Download - Federal Health Care Reform Implementation Update Elizabeth Hall, Vice President, Federal Affairs
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Note: This presentation is not intended to advise you on how to comply with PPACA or its related regulations. This presentation is not intended to offer legal advice. For specific questions, please consult with your counsel or benefits advisor.
Topics for Today
Implementation Updates▪ Supreme Court ▪ Exchanges▪ Essential Health Benefits
Political Environment
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Issue: Individual Mandate Constitutionality
Is the individual mandate constitutional:
• Commerce Clause – Can Congress force engagement in commerce/regulate “inactivity”?
• Necessary and Proper Clause
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Issue: Medicaid Expansion
Is the Medicaid Expansion Constitutional?• Is the Federal Government coercing states to expand
Medicaid benefits?
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Issue: Severability
Is the individual mandate severable?• The law includes no “severability clause”• If the law finds a portion of the legislation unconstitutional, what
portion of the law must stand or fall?
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Exchange Enabling Legislation
CT
VT
* Represents legislative activity as of 1/19/12, not compliance with ACA. No regular 2012 session: MT, NV, ND and TXSource: Blue Cross and Blue Shield Association, January 19, 2012
WV
MA
RI
WA
OR
NV
MT
CO
NE
SD
ND
KS
AZ NMOK
WI
IA
MO
IL
MI
OH
TN
MS
LA
AL GA
SC
NC
PA NJ
ME
UT
ID
KY
IN
AR
CA
FL
MD
MNNY
VA
WY
TX
Pending bill: 12
Failed 2012: 1
Enacted: 13
Executive Order: 7
DE
NH
Study Law: 3
DC
Failed 2012 + planning ongoing
No Bill + planning ongoing: 12
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Essential Health Benefits
Key Provisions in the Legislation
HHS to define essential health benefits (Institute of Medicine to provide guidance)
However, benefits shall include the following categories:1. Ambulatory patient services 6. Mental health and substance abuse disorder services2. Emergency services 7. Rehabilitative and habilitative services and devices3. Hospitalization 8. Laboratory services4. Maternity and newborn care 9. Preventive and wellness services & chronic disease mgt. 5. Prescription drugs 10. Pediatric services, including oral and vision care
Scope equal to “typical employer plan”
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Essential Health Benefits Bulletin
HHS Gives States Four Options:
1. The largest plan by enrollment in any of the three largest small group products in the state
2. One of top 3 state employee plans in the state
3. One of top 3 national Federal Employees Health Benefit Program plans in the state
4. The top HMO Commercial plan in the state
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Top Small Group Plans in Any of the 3 Largest Products
Anthem products are among the top 3 SG products in most states per HHS Web PortalState First* Second Third
CA Kaiser SG HMO Anthem PPO Anthem PPO
CO United Choice Plus Kaiser HMO Rocky Mountain PPO (Anthem)
CT Oxford PPO ConnectiCare HMO Blue Care HMO (Anthem)
GA BCBS Healthcare Plan of GA POS BCBS Healthcare of GA HMO Aetna HMO
IN Anthem PPO Anthem Lumenos United Choice Plus
KY Anthem PPO Anthem Lumenos Humana PPO
ME Anthem PPO Aetna PPO Anthem Lumenos
MO Blue Access Choice PPO (Anthem) United Choice Plus Mercy Health Plans PPO
NH HMO Blue New England (Anthem) Matthew Thorne Blue (Anthem) Access Blue New England (Anthem)
NV Rocky Mountain PPO (Anthem) Health Plan of NV POS Health Plan of NV HMO
NY Oxford Health EPO Prism EPO (Empire BCBS) Oxford HMO
OH Anthem PPO Med Mutual of OH Super Med. Anthem Lumenos
VA Anthem Health Plans of VA PPO Anthem Health Keepers HMO Optima Vantage HMO
WI United Choice Plus Compcare POS (Anthem) Medical Associates HMO
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Note: This presentation is not intended to advise you on how to comply with PPACA or its related regulations. This presentation is not intended to offer legal advice. For specific questions, please consult with your counsel or benefits advisor.
Topics for Today
Implementation Updates▪ Supreme Court ▪ Exchanges▪ Essential Health Benefits
Political Environment
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Americans See Country Headed in the Wrong Direction
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Source: NBC News/Wall Street Journal Survey, Jan. 24 th, 2012 1,000 Am
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Republican Base Unimpressed with Party’s Candidates
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Source: Pew Research Center
• More Republican and Republican-leaning registered voters say the GOP field is only fair or poor (52%) than did so in early January (44%).
