Transcript The New Health Law

The New Health Law:
What It Means for
New Hampshire
About NH Voices for Health
• A network of advocacy organizations,
consumers & small businesses committed to
expanding access to quality, affordable health
care
• Representing 200,000 consumers statewide
• Our activities:
• Convening stakeholders
• Sharing information and promoting a public
dialog
• Expanding the state’s advocacy capacity
• Advancing savvy and meaningful policy
changes on the state and federal level
Patient Protection &
Affordable Care Act:
A Historic Milestone
• A century in the making
• Builds on & strengthens our current health care
system
• Strengthens and expands coverage options
• Makes coverage more affordable
• Makes coverage more stable & higher quality
• Invests in health care cost control, quality,
workforce, public health & equity
Strengthening and Expanding
Coverage Options
• Strengthens public programs
• Medicaid – Federal funding for expanded
eligibility and improved reimbursement
• Medicare – Improved preventive care, closing
the donut hole and extending the solvency of the
trust fund
• CHIP / Healthy Kids Silver – Extended &
increased federal funding
• Streamlined enrollment
Strengthening and Expanding
Coverage Options
• Expands access to private coverage
• Can keep the coverage you have
• Access regardless of health status / history
• Extended family coverage for young adults
• Improved access / choice through the Exchange
• Web portal
Making Coverage More Affordable
• Reigns in excessive and wasteful costs
– Promotes preventive care & efficiency
– Strengths premium rate review
– Limits administrative spending
• Makes premium charges more equitable
• Reducing cost shifting
Making Coverage More Affordable
• Provides assistance for working families and small
businesses
– Individual premium subsidies & cost-sharing
assistance
– Small business tax credits & grants
Making Coverage More Stable &
Higher Quality
• No benefit limits
• No rescissions
• Cost-sharing limited & no cost-sharing for
preventive services
• Waiting periods limited
• “Essential health benefits” package
• Transparency of information
Shared Responsibility
• Based on the notions that:
– The system works best when everyone is in it
– We have an employer-based coverage system
• Must purchase coverage if it’s affordable to you
– Various exemptions and waivers
• Expectation that employers provide coverage
– Does not apply to small employers
Other Investments
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Health care cost control
Health care quality
Health care equity
Public health
Health care workforce
Example: Personal Story
• Your child is now a young adult, but unable to
get a job that provides health coverage and they
do not qualify for public coverage. You are
worried because your son or daughter requires
regular medical attention.
Under the New Health Law …
• The new health law allows young adults to stay
on parent’s plans up to age 26
• Expanded eligibility reimbursements may allow
them to enroll in subsidized plans on their own
(including cost-sharing)
• New regulations prohibiting insurance
companies from denying coverage based on preexisting conditions will ensure they are able to
access potential health plans
Example: Personal Story
• Your child has a chronic illness which makes
them more susceptible to health problems. Your
primary insurance has cost sharing at 80/20 but
your family is concerned about being able to
afford frequent visits to the doctor and/or
hospital.
Under the New Health Law …
• Free preventative care (which will help lower
additional visits to the hospital, especially for
those with weakened immune systems)
• Cost-sharing provisions
• The end of discrimination based on pre-existing
conditions gives families more flexibility to
change insurers to a plan that might be a better
fit
The New Health Law:
What It Means for Alcohol
and Other Drug Problems
Patient Protection & Affordable Care Act:
• An unprecedented understanding that addiction is a
disease
• That this chronic condition deserves effective
treatment as part of regular healthcare
• That access to substance abuse services must be
increased, integrated and universal
• And is our opportunity to close the addiction
treatment gap for the many men, women, and
adolescents who need help in New Hampshire -- and
do not receive it.
A Revolutionary Opportunity
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Private Insurance reimbursement
Medicaid reimbursement
Recovery Support services reimbursement
INTEGRATED CARE
Private Insurance
Health Insurance Exchange
• Required to offer mental health and substance
use disorder services
• Required to be at parity per MHAEPA of 2008
federal law
Policy opportunities
• Provider readiness – moving from stand alone system
to integrated system with multi-payors
• Prevention – integrated into primary care and public
health policy
• Integration of treatment – bi-directional with mental
health and physical health
• And then the Medicaid expansion population …
Medicaid Coverage
• Current Medicaid Program
• Expansion of Medicaid
• Medicaid Managed Care in NH
Current Medicaid Services in NH
• Medicaid is “diagnosis blind”
• Does not include alcohol and other drug
prevention, intervention, treatment or
recovery support services
• Does not include specialty trained
providers, MLADCs and LADCs are not
reimbursable
Medicaid Managed Care in NH
• Bids due December 16, 2011
• Contract operational July 1, 2012
• Should have alcohol and other drug services
at parity to medical
• Current advocacy focused on inclusion in
contract language
Medicaid Expansion
• 2014 Affordable Care Act Expansion of
Medicaid to “healthy adults” under 133% of
federal poverty guidelines
• Requires alcohol and other drug services to
be provided at parity
• Will cover previous non-participants in
health care
• Will require a resiliency and recoveryoriented system of care
• Will require lessons learned from
implementation of managed care of alcohol
and other drug services
• Will require provider integration to
effectively serve multi-morbid clients
• Will require vigilance and advocacy for
effective implementation
Next Steps: The Work Continues
• Public education
– People can only benefit from the new health
law if they know what’s in it
– People support the law when they know the
details
• How you can be involved
– Letters to the Editor, op-eds
– Talk to your colleagues, patients, family
Next Steps: The Work Continues
• Decisions continue to be made
– Federal & state level challenges
– Federal & state level implementation
• How you can be involved
– Work with New Futures & NH Providers to
attend meetings
– Attend hearings, contact elected officials
– Share your experiences!
For More Information…
• New Futures: www.new-futures.org
Amy Pepin, Policy Director, [email protected]
or 603-225-9540
• NH Voices for Health: www.nhvoicesforhealth.org
mailing lists for updates and public meetings
• HealthReform.gov learn about the law and search
coverage options
• Kaiser Health Reform Gateway:
www.healthreform.kff.org learn about the law