1 / 23

State and Federal Health Care Reform Activity

State and Federal Health Care Reform Activity. Presented by Janet Stokes Trautwein Executive Vice President and CEO National Association of Health Underwriters. Control of Congress remains unclear Democrats need 15 seats in the House and 6 in the Senate to gain control

sagira
Download Presentation

State and Federal Health Care Reform Activity

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. State and Federal Health Care Reform Activity Presented by Janet Stokes Trautwein Executive Vice President and CEO National Association of Health Underwriters

  2. Control of Congress remains unclear Democrats need 15 seats in the House and 6 in the Senate to gain control Lobbying reform scandals, support for the administration, and the handling of the Iraq War are major factors in this year’s election How will the elections affect health care reforms? November 7, 2006—Election Day

  3. 85% of state legislative seats up for re-election 36 Gubernatorial races (including OH, IL, and TN) Current state legislative majorities Republican controlled - 20 Democrats controlled - 19 Divided - 11 November 7, 2006 –At the State Level

  4. Congress adjourned on September 29 and members returned to their districts until after the election Pension reform legislation passed just prior to August recess (H.R. 4) Did not include FSA rollover HSA legislation (H.R. 6134) marked-up by Ways and Means Committee Lame duck session post-election What is Congress Doing?

  5. Passed Congress in February 2006 Extends funding to states for existing high-risk pools and appropriates funding for states to start up high-risk pools Increased the authorization level to $75 million annually through 2010 HOWEVER…the funding reauthorization was too late to make it into the appropriations bills NAHU working to work out technical issues to have the funding for HRPs included for 2006 High-Risk Pool Funding Extension

  6. Over 3.2 million covered under HSAs since HSAs were first made available in 2004 (AHIP study) NAHU advocates for HSAs to be portable and more accessible Increase tax incentives for employees and employers to put money into their HSAs Mark-Up of the Health, Opportunity Patient Empowerment Act of 2006 (H.R. 6134) held on Sept. 26 Health Savings Accounts

  7. Allows rollovers from FSAs and HRAs into HSAs for a limited time Removes deductible as a limit on HSA contributions and increases contribution level Requires earlier indexing of cost of living adjustments Allows full deductible contribution for months preceding month that taxpayer is an eligible individual Modifies employer comparable contributions requirements Allows one-time rollover from IRAs to HSAs H.R. 6134

  8. Health Insurance Marketplace Modernization Affordability Act of 2005 Alternative to traditional AHP legislation Bill aimed to create a level-playing field within the small group market. Allows only fully-insured AHPs and only if the plans adhere to state regulation and some level of mandated benefits (SBHPs) Failed vote of cloture, so it died before it could be brought to the floor for a vote Look for a version of the Enzi bill to reintroduced in the 110th Congress S. 1955, the “Enzi bill”

  9. On August 22, 2006, President Bush Signed An Executive Order To Help Increase The Transparency Of America's Health Care System - Empowering Americans To Find Better Value And Better Care. This Executive Order Directs Federal Agencies That Administer Or Sponsor Federal Health Insurance Programs To: Share with beneficiaries information about prices paid to health care providers for procedures. Share with beneficiaries information on the quality of services provided by doctors, hospitals, and other health care providers. Use improved health IT systems to facilitate the rapid exchange of health information. Develop and identify approaches that facilitate high quality and efficient care. Executive Action on Transparency

  10. Senate and House passed different health IT bills – now in conference Conferees not named but staff level discussions continue during recess Expectations are that agreement will be reached during lame duck session Health IT

  11. Funding – Senate bill provides grant funding for entities to employ health IT, house version does not Safe harbors – House version provides safe harbors to hospitals who provide their business partners technology but doesn’t require interoperability which could lead to closed systems House version includes coding update to ICD-10 codes (219,000 codes) with implementation date set for 2010. Industry has requested additional 18-24 months to comply. Of these key issues, safe harbors may be the most difficult. Key Issues to Resolve in Conference

  12. Reduces repeated testing Reduces number of physician visits Will reduce medical errors Less hassle for patients – won’t need to repeat family history over and over and potentially miss something important. New history information can be easily added. Why is Health IT Important?

  13. Massachusetts-style legislation Pay or play legislation Employer Mandates City/County programs Single Payer Wal-Mart legislation High-Risk Pools Medicaid Expansion Long-Term Care Partnership Implementation Individual Mandate Legislation State Trends in Health Reform

  14. MA stood to lose $385 M in federal Medicaid funding Implements an individual mandate to purchase health insurance “if affordable” by Jan. 1, 2007 All employers with 11+ employees must offer a Section 125 plan or be assessed a $295 annual penalty per employee Establishes the Commonwealth Health Insurance Connector, which will offer individual plans (non-group market) Massachusetts Starts the Trend

  15. MassHealth (Medicaid) Expansion to children of guardians who earn up to 300% FPL Uncompensated Care Pool safety net Yet to be Determined… What is considered “affordable coverage?” Co-pays and deductibles? How many plans will be available? How an agent will be compensated for plan sold through the Connector? How much will policies cost? (Target=$200/mo) Who provides independent advice when someone purchasing without an agent has a question or problem? *The Devil is in the Details… Other Provisions of the “Massachusetts Legislation”

  16. Catamount Health High-deductible private insurance Subsidies available up to 300% FPL Chronic Care Initiative (thru Medicaid) If 96% are not insured by 2010, then the legislature will consider an individual mandate Financed though sliding scale premiums, employer assessment ($365/FTE), tobacco tax, and matching federal grant money Vermont Follows Suit

  17. Pay or Play legislation Big push of AFL-CIO—introduced in 35 states Passed in Maryland only—became known as the “Wal-Mart Bill” Required employers with more than 10,000 employees to contribute 8% of their payroll towards health benefits or pay into a state health care fund MD court recently overturned the decision because it violated ERISA “Fair-Share” Legislation

  18. Applying for a Medicaid Waiver was simplified in the DRA Kentucky and West Virginia were the first to file Medicaid Waivers under the new standards KyHealth Choices will be a managed care system with four choices for beneficiary groups Cost-sharing and co-payments will be included, however, there is an OOP maximum of $450 annually Medicaid Waivers

  19. Access TN – HRP Cover Kids—creates SCHIP program in TN Cover TN Voluntary partnership among the state, individual and “willing” employer Available guaranteed-issue to previously uninsured with household income up to 250% FPL Plans are portable and cover “basic services” Plans are estimated at $150 per month and vary based on age, tobacco use and obesity Tennessee Reforms TennCare

  20. Targeted at non-union “big box” stores Companies with more than 90,000 square feet must provide a living wage of $10 per hour for each employee Also requires $3 per hour toward employee benefits Target has already pulled 2 planned stores and Wal-Mart has put plans on hold in the Chicago area Mayor Daley vetoed the legislation—his first in his 17 year tenure City of Chicago

  21. Pay or Play System All employers with 20+ employees must contribute to employee health benefits or pay into a state fund 20-99 employees=$1.06 per hr/per employee 100 or more=$1.60 per hr/per employee Will treat only city residents, including illegal aliens Cost estimate $200 million annually Co-pays and premiums are income-based and established on a sliding scale San Francisco

  22. NAHU is preparing for single payer proposals for next year The rising cost of health care is causing officials at the federal, state, and local level to look at possible solutions The Fall elections look to be favorable for government-directed health care fans Many states will propose “Massachusetts-style” proposals next year Looking Ahead to 2007

  23. Janet Stokes TrautweinExecutive Vice President and CEONational Association of Health Underwriters jtrautwein@nahu.org 703-276-3806

More Related