What’s Next in Health Care Reform: Training for Trainers.

Goals: 1) To provide an overview of the new law.
2) To prepare you to talk about the new law. 3) To introduce you to state and federal implementation of the new law.

What it is not: 1) A PhD Program in Health Policy.
2) How the law will affect your Aunt Edna. 3) Scripture via Powerpoint. 4) A Health Care Town Hall Forum, circa August of 2009.

Agenda: 1) Introduction and Overview (10 min) 2) Law Overview (40 min)
3) Presentation Practice (20 min) 4) Presentation Practice Debrief (15 min) 5) Q&A on Law (20 min) 6) Next Steps (10 min) 7) Evaluation (5 min)

Law Overview: 1) What Happened and Why? 2) What Does The New Law Do?
3) What Does the New Law Mean for You and Your Fellow Minnesotans? 4) What’s Next?

What it is… What it is NOT… What Happened…?
In March 2010, President Obama signed the “Patient Protection and Affordable Care Act” (PPACA) into law. What it is… What it is NOT… Insurance Industry Reform “Single-Payer” Medicare Improvements “Medicare for All” Medicaid Expansion “Socialized Medicine” Delivery System Reform “Death Panels” New Requirements to Have Insurance Tea Act of 1773, The October Revolution, Natl Socialism Govt Help to Buy Insurance The Apocalypse This slide developed from Health Care for All New York’s Health Reform: What is it and What Does it Mean for New York?

…and Why? -Since 2000, premiums have more than doubled while wages have virtually stood still. -Since 1987, the cost of the average family health insurance policy has risen from 7% of median family income to 17%. -At least 46 million Americans were uninsured ‐ more than 85% of whom are in working families. -Since the recession began, an estimated 4 million additional Americans have lost their health insurance – and were losing coverage at an average of 10,680 workers each day. -In 2009, 53% of Americans say their household cut back on health care due to cost concerns. -Today, only 4 cents of every health care dollar is spent on prevention. -In 2007, 60% of U.S. bankruptcies were due to medical costs.

What Does the New Law Do? 1) Expands Health Insurance Coverage 2) Regulates the Health Insurance Industry 3) Makes Health Insurance More Affordable 4) Reforms the Health Care Delivery System 5) Includes Measures to Increase Prevention and Decrease Inequality

Expanding Health Insurance Coverage
What Does the New Law Do? Expanding Health Insurance Coverage Increases Bargaining Power with Insurers Individual Market: Ex. Individual Consumers who purchase for themselves. Small Group Market: Ex. Small businesses, non-profits, local government, etc. Large Group Market: Ex. Large Corporations, State Government Pools, etc. Self-Insured: Ex. Organizations that pool resources to pay own claims.

What Does the New Law Do? Expanding Health Insurance Coverage How people are insured: pre-reform.

What Does the New Law Do? Expanding Health Insurance Coverage How people are insured: post-reform.

Expanding Health Insurance Coverage Expanding Public Coverage
What Does the New Law Do? Expanding Health Insurance Coverage Expanding Public Coverage Medicaid Medicaid will be expanded to all individuals under age 65 with incomes up to 133% of the federal poverty level ($14,404 for an individual and $29,327 for a family of four in 2009) based on modified adjusted gross income. Children’s Health Insurance Program Eligibility for Medicaid and the Children’s Health Insurance Program (CHIP) for children is extended at their current eligibility levels until 2019.

Expanding Health Insurance Coverage Individual Mandate
What Does the New Law Do? Expanding Health Insurance Coverage Individual Mandate All individuals will be required to have health insurance, with some exceptions, beginning in Those who do not have coverage will be required to pay a yearly financial penalty of the greater of $695 per person (up to a maximum of $2,085 per family), or 2.5% of household income, which will be phased-in from Exceptions will be given for… …financial hardship …religious objections …American Indians …people who have been uninsured for less than three months …those for whom the lowest cost health plan exceeds 8% of income …individuals with income below the tax filing threshold ($9,350 for an individual and $18,700 for a married couple in 2009).

Expanding Health Insurance Coverage Employer Penalty
What Does the New Law Do? Expanding Health Insurance Coverage Employer Penalty There is no employer mandate but employers with 50 or more employees will be assessed a fee of $2,000 per full-time employee (in excess of 30 employees) if they do not offer coverage and if they have at least one employee who receives a premium credit through an Exchange. Free Choice Voucher: Employers that offer coverage will be required to provide a voucher to employees with incomes below 400% of the poverty level if their share of the premium cost is between 8-9.8% of income to enable them to enroll in a plan in an Exchange. Employers that offer a free choice voucher will not be subject to penalty. Auto Enrollment: Large employers that offer coverage will be required to automatically enroll employees into the employer’s lowest cost premium plan if the employee does not sign up for employer coverage or does not opt out of coverage.

