Health Care Reform: Get It Right for Maryland Leni Preston, Chair (301) © 2012 Maryland Women’s Coalition For Health Care Reform

About the Coalition Nonpartisan alliance of individuals and 81 state-wide organizations, including Frederick County & all Commissions for Women National Partners – Raising Women’s Voices – National Women’s Law Center © 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 our members and supporters, elected officials and the public Reach out to all potential allies of reform Engage our members in the reform issues and debates Advocate and take action, as a Coalition and as individuals, to bring quality, affordable health care to every resident in Maryland. © 2012 Maryland Women’s Coalition For Health Care Reform

Why Health Care Reform Is Important to Women 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. Women have historically been charged more than men for health insurance. © 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

Patient Protections: What We Have Gained to Date Ban on pre-existing conditions for children. Children remain on parents coverage until 26. Medicare covers preventative health benefits (no-cost annual checkups and mammograms) & closes the Medicare Part D “donut hole.” August 1 st – New plans must cover preventive services without co-pays and deductibles. Direct access to ob-gyn services. © 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

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 Options Exchanges. Qualified health plans – 4 “metal” levels © 2012 Maryland Women’s Coalition For Health Care Reform

The Health Benefit Exchange: A Health Insurance Supermarket 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: A National Leader Commitment and Leadership Effective Process: – Health Care Reform Coordinating Council; – Office of Health Care Reform; & – Health Benefit Exchange Board Roadmap © 2012 Maryland Women’s Coalition For Health Care Reform

Health Benefit Exchange Timeline © 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’s Health Benefit Exchange Act of 2011 Public corporation/independent unit of state government 9-member board Key goals: – Reduce number of uninsured – Facilitate purchase and sale of Qualified Health Plans – Require cultural competency in all operations to ensure all populations can gain access – Financially self-sustainable – 6 Legislative Studies © 2012 Maryland Women’s Coalition For Health Care Reform

Creating the Exchange: Stakeholder Input Four Advisory Committees Operating Model (Market Rules & Risk Mitigation) SHOP (Small Business Exchange) Navigator Program (Marketing & Public Relations) Financing © 2012 Maryland Women’s Coalition For Health Care Reform

Creating the Exchange: 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

Health Benefit Exchange Act of 2012 Selective Contracting Small Business Health Options (SHOP) Navigator Program Essential Health Benefits Financing © 2012 Maryland Women’s Coalition For Health Care Reform

SHOP – What is It? Marketplace where small employers & nonprofits (under 50 employees) can purchase insurance. Tax credit available through 2016 © 2012 Maryland Women’s Coalition For Health Care Reform

SHOP Proposals Create separate SHOP exchange. Retain small group size at 50 until Provide two options: – Employers select metal level & employees choose among carriers at that level – Employers select one carrier & employees select the metal level that meets their needs – Consider additional options in 2016 © 2012 Maryland Women’s Coalition For Health Care Reform

Navigator Program Proposals Individual Exchange – CBOs & similar organizations SHOP – Navigators at HBE © 2012 Maryland Women’s Coalition For Health Care Reform

What to Watch - Navigator © 2012 Maryland Women’s Coalition For Health Care Reform

Essential Health Benefits (EHB) HHS: States to Select Benchmark Plan with 10 Categories of Services – Ambulatory patient services – Emergency services – Hospitalization – Maternity & newborn care – Mental health & substance use disorder services – Prescription drugs – Rehabilitative & habilitative services & devices – Laboratory services – Preventive & wellness services & chronic disease management – Pediatric, including oral & vision care © 2012 Maryland Women’s Coalition For Health Care Reform

EHB: Coalition Proposals Stakeholder & consumer group to advise HCRCC Guidance – Balance benefits in each of the 10 mandated categories. – Specificity in defining health services to ensure comprehensive care according to national standards. – Require that there be equal actuarial values. – Provide mental health & substance use disorder benefits in parity. – Do not permit benefit design that discriminates on basis of age, gender, disability, or expected length of life. © 2012 Maryland Women’s Coalition For Health Care Reform

What to Watch - EHB Our Principals: © 2012 Maryland Women’s Coalition For Health Care Reform

Resources You Can Use Maryland – Health Benefit Exchange – Department of Health & Mental Hygiene – Maryland Health Insurance Plan (MHIP) – Health Care Reform Coordinating Council Federal – Department of Health & Human Services © 2012 Maryland Women’s Coalition For Health Care Reform

Stay Informed & Get Involved Join the Coalition – Newsletters, Alerts, Member Calls & Webinars – Educational forums: February 22 nd in Frederick – Facebook and Twitter Encourage others to join Share your stories MDHealthCareReform.org © 2012 Maryland Women’s Coalition For Health Care Reform

Leni Preston, Chair Phone: (301) Website: