Maryland Takes Action on Health Care Reform: The Affordable Care Act Leni Preston, Chair (301) © 2012 Maryland Women’s Coalition For Health Care Reform

About the Coalition Nonpartisan alliance of individuals and 88 state-wide organizations committed to transforming our health care system to meet the needs of all Marylanders. National Partners – Raising Women’s Voices – National Women’s Law Center – Open Society Institute – Baltimore © 2012 Maryland Women’s Coalition For Health Care Reform

Coalition Mission Work collaboratively with our members and partners to seek solutions and advance reforms to ensure that every resident of Maryland has access to affordable, comprehensive & high quality health care that is always there. © 2012 Maryland Women’s Coalition For Health Care Reform

How We Achieve Our Mission Educate and engage our members and supporters, elected officials, policy makers and the public Reach out to all potential allies of reform Advocate and take action, as a Coalition and as individuals, to achieve our shared mission. © 2012 Maryland Women’s Coalition For Health Care Reform

Why Health Care Reform Is Important to Women Caregivers for ourselves, our families & our communities – historically being a woman has been considered a pre-existing condition. 80% of health care decisions are made by women (Department of Labor). In 2008, 1 in 4 women went without necessary health care services. Only 13% of plans in individual market included comprehensive maternity care. © 2012 Maryland Women’s Coalition For Health Care Reform

Why It Matters to Maryland Women 15% (280,000) are uninsured in Maryland 56% are currently employed A majority are under 200% FPL 38.7% are Hispanic/Latino 17.7% are African American 10.4% are Caucasian © 2012 Maryland Women’s Coalition For Health Care Reform

The Patient Protection and Affordable Care Act A 3-Legged Stool: 1.Everyone is “in” 2.Personal responsibility 3.Affordability © 2012 Maryland Women’s Coalition For Health Care Reform

Patient Protections: What We Have Gained to Date By December 2011: 46,000 young adults up to age 26 can stay on their parents’ health plans 1, 153,000 individuals gained preventive care coverage without co-pays or deductibles Policies purchased or renewed by women after August 1 st - 1,042,794 will get additional preventive services 872,000 women and 585,000 children no longer worry about lifetime limits for their care © 2012 Maryland Women’s Coalition For Health Care Reform

More Patient Protections 52,234 seniors got help paying for their prescription drugs 553,920 people on Medicare received free preventive services or a free annual wellness visit with their doctor Insurance companies now have to spend larger share of your dollars (80%) on health care services – 141,291 Marylanders benefited © 2012 Maryland Women’s Coalition For Health Care Reform

Maryland: A National Leader Commitment and Leadership Effective Process: – HCRCC – OHCR – Health Benefit Exchange Board Roadmap $157 million – 4 federal grants © 2012 Maryland Women’s Coalition For Health Care Reform

Affordability in the Affordable Care Act Expand Medicaid program: individuals with incomes up to 138% FPL Tax-credits to individuals with incomes between 138% & 400% FPL Tax credits for small businesses Creates Individual and Small Business Health Exchanges (SHOP) Qualified health plans – 4 “metal” levels © 2012 Maryland Women’s Coalition For Health Care Reform

Maryland Health Connection: A Health Insurance Marketplace Exchange will describe each plan in a standard format – Monthly cost and co- pays – Plan performance on quality measures – Plan ratings by quality and price Compare Apples to Apples Can’t decide between a Fuji and a Rome? Get help! – Website – Telephone hotline – Navigators © 2012 Maryland Women’s Coalition For Health Care Reform

Maryland Health Connection Timeline 4/12/2011 Governor O’Malley Signed Health Benefit Exchange Act into Law 6/3/2011 Exchange Board 1 st Meeting 9-11/2011 Advisory Committees Met 1/1/2013 Exchange Must be Certified by Federal Government 10/1/2013 Individuals and Groups Begin Enrolling in Exchange 1/1/2014 Maryland Health Connection will be Operational © 2012 Maryland Women’s Coalition For Health Care Reform Source: A Report to the Governor and Maryland General Assembly Maryland Health Benefit Exchange, December 23, 2011, p. 1 Landmark ACA Legislation signed into Law 3/23/2010 by President Obama

Maryland Health Connection Public corporation/independent unit of state government 9-member board 7 Principles – Access – Affordability – Sustainability – Stability – Health Equity – Flexibility – Transparency © 2012 Maryland Women’s Coalition For Health Care Reform

Creating the Exchange: Stakeholder Input Exchange Advisory Committees Navigator Continuity of Care Plan Management Exchange Implementation OHCR Advisory Committees Essential Health Benefits Finance & Sustainability Communications © 2012 Maryland Women’s Coalition For Health Care Reform

Stakeholder Representation © 2012 Maryland Women’s Coalition For Health Care Reform Source: A Report to the Governor and Maryland General Assembly, Maryland Health Benefit Exchange December 23, 2011, p. 2

Decisions To Date: Essential Health Benefits Benchmark for Qualified Health Plans Ambulatory services Emergency services In-patient hospital services Prescription drugs Laboratory services Maternity & newborn care Rehabilitative and habilitative service Pediatric, inc. oral & vision Preventive/wellness services & chronic disease m’ment Mental health and substance use disorder treatment © 2012 Maryland Women’s Coalition For Health Care Reform

Decisions To Date: Plan Management Insurance Carriers: Certification Standards – # of QHPs at 4 “metal” levels Carrier Certification for Qualified Health Plans (QHP) – Data Collection – Provider Network MH/SUD Parity Essential Community Providers © 2012 Maryland Women’s Coalition For Health Care Reform

Decisions To Date: Navigator Program Navigator Entities & Individual Navigators – Conduct public education and outreach – Distribute fair and impartial information that is culturally & linguistically appropriate for all populations – Facilitate enrollment in health plans – Medicaid & subsidized insurance – Provide referrals for grievances, complaints and questions SHOP – SHOP navigators – licensing/training through MIA – receives compensation from Exchange – Authorized brokers can sell in and out of the Exchange – compensated by carriers © 2012 Maryland Women’s Coalition For Health Care Reform

Issues To Watch Financing –self-sustaining by 2015 Continuity of Care – “churn” & transitioning between plans Affordability Pediatric & Adult Dental & Vision Communications © 2012 Maryland Women’s Coalition For Health Care Reform

Relationship of Health Improvement Efforts Federal Health Care Reform/ACA Maryland Health Care Reform SHIP-Local Action Health Equity Cultural Competency Health Literacy Affordability Continuity of Care Workforce Diversity & Development

Resources You Can Use: State & Federal – Maryland Health Connection – Exchange Stakeholder Website – Department of Health & Mental Hygiene – Health Care Reform Coordinating Council – Department of Health & Human Services © 2012 Maryland Women’s Coalition For Health Care Reform

Stay Informed & Get Involved Join the Coalition & Encourage Others to Join – Newsletters, Alerts, Member Calls & Webinars – Information/Resources: September 8 th Women of Color Health Care Reform Conference – Host or Attend Health Care Reform Events October 27 – NAMI-MD October 28 – Prince George’s County Commission for Women – Women’s Legislative Conference Facebook and Twitter Share your stories © 2012 Maryland Women’s Coalition For Health Care Reform

Leni Preston, Chair Phone: (301) Website: