Download - How Health Reform Helps Missouri: Today and in the Future Brian Colby MO Health Advocacy Alliance
Health Reform in a Nutshell
• Reforms the private insurance market with new consumer protections
• Creates new exchanges where uninsured people can purchase coverage, some with subsidies
• Expands Medicaid• Medicare: strengthens
preventive benefits and drug coverage; stops windfall payments to Medicare Advantage plans
Provisions Effective Immediately!
• Grants for states to establish consumer assistance and health insurance ombudsman programs
• Insurers must justify unreasonable rate hikes; grants available for states to conduct rate review
• Qualifying small businesses can receive tax credits for covering their workers this year
• Increased funding for community health centers
• Increased funding for primary care provider training programs
Insurance Market Improvements: Effective 90-
Days After Passage• Temporary funding ($5 B until
2014) for covering high-risk individuals
• Reinsurance for employers providing coverage to early retirees to help hold down premiums for plan enrollees
Provisions Effective July 1, 2010
• New HHS web-based internet portal for consumers and small businesses to look for affordable coverage in their state must be in place
Private Insurance Improvements: (Plan Years Starting) Six Months
After Passage• Ban on lifetime limits,
restriction of annual limits (annual limits outright prohibited in 2014)
• Coverage of preventive care with no cost-sharing in new plans
• Coverage of adult children until age 26
• No pre-existing condition exclusions allowed for children under 19
Private Insurance Improvements: (Plan Years Starting) Six Months
After Passage• Stronger protections against unfair
rescissions• Internal and external appeals
processes• Emergency care: no prior
authorization, cost-sharing same for in and out-of-network
• OB/GYNs considered primary care providers
Provisions Effective in 2011
• Medical loss ratio requirements• Plans must have standardized
descriptions (benefits and cost-sharing)• Medicare: Preventive care with no cost-
sharing, 50% discount on brand-name drugs in the Part D donut hole (also, $250 rebate for beneficiaries in donut hole in 2010)
Provisions Effective in 2011
• No later than one year after passage: Secretary provides grants for state implementation of exchanges
• CLASS Act- Voluntary, public long-term care insurance program
Full Implementation (2014)-Market Regulation
• No denials of coverage based on health status/ pre-existing conditions
• No pre-existing condition exclusions
• No premiums hikes based on health status
Full Implementation (2014)- Exchanges
• Can contract exchange responsibilities
• Coverage for individuals and small groups, some eligible for subsidies/ tax credits
• Standardized, comprehensive benefits
• Can operate in more than one state; states can have more than one
Full Implementation: Medicaid and Medicare
• Medicaid: By 2014, expanded eligibility to 133% FPL nationwide ($14,404/ year for an individual in 2010)
– Adults without children eligible everywhere!
• Medicare: Donut hole eliminated by 2020
Questions?
Brian Colby
Health Care Foundation of Greater Kansas City
Missouri Foundation for Health
Kaiser Family Foundation