1. 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”

2. Introduction to Consumers for Affordable Health Care
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

3. Introduction to Consumers for Affordable Health Care

4. PO Box 2490 Augusta, ME 04338-2490 www.mainecahc.org 1-800-838-0388

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 Maine
Consumer Assistance Program
Policy Research and Advocacy

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

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)

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

9. Health Care Policy Environment in Maine

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

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

12. Chapter 90 (cont.)

13. The Affordable Care Act:
Two Minute Review

14. 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

15. 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
Excise tax on high-cost
health plans
2010
2011
2013
2014
2016
2018
Option for multi-state compacts
System improvement initiatives
Insurance reforms
Medicare reforms
(free preventative services)

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…

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

18. Issues That Need Your Involvement
Moving Forward:
Issues That Need Your Involvement

19. 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

20. 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

21. 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

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

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

24. Sources/Acknowledgements
Consumers for Affordable Health Care Kaiser Family Foundation HealthCare.Gov

25. Questions?
Consumers for Affordable Health Care Ph:
HelpLine:
Web:
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26. Thank You!