How Health Reform Helps Missouri: Today and in the Future Brian Colby MO Health Advocacy Alliance

Health Reform in a Nutshell 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! 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 Temporary funding ($5 B until 2014) for covering high-risk individuals Reinsurance for employers providing coverage to early retirees to help hold down premiums for plan enrollees

Provisions Effective July 1, 2010 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 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 Stronger protections against unfair rescissions Internal and external appeals processes Emergency care: no prior authorization, cost-sharing same for in and out-of- network OB/GYNs considered primary care providers

Provisions Effective in 2011 Medical loss ratio requirements Plans must have standardized descriptions (benefits and cost-sharing) Medicare: Preventive care with no cost- sharing, 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 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/ pre- existing conditions No pre-existing condition exclusions No premiums hikes based on health status

Full Implementation (2014)- Exchanges 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 Medicaid: By 2014, expanded eligibility to 133% FPL nationwide ($14,404/ year for an individual in 2010) –Adults without children eligible everywhere! Medicare: Donut hole eliminated by 2020

Questions? Brian Colby Health Care Foundation of Greater Kansas City Missouri Foundation for Health Kaiser Family Foundation