healthcare reform
DESCRIPTION
Healthcare Reform. Bryan Lagg Blue Cross Blue Shield of Mississippi. Major Timelines Related to Healthcare Reform. 2010 - 2011: Market Reform 2012 - 2013: Financing Alignment 2014 - Ongoing: The Exchange / Individual Mandates. 2010 Provisions. March 23, 2010. January 1, 2010. - PowerPoint PPT PresentationTRANSCRIPT
Major Timelines Related to Healthcare Reform
2010 - 2011: Market Reform
2012 - 2013: Financing Alignment
2014 - Ongoing: The Exchange / Individual Mandates
March 23, 2010January 1, 2010
2010 Provisions
Rate Review
Consumer Information
Grants to States
Grandfathered Plan Status
in Effect
Small BusinessTax Credits
2010-2013
Estimated Annual Premiums
Funding Percentage
Total Tax Credit Available
Potential Tax Credit
Reduction Phase-Out (# of Employees)
Reduction Phase-Out (Average Salary)
Total Tax Credit
$70,000 50% 35% $12,250 0 0 $12,250
Number of Employees: 10Assumed Premiums: $70,000/yearFunding Percentage: 50%Average Annual Wages: $25,000Potential Tax Credit: 35%
Main Street Mechanic Auto Repair Shop
2010-2013
Estimated Annual Premiums
Funding Percentage
Total Tax Credit Available
Potential Tax Credit
Reduction Phase-Out (# of Employees)
Reduction Phase-Out (Average Salary)
Total Tax Credit
$240,000 50% 35% $42,000 -$28,000 0 $14,000
Number of Employees: 40 Part-Time Employees (equivalent of 20 FTEs)Assumed Premiums: $240,000/yearFunding Percentage: 50%Average Annual Wages: $25,000Potential Tax Credit: 35%
Downtown Diner
2010-2013
Estimated Annual Premiums
Funding Percentage
Total Tax Credit Available
Potential Tax Credit
Reduction Phase-Out (# of Employees)
Reduction Phase-Out (Average Salary)
Total Tax Credit
$72,000 50% 25% $9,000 0 0 $9,000
Number of Employees: 9Assumed Premiums: $72,000/yearFunding Percentage: 50%Average Annual Wages: $22,000Potential Tax Credit: 25%
1st Street Family Services(Non-profit Foster Care)
2010-2013
Estimated Annual Premiums
Funding Percentage
Total Tax Credit Available
Potential Tax Credit
Reduction Phase-Out (# of Employees)
Reduction Phase-Out (Average Salary)
Total Tax Credit
$90,000 50% 35% $15,750 -$2,100 -$6,300 $7,350
Number of Employees: 12Assumed Premiums: $90,000/yearFunding Percentage: 50%Average Annual Wages: $35,000Potential Tax Credit: 35%
Acme Air Conditioning, LLC(Manufacturer)
March 23, 2010January 1, 2010 June/July, 2010 September 2010
2010 Provisions
Rate Review
Consumer InformationGrants to States
Grandfathered PlanStatus in Effect
Small BusinessTax Credits
Part D “DonutHole”
Decreased
Sec. 833 Changes
Limits deductibility
of insurerexecutive
compensation
(90 days out)
National highrisk pool
Early retireereinsurance
grants
July 1
HHS Internet portal
Part D discounts in “donut hole”
(180 days out)
HHS regulations on state
Exchange waivers
HIT standards
Plan Years 6 Months OutDependent
Coverage to Age 26
No pre-ex exclusion period < age 19
Preventive services with no cost-sharing
Preventive MeasuresHealthy You! Compared to USPSTF
Services / FrequencyBirth-24 Months
2-11 Years
12-17 Years
18-34 Years
35-39 Years
40-49 Years
50+ Years
Preventive medicine evaluation or re-evaluation / 1 visit per calendar year
8
Hemoglobin, hematocrit or CBC / Once per calendar year
Urinalysis / Once per calendar year
Immunizations
Blood pressure / Once per calendar year
Breast exam / Once per calendar year
Pap smear and pelvic exam / Once per calendar year
Preventive MeasuresHealthy You! Compared to USPSTF
Services / Frequency
Birth-24 Months
2-11 Years
12-17 Years
18-34 Years
35-39 Years
40-49 Years
50+ Years
Glucose
Lipid profile / Once per calendar year
Mammogram / Once per calendar year
PSA / Once per calendar year
Stool for occult blood / Once per calendar year
Flexible sigmoidoscopy / Once every five years or Colonoscopy / Once every 10 years
Bone density / Once per lifetime
March 23, 2010January 1, 2010 June/July, 2010 September 2010
2010 Provisions
Rate Review
Consumer InformationGrants to States
Grandfathered PlanStatus in Effect
Small BusinessTax Credits
Part D “DonutHole”
Decreased
Sec. 833 Changes
Limits deductibility
of insurerexecutive
compensation
(90 days out)
National highrisk pool
Early retireereinsurance
grants
July 1
HHS Internet portal
Part D discounts in “donut hole”
(180 days out)
HHS regulations on state
Exchange waivers
HIT standards
Plan Years 6 Months OutDependent
Coverage to Age 26
No pre-ex exclusion period < age 19
Preventive services with no cost-sharing
Restrictions on Rescissions
No lifetime limits; restricted annual
limits
MLR reporting
January 1, 2011
MLR rebates
HSA/FSA changes
2013
Contribution limitson HSAs
Itemized deductions forunreimbursed medical
expenses
