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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