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National Heath Care Reform The Affordable Care Act

National Heath Care Reform The Affordable Care Act. Angela Marese Boyle, NODD Specialist, Region 3 & Kathy Rallings, NODD Health Benefits Specialist. About The Law. Signed into law March, 23 2010 Puts in place health insurance reforms to Hold insurance companies more accountable

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National Heath Care Reform The Affordable Care Act

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  1. National Heath Care Reform The Affordable Care Act Angela Marese Boyle, NODD Specialist, Region 3 & Kathy Rallings, NODD Health Benefits Specialist

  2. About The Law Signed into law March, 23 2010 Puts in place health insurance reforms to Hold insurance companies more accountable Lower health care costs Guarantee more choices Enhance quality of health care

  3. New Consumer Protections2010 • Must provide coverage for children with pre-existing conditions • No lifetime limits on essential benefits * • Annual limits will be restricted* • External appeals process • State consumer assistance • No rescissions for minor errors

  4. Improving Quality and Lowering Costs • Small business tax credits • Relief for seniors prescriptions • No cost sharing for preventive care* • Wellness and disease management • Reducing health care fraud • Early retirees* • Partnership for Patients*

  5. Increasing Access • Uninsured with pre-existing conditions • Young adults* • Primary care workforce • States to allow more on Medicaid • Better payments for rural providers • Community health centers • Insurance companies unreasonable rate hikes

  6. Grandfathered Plans Collectively Bargained by Enactment To Qualify Cannot: Changes in annual benefit limits Elimination of benefits for certain conditions 5% increase to employee share of premium Increases of 15% plus medical inflation to deductibles More then a $5 or 15% adjusted for medical inflation on co-pays 6

  7. Grandfather Plans Exceptions • Cost sharing for preventive care • No patient protections • No limit on deductibles in 2014 Only 35% will retain this status by 2013

  8. First Renewal on or After September 23, 2010 • Coverage for dependents under age 26 • AB 36 (tax conformity) • Elimination of lifetime limits • Elimination of annual limits • 2010 - $750,000 • 2011 - $1.25 Million • 2012 - $2 Million • Completely banned Jan. 1 2014

  9. Early Retiree Reinsurance Program • Chronic or high cost claims between $15,000-$90,000 • 55-Medi Care eligible • Approved Plan Sponsors • 2014 or 5 Billion • Reductions in: • Premiums • Deductibles • Co-pays • Other out-of-pocket costs

  10. Accountable Care Organizations • 2012 for Medicare • Voluntary participation • Patient centered • Restructure payments • Shared savings • Measurements to improve quality • Improved coordination & communication http://video.pbs.org/video/1880261065

  11. Partnership for Patients: Better Care, Lower Costs • GOALS BY 2013 • 40% decrease in preventable hospital-acquired conditions • 60,000 lives saved • Reduce hospital readmissions by 20% • 1.8 million patients would not suffer complications • Potential Savings of $35 Billion • http://www.healthcare.gov/

  12. California Health Benefit Exchange • First in the nation • In place by 2014 • Governing Board • Kimberly Belshé • Diana S. Dooley , Chair • Paul Fearer • Susan Kennedy • VACANT (Senator Steinberg to appoint) • Pending bills to make Exchange Work

  13. California Health Benefit Exchange • Est. 2.4 million Californians eligible • Subsidy based on family income • Under 400% FPL • Unaffordable employer based • 9.5% of income • 60% actuarial value • Not eligible for Medi-Cal May opt out of employer-based coverage if cost is between 8% and 9.8% of income.

  14. Actuarial Examples

  15. Individual Mandate2014 • Tax penalty • Hardship waiver • Sets minimum standards • Establishes floor for negotiations • Limit on waiting periods to 90 days

  16. Employer Penalties • Firms with 50 or more FTEs • No coverage offering • $2,000 per full-time employee • At least one employee receives subsidy • 1st 30 except • Unaffordable offering • $3,000 per employee receiving a subsidy

  17. Maximum Out of Pocket

  18. Employee Only

  19. Family Coverage

  20. Taxes • Report value of benefits on W-2 • Includes employer contributions to HSA, MSA or FSA • excludes dental and vision. • 2018-40% tax on INSURERS • $10,200 single • $27,500 family • Adjusted for age, CPI, and gender • Employers must report annually to the IRS

  21. California Statutes and Proposals • SB1088 (Price) • Conformed California state law regarding 26 year olds • AB52 (Feuer) • Rate Regulation • Pending Exchange bills • AB1296 • AB714 • AB792

  22. How You Can Stay Informed @ Good sources of information: • Heath and Human Services www.healthcare.gov • The Commonwealth Fund www.commonwealthfund.org • Kaiser Family Foundation www.kff.org • California HealthCare Foundation www.chcf.org • The California Endowment www.calendow.org • Physicians for a National Health Program www.pnhp.org • UC Berkley Labor Center www.laborcenter.berkeley.edu • For additional information and links to various • health care websites:www.cechcr.org

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