Health Care Reform Isn’t Just for Congress – Why Advocacy at the State House Matters.
26
Health Care Reform Isn’t Just for Congress – Why Advocacy at the State House Matters. Mitchell Stein Policy Director Consumers for Affordable Health Care “Advocating the right to health care for every man, woman, and child” 1-800-838-0388 www.mainecahc.org Aging Advocacy Summit Wednesday, November 14, 2012
description
Aging Advocacy Summit Wednesday , November 14, 2012. Health Care Reform Isn’t Just for Congress – Why Advocacy at the State House Matters. . Mitchell Stein Policy Director Consumers for Affordable Health Care “Advocating the right to health care for every man, woman, and child” - PowerPoint PPT Presentation
Transcript of Health Care Reform Isn’t Just for Congress – Why Advocacy at the State House Matters.
Health Care Reform Isn’t Just for Congress – Why Advocacy at the State House Matters.
Mitchell Stein Policy DirectorConsumers for Affordable Health Care
“Advocating the right to health care for every man, woman, and child”
1-800-838-0388 www.mainecahc.org
Aging Advocacy Summit Wednesday, November 14, 2012
www.mainecahc.org 2
Agenda
• Introduction to Consumers for Affordable Health Care
• Health Care Environment• The Supreme Court Decision• Other factors (Chapter 90)
• The Affordable Care Act• Two Minute Review
• Moving Forward: Issues that need your involvement
www.mainecahc.org 3
Introduction to Consumers for Affordable Health Care
www.mainecahc.org 4
MISSION STATEMENT Consumers for Affordable Health Care is a Maine advocacy organization that strives to ensure a strong consumer voice in decision making at all levels and in all forums in order to advocate for a consumer-oriented health system in Maine and the United States. Since 1988, Consumers for Affordable Health Care has provided leadership and support to consumers, businesses, organizations, and policymakers to specifically advocate for:
Access to health care for all Maine residents including preventive, acute, chronic and long-term care that is assured through health care coverage
Affordable health care coverage that is guaranteed for all Maine residents, taking into account an individual’s ability to pay
An individual's right to freely choose her or his provider and method of care within the confines of quality care that is based on objective standards and supported by publicly available data on individual providers and hospitals
Financing coverage from a broad variety of government and private sources
Controlling rising costs while preserving quality care
Consumers for Affordable Health Care provides resources to educate consumers and assist them in navigating the existing system.
Consumers for Affordable Health Care works with other organizations to educate them and to advocate our mission before legislative and regulatory bodies.
PO Box 2490Augusta, ME 04338-2490
www.mainecahc.org
1-800-838-0388
www.mainecahc.org 5
About Consumers for Affordable Health Care (CAHC)
Non-profit, non-partisan mission driven advocacy organization since 1988
Our mission is to make quality health care more affordable for everyone in MaineConsumer Assistance ProgramPolicy Research and Advocacy
www.mainecahc.org 6
Consumer Assistance Program
HelpLine Our statewide, toll-free Consumer HelpLine assists people who
need insurance or have been denied care Provides help finding programs to help with health care and drug
costs Help with Coverage Disputes
Understanding your coverage and rights Help with denials, appeals or complaints
On-line health care guide Workshops and presentations
Train service professionals on MaineCare eligibility, private insurance and non-insurance programs that can help people
www.mainecahc.org 7
Policy Advocacy Monitor Statehouse and Washington activities Speak on behalf of consumers at state level Represent consumers in rate review hearings
(and help consumers to represent themselves) Info we get thru our Helpline and Outreach
informs our policy and advocacy work; we often are able to spot harmful trends
Founding member of the Health Care for Maine Alliance (HC4ME)
www.mainecahc.org 8
Policy Advocacy – Your Voice Why should you have a voice? Because ultimately you are the
payer Individual coverage – you pay the premium directly Medicare - paid for through taxes/ individual premiums Employer-sponsored coverage - the costs of the health plan are
taken into account as a fringe benefit resulting in lower wages or salaries to the employee
Trust but Verify Changes to the health care system may look good on paper, but
the devil is in the details Everyone may have the best of intentions, but that doesn’t mean
things can’t go off track
www.mainecahc.org 9
Health Care Policy Environment in Maine
www.mainecahc.org 10
Supreme Court Decision(s)
Court has jurisdiction to decide case now Mandate is a constitutional exercise of Congress’ power
to tax Medicaid expansion violates Congress’ spending clause
power as unconstitutionally coercive of states because all existing Medicaid funds at risk and states not given adequate notice to voluntarily consent Remedy is to limit HHS Secretary’s power to withhold existing
federal Medicaid funds for state non-compliance with Medicaid expansion
www.mainecahc.org 11
Other Factors: Chapter 90(Insurance Bill passed in 2011)
Widened rating bands and added rating factors resulting in increased premiums based on age, geography and additional factors
Changed rate review resulting in weaker standards Ability to close books of business resulting in
introduction of new plans with less benefits and increased cost-sharing
Instituted a new reinsurance tax Allowed for health care “captive” insurance
companies that are exempt from most insurance regulations – including consumer protections
www.mainecahc.org 12
Chapter 90 (cont.)
www.mainecahc.org 13
The Affordable Care Act:Two Minute Review
What does the ACA do?