Regulates the Health Insurance Industry
What Does the New Law Do? Regulates the Health Insurance Industry Getting Insurance -Guaranteed Issue -Pre-Existing Conditions -Limiting Waiting Periods -Dependent Coverage -Lifetime & Annual Limits -Prohibiting Rescission Benefits Package -Comprehensive Benefits -Standard Benefit Categories Price -Premium Rating -Rate Review -Medical Loss Ratios

What Does the New Law Do? Regulates the Health Insurance Industry Getting Insurance -Guaranteed Issue -Pre-Existing Conditions -Limiting Waiting Periods -Dependent Coverage -Lifetime & Annual Limits -Prohibiting Rescission Benefits Package -Comprehensive Benefits -Standard Benefit Categories Price -Premium Rating -Rate Review -Medical Loss Ratios Sec Guaranteed availability of coverage. Each health insurance issuer must accept every employer and individual in the State that applies for coverage, permitting annual and special open enrollment periods for those with qualifying lifetime events. Sec Guaranteed renewability of coverage. Requires guaranteed renewability of coverage regardless of health status, utilization of health services or any other related factor.

What Does the New Law Do? Regulates the Health Insurance Industry Getting Insurance -Guaranteed Issue -Pre-Existing Conditions -Limiting Waiting Periods -Dependent Coverage -Lifetime & Annual Limits -Prohibiting Rescission Benefits Package -Comprehensive Benefits -Standard Benefit Categories Price -Premium Rating -Rate Review -Medical Loss Ratios Sec Prohibition of preexisting condition exclusions or other discrimination based on health status. No group health plan or insurer offering group or individual coverage may impose any pre-existing condition exclusion or discriminate against those who have been sick in the past. Sec Prohibiting discrimination against individual participants and beneficiaries based on health status. No group health plan or insurer offering group or individual coverage may set eligibility rules based on health status, medical condition, claims experience, receipt of health care, medical history, genetic information, evidence of insurability – including acts of domestic violence or disability.

What Does the New Law Do? Regulates the Health Insurance Industry Getting Insurance -Guaranteed Issue -Pre-Existing Conditions -Limiting Waiting Periods -Dependent Coverage -Lifetime & Annual Limits -Prohibiting Rescission Benefits Package -Comprehensive Benefits -Standard Benefit Categories Price -Premium Rating -Rate Review -Medical Loss Ratios Sec Prohibition on excessive waiting periods. Prohibits any waiting periods for group coverage that exceeds 90 days.

What Does the New Law Do? Regulates the Health Insurance Industry Getting Insurance -Guaranteed Issue -Pre-Existing Conditions -Limiting Waiting Periods -Dependent Coverage -Lifetime & Annual Limits -Prohibiting Rescission Benefits Package -Comprehensive Benefits -Standard Benefit Categories Price -Premium Rating -Rate Review -Medical Loss Ratios Sec Extension of dependent coverage. Requires all plans offering dependent coverage to allow unmarried individuals until age 26 to remain on their parents’ health insurance.

What Does the New Law Do? Regulates the Health Insurance Industry Getting Insurance -Guaranteed Issue -Pre-Existing Conditions -Limiting Waiting Periods -Dependent Coverage -Lifetime & Annual Limits -Prohibiting Rescission Benefits Package -Comprehensive Benefits -Standard Benefit Categories Price -Premium Rating -Rate Review -Medical Loss Ratios Sec No lifetime or annual limits. As amended by Section 10101, prohibits plans from establishing lifetime limits, and annual limits beginning in 2014, on the dollar value of benefits. Prior to 2014, plans may only establish restricted annual limits as defined by the Secretary of Health and Human Services (HHS), ensuring access to needed services with minimal impact on premiums.

What Does the New Law Do? Regulates the Health Insurance Industry Getting Insurance -Guaranteed Issue -Pre-Existing Conditions -Limiting Waiting Periods -Dependent Coverage -Lifetime & Annual Limits -Prohibiting Rescission Benefits Package -Comprehensive Benefits -Standard Benefit Categories Price -Premium Rating -Rate Review -Medical Loss Ratios Sec Prohibition on rescissions. Prohibits all plans from rescinding coverage except in instances of fraud or misrepresentation.

