federal healthcare reform 2009 presented by: ronald r. diluigi v.p. advocacy, govt’ relations and...

Federal Healthcare Reform 2009

Presented by:

Ronald R. DiLuigi

V.P. Advocacy, Govt’ Relations and Public Policy

November 14, 2009

Federal Healthcare Reform - 2009

Insurance Market Reforms: Guaranteed eligibility for private/public plans Plans prohibited from discrimination (ie; pre-existing

condition, gender) No annual or lifetime limits on medical spending Limited variation in premium rates permitted

based on tobacco use, age Actuarially equivalent benefit packages Requires health plan spend a minimum of 85% of

premium dollars on medical care


Health Insurance Exchange (HIE) Creates a new market place which would

simplify comparison of health insurance

plan benefits and premium costs Information about coverage and cost

sharing available in standard format Plans compete to offer individual/small

employer coverage Rules/standards for participating plans


Public Option Maybe the most widely discussed,

misunderstood and disagreed upon element of the reform proposals

A government directed plan designed to compete with private insurance plans

Stated purpose is to promote cost savings in the insurance industry and bring lower cost to the consumer, creating greater competition in the insurance market

Proposed to serve the individual and small employers


Public Option (continued) Alternatives proposed include: not for profit cooperatives; State opt-in or State opt-out Final alternative is so-called “trigger”, meaning there would be no public option to begin with, but one would be triggered into existence if private insurers fail to deliver affordable plans to pre-agreed upon numbers of currently un- insured people


Shared Responsibility Employers

– must provide health insurance to their employees or make a contribution to the HIE to fund affordable coverage (play or pay)

Small business – small employers with fewer than 25

employees or a payroll of less than $500,000 would be exempt

– small business tax credits Individuals

– are required to obtain health coverage or pay a penalty fee


Shared Responsibility (continued)

Government – ensure that essential health coverage is

affordable and available to all Americans

– provide financial assistance to Low income

residents.

Affordability Factor HR 3962

Income

Premium Limit as a Percent of Income

Annual Out-of PocketCap Individual/Family

Under 133 - 150% FPL

1.5-3% $500/$1000

150 - 200% FPL 3-5.5% $1,000/$2,000

200 - 250% FPL 5.5 -8% $2,000/$4,000

250 - 300% FPL 8-10% $4,000/$8,000

300 - 350% FPL 10-11% $4,500/$9,000

350 - 400% FPL 11-12% $5,000/$10,000

Federal Poverty Guidelines-Eligibility


Abortion Intent of the U.S. Conference of Catholic Bishops

and the Catholic Healthcare Association is to ensure that Healthcare Reform Legislation is “Abortion Neutral”

• Bars the use of federal funds to pay for abortions, except to save the mother’s life, or in cases of rape or incest. (Hyde Amendment)

• Maintains conscience protection for healthcare professionals and hospitals (Weldon Amendment)


Where does Healthcare Reform go from here?


Agreement General Consensus among almost all members of

Congress• Mandate for more individuals to have some level of

insurance• Pre-existing conditions do not block eligibility• Subsidies for lower income families & small business• Contributions from most employers• Health Insurance Exchange (voluntary)• Narrow premium pricing bands


Agreement (continued)

Benefits• “Young and invincible” with catastrophic and preventive

care• Bronze: Essential benefits (minimum package)• Silver, Gold & Platinum plans with specific actuarial values

Cap Maximum out-of-pocket expensesEnd lifetime expenditure maximumNew government regulations on insurance companiesMedicare savings


Disagreement Major differences among members of Congress

• Public Option• Cost

• Federal deficit Additional taxes for employers, beneficiaries & insurers

• Tax the rich• Tax rich benefit plans• Tax poor (inadequate) benefit plans• Tax insurers


Disagreement (continued) Medicare reductions Medicaid expansion

• State burdens Universal vs. increased coverage Eligibility

• Income• Part-time employees• Illegal aliens & undocumented workers

End-of-life counseling (euthanasia) (“death squads”) Abortions

THE ROAD AHEAD

16

CBOANALYSIS

CBOANALYSIS

CBOANALYSIS

THE ROAD AHEAD

federal healthcare reform 2009 presented by: ronald r. diluigi v.p. advocacy, govt’ relations and...

Documents