Keith J. Mueller, PhD Director, RUPRI Center for Rural Health Policy Analysis Head, Department of Health Management and Policy College of Public Health University of Iowa Presentation to the Rural Health Association of Tennessee, West Tennessee Regional Meeting McKenzie, TN August 25, 2011

 Immediate insurance benefits  Immediate benefits in community health programs  Developing health insurance exchanges 2

 No pre-existing conditions for children  No lifetime limits in individual market  Change in age of eligibility for dependents 3

 500 new primary care residency slots  Support for training 600 new physician assistants  $5 million for state workforce planning  $29 million for National Health Service Corps  $8 million additional training grants to Community Health Centers 4

 Temporary program to bridge to 2014  State based, federally funded effort  $5 billion in federal funds through end of 2013  As of June 30, 2011 – 1491 enrolled in Illinois 5

 Citizen or lawfully present person  Not have been covered for previous 6 months  Have a pre-existing condition 6

 State programs, or  Run by US Department of Health and Human Services  Find state and specifics: 7

 Premium information on state page  Premiums in national plan reduced in June  Low participation thus far: 18,313 as of end of March  Changed enrollment in federal program to require only a letter from doctor, physician assistant or nurse practitioner, not a letter of denial for an insurance company 8

1. Better Care: improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe. 2. Healthy People and Communities: improve the health of the U.S. population by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care. 3. Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government. 9

1. Making care safer by reducing harm caused in the delivery of care 2. Ensuring that each person and family is engaged as partners in their care 3.Promoting effective communication and coordination of care 10

4.Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease 5.Working with communities to promote wide use of best practices to enable healthy living 6.Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models 11

 The new National Prevention, Health Promotion and Public Health Council  The new Advisory Group on Prevention, Health Promotion, and Integrative Public Health  Use of a new Prevention and Public Health Fund  CDC to convene an independent Community Preventive Services Task force 12

 Planning and implementation of a national public-private partnership for a prevention and health promotion outreach and education campaign to raise public awareness of health improvement across the life span  Establish and implement a national science- based media campaign on health promotion and disease prevention 13

 $500 million in FY 2010  $750 million in FY 2011  $2 billion per year in FY

 Healthy and Save Community Environment  Clinical and Community Preventive Servcies  Empowered People  Elimination of Health Disparities 15

 Purpose of exchange: connect consumers and insurers  Enlisting plans and display of options  Enroll individuals and small groups 16

 Special challenges to reach into all geographic areas  Navigators to help individuals and employers  Could include community nonprofit organizations, local chambers of commerce, unions, brokers 17

 Bring in people and groups who have not been participating in insurance market  Facilitate enrollment 18

 Affordable coverage with high take up  Healthy communities  Affordable health care for all 19

 Special rural circumstances  Reaching vulnerable populations  Improving and sustaining population health  Sustaining healthy rural communities in broadest sense of that term 20

 Level of influence over the market  Governance  Navigators  Access standards  Relationship to Medicaid  Small Business Health Options Program 21

 Creating new markets in rural places  How much to influence the types of choices consumers will have 22

 Governing body set by the state statute  Could be either public or private entity  Specify rural awareness? 23

 Should non-profit organizations be required? – could be a way to assure community focus  What is the appropriate role for brokers? 24

 What should be promulgated as federal standards?  Network adequacy standards, including sufficient number of providers  Include sufficient number of essential community providers 25

 Pairing up changes in policies, including certifying Qualified Health Plans that might serve both Medicaid and private enrollment  Transitions between Medicaid and private purchase – matching up benefits, providers 26

 Could be separate exchange  Could vary the size of employer that can participate (under 50 instead of under 100 initially, expand in 2018) 27

 Quality of plan to meet state expectations and be reviewed  Quality of health care services delivered  Non-renewal and decertification procedures for plans and enrollees 28

 Spring 2012: Supreme Court may rule on constitutionality of individual mandate  January 2013: State plans need to be approved (flexibility in what and how)  January 2014: Exchanges to go live 29

 All provisions in 10 titles of legislation and subsequent rule-making  Time of trying like never before to achieve “triple aim”  Private and public sector initiatives  Voice for rural will be critical 30

The RUPRI Center for Rural Health Policy Analysis The RUPRI Health Panel 31

Department of Health Management and Policy College of Public Health 200 Hawkins Drive, E203 GH Iowa City, IA