What Does the New Law Do? Regulates the Health Insurance Industry Getting Insurance -Guaranteed Issue -Pre-Existing Conditions -Limiting Waiting Periods -Dependent Coverage -Lifetime & Annual Limits -Prohibiting Rescission Benefits Package -Comprehensive Benefits -Standard Benefit Categories Price -Premium Rating -Rate Review -Medical Loss Ratios Sec Comprehensive health insurance coverage. Requires health insurance issuers in the small group and individual markets to include coverage which incorporates defined essential benefits, provides a specified actuarial value, and requires all health plans to comply with limitations on allowable cost-sharing. Sec Coverage of preventive health services. Requires all plans to cover preventive services and immunizations recommended by the U.S. Preventive Services Task Force and the CDC, certain child preventive services recommended by the Health Resources and Services Administration (HRSA), and women’s preventive care and screening recommended by HRSA, without any cost-sharing.

What Does the New Law Do? Regulates the Health Insurance Industry Getting Insurance -Guaranteed Issue -Pre-Existing Conditions -Limit Waiting Periods -Dependent Coverage -Lifetime Limits -Prohibits Rescission Benefits Package -Comprehensive Benefits -Standard Benefit Categories Price Premium Rating Limit Deductibles Rate Review Medical Loss Ratios Sec Essential health benefits requirements. Defines an essential health benefits package as one that covers essential health benefits, limits cost-sharing, and has a specified actuarial value (pays for a specified percentage of costs), as follows: 1. For the individual and small group markets, requires the Secretary to define essential health benefits, which must be equal in scope to the benefits of a typical employer plan. 2. For all plans in all markets, prohibits out-of-pocket limits that are greater than the limits for Health Savings Accounts. For the small group market, prohibits deductibles that are greater than $2,000 for individuals and $4,000 for families. Indexes the limits and deductible amounts by the percentage increase in average per capita premiums. 3. For the individual and small group markets, requires one of the following levels of coverage, under which the plan pays for the specified percentage of costs: Bronze: 60 percent Silver: 70 percent Gold: 80 percent Platinum: 90 percent

What Does the New Law Do? Regulates the Health Insurance Industry Getting Insurance -Guaranteed Issue -Pre-Existing Conditions -Limiting Waiting Periods -Dependent Coverage -Lifetime & Annual Limits -Prohibiting Rescission Benefits Package -Comprehensive Benefits -Standard Benefit Categories Price -Premium Rating -Rate Review -Medical Loss Ratios Sec Fair health insurance premiums. Establishes that premiums in the individual and small group markets may vary only by family structure, geography, the actuarial value of the benefit, age (limited to a ratio of 3 to 1), and tobacco use (limited to a ratio of 1.5 to 1). Section clarifies that this provision applies to insured plans in the large group market, not self-insured plans.

What Does the New Law Do? Regulates the Health Insurance Industry Getting Insurance -Guaranteed Issue -Pre-Existing Conditions -Limiting Waiting Periods -Dependent Coverage -Lifetime & Annual Limits -Prohibiting Rescission Benefits Package -Comprehensive Benefits -Standard Benefit Categories Price -Premium Rating -Rate Review -Medical Loss Ratios Sec Ensuring that consumers get value for their dollars. For plan years beginning in 2010, the Secretary and States will establish a process for the annual review of increases in premiums for health insurance coverage. Requires States to make recommendations to their Exchanges about whether health insurance issuers should be excluded from participation in the Exchanges based on unjustified premium increases. Provides $250 million in funding to States from 2010 until 2014 to assist States in reviewing and, if appropriate under State law, approving premium increases for health insurance coverage and in providing information and recommendations to the Secretary.

What Does the New Law Do? Regulates the Health Insurance Industry Getting Insurance -Guaranteed Issue -Pre-Existing Conditions -Limiting Waiting Periods -Dependent Coverage -Lifetime & Annual Limits -Prohibiting Rescission Benefits Package -Comprehensive Benefits -Standard Benefit Categories Price -Premium Rating -Rate Review -Medical Loss Ratios Sec Bringing down the cost of health care coverage. As amended by Section 10101, requires plans offering coverage in the group and individual markets (including grandfathered plans but excluding self-insured plans) to report to the Secretary the amount of premium revenues spent on clinical services, activities to improve quality, and all other non-claims costs as defined by the National Association of Insurance Commissioners and certified by the Secretary of HHS. Beginning in 2011, large group plans that spend less than 85 percent of premium revenue and small group and individual market plans that spend less than 80 percent of premium revenue on clinical services and quality must provide a rebate to enrollees. In addition, each hospital operating within the United States shall publish a list of standard charges for items and services provided by the hospital.