Universal access to health coverage 32 million uninsured Americans (est. by 2019)
Expansions to public programs New Options for Individuals and Small Businesses
Insurance Reform at the Federal Level Patients’ Bill of Rights Holding Insurance Companies Accountable
Workforce Expansion and Quality Improvement Provisions
14
Highlights of the ACATimeline
2010 2018
Immediate insurance reforms Tax credits for small employers Begin to close doughnut hole Medicaid expansion option Funding opportunities Early planning
2011 2013
System improvement initiatives Insurance reforms Medicare reforms (free preventative services)
2014
Medicaid expansion Exchanges launched Employer requirements/assessments Premium & cost sharing subsidies Excise tax on high-cost
health plans
2016
Option for multi-state compacts
15
16
What’s happened so far Young adult dependent coverage until age 26 No pre-existing condition exclusions for children Interim coverage available for adults with pre-existing conditions New Consumer Protections (e.g. appeal rights, etc.) Medicare prescription drug coverage donut hole being plugged in
phases (in 2011 $6.3 million saved in Maine) Small Employer Tax Credits No cost preventative services End to recisions And more…
www.mainecahc.org 17
And coming in 2014 Minimum Credible Coverage Requirement: The
Mandate Expanded MaineCare eligibility - incomes up to
133% FPL (may vary by state) Health Insurance Exchanges (Marketplace)
Subsidies toward Premiums and Cost Sharing Additional Small Employer Tax Credits Limits on Out-of-pocket spending One-stop shopping: consumer-friendly
www.mainecahc.org 18
Moving Forward:Issues That Need Your
Involvement
www.mainecahc.org 19
Private Expansion in MaineExchanges Supreme Court decision left Exchanges untouched Maine has been awarded two Exchange Grants but sent
back the second one Currently no work on creating Maine based Exchange Maine will have Federally-facilitated Exchanges (FFE) for
initial enrollment (begins 10/1/13) but each year the State has the option to create their own Exchange
Expecting comment period on FFE during 4th quarter 2012
www.mainecahc.org 20
Private Expansion in MaineEssential Health Benefits (EHB) EHB is the minimum benefits all (insured) plans must
cover (inside OR outside the Exchange) Each state has the ability to define EHB (at least for
2014 and 2015) from one of 10 possible benchmark plans
The deadline is past for Maine to take action The starting point for Maine’s EHB will be the default
benchmark plan (the largest small group plan) Part of the Federal process will be a comment period
for each state on their plan
www.mainecahc.org 21
Public Expansion in MaineMedicaid/MaineCare
While the Medicaid decision is more problematic, there is still a clear path forward.
Most states will still choose to participate in the Medicaid expansion. The increased reimbursement rate (100% for the first few years) is too good an offer to turn down.
While in the out-years there will be some cash outlay for the states (although the reimbursement rate eventually settles at 90%, higher than today’s reimbursement rate)
Many organizations in Maine will join together to promote Maine’s participation in the expansion
www.mainecahc.org 22
Other Maine Issues: ACO Regulations – Payment reform pilot
rulemaking underway by the Bureau of Insurance
Budget – The new legislature will immediately need to deal with a budget shortfall in the current fiscal year, what programs will be cut?
Chapter 90 Pushback – Attempts to reinstate vigorous rate review standards and undo other changes
www.mainecahc.org 23
Action Steps: Let your voice be heard
Federal comment period on Federally-facilitated Exchange regulations expects during 4th quarter 2012
Federal comment period on Essential Health Benefits plan for Maine expected soon
The legislature will likely take up the issue of Medicaid expansion during the next session
Stay informed and talk to your state representatives on issues such as how to handle the budget shortfall and reinstating strict rate review
www.mainecahc.org 24
Sources/Acknowledgements
Consumers for Affordable Health Carehttp://www.mainecahc.org/ACA/updates.htm
Kaiser Family Foundationhttp://healthreform.kff.org/
HealthCare.Govhttp://www.healthcare.gov/
www.mainecahc.org 25
Questions?
Consumers for Affordable Health CarePh: 1-800-838-0388
HelpLine: 1-800-965-7476Web: http://www.mainecahc.org
“Like” us on FacebookRead our blog: http://mecahc.blogspot.com/
Follow us on Twitter: @MAINECAHC
www.mainecahc.org 26
Thank You!
