Healthcare Reform

Healthcare ReformImplications for CDPHESara Russell RodriguezChronic Disease DirectorColorado Department of Public Health and EnvironmentBackgroundSigned into law on March 23, 2010Final bill created through a reconciliation processCould change items with fiscal impactNo ability to change timelinesTimelines are aggressiveMany of the provisions in the bill have not had funding appropriatedInsurance Coverage: Pre-existing Insurance Plan CoverageEffective July 6, 2010 in ColoradoColorado runs plan (as opposed to HHS)EligibilityLawfully present in USUninsured for the last 6 monthsDifficulty getting insurance due to a pre-existing condition

Individual MandateTax penalty$695-$2085 or 2.5% of family income Penalties are phased in$95 in 20142.5% of income in 2016Increases yearly with cost of livingExemptionsReligiousNative AmericanThose without coverage for less than 3 monthsUndocumentedIncarcerated individualsIndividual MandateExemptionsPremium exceeds 8% of incomeIncome less than filing threshold$9,350 for singles$18,700 for couples

Employer MandatesEffective January 1, 201450+ employees with at least one full-time employeePenalties for those receiving subsidies for purchasing health insuranceMust offer vouchers to those whose employer-based coverage is unaffordable200+ employeesAutomatically enroll employees in coverageEmployees can opt out

Employer MandatesLess than 50 employees are exempt from penaltiesEmployers with less than 25 employees receive tax credit for purchasing health insuranceMedicaid ExpansionEffective January 1, 2014All individuals under age 65Up to 133% of the federal poverty level (FPL)Financed through100% federal funding for 2014-2016Decreases incrementally to 90% in 2020Increases provider payments for primary care to Medicare rates100% federally financed

Childrens Health Insurance PlanMaintain current income eligibility2015 states will receive a 23% increase in federal cost sharingChildren ineligible to enroll will receive tax credits in state exchangesMedicaid InitiativesFunding for innovative payment reformAccountable care collaborativesRural telehealthOther pilotsPilots for obesity preventionPilots for incentives for chronic disease prevention and managementMedical home incentives

Medicaid InitiativesRequires tobacco cessation counseling and pharmacotherapy for pregnant womenEncourages no cost sharing for preventive benefitsReceive additional federal fundingWaiversFamily planningLong term care

Medicare Initiatives Payment reformAccountable care organizationsPreventable admissions; conditionsReduce Medicare Disproportionate Share Hospital paymentsIndependent payment advisory boardIndependence at home pilotNew office for dual eligiblesEliminates cost sharing for preventive benefitsHealth Insurance ExchangesExchanges need to be effective as of January 1, 2014Individuals and small businesses (