What Does the New Law Do? Regulates the Health Insurance Industry Creating a Health Insurance Exchange What is a Health Insurance Exchange? The law creates state-based American Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges, administered by a governmental agency or non-profit organization, through which individuals and small businesses with up to 100 employees can purchase qualified coverage. Who Can and Can’t Use the Exchange? How Can People Use the Exchange? Are there Non-Profit Options? What benefits will be offered? 29 million by 2019

What Does the New Law Do? Regulates the Health Insurance Industry Creating a Health Insurance Exchange What is a Health Insurance Exchange? Individuals who are not incarcerated, are lawfully residing in a State, and who do not have access to affordable employer coverage are qualified to enroll in qualified health plans through that State’s Exchange. Who Can and Can’t Use the Exchange? How Can People Use the Exchange? Are there Non-Profit Options? What benefits will be offered?

What Does the New Law Do? Regulates the Health Insurance Industry Creating a Health Insurance Exchange What is a Health Insurance Exchange? The law requires Exchanges to certify qualified health plans, operate a toll-free hotline and Internet website, rate qualified health plans, present plan options in a standard format, inform individuals of eligibility for Medicaid and CHIP, provide an electronic calculator to calculate plan costs, and grant certifications of exemption from the individual responsibility requirement. Who Can and Can’t Use the Exchange? How Can People Use the Exchange? Are there Non-Profit Options? What benefits will be offered?

What Does the New Law Do? Regulates the Health Insurance Industry Creating a Health Insurance Exchange What is a Health Insurance Exchange? Yes, the law requires the Office of Personnel Management to contract with insurers to offer at least two multi-state plans in each Exchange. At least one plan must be offered by a nonprofit entity. The law also creates the Consumer Operated and Oriented Plan (CO-OP) program to foster the creation of non-profit, member-run health insurance companies in all 50 states and District of Columbia to offer qualified health plans. Who Can and Can’t Use the Exchange? How Can People Use the Exchange? Are there Non-Profit Options? What benefits will be offered?

What Does the New Law Do? Regulates the Health Insurance Industry Creating a Health Insurance Exchange What is a Health Insurance Exchange? The law requires the DHHSSecretary to define essential health benefits, which must include at least the following general services: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health benefits and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices,laboratory services, preventive and wellness services and chronic disease management, and pediatric services including oral and vision care. . Who Can and Can’t Use the Exchange? How Can People Use the Exchange? Are there Non-Profit Options? What benefits will be offered?

What Does the New Law Do? Regulates the Health Insurance Industry Creating a Health Insurance Exchange What is a Health Insurance Exchange? The scope of these benefits must be equal to the scope of benefits provided under a typical employer plan,. The four levels of coverage, which vary depending on how much the insurer pays, include: • Bronze: equivalent to 60% of the full actuarial value of plan benefits • Silver: equivalent to 70% of full value • Gold: equivalent to 80% full value • Platinum: equivalent to 90% of full value Who Can and Can’t Use the Exchange? How Can People Use the Exchange? Are there Non-Profit Options? What benefits will be offered? e

Annual Out-of-Pocket Cap for Those Who Qualify for Subsidies
What Does the New Law Do? Makes Health Insurance More Affordable Caps on Out of Pocket Costs Before After Income as a percent of the Federal Poverty Level Annual salary (for a family of three) Annual Out-of-Pocket Cap for Those Who Qualify for Subsidies 150% $27,465 $3,867 200% $36,620 300% $54,930 $5,800 400% $73,240 $7,733 No Federal Caps on Out-of-Pocket Costs for non-HSA plans

Makes Health Insurance More Affordable Subsidies for Low Income
What Does the New Law Do? Makes Health Insurance More Affordable Subsidies for Low Income -The availability of premium credits and cost-sharing subsidies through the Exchanges is limited to U.S. citizens and legal immigrants who meet income limits. -Employees who are offered coverage by an employer are not eligible for premium credits unless the employer plan does not have an actuarial value of at least 60% or if the employee share of the premium exceeds 9.5% of income. -Legal immigrants who are barred from enrolling in Medicaid during their first five years in the U.S. will be eligible for premium credits. Eligibility Premium Credits Cost Sharing Subsidies

