Transcript Subsides & the Exchange: A (Very) Brief Overview

How Health Reform Helps
Missouri:
Today and in the Future
Brian Colby
MO Health Advocacy Alliance
Health Reform in a Nutshell
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Reforms the private insurance
market with new consumer
protections
Creates new exchanges where
uninsured people can purchase
coverage, some with subsidies
Expands Medicaid
Medicare: strengthens preventive
benefits and drug coverage; stops
windfall payments to Medicare
Advantage plans
Provisions Effective Immediately!
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Grants for states to establish
consumer assistance and health
insurance ombudsman programs
Insurers must justify unreasonable
rate hikes; grants available for
states to conduct rate review
Qualifying small businesses can
receive tax credits for covering
their workers this year
Increased funding for community
health centers
Increased funding for primary care
provider training programs
Insurance Market Improvements:
Effective 90-Days After Passage
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Temporary funding ($5 B until 2014) for
covering high-risk individuals
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Reinsurance for employers providing
coverage to early retirees to help hold
down premiums for plan enrollees
Provisions Effective July 1, 2010
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New HHS web-based internet portal for
consumers and small businesses to look
for affordable coverage in their state
must be in place
Private Insurance Improvements: (Plan
Years Starting) Six Months After Passage
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Ban on lifetime limits, restriction
of annual limits (annual limits
outright prohibited in 2014)
Coverage of preventive care with
no cost-sharing in new plans
Coverage of adult children until
age 26
No pre-existing condition
exclusions allowed for children
under 19
Private Insurance Improvements: (Plan
Years Starting) Six Months After Passage
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Stronger protections against unfair
rescissions
Internal and external appeals processes
Emergency care: no prior authorization,
cost-sharing same for in and out-ofnetwork
OB/GYNs considered primary care
providers
Provisions Effective in 2011
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Medical loss ratio requirements
Plans must have standardized descriptions
(benefits and cost-sharing)
Medicare: Preventive care with no costsharing, 50% discount on brand-name drugs
in the Part D donut hole (also, $250 rebate
for beneficiaries in donut hole in 2010)
Provisions Effective in 2011
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No later than one year after passage:
Secretary provides grants for state
implementation of exchanges
CLASS Act- Voluntary, public long-term care
insurance program
Full Implementation (2014)Market Regulation
• No denials of
coverage based on
health status/ preexisting conditions
• No pre-existing
condition
exclusions
• No premiums hikes
based on health
status
Full Implementation (2014)Exchanges
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Can contract exchange responsibilities
Coverage for individuals and small
groups, some eligible for subsidies/ tax
credits
Standardized, comprehensive benefits
Can operate in more than one state;
states can have more than one
Full Implementation: Medicaid
and Medicare
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Medicaid: By 2014, expanded eligibility to
133% FPL nationwide ($14,404/ year for
an individual in 2010)
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Adults without children eligible everywhere!
Medicare: Donut hole eliminated by 2020
Questions?
Brian Colby
[email protected]
Health Care Foundation of Greater Kansas City
Missouri Foundation for Health
Kaiser Family Foundation