1. National Heath Care Reform The Affordable Care Act Angela Marese Boyle, NODD Specialist, Region 3 & Kathy Rallings, NODD Health Benefits Specialist

2. About The Law  Signed into law March, 23 2010  Puts in place health insurance reforms to Hold insurance companies more accountable Lower health care costs Guarantee more choices Enhance quality of health care

3. New Consumer Protections 2010  Must provide coverage for children with pre- existing conditions  No lifetime limits on essential benefits *  Annual limits will be restricted*  External appeals process  State consumer assistance  No rescissions for minor errors

4. Improving Quality and Lowering Costs  Small business tax credits  Relief for seniors prescriptions  No cost sharing for preventive care*  Wellness and disease management  Reducing health care fraud  Early retirees*  Partnership for Patients*

5. Increasing Access  Uninsured with pre-existing conditions  Young adults*  Primary care workforce  States to allow more on Medicaid  Better payments for rural providers  Community health centers  Insurance companies unreasonable rate hikes

6. Grandfathered Plans Collectively Bargained by Enactment To Qualify Cannot:  Changes in annual benefit limits  Elimination of benefits for certain conditions  5% increase to employee share of premium  Increases of 15% plus medical inflation to deductibles  More then a $5 or 15% adjusted for medical inflation on co-pays 6

7. Grandfather Plans Exceptions 7  Cost sharing for preventive care  No patient protections  No limit on deductibles in 2014 Only 35% will retain this status by 2013

8. First Renewal on or After September 23, 2010  Coverage for dependents under age 26 AB 36 (tax conformity)  Elimination of lifetime limits  Elimination of annual limits 2010 - $750,000 2011 - $1.25 Million 2012 - $2 Million Completely banned Jan. 1 2014 8

9. Early Retiree Reinsurance Program  Chronic or high cost claims between $15,000-$90,000  55-Medi Care eligible  Approved Plan Sponsors  2014 or 5 Billion  Reductions in:  Premiums  Deductibles  Co-pays  Other out-of-pocket costs

10. Accountable Care Organizations  2012 for Medicare  Voluntary participation  Patient centered  Restructure payments  Shared savings  Measurements to improve quality  Improved coordination & communication http://video.pbs.org/video/1880261065

11. Partnership for Patients: Better Care, Lower Costs GOALS BY 2013  40% decrease in preventable hospital-acquired conditions  60,000 lives saved  Reduce hospital readmissions by 20%  1.8 million patients would not suffer complications Potential Savings of $35 Billion http://www.healthcare.gov/

12. California Health Benefit Exchange  First in the nation  In place by 2014  Governing Board Kimberly Belshé Diana S. Dooley, Chair Paul Fearer Susan Kennedy VACANT (Senator Steinberg to appoint)  Pending bills to make Exchange Work

13. California Health Benefit Exchange  Est. 2.4 million Californians eligible  Subsidy based on family income Under 400% FPL Unaffordable employer based 9.5% of income 60% actuarial value Not eligible for Medi-Cal May opt out of employer-based coverage if cost is between 8% and 9.8% of income.

14. Actuarial Examples

15. Individual Mandate 2014  Tax penalty Hardship waiver Sets minimum standards  Establishes floor for negotiations  Limit on waiting periods to 90 days

16. Employer Penalties Firms with 50 or more FTEs No coverage offering $2,000 per full-time employee At least one employee receives subsidy 1 st 30 except Unaffordable offering $3,000 per employee receiving a subsidy

17. Maximum Out of Pocket

18. Employee Only

19. Family Coverage

20. Taxes  Report value of benefits on W-2 Includes employer contributions to HSA, MSA or FSA excludes dental and vision.  2018 -40% tax on INSURERS $10,200 single $27,500 family Adjusted for age, CPI, and gender  Employers must report annually to the IRS

21. California Statutes and Proposals  SB1088 (Price) Conformed California state law regarding 26 year olds  AB52 (Feuer) Rate Regulation  Pending Exchange bills AB1296 AB714 AB792

22.  Heath and Human Services www.healthcare.govwww.healthcare.gov  The Commonwealth Fund www.commonwealthfund.orgwww.commonwealthfund.org  Kaiser Family Foundation www.kff.orgwww.kff.org  California HealthCare Foundation www.chcf.orgwww.chcf.org  The California Endowment www.calendow.orgwww.calendow.org  Physicians for a National Health Program www.pnhp.orgwww.pnhp.org  UC Berkley Labor Center www.laborcenter.berkeley.edu  For additional information and links to various health care websites: www.cechcr.orgwww.cechcr.org How You Can Stay Informed Good sources of information: 22