A Trail Guide to Health Care Reform Roberta Rifkin, Vice President for Government Affairs

2 The Map The Patient Protection and Affordable Care Act (ACA) was signed into law on March 23, 2010 and provides the way to reform. The ACA map is designed to lead us toward: A Better Patient Experience; Improved Community Health; and Lower Costs. Though there are different ways to get there, the destination is the same and we all need to move forward together.

3 Three Main Groups Carving Trails to Reform FederalStateCommunity

4 Federal Team is Providing State and Community Teams an Understanding of the Terrain Coverage Affordability Quality

5 Federal Team is Leading the Way Federal Team Creates guidance and support for states and communities Providing states and communities with tools –Grants –Flexibility –Access

6 Landmarks on the Federal Trail Individual Mandate Employer Responsibility Health Exchange

7 Obstacles on the Federal Trail Legal Challenges: Supreme Court will be hearing arguments regarding the following issues: –Constitutionality of individual mandate and Medicaid expansion –Severability –Anti injunction tax act Decision expected in June Political Challenges Republican Opposition –“Repeal and Replace” –Defund provisions –Election Issue –Creates State uncertainty Implement or wait

8 A New Challenge on the Federal Trail The Budget Control Act of 2011 To raise the debt ceiling by a total of $2.1 trillion Congress must either Congressional vote on a balanced budget amendment; or Super Committee proposal for $1.2-$1.5 trillion cuts. Without a balanced budget amendment or a proposal from the Super Committee across the board cuts will occur January 2013, including cuts to Medicare, but not Medicaid

9 State Trails Each state has opportunities to chart their own course. Grants for Reform Health Insurance Exchanges

10 New York State Trail –Federal Grants ($40.8 million) Exchange Early Innovators Exchange Planning Grants Establishment Level 1 Rate Review Consumer Assistance –Exchange Legislation Waiting for Senate to vote on Exchange bill

11 Obstacles on the State Trails Implementation Challenges: –Budget shortfalls –Reconcile ACA with existing state law –Uncontrolled Costs

12 Navigation Challenge: Payment Reform Medicaid: over $53 billion for 4.7 million people Highest Medicaid costs per capita Governor Cuomo developed a Medicaid Redesign Team to propose reforms Medicaid Redesign Team (MRT): –Short term: budget proposals –Long term: multi year reform proposals

13 Navigating the Community’s Trail Creating a Culture of Health Community Planning Promoting Health and Self-management Improving Quality in Health Care Delivery Expanding Health Information Technology Networks

14 Keeping Everyone on the Trail Recognize and engage within your spheres of influence: WORK FAMILY COMMUNITYPHYSICIANS

15 Reaching Our Destination Together The Federal team is charting the course according to the Affordable Care Act. The State teams are proceeding along the path within federal guidelines, but in accordance with their state’s needs. The Community teams are being formed as local leaders emerge to help guide their residents. To ensure that all hikers reach the goals of health care reform, all team must continue to move forward together.

16 Individual Mandate Everyone is required to have health insurance or pay a penalty up to $695 or 2.5% of gross income. Medicaid eligibility expanded to 133% of Federal Poverty Level (FPL). Premium subsidies and cost sharing available for incomes between 133%- 400% FPL ($14,484/$29,726 to $43,560/$89,400). Individuals with a religious conscience exemption are not required to have health insurance. Exemptions from the penalty for economic hardship and low income levels. Individuals are required to have minimum essential coverage which is defined as coverage under a government program like Medicaid.

17 Employer Responsibility Employers with at least 50 Full Time Equivalents (FTEs) have a responsibility to provide affordable coverage that meets minimum standards. Employers that do NOT offer coverage and at least 1 worker receives a subsidy will pay $2000 times total FTEs minus 30. Employers that DO offer coverage will pay a penalty for each worker receiving a subsidy:  Lesser of total employees X $2000 or $3,000 for each employee requiring a subsidy

18 Health Exchange The exchange is an electronic marketplace for purchasing health coverage. Individuals and Small Groups are eligible in Large Groups eligible to join in All plans that are offered through the exchange must be certified as a Qualified Health Benefits Plans and offer bronze, silver, gold, platinum, and/or catastrophic plans. State-based exchange must be operational by 2014 or the Federal Government will offer its exchange. NY State will face many issues in designing its exchange:  Governance, Financing, Market Dynamics,  Products, Consumer & Employer Experience,  Operations and Technology.