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Health Care Reform Isn’t Just for Congress – Why Advocacy at the State House Matters.

Aging Advocacy Summit Wednesday , November 14, 2012. Health Care Reform Isn’t Just for Congress – Why Advocacy at the State House Matters. . Mitchell Stein Policy Director Consumers for Affordable Health Care “Advocating the right to health care for every man, woman, and child”

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Health Care Reform Isn’t Just for Congress – Why Advocacy at the State House Matters.

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  1. Aging Advocacy Summit Wednesday, November 14, 2012 Health Care Reform Isn’t Just for Congress – Why Advocacy at the State House Matters. Mitchell Stein Policy Director Consumers for Affordable Health Care “Advocating the right to health care for every man, woman, and child” 1-800-838-0388 www.mainecahc.org

  2. Agenda • Introduction to Consumers for Affordable Health Care • Health Care Environment • The Supreme Court Decision • Other factors (Chapter 90) • The Affordable Care Act • Two Minute Review • Moving Forward: Issues that need your involvement www.mainecahc.org

  3. Introduction to Consumers for Affordable Health Care www.mainecahc.org

  4. PO Box 2490 Augusta, ME 04338-2490 www.mainecahc.org 1-800-838-0388 www.mainecahc.org

  5. About Consumers for Affordable Health Care (CAHC) • Non-profit, non-partisan mission driven advocacy organization since 1988 • Our mission is to make quality health care more affordable for everyone in Maine • Consumer Assistance Program • Policy Research and Advocacy www.mainecahc.org

  6. Consumer Assistance Program • HelpLine • Our statewide, toll-free Consumer HelpLine assists people who need insurance or have been denied care • Provides help finding programs to help with health care and drug costs • Help with Coverage Disputes • Understanding your coverage and rights • Help with denials, appeals or complaints • On-line health care guide • Workshops and presentations • Train service professionals on MaineCare eligibility, private insurance and non-insurance programs that can help people www.mainecahc.org

  7. Policy Advocacy • Monitor Statehouse and Washington activities • Speak on behalf of consumers at state level • Represent consumers in rate review hearings (and help consumers to represent themselves) • Info we get thru our Helpline and Outreach informs our policy and advocacy work; we often are able to spot harmful trends • Founding member of the Health Care for Maine Alliance (HC4ME) www.mainecahc.org

  8. Policy Advocacy – Your Voice • Why should you have a voice? Because ultimately you are the payer • Individual coverage – you pay the premium directly • Medicare - paid for through taxes/ individual premiums • Employer-sponsored coverage - the costs of the health plan are taken into account as a fringe benefit resulting in lower wages or salaries to the employee • Trust but Verify • Changes to the health care system may look good on paper, but the devil is in the details • Everyone may have the best of intentions, but that doesn’t mean things can’t go off track www.mainecahc.org

  9. Health Care Policy Environment in Maine www.mainecahc.org

  10. Supreme Court Decision(s) • Court has jurisdiction to decide case now • Mandate is a constitutional exercise of Congress’ power to tax • Medicaid expansion violates Congress’ spending clause power as unconstitutionally coercive of states because all existing Medicaid funds at risk and states not given adequate notice to voluntarily consent • Remedy is to limit HHS Secretary’s power to withhold existing federal Medicaid funds for state non-compliance with Medicaid expansion www.mainecahc.org

  11. Other Factors: Chapter 90(Insurance Bill passed in 2011) • Widened rating bands and added rating factors resulting in increased premiums based on age, geography and additional factors • Changed rate review resulting in weaker standards • Ability to close books of business resulting in introduction of new plans with less benefits and increased cost-sharing • Instituted a new reinsurance tax • Allowed for health care “captive” insurance companies that are exempt from most insurance regulations – including consumer protections www.mainecahc.org

  12. Chapter 90 (cont.) www.mainecahc.org

  13. The Affordable Care Act: Two Minute Review www.mainecahc.org

  14. What does the ACA do? • Universal access to health coverage • 32 million uninsured Americans (est. by 2019) • Expansions to public programs • New Options for Individuals and Small Businesses • Insurance Reform at the Federal Level • Patients’ Bill of Rights • Holding Insurance Companies Accountable • Workforce Expansion and Quality Improvement Provisions

  15. Highlights of the ACATimeline Medicaid expansion Exchanges launched Employer requirements/assessments Premium & cost sharing subsidies Immediate insurance reforms Tax credits for small employers Begin to close doughnut hole Medicaid expansion option Funding opportunities Early planning Excise tax on high-cost health plans 2010 2011 2013 2014 2016 2018 Option for multi-state compacts System improvement initiatives Insurance reforms Medicare reforms (free preventative services)

  16. What’s happened so far • Young adult dependent coverage until age 26 • No pre-existing condition exclusions for children • Interim coverage available for adults with pre-existing conditions • New Consumer Protections (e.g. appeal rights, etc.) • Medicare prescription drug coverage donut hole being plugged in phases (in 2011 $6.3 million saved in Maine) • Small Employer Tax Credits • No cost preventative services • End to recisions • And more…

  17. And coming in 2014 • Minimum Credible Coverage Requirement: The Mandate • Expanded MaineCare eligibility - incomes up to 133% FPL (may vary by state) • Health Insurance Exchanges (Marketplace) • Subsidies toward Premiums and Cost Sharing • Additional Small Employer Tax Credits • Limits on Out-of-pocket spending • One-stop shopping: consumer-friendly www.mainecahc.org

  18. Moving Forward: Issues That Need Your Involvement www.mainecahc.org

  19. Private Expansion in Maine Exchanges • Supreme Court decision left Exchanges untouched • Maine has been awarded two Exchange Grants but sent back the second one • Currently no work on creating Maine based Exchange • Maine will have Federally-facilitated Exchanges (FFE) for initial enrollment (begins 10/1/13) but each year the State has the option to create their own Exchange • Expecting comment period on FFE during 4th quarter 2012 www.mainecahc.org

  20. Private Expansion in Maine Essential Health Benefits (EHB) • EHB is the minimum benefits all (insured) plans must cover (inside OR outside the Exchange) • Each state has the ability to define EHB (at least for 2014 and 2015) from one of 10 possible benchmark plans • The deadline is past for Maine to take action • The starting point for Maine’s EHB will be the default benchmark plan (the largest small group plan) • Part of the Federal process will be a comment period for each state on their plan www.mainecahc.org

  21. Public Expansion in MaineMedicaid/MaineCare • While the Medicaid decision is more problematic, there is still a clear path forward.  • Most states will still choose to participate in the Medicaid expansion. The increased reimbursement rate (100% for the first few years) is too good an offer to turn down. • While in the out-years there will be some cash outlay for the states (although the reimbursement rate eventually settles at 90%, higher than today’s reimbursement rate) • Many organizations in Maine will join together to promote Maine’s participation in the expansion www.mainecahc.org

  22. Other Maine Issues: ACO Regulations – Payment reform pilot rulemaking underway by the Bureau of Insurance Budget – The new legislature will immediately need to deal with a budget shortfall in the current fiscal year, what programs will be cut? Chapter 90 Pushback – Attempts to reinstate vigorous rate review standards and undo other changes www.mainecahc.org

  23. Action Steps: Let your voice be heard • Federal comment period on Federally-facilitated Exchange regulations expects during 4thquarter 2012 • Federal comment period on Essential Health Benefits plan for Maine expected soon • The legislature will likely take up the issue of Medicaid expansion during the next session • Stay informed and talk to your state representatives on issues such as how to handle the budget shortfall and reinstating strict rate review www.mainecahc.org

  24. Sources/Acknowledgements Consumers for Affordable Health Care http://www.mainecahc.org/ACA/updates.htm Kaiser Family Foundation http://healthreform.kff.org/ HealthCare.Gov http://www.healthcare.gov/ www.mainecahc.org

  25. Questions? Consumers for Affordable Health CarePh: 1-800-838-0388 HelpLine: 1-800-965-7476 Web:http://www.mainecahc.org “Like” us on FacebookRead our blog: http://mecahc.blogspot.com/ Follow us on Twitter: @MAINECAHC www.mainecahc.org

  26. Thank You! www.mainecahc.org

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