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Federal Healthcare Reform 2009

Federal Healthcare Reform 2009. Presented by: Ronald R. DiLuigi V.P. Advocacy, Govt’ Relations and Public Policy November 14, 2009. Federal Healthcare Reform - 2009. Insurance Market Reforms: Guaranteed eligibility for private/public plans

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Federal Healthcare Reform 2009

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  1. Federal Healthcare Reform 2009 Presented by: Ronald R. DiLuigi V.P. Advocacy, Govt’ Relations and Public Policy November 14, 2009

  2. Federal Healthcare Reform - 2009 Insurance Market Reforms: • Guaranteed eligibility for private/public plans • Plans prohibited from discrimination (ie; pre-existing condition, gender) • No annual or lifetime limits on medical spending • Limited variation in premium rates permitted based on tobacco use, age • Actuarially equivalent benefit packages • Requires health plan spend a minimum of 85% of premium dollars on medical care

  3. Federal Healthcare Reform - 2009 Health Insurance Exchange (HIE) • Creates a new market place which would simplify comparison of health insurance plan benefits and premium costs • Information about coverage and cost sharing available in standard format • Plans compete to offer individual/small employer coverage • Rules/standards for participating plans

  4. Federal Healthcare Reform - 2009 Public Option • Maybe the most widely discussed, misunderstood and disagreed upon element of the reform proposals • A government directed plan designed to compete with private insurance plans • Stated purpose is to promote cost savings in the insurance industry and bring lower cost to the consumer, creating greater competition in the insurance market • Proposed to serve the individual and small employers

  5. Federal Healthcare Reform - 2009 Public Option (continued) • Alternatives proposed include: not for profit cooperatives; State opt-in or State opt-out • Final alternative is so-called “trigger”, meaning there would be no public option to begin with, but one would be triggered into existence if private insurers fail to deliver affordable plans to pre-agreed upon numbers of currently un- insured people

  6. Federal Healthcare Reform - 2009 Shared Responsibility • Employers – must provide health insurance to their employees or make a contribution to the HIE to fund affordable coverage (play or pay) • Small business – small employers with fewer than 25 employees or a payroll of less than $500,000 would be exempt – small business tax credits • Individuals – are required to obtain health coverage or pay a penalty fee

  7. Federal Healthcare Reform - 2009 Shared Responsibility (continued) • Government – ensure that essential health coverage is affordable and available to all Americans – provide financial assistance to Low income residents.

  8. Affordability Factor HR 3962

  9. Federal Poverty Guidelines-Eligibility

  10. Federal Healthcare Reform - 2009 Abortion • Intent of the U.S. Conference of Catholic Bishops and the Catholic Healthcare Association is to ensure that Healthcare Reform Legislation is “Abortion Neutral” • Bars the use of federal funds to pay for abortions, except to save the mother’s life, or in cases of rape or incest. (Hyde Amendment) • Maintains conscience protection for healthcare professionals and hospitals (Weldon Amendment)

  11. Federal Healthcare Reform - 2009 Where does Healthcare Reform go from here?

  12. Federal Healthcare Reform - 2009 Agreement • General Consensus among almost all members of Congress • Mandate for more individuals to have some level of insurance • Pre-existing conditions do not block eligibility • Subsidies for lower income families & small business • Contributions from most employers • Health Insurance Exchange (voluntary) • Narrow premium pricing bands

  13. Federal Healthcare Reform - 2009 Agreement (continued) • Benefits • “Young and invincible” with catastrophic and preventive care • Bronze: Essential benefits (minimum package) • Silver, Gold & Platinum plans with specific actuarial values • Cap Maximum out-of-pocket expenses • End lifetime expenditure maximum • New government regulations on insurance companies • Medicare savings

  14. Federal Healthcare Reform - 2009 Disagreement • Major differences among members of Congress • Public Option • Cost • Federal deficit • Additional taxes for employers, beneficiaries & insurers • Tax the rich • Tax rich benefit plans • Tax poor (inadequate) benefit plans • Tax insurers

  15. Federal Healthcare Reform - 2009 Disagreement (continued) • Medicare reductions • Medicaid expansion • State burdens • Universal vs. increased coverage • Eligibility • Income • Part-time employees • Illegal aliens & undocumented workers • End-of-life counseling (euthanasia) (“death squads”) • Abortions

  16. THE ROAD AHEAD THE ROAD AHEAD CBO ANALYSIS CBO ANALYSIS CBO ANALYSIS 16

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