• At about this point four years ago, 68% of Republican and GOP-leaning voters rated the field as excellent or good.
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Obama vs. Romney Presidential Matchup
• A USA TODAY/Gallup Swing States Poll from Jan. 28th found that registered voters in 12 key swing states are evenly split between Barack Obama and Mitt Romney in their 2012 presidential election preferences.
▪ Obama and Romney have also been statistically tied in each of five polls conducted among swing state registered voters dating back to August
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Source: Gallup USA/Today Poll
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Battle for the House of Representatives
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Map Source: Real Clear Politics
Current House: 242 Republicans & 193 Democrats
Democrats Need to Win 25 New Seats to Flip House
50 Seats are Considered Slight Lean/Toss-Ups
Republican Held Seats Democrat Held Seats
GOP Currently Holds 28 of those Seats
Democrats Holds 22 of those Seats
Magic Number: 218 Seats are needed for House Majority
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Battle for the Senate
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Map Source: Real Clear Politics
Current Senate: 53 Democrats & 47 Republicans
GOP Need to Win 4 New Seat to Re-Gain Control of Senate
8 Senate Races this Election Cycle are Considered Toss-Ups
6 of those Toss-Up Senate Races are Currently Controlled by Democrats
Majority
Magic Number: 51Seats are needed for Senate
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Key Battleground Senate Races Up-Close
Four Most Competitive Senate Races
• Massachusetts
• Florida
• Nevada
• Virginia
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Massachusetts Senate Race
Senator Scott Brown (R-Incumbent)
Elizabeth Warren (D)
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• Scott Brown won this seat in a special election against a weak opponent
• Moderate voting record and bipartisan appeal
• President Obama won Massachusetts with 62 percent of the vote in 2008
• 54 percent of the state’s voters are registered independents
• Latest poll had both candidates in statistical tie
• Viewed as liberal star who plays well to the deep blue party base in state
• Harvard law professor, oversaw TARP and established the Consumer Financial Protection Bureau.
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Florida Senate Race
Senator Bill Nelson (D-Incumbent)
Congressman Connie Mack (R) *Likely Republican Nominee*
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• Has been Senator since 2000
• Only Democrat to hold state-wide office in a increasingly conservative state
• Nelson currently has a huge fundraising advantage
• Latest poll had candidates in statistical tie
• Fits the conservative trending of the electorate
• Father was two term Florida Senator
• Still needs to survive a bruising primary race
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Nevada Senate Race
Senator Dean Heller
(R-Incumbent)
Congresswoman Shelley Berkley (D)
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• Appointed to the Senate last year
• Former Congressman and Secretary of State
• Large Hispanic population and large influx of new voters
• Polls have both candidates in statistical dead heat
• Largely unknown outside her Vegas area district
• Has represented Clark County (Las Vegas) since 1998
• Nevada economy has been devastated by the recession and the drag of President Obama could hurt Berkley’s chances
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Virginia Senate Race
Former Senator George Allen (R)
Former Gov. Tim Caine (D)
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• Former Governor and Senator
• Strong possibility that the current Gov. Bob McDonnell could be picked as Romney’s running mate
• Polls have both candidates in statistical tie
• Chosen to run with President Obama’s message
• Former Governor and DNC Chair
• Once a solidly republican state, the voter demographics have shifted to become more favorable to democrats
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40%
44%
41%
35%
45%
40%
44%
40% 41%
50%48%
46%
41%44%
46%43% 44% 43%
51%
44% 43% 44%
14% 14%10%
14%12% 11%
15%18% 18%
9% 8%
13%
18%
14%12%
15%17% 16% 15%
19%17%
19%
46%
41%
48%50%
43%
49%
42%
42% 42%
41%43% 42% 41% 42% 42% 42%
39%41%
34%37%
41%
37%
0%
20%
40%
60%
80%
Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan
Public Remains Largely Split On ACA
Favorable Unfavorable
Don’t know/Refused
ACA signed into law on
March 23, 2010
Source: Kaiser Family Foundation Health Tracking Polls
2010 2011 2012
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Republican Opposition to ACA Far More Intense Than Democratic Support
16%
17%
14%
57%
34%
9%
30%
6%
19%
27%
19%
6%
11%
35%
18%
10%
Very favorable Somewhat favorable Somewhat unfavorable Very unfavorable
Total
Democrats
Independents
Republicans
Source: Kaiser Family Foundation Health Tracking Poll , conducted January 12-17, 2012