Health Care Reform Bill: A Summary of opportunities

1. Health Care Reform Bill:A Summary(of opportunities!) Tom Bost MD HCACF 4/17/10

2. Health Care Reform Bill Summary:Tom�s Menu Handout: the details Presentation: the highlights Focus: on Colorado specifically on the timing/process of implementation What and how much is �plastic� Set up context for Elinor and Jim Links: www.KFF.org DPC.SENATE.GOV/DPCDOC-SEN_HEALTH_CARE_BILL.CFM

3. Health Care Reform Bill:The Bottom Line �Implementation is forever�� Drew Altman, CEO of Kaiser Family Foundation �The real solution here is a legislative fix so all players in the industry can act according to a clear set of rules� Wm Schiffbauer, Lawyer for AHIP This is only the beginning�

4. Health Care Reform Bill Summary Title I: Quality, Affordable Health Care for (almost) All Title II: Role of Public Programs Title III: Improving Quality/Efficiency of Health Care Title IV: Prevention of Chronic Disease/Public Health Title V: Health Care Workforce Title VI: Transparency and Program Integrity Title VII: Improving Access to Innovative Therapies Title VIII: CLASS Act Title IX: Revenue Provisions Title X: Reauthorization of Indian Health Act Editorial comments in pink�

5. Health Care Reform Bill Summary: Where�s Our Beef? Title I: Quality, Affordable Health Care for (almost) All *state based exchange options (CO-OP, Basic Plan) Title II: Role of Public Programs *state based expansion of Medicaid Title III: Improving Quality/Efficiency of Health Care Title IV: Prevention of Chronic Disease/Public Health Title V: Health Care Workforce Title VI: Transparency and Program Integrity *state oversight/regulation; multi-state options Title VII: Improving Access to Innovative Therapies Title VIII: CLASS Act Title IX: Revenue Provisions Title X: Reauthorization of Indian Health Act

6. Health Care Reform Bill Highlights:Title I: Quality, Affordable Care Implications for citizens Implications for employers Implications for states Federal programs with state implications The plans themselves

7. Health Care Reform Bill Highlights:Title I: Quality, Affordable Care Implications for citizens: Must buy insurance or pay penalty Sliding scale for premium assistance and out of pocket limits based on Fed. Poverty Line FPL=$10k individual; $22k family of 4 Deductibles limited to $2k individ/$4k family Can opt out if premium >8% of income Catastrophic only coverage available for <30 and/or those who do not meet criteria Massachusetts experience

8. Health Care Reform Bill Highlights:Title I: Quality, Affordable Care Implications for Individual citizens: <133% FPL get enrolled into Medicaid 133% FPL ($14k) 4% premium $290 + $2000 max out of pocket 1/3 HSA limit 200% FPL ($21k) 4% premium $440 + $2000 max out of pocket 1/3 HSA limit 300% FPL ($32k) 8% premium $1320 + $3000 max out of pocket � HSA limit 400% FPL ($43k; Colo. Median 50k) 8% premium $2090 + $4000 max out of pocket 2/3 HSA limit 96% of uninsured Coloradoans <400% FPL

9. Health Care Reform Bill Highlights:Title I: Quality, Affordable Care <133% FPL ($29k): get enrolled into Medicaid 133% FPL ($29k): 4% premium $1160 + $4000 max out of pocket--1/3 HSA limit 200% FPL ($44k) 4% premium $1760 + $4000 max out of pocket�1/3 HSA limit 300% FPL ($66k) 8% premium $5280 + $6000 max out of pocket�1/2 HSA limit 400% FPL ($88k) 9.5% premium $8360 + $8000 max out of pocket�2/3 HSA limit

10. Health Care Reform Bill Highlights:Title I: Quality, Affordable Care Implications for employers: >200 employees: must provide insurance <50 employees: need not provide insurance (though tax break if they do) 50-200 employees: don�t have to provide insurance, BUT if even one of their employees qualifies for premium subsidies, they pay penalty per total # employee - 30

11. Health Care Reform Bill Highlights:Title I: Quality, Affordable Care Implications for states: Greatly expand Medicaid May choose to create Basic Health Plan (eg Medicaid-like) for citizens 133-200% FPL Must create AND administer: -Health Exchange for Individuals -Exchange for Small Businesses (SHOP)

12. Health Care Reform Bill Highlights:Title I: Quality, Affordable Care Fed Programs impacting State Exchanges: �2 OPM created multi-state (�national�) plans --one must be non-profit �CO-OP: consumer operated and oriented plan --non-profit, Federal grant sponsored --by July 2013; cannot exist now �Regulate Health Care Choice Compacts --allows plans to be offered in other states but subject only to the regulations of the state of origin

13. Health Care Reform Bill Highlights:Title I: Quality, Affordable Care The plans themselves Guaranteed issue/renewability no pre-existing conditions/rescissions Limits on out of pocket expenses/deductibles Limits on ratings (age 3:1; smoke 1.5:1) State determined essential package elements Free preventative services Limited abortion coverage Streamlined application form/process Standardized information

14. Health Care Reform Bill Highlights:Title I: Quality, Affordable Care The plans themselves: Various levels: Bronze: 60% coverage Silver: 70% Gold: 80% Platinum: 90% NO Maximum life time/yearly benefits Must cover dependents up to age 26 Catastrophic only: <30 yr old or exempt

15. Health Care Reform Bill Highlights:Title II: Role of Public Programs Changes in Medicaid Changes in Medicare Gradual closing of donut hole Create Independent Payment Advisory Board SCHIP High risk pool program Re-insurance program Community Health Center support

16. Health Care Reform Bill Highlights:Title III: Improving Quality of Health Care Grants to states to develop tort reform Community based collaborative care network program (for un/underinsured) Collection of data on disparities

17. Health Care Reform Bill Highlights:Title IV: Public Health/Prevention Grants for evidence- and community-based programs Employer wellness programs Good idea in theory Possible area for abuse/gouging

18. Health Care Reform Bill Highlights:Title V: Health Care Workforce Grants to: enhance primary care/underserved areas Primary care models Obvious tie-in to existing Colorado entities San Luis Valley consortium Grand Junction network

19. Health Care Reform Bill Highlights:Title VI: Transparency State exchanges State ombudsman Consumer protection/advocacy Dispute arbitration State regulation of Insurance industry Share reports on claims/denials etc Justify rate hikes prove that 80-85% of premiums go to services

20. Health Care Reform Bill Highlights:Title VIII: Community Living Assistance Services, Supports (CLASS Act) Medicaid program (therefore state determined) Encourage community based (vs. institutional care) for those at risk Up to $50/day for non-medical expenses to maintain community residence

21. Health Care Reform Bill Highlights:Title IX: Revenue Provisions Projected cost: $938 billion/ten years Projected savings: $124 billion reduction in budget over ten years PALES IN COMPARISON TO SINGLE PAYER (Lewin Group 2008: 1.4 billion/yr for Colorado alone)

22. Health Care Reform Bill: In Summary, then: �Americans will always do the right thing� only after exhausting all the other possibilities� Winston Churchill �If we believe leaders must be just, violence muzzled, power accountable and the riches of the Earth shared equitably, such a world will come to pass. I am not deceived. It is the hardest of worlds to make real. Torturous advances won over generations can be lost by a s single stroke of myopic president�s pen or a vainglorious general�s sword� �David Mitchell