Transcript 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.

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”
1-800-838-0388
www.mainecahc.org
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
2
Introduction to Consumers for
Affordable Health Care
www.mainecahc.org
3
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.
PO Box 2490
Augusta, ME 04338-2490
www.mainecahc.org
1-800-838-0388
Consumers for Affordable Health Care works with other organizations to
educate them and to advocate our mission before legislative and regulatory
bodies.
www.mainecahc.org
4
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 Maine

 Consumer
Assistance Program
 Policy Research and Advocacy
www.mainecahc.org
5
Consumer Assistance Program

HelpLine



Help with Coverage Disputes




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
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
6
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
7
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
8
Health Care Policy
Environment in Maine
www.mainecahc.org
9
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
10
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
11
Chapter 90 (cont.)
www.mainecahc.org
12
The Affordable Care Act:
Two Minute Review
www.mainecahc.org
13
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 ACA
Timeline
Medicaid expansion
Exchanges launched
Employer requirements/assessments
Premium & cost sharing subsidies
Immediate insurance reforms
Tax credits for small employers
Begin to close doughnut hole
Medicaid expansion option
Funding opportunities
Early planning
2010 2011
2013
System improvement initiatives
Insurance reforms
Medicare reforms
(free preventative services)
2014
Excise tax on high-cost
health plans
2016
2018
Option for multi-state compacts
15
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…
16
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
17
Moving Forward:
Issues That Need Your
Involvement
www.mainecahc.org
18
Private Expansion in Maine
Exchanges





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
19
Private Expansion in Maine
Essential 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
20
Public Expansion in Maine
Medicaid/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
21
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
22
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
23
Sources/Acknowledgements
Consumers for Affordable Health Care
http://www.mainecahc.org/ACA/updates.htm
Kaiser Family Foundation
http://healthreform.kff.org/
HealthCare.Gov
http://www.healthcare.gov/
www.mainecahc.org
24
Questions?
Consumers for Affordable Health Care
Ph: 1-800-838-0388
HelpLine: 1-800-965-7476
Web: http://www.mainecahc.org
“Like” us on Facebook
Read our blog: http://mecahc.blogspot.com/
Follow us on Twitter: @MAINECAHC
www.mainecahc.org
25
Thank You!
www.mainecahc.org
26