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Health Care Reform Isn’t Just for Congress – Why Advocacy at the State House Matters. Mitchell Stein Policy Director Consumers for Affordable Health Care.

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Presentation on theme: "Health Care Reform Isn’t Just for Congress – Why Advocacy at the State House Matters. Mitchell Stein Policy Director Consumers for Affordable Health Care."— Presentation transcript:

1 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” Aging Advocacy Summit Wednesday, November 14, 2012

2 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

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 14

15 Highlights of the ACA Timeline Immediate insurance reforms Tax credits for small employers Begin to close doughnut hole Medicaid expansion option Funding opportunities Early planning System improvement initiatives Insurance reforms Medicare reforms (free preventative services) 2014 Medicaid expansion Exchanges launched Employer requirements/assessments Premium & cost sharing subsidies Excise tax on high-cost health plans 2016 Option for multi-state compacts 15

16 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 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 4 th 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 4 th 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: “Like” us on Facebook Read our blog: Follow us on

26 Thank You!


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