Health Care Reform: Get It Right for Maryland

Leni Preston, Chairleni@mdchcr.org(301) 351-9381

© 2012 Maryland Women’s Coalition For Health Care Reform

Patient Protections: What We Have Gained to Date• Ban on pre-existing conditions for

children.• Children remain on parents coverage until

26.• Medicare covers preventative health

benefits (no-cost annual checkups and mammograms) & closes the Medicare Part D “donut hole.”

• August 1st – New plans must cover preventive services without co-pays and deductibles.

• Direct access to ob-gyn services.© 2012 Maryland Women’s Coalition For Health Care

Reform

The Patient Protection and Affordable Care ActA 3-Legged Stool:1.Everyone is “in”2.Personal responsibility3.Affordability

© 2012 Maryland Women’s Coalition For Health Care Reform

Affordability in the Affordable Care Act

• Expand Medicaid program: individuals with incomes up to 138% FPL.

• Tax-credits to individuals with incomes between 138% & 400% FPL.

• Tax credits for small businesses.• Creates Individual and Small

Business Health Options Exchanges.• Qualified health plans – 4 “metal”

levels

© 2012 Maryland Women’s Coalition For Health Care Reform

The Health Benefit Exchange:A Health Insurance Supermarket• Exchange will

describe each plan in a standard format– Monthly cost and

co-pays– Plan performance

on quality measures

– Plan ratings by quality and price

• Compare Apples to Apples

• Can’t decide between a Fuji and a Rome? Get help!– Website– Telephone hotline– Navigators

© 2012 Maryland Women’s Coalition For Health Care Reform

Maryland: A National Leader

• Commitment and Leadership

• Effective Process:– Health Care

Reform Coordinating Council;

– Office of Health Care Reform; &

– Health Benefit Exchange Board

• Roadmap© 2012 Maryland Women’s Coalition For Health Care Reform

Health Benefit Exchange Timeline

4/12/2011Governor O’Malley Signed Health Benefit

Exchange Act into

Law

6/3/2011Exchange Board 1st Meeting

9-11/2011 Advisory

Committees Met

1/1/2013 Exchange Must be

Certified by Federal

Government

10/1/2013 Individuals and Groups

Begin Enrolling in Exchange

1/1/2014 Maryland

Health Benefit

Exchange will be

Operational

© 2012 Maryland Women’s Coalition For Health Care Reform

Source: A Report to the Governor and Maryland General AssemblyMaryland Health Benefit Exchange, December 23, 2011, p. 1

Landmark ACA Legislation signed into Law 3/23/2010 by President Obama

Maryland’s Health Benefit Exchange Act of 2011• Public corporation/independent unit of

state government • 9-member board• Key goals:– Reduce number of uninsured– Facilitate purchase and sale of Qualified

Health Plans– Require cultural competency in all operations

to ensure all populations can gain access– Financially self-sustainable– 6 Legislative Studies

© 2012 Maryland Women’s Coalition For Health Care Reform

Creating the Exchange: Stakeholder InputFour Advisory Committees• Operating Model (Market Rules & Risk

Mitigation)• SHOP (Small Business Exchange)• Navigator Program (Marketing & Public

Relations)• Financing

© 2012 Maryland Women’s Coalition For Health Care Reform

Creating the Exchange: Stakeholder Representation

© 2012 Maryland Women’s Coalition For Health Care Reform

Source: A Report to the Governor and Maryland General Assembly, Maryland Health Benefit ExchangeDecember 23, 2011, p. 2

Consultants3%

Local Government3%

Health Insurance In-dustry34%

Community Care Providers and Associations

18%

Community Members and Advocates

21%

Academia12%

Business Owners9%

Advisory Committee Membership by Affili-ation

Health Benefit Exchange Act of 2012

• Selective Contracting• Small Business Health Options

(SHOP)• Navigator Program• Essential Health Benefits• Financing

© 2012 Maryland Women’s Coalition For Health Care Reform

SHOP – What is It?

• Marketplace where small employers & nonprofits (under 50 employees) can purchase insurance.

• Tax credit available through 2016

© 2012 Maryland Women’s Coalition For Health Care Reform

SHOP Proposals

• Create separate SHOP exchange.• Retain small group size at 50 until 2016.• Provide two options:– Employers select metal level &

employees choose among carriers at that level

– Employers select one carrier & employees select the metal level that meets their needs

– Consider additional options in 2016© 2012 Maryland Women’s Coalition For Health Care

Reform

Navigator Program Proposals

• Individual Exchange – CBOs & similar organizations

• SHOP – Navigators at HBE

© 2012 Maryland Women’s Coalition For Health Care Reform

What to Watch - Navigator

© 2012 Maryland Women’s Coalition For Health Care Reform

Role of Community-

based Organizations

SHOP Exchange Broker Training

& Licensure

Legislative Language

Financing Mechanisms

Navigator

Program

Essential Health Benefits (EHB)• HHS: States to Select Benchmark Plan with 10 Categories

of Services– Ambulatory patient services– Emergency services– Hospitalization– Maternity & newborn care– Mental health & substance use disorder services– Prescription drugs– Rehabilitative & habilitative services & devices– Laboratory services– Preventive & wellness services & chronic disease

management– Pediatric, including oral & vision care

© 2012 Maryland Women’s Coalition For Health Care Reform

EHB: Coalition Proposals

• Stakeholder & consumer group to advise HCRCC

• Guidance– Balance benefits in each of the 10 mandated categories.– Specificity in defining health services to ensure

comprehensive care according to national standards.– Require that there be equal actuarial values.– Provide mental health & substance use disorder

benefits in parity.– Do not permit benefit design that discriminates on basis

of age, gender, disability, or expected length of life.

© 2012 Maryland Women’s Coalition For Health Care Reform

What to Watch - EHB

• Our Principals:

© 2012 Maryland Women’s Coalition For Health Care Reform

Ensure Consumer

& Stakeholder Participatio

n

Share Relevant

Information Timely

& Effectively

ProvideComplete

&AffordableBenefits

Provide aFull Range

of Preventative Services for Women

Resources You Can Use

• Maryland – Health Benefit Exchange

www.dhmh.maryland.gov/healthreform/exchange/index.html

– Department of Health & Mental Hygienewww.dhmh.maryland.gov

– Maryland Health Insurance Plan (MHIP)www.marylandhealthinsuranceplan.state.md.us

– Health Care Reform Coordinating Councilwww.dhmh.maryland.gov/healthreform/index.html

• Federal– Department of Health & Human Services

www.healthcare.gov© 2012 Maryland Women’s Coalition For Health Care

Reform

Stay Informed & Get Involved

• Join the Coalition– Newsletters, Alerts, Member Calls &

Webinars– Educational forums:• February 22nd in Frederick

– Facebook and Twitter

• Encourage others to join• Share your stories

MDHealthCareReform.org© 2012 Maryland Women’s Coalition For Health Care

Reform

© 2012 Maryland Women’s Coalition For Health Care Reform

Leni Preston, ChairPhone: (301) 351-9381E-mail: leni@mdchcr.org Website: www.MDHealthCareReform.org