Medicare taxes
2014
Long-Term Provisions
$8B insurer fee
Key Provisions:Financing
FSA Limits(2011+)
Limited to $2,500 per year
Tax on Rx/Devices(2011)
$47B in new taxes
Increased Medicare Tax(2013+)
Increases tax on income and investments for high-income people‣ Additional .9% HI tax for individuals earning more than $200,000 and joint filers earning more than $250,000
Insurance Tax (2014+)$60B tax on insured products; $8B in 2014
Cadillac Tax (2018+)Tax on high-value plans ($10,200 single/$27,500 family)
2013
Contribution limitson HSAs
Itemized deductions forunreimbursed medical
expenses
Medicare taxes
2014
Long-Term Provisions
$8B insurer fee
Health insuranceExchanges
Key Provisions:Exchanges
Exchanges(2014+)
‣ States must establish Exchanges for individuals and small employers (federal fallback)‣ Employee choice‣ Subsidies and small employer credits only available through Exchange‣Options limited to 4 “actuarial value” benefit packages‣ Bronze (60%), Silver (70%), Gold (80%), Platinum (90%)‣ Insurers must offer Silver and Gold
Key Provisions:Exchanges
Exchanges(2014+)
‣ Catastrophic plan offering available to individuals less than 30 or with financial hardship‣ State mandates required only if state pays added costs‣ Participating plans must meet extensive requirements‣ Grants to “navigators” for education and enrollment
Outside Exchange
‣Individual and group coverage can be sold‣ Must meet “essential benefits”‣ Follow cost-sharing limits‣ Apply state benefits mandates
Small Business Tax CreditsEmployees 2010 2011 2012 2013 2014 2015
1-25
35% tax credit eligible if:1) 50% funding level2) Average Annual Wage (AAW) < $25,0003) Phase-out based on size & AAW
Early retiree reinsurance grants
50% tax credit eligible if:1) Exchange participation2) 50% funding level3) AAW < $25,0004) Phase-out based on size & AAW
Employers required to report value of healthcare benefits on W-2
Part D subsidy deduction elimi-nated
Medicare tax increase
2010-2013
Estimated Annual Premiums
Funding Percentage
Total Tax Credit Available
Potential Tax Credit
Reduction Phase-Out (# of Employees)
Reduction Phase-Out (Average Salary)
Total Tax Credit
$90,000 50% 35% $15,750 -$2,100 -$6,300 $7,350
Number of Employees: 12Assumed Premiums: $90,000/yearFunding Percentage: 50%Average Annual Wages: $35,000Potential Tax Credit: 35%
Acme Air Conditioning, LLC(Manufacturer)
2014-2015
Estimated Annual Premiums
Funding Percentage
Total Tax Credit Available
Tax Credit
Reduction Phase-Out (# of Employees)
Reduction Phase-Out (Average Salary)
Total Tax Credit
$90,000 50% 50% $22,500 -$3,000 -$9,000 $10,500
2013
Contribution limitson HSAs
Itemized deductions forunreimbursed medical
expenses
Medicare taxes
2014
Long-Term Provisions
$8B insurer fee
Health insuranceExchanges
Individualmandate and
subsidies
Key Provisions:Individual Mandate and
Subsidies
Individual Mandate(2014+)
All individuals must purchase minimum coverage. Penalty (with exceptions) is lower of:‣ National average premium, or‣ Greater of: % income (up to 2.5%), or $95 (2014), $695 (2016)
Subsidies(2014+)
Sliding scale, up to 400% Federal Poverty Level ($88,000 per year for family of 4)‣ Only available through Exchanges
2013
Contribution limitson HSAs
Itemized deductions forunreimbursed medical
expenses
Medicare taxes
2014
Long-Term Provisions
$8B insurer fee
Health insuranceExchanges
Individualmandate and
subsidies
Employerrequirements
Key Provisions:Employer Requirements
Requirement:“Play”(2014+)
Employers with more than 50 full-time employees (FTEs) must offer minimum coverage:‣ Part-time are included on FTE basis in calculating more than 50 FTEs‣ FTE is 30+ hours per week‣ No minimum contribution‣ Must provide “essential coverage”
Coverage Penalty:“Pay”(2014+)
Employers with more than 50 FTEs:‣ Not offering coverage and at least one FTE receives tax credit ‣ $2,000 x total number of FTEs (minus first 30 FTEs)‣ Offering coverage at least one FTE receives tax credit but actuarial value less than 60% or employee cost is more than 9.5% of household income‣ Lesser of $2,000 x total FTEs or $3,000 x number of employees receiving tax credit
2013
Contribution limitson HSAs
Itemized deductions forunreimbursed medical
expenses
Medicare taxes
2014
Long-Term Provisions
$8B insurer fee
Health insuranceExchanges
Individualmandate and
subsidies
Employerrequirements
Medicaidexpansion
Risk Pool eliminated
Final Summary:State of the Union 2014
Government subsidies
Medicaid rolls increased
Exchange implemented/incentives to enroll
Rich benefit designs taxed
No real measures addressing cost, only attempts to increase access;
rates will increase
Coverage mandated/insufficient penalties