What Does the New Law Do? Makes Health Insurance More Affordable Subsidies for Low Income The law provides refundable and advanceable premium credits to eligible individuals and families with incomes between % FPL to purchase insurance through the Exchanges. The premium contributions are limited to the following percentages of income for specified income levels: Up to 133% FPL: 2% of income % FPL: 3 – 4% of income % FPL: 4 – 6.3% of income % FPL: 6.3 – 8.05% of income % FPL: 8.05 – 9.5% of income % FPL: 9.5% of income Eligibility Premium Credits Cost Sharing Subsidies

What Does the New Law Do? Makes Health Insurance More Affordable Subsidies for Low Income What is Actuarial Value? Plan Premium Benefits Cost-sharing 1) Total Tonsils Plan $4/Month Tonsillectomies only 100% on Tonsillectomies 2) Every Inch Plan $50/Month All Doctor Visits % You / 2% Insurance 3) Worse Plan $200/Month Limited Doctor Visits $2500 Deductible $35 Co-Pays 80% You / 20% Insurance on Everything 4) Better Plan $300/Month All Doctor Visits $500 Deductible $5 Co-Pays 80% / 20% Some Electives 100% on Everything Else

What Does the New Law Do? Makes Health Insurance More Affordable Subsidies for Low Income What is Actuarial Value? A measure of the average value of benefits in a health insurance plan. It is calculated as the percentage of benefit costs a health insurance plan expects to pay for a standard population, using standard assumptions and taking into account cost-sharing provisions. Placing an average value on health plan benefits allows different health plans to be compared.

What Does the New Law Do? Makes Health Insurance More Affordable Subsidies for Low Income The law provides cost-sharing subsidies to eligible individuals and families. The cost-sharing credits reduce the cost-sharing amounts and annual cost-sharing limits and have the effect of increasing the actuarial value of the basic benefit plan to the following percentages of the full value of the plan for the specified income level: % FPL: 94% % FPL: 87% % FPL: 73% % FPL: 70% Eligibility Premium Credits Cost Sharing Subsidies

Makes Health Insurance More Affordable Medicaid Expansion
What Does the New Law Do? Makes Health Insurance More Affordable Medicaid Expansion Sec Medicaid coverage for the lowest income populations. Eligibility. Creates a new State option to provide Medicaid coverage through a State plan amendment beginning on April 1, 2010, as amended by Section Eligible individuals include: all non-elderly, non-pregnant individuals who are not entitled to Medicare (e.g., childless adults and certain parents). Creates a new mandatory Medicaid eligibility category for all such “newly-eligible” individuals with income at or below 133 percent of the Federal Poverty Level (FPL) beginning January 1, 2014.

Makes Health Insurance More Affordable Medicaid Expansion
What Does the New Law Do? Makes Health Insurance More Affordable Medicaid Expansion Medicaid is usually paid 50% by the federal government and 50% by the state government. To finance the coverage for the newly eligible, states will receive: 100% federal funding for 2014 through 2016, 95% federal financing in 2017 94% federal financing in 2018 93% federal financing in 2019 90% federal financing for 2020 and years after. Medicaid payments to primary care doctors for primary care services will be increased to 100% of Medicare payment rates in 2013 and 2014 with 100% federal financing.

Reforms the Health Care Delivery System
What Does the New Law Do? Reforms the Health Care Delivery System “Turn to page 621 of the Senate version, the section entitled “Transforming the Health Care Delivery System,” and start reading. Does the bill end medicine’s destructive piecemeal payment system? Does it replace paying for quantity with paying for quality? Does it institute nationwide structural changes that curb costs and raise quality? It does not. Instead, what it offers is pilot programs.” -Dr. Atul Gawande

What Does the New Law Do? Reforms the Health Care Delivery System “Getting our medical communities, town by town, to improve care and control costs isn’t a task that we’ve asked government to take on before. But we have no choice. At this point, we can’t afford any illusions: the system won’t fix itself, and there’s no piece of legislation that will have all the answers, either. The task will require dedicated and talented people in government agencies and in communities who recognize that the country’s future depends their sidestepping the ideological battles, encouraging local change, and following the results. But if we’re willing to accept an arduous, messy, and continuous process we can come to grips with a problem even of this immensity.” - Dr. Atul Guwande

