national heath care reform the affordable care act angela marese boyle, nodd specialist, region 3...
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National Heath Care Reform The Affordable Care Act
Angela Marese Boyle, NODD Specialist, Region 3&
Kathy Rallings, NODD Health Benefits Specialist
About The Law
Signed into law March, 23 2010 Puts in place health insurance reforms to
Hold insurance companies more accountable Lower health care costs Guarantee more choices Enhance quality of health care
New Consumer Protections2010
Must provide coverage for children with pre-existing conditions
No lifetime limits on essential benefits * Annual limits will be restricted* External appeals process State consumer assistance No rescissions for minor errors
Improving Quality and Lowering Costs
Small business tax credits Relief for seniors prescriptions No cost sharing for preventive care* Wellness and disease management Reducing health care fraud Early retirees* Partnership for Patients*
Increasing Access
Uninsured with pre-existing conditions Young adults* Primary care workforce States to allow more on Medicaid Better payments for rural providers Community health centers Insurance companies unreasonable rate hikes
Grandfathered Plans
Collectively Bargained by Enactment
To Qualify Cannot:Changes in annual benefit limitsElimination of benefits for certain conditions5% increase to employee share of premiumIncreases of 15% plus medical inflation to deductibles More then a $5 or 15% adjusted for medical inflation on co-pays
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Grandfather Plans Exceptions
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Cost sharing for preventive care No patient protections No limit on deductibles in 2014
Only 35% will retain this status by 2013
First Renewal on or After September 23, 2010
Coverage for dependents under age 26 AB 36 (tax conformity)
Elimination of lifetime limits Elimination of annual limits
2010 - $750,000 2011 - $1.25 Million 2012 - $2 Million Completely banned Jan. 1 2014
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Early Retiree Reinsurance Program
Accountable Care Organizations
2012 for Medicare Voluntary participation Patient centered Restructure payments Shared savings Measurements to improve quality Improved coordination & communication
http://video.pbs.org/video/1880261065
Partnership for Patients: Better Care, Lower Costs
GOALS BY 201340% decrease in preventable hospital-acquired conditions
60,000 lives saved
Reduce hospital readmissions by 20% 1.8 million patients would not suffer complications
Potential Savings of $35 Billionhttp://www.healthcare.gov/
California Health Benefit Exchange
First in the nation In place by 2014 Governing Board
Kimberly Belshé Diana S. Dooley , Chair Paul Fearer Susan Kennedy VACANT (Senator Steinberg to appoint)
Pending bills to make Exchange Work
California Health Benefit Exchange
Est. 2.4 million Californians eligible Subsidy based on family income
Under 400% FPL Unaffordable employer based
9.5% of income 60% actuarial value
Not eligible for Medi-Cal
May opt out of employer-based coverage if cost is between 8% and 9.8% of income.
Actuarial Examples
Individual Mandate2014
Tax penalty Hardship waiver Sets minimum standards
Establishes floor for negotiations
Limit on waiting periods to 90 days
Employer Penalties
Firms with 50 or more FTEs
No coverage offering$2,000 per full-time
employeeAt least one employee
receives subsidy1st 30 except
Unaffordable offering$3,000 per employee
receiving a subsidy
Maximum Out of Pocket
Employee Only
Family Coverage
Taxes
Report value of benefits on W-2 Includes employer contributions to HSA, MSA or FSA excludes dental and vision.
2018 -40% tax on INSURERS $10,200 single $27,500 family Adjusted for age, CPI, and gender Employers must report annually to the IRS
California Statutes and Proposals
SB1088 (Price) Conformed California state law regarding 26 year olds
AB52 (Feuer) Rate Regulation Pending Exchange bills AB1296 AB714 AB792
Heath and Human Services www.healthcare.gov The Commonwealth Fund www.commonwealthfund.org Kaiser Family Foundation www.kff.org California HealthCare Foundation www.chcf.org The California Endowment www.calendow.org Physicians for a National Health Program www.pnhp.org UC Berkley Labor Center www.laborcenter.berkeley.edu For additional information and links to various
health care websites: www.cechcr.org
How You Can Stay Informed
Good sources of information:
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