premium tax on Health Plans (2014) Premium tax on Plans for Research (2012) Limits of Blue Cross Federal Tax Exemption New Fee on Pharmaceutical Industry (2010) New Fee on Medical Device (2013) New Tax on Indoor Tanning (2010) 12

    13. Today’s response: federal reform act TAXES/CREDITS Surcharge on High Income Tax Payers Tax Increase on HSA distribution (2011) Medicare Payroll Tax increase (2013) Federal Income tax deduction on Medical threshold increased (2013) 13

    14. Today’s response: federal reform act HOSPITAL AND PROVIDER Expansion of RAC Audits to Medicaid (2010) Non Profit Hospital Community Survey (2010) Medicare Institutional Payment Reductions (2010) Reductions in Medicaid/Medicare DSH (2014) Readmission Payment Adjustments (2012) Physician Quality Reporting (2012) 14

    15. Today’s response: federal reform act HOSPITAL AND PROVIDER Accountable Care Organizations and payment bundling pilots (2012) Medicaid Payments to Primary Care Physicians increase to Medicare level (2013) Scholarship and Loan Repayments (2010) Workforce Commission created (2010) GME residency slots for Primary Care (2011) 15

    16. Today’s response: federal reform act MEDICARE, DUAL ELIGIBLES, LONG TERM CARE Medicare Advantage Plan payments (2011) Eliminate Employer subsidy for Part D Payroll deduction for long term care (2011) Community Care Transitions for high risk Medicare (2011) Home and Community Based Services options (2011) Doughnut hole reduction (2010) then elimination (2020) 50% discount on all drugs in “doughnut hole” Care Coordination for Dual Eligibles (2010) 16

    17. Today’s response: federal reform act OTHER REFORM PROVISIONS Insurer Administrative Simplification (2013) Health Care Choice Compacts-Interstate (2013) Medicaid Drug Rebate changes (2010) Fraud And Abuse (2010) Tort Reform 17

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    19. POLITICAL ENVIRONMENT TERM LIMITS--WHAT WE CAN LOOK FORWARD TO ON JAN 1, 2011: NEW GOVERNOR NEW SPEAKER OF HOUSE NEW SENATE MAJORITY LEADER NEW ATTORNEY GENERAL NEW SECRETARY OF STATE NEW DEPARTMENT DIRECTORS 34 NEW STATE REPRESENTATIVES 30 NEW STATE SENATORS EARLY RETIREMENT LEGISLATION MAY ALSO RESULT IN THE DEPARTURE OF MANY SENIOR STATE EMPLOYEES INVOLVED IN CRITICAL POLICY AND BUDGETARY ISSUES.

    20. POLITICAL ENVIRONMENT Michigan Economic Forecast Continues to leave between $1.4 and $1.7 Billion shortfall. No support nor advocacy for new general revenue--requires “reform” and reductions for balance budget requirement. FY 11 likely to be approved with over $1 B in one time fixes--pushing budget shortfalls to FY 12 --(coincidentally, new administration and legislature).

    21. POLITICAL ENVIRONMENT Michigan’s Term Limit Provisions provide incentives to defer hard decisions to the next legislature/governor/state agency directors. This 2010 state election cycle will require all interested parties to seek more disclosure on intention in health care reform. In our pursuit of meaningful health care reform, lets make sure we “first of all, do no harm”. 21

    22. CHALLENGES AND OPTIONS Governor Granholm Executive Order Coordination at State Level—led by MDCH Insurance Ombudsman Office Work on High Risk Pool and Exchange options Focus is on Cabinet Coordination and Communication—not on stakeholders Focus is on Short Term Implementation

    23. CHALLENGES AND OPTIONS Rep. Marc Corriveau/Sen. Tom George Legislative Reform Package Developed assuming no Federal Reform—extensive 2009 hearings and involvement with stakeholders Now positioned for legislative approach to implementing federal reform in long term “Vehicle for Stakeholders role in Reform?”

    24. CHALLENGES AND OPTIONS The reform legislation at the federal and state level assumes more accountable delivery of care and flexibility—Will Michigan take advantage of this?

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