What Does the New Law Do? Reforms the Health Care Delivery System Examples of Demonstrations, Pilots, and Studies Sec Study of large group market. Sec Study of geographic variation in application of FPL. Sec GAO study regarding the rate of denial of coverage and enrollment by health insurance issuers and group health plans. Sec Money Follows the Person Rebalancing Demonstration. Sec Demonstration project to evaluate integrated care around a hospitalization. Sec Medicaid global payment system demonstration project. Sec Prohibiting discrimination against individual participants and beneficiaries based on health status. Sec Pediatric Accountable Care Organization demonstration project. Sec Medicaid emergency psychiatric demonstration project. Sec National pilot program on payment bundling. Sec Independence at home demonstration program. Sec Treatment of certain complex diagnostic laboratory tests. Sec Extension of the Rural Community Hospital Demonstration Program. Sec Improvements to the demonstration project on community health integration models in certain rural counties. Sec MedPAC study on adequacy of Medicare payments for health care providers serving in rural areas. Sec Treatment of certain cancer hospitals. Sec Medicare hospice concurrent care demonstration program. Sec HHS study on urban Medicare-dependent hospitals. Sec Making senior housing facility demonstration permanent. Sec Office of the Inspector General studies and reports. Sec Design and implementation of regionalized systems for emergency care. Sec Demonstration program to integrate quality improvement and patient safety training into clinical education of health professionals. Sec Patient navigator program. Sec GAO study and report on causes of action. Sec Oral healthcare prevention activities. Sec Healthy aging, living well; evaluation of community-based prevention and wellness programs for Medicare beneficiaries. Sec Immunizations. Sec Demonstration project concerning individualized wellness plan. Sec Funding for childhood obesity demonstration project. Sec Alternative dental health care provider demonstration project. Sec Demonstration grants for family nurse practitioner training programs. Sec Demonstration project to address health professions workforce needs; extension of family-to-family health information centers. Sec Graduate nurse education demonstration program. Sec National independent monitor demonstration project. Sec National demonstration projects on culture change and use of information technology in nursing homes. Sec GAO study and report on Five-Star Quality Rating System. Sec GAO study to make recommendations on improving the 340B program. Sec Study and report of effect on veterans health care. Sec GAO study and report on Medicare beneficiary access to high- quality dialysis services. Sec Pilot testing pay-for-performance programs for certain Medicare providers. Sec Demonstration project to provide access to affordable care. Sec State demonstration programs to evaluate alternatives to current medical tort litigation. Oral healthcare family nurse practitioner training Rural Community Hospital Medicare tort litigation

What Does the New Law Do? Reforms the Health Care Delivery System Sec National strategy. Requires the Secretary to establish and update annually a national strategy to improve the delivery of health care services, patient health outcomes, and population health. Sec Data Collection; Public Reporting. Requires the Secretary to collect and aggregate consistent data on quality and resource use measures from information systems used to support health care delivery to implement the public reporting of performance information. Sec Patient-Centered Outcomes Research. Establishes a private, nonprofit entity (the Patient-Centered Outcomes Research Institute) governed by a public-private sector board appointed by the Comptroller General to identify priorities for and provide for the conduct of comparative outcomes research.

Includes Measures to Increase Prevention and Decrease Inequity
What Does the New Law Do? Includes Measures to Increase Prevention and Decrease Inequity Measures to Decrease Racial Health Disparities 1) Workforce Development 2) Data Collection and Reporting 3) Community Health Center Funding 4) Indian Health Care Improvement 5) Quality Improvements 6) Community Health Needs Assessment

What Does the New Law Do? Includes Measures to Increase Prevention and Decrease Inequity 1) Workforce Development Workforce Development & Training Section 5102 State Healthcare Workforce Development Grants Section 5301 Primary Care Training and Enhancement Section 5303 Training in General, Pediatric, and Public Health Dentistry Section 5307 Cultural Competency, Prevention, and Public Health and Individuals with Disability Training Section 5313 Grants to Promote the Community Health Workforce Section 5507 Demonstration Projects to Address Health Professions Workforce Needs Section 5405 Primary Care Extension Program Loan Repayments Section 5203 Healthcare Workforce Loan Repayment Programs Section 5207 Funding for National Health Services Corps Workforce Recruitment Section 5401 Centers of Excellence Section 5402 Health Professions Training for Diversity Section 5404 Workforce Diversity Grants Section 5606 State Grants to Health Care Providers Who Provide Services to a High Percentage of Medically Underserved Population or Other Special Population Section Rural Physician Training Grants Section 5403 Interdisciplinary, community-based linkages

What Does the New Law Do? Includes Measures to Increase Prevention and Decrease Inequity 2) Data Collection and Reporting Section 6301 Patient-Centered Outcomes Research Institute Section 4302 Understanding Health Disparities: Data Collection and Analysis 3) Community Health Center Funding Section 2303 Community Health Centers. 4) Indian Health Care Improvement Act Section Indian Healthcare Improvement 5) Quality Improvements Section 1311 Rewarding Quality Through Market Based Incentives Section 3501 Quality Improvement Technical Assistance and Implementation Section 2951Maternal, Infant and Early Childhood Home Visiting Programs Section 3502 Establishing Community Health Teams to Support the Patient-Centered Medical Home Section 1331 To provide for transparency in coverage. 6) Community Health Needs Assessment Section 4959 Additional Requirements for Non-Profit Tax-Exempt Hospitals

What Does the New Law Do? Includes Measures to Increase Prevention and Decrease Inequity Sec National Prevention, Health Promotion and Public Health Council. Creates an interagency council dedicated to promoting healthy policies at the Federal level. The Council shall consist of representatives of Federal agencies that interact with Federal health and safety policy, including the departments of HHS, Agriculture, Education, Labor, Transportation, and others. Sec Prevention and Public Health Fund. Establishes a Prevention and Public Health Investment Fund. This will involve a dedicated, stable funding stream for prevention, wellness and public health activities authorized by the Public Health Service Act. Sec Education and outreach campaign regarding preventive benefits. Directs the Secretary to convene a national public/private partnership for the purposes of conducting a national prevention and health promotion outreach and education campaign.

What Does the New Law Do? Includes Measures to Increase Prevention and Decrease Inequity Increasing Access to Clinical Preventive Services Sec School-based health centers. Sec Oral healthcare prevention activities. Sec Medicare coverage of annual wellness visit providing a personalized prevention plan. Sec Removal of barriers to preventive services in Medicare. Sec Evidence-based coverage of preventive services in Medicare. Sec Improving access to preventive services for eligible adults in Medicaid. Sec Coverage of comprehensive tobacco cessation services for pregnant women in Medicaid. Sec Incentives for prevention of chronic diseases in Medicaid. Increasing Prevention

What Does the New Law Do? Includes Measures to Increase Prevention and Decrease Inequity Creating Healthier Communities Sec Community transformation grants. Sec Healthy aging, living well; evaluation of community- based prevention and wellness programs for Medicare beneficiaries. Sec Removing barriers and improving access to wellness for individuals with disabilities. Sec Immunizations. Sec Nutrition labeling of standard menu items at chain restaurants. Sec Demonstration project concerning individualized wellness plan. Sec Reasonable break time for nursing mothers. Increasing Prevention

What Does the New Law Do? Includes Measures to Increase Prevention and Decrease Inequity Support for Prevention and Public Health Innovation Sec Research on optimizing the delivery of public health services. Sec Understanding health disparities; data collection and analysis. Sec CDC and employer-based wellness programs. Sec Epidemiology-Laboratory Capacity Grants. Sec Advancing research and treatment for pain care management. Sec Funding for childhood obesity demonstration project. Increasing Prevention

What Does the New Law Mean for You and Your Fellow Minnesotans?
What is your current health care situation? Are you insured through work? Through Medicare? Medicaid? Are you uninsured?

If you are insured through an employer 2010 No canceling policies when you get sick or setting lifetime limits. Children up to age 26 can stay on your plan. Insurance companies will have to cover children with pre-existing conditions. No lifetime limits on coverage. New plans must provide free preventative services & allow you to appeal denials of coverage. 2011 – 2013 Insurance companies required to spend 80-85% of premium dollars on medical services or else provide rebates to their policyholders. States can require insurance companies to submit justification for premium increases. 2014 Insurers will have to cover adults with pre-existing conditions. No annual limits on coverage. Qualified individuals can begin buying subsidized coverage in the Exchange. Begin employer requirement and standards. Insurers will have to pay a 40% excise tax on high cost insurance plans. The tax is on the cost of coverage in excess of $27,500 (family coverage) and $10,200 (individual coverage). This slide developed from PICO National Network’s Bringing Health Reform Home

If you are insured through Medicare 2010 Seniors on traditional Medicare will have no losses in coverage and will add important benefits. Seniors that reach the “donut hole” will receive a $250 rebate for prescription drugs. Seniors in the “donut hole” will receive a 50% discount on brand name drugs. The “donut hole” will be closed slowly through 2020. Annual checkups and most preventative care and screenings are at no cost. 2013 Government begins to cut subsidies to Medicare Advantage, which costs the government more than traditional Medicare. Seniors on these plans may face reduced benefits or higher costs. Seniors have the option of transitioning to traditional Medicare during the first 45 days of the year. The donut hole will fully close. This slide developed from PICO National Network’s Bringing Health Reform Home

If you are uninsured 2010 Temporary high-risk pool for people with pre-existing conditions uninsured for at least 6 months For early retirees, age 55-64, a temporary re-insurance program is created until the Exchange is running. A large expansion in funds to Community Health Centers. This is expected to double the number of patients that clinics serve. This will help millions of undocumented immigrants. If you are under age 26, you can join your parent’s plan. 2014 Individuals and families will be able to purchase health insurance in state-based Exchanges. Those earning up to 400% FPL ($88,200 for a family of 4) will have access to subsidies on a sliding scale. Cap on out-of-pocket costs of $5,950 for individuals and $11,900 for families, with lower caps for lower-income families. Individuals and families under 133% FPL will be eligible for Medicaid. Most Americans will be required to buy health insurance or pay a penalty. Undocumented immigrants will not be able to purchase insurance in the Exchange. Those who are exempt, or under 30, can buy a catastrophic policy (must also allow for 3 primary care visits a year). Members of Congress will get their health insurance through the Exchange. This slide developed from PICO National Network’s Bringing Health Reform Home

If you are insured by Medicaid 2010 All children currently receiving Medicaid and CHIP can continue to receive coverage. States cannot cut children from Medicaid or CHIP until 2019, at which point some children may transition into the Exchange. All adults under 133% of the Federal Poverty Level can continue to receive coverage. States cannot cut adults that make under 133% FPL from Medicaid. Many preventive services will be offered without cost. 2014 Medicaid’s physician reimbursement levels for specific primary care services will be increased, leading more doctors to accept Medicaid. Anyone with an income below 133% FPL, about $29,327 in 2009 for a family of four, will be eligible for Medicaid. When the Exchange is operating, states can decide to keep adults on Medicaid that are over 133% FPL or transition them into the Exchange. This slide developed from PICO National Network’s Bringing Health Reform Home

How is it paid for? Starting 2010: Cost saving changes in Medicare Greater oversight and enforcement to reduce fraud, waste and abuse; greater efficiency and collaboration among doctors and reduced over-payments to the Medicare Advantage companies. Starting in : Increasing penalties on contribution loopholes in Health Saving Accounts Increased penalties on nonqualified distributions from Health Saving Accounts, a lower cap on Flexible Spending Accounts contributions, and a standardization of the definition of qualified medical expenses. Starting in 2013: High-income earners will contribute more to the Medicare fund Individuals earning over $200,000 and families earning over $250,000 will contribute 2.35% for income above the threshold instead of the current 1.45%. They will also pay a 3.8% tax on net investment income (excluding retirement plans). Starting in 2018: insurers will have to pay a 40% excise tax on high cost group plans The tax is on the cost of coverage in excess of $27,500 (family coverage) and $10,200 (individual coverage). There are higher thresholds for retirees and employees in high risk professions. This slide developed from PICO National Network’s Bringing Health Reform Home

What’s Next? 1) Building Public Support and Implementing Early Reforms
2) Defending Existing Programs and Current Levels of Coverage 3) Developing Policy and Regulations at the National and State Levels 4) Enrolling People in New Programs and Monitoring Impact of Reform 5) Ensuring the Sustainability of Reform through Health Care Delivery System Reforms

1) Early Expansion of Medicaid
What’s Next? 1) Early Expansion of Medicaid Signable by Governor till January 15, 2011 2) Preparing our Health Insurance Exchange Health Care Access Commission vs. Governor’s, Benefit Set 3) Insurance Regulation Natl Assoc of Insurance Commissioners, Early Adoption of Insurance Regulations 4) Appropriations for Health Equity Provisions Indian Health Services, Community Transformation Grants 5) The 2011 Legislative Session $5.8 Billion Dollar Deficit

What’s Next? + =

Thanks and Resources Community Catalyst: www.communitycatalyst.org
Health Care for America Now!: Health Rights Organizing Project: PICO National Network: Kaiser Family Foundation: Families USA: Robert Wood Johnson Foundation: Urban Institute: Health Reform GPS: United States Government: Democratic Policy Committee: National Association of Insurance Commissioners: National Academy for State Health Policy: Georgetown Center for Children and Families:

What’s Next in Health Care Reform: Training for Trainers.

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What’s Next in Health Care Reform: Training for Trainers.

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