1. Leni Preston, Chair leni@mdchcr.org 301.530.8153

2. © 2013 Maryland Women’s Coalition For Health Care Reform
Today’s Objectives:
Introductions and Overview of Coalition
ACA Overview and Key Provisions
Maryland Health Care Reform Implementation Update
Resources and Handouts
“Health Reform Hits Main Street” Video – Kaiser Family Foundation
Q&A
© Maryland Women’s Coalition For Health Care Reform

3. © 2013 Maryland Women’s Coalition For Health Care Reform
About the Coalition
Nonpartisan alliance of individuals and 90 state-wide organizations working together to ensure that all Marylanders have the health care they need and
deserve.
National Partners
Raising Women’s Voices
National Women’s Law Center
Open Society Institute - Baltimore [
© Maryland Women’s Coalition For Health Care Reform

4. How We Achieve Our 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.
© Maryland Women’s Coalition For Health Care Reform

5. 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. 
© Maryland Women’s Coalition For Health Care Reform

6. Why Health Care Reform Is Important to Women & Families
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.
© Maryland Women’s Coalition For Health Care Reform

7. 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
© Maryland Women’s Coalition For Health Care Reform

8. Prevention, Prevention, Prevention
Women’s preventive care
without co-pays and deductibles
Well woman visit
Breast feeding support
Family planning services, including contraception
Screenings for HIV, STI, and domestic violence
Mammograms and cervical cancer screenings
HPV testing
© Maryland Women’s Coalition For Health Care Reform

9. Patient Protections: What We Have Gained to Date
By 2011:
51,868 young adults can stay on their parents’ health plans
52,234 seniors got help paying for their prescription drugs
1,153,000 individuals gained preventive care coverage without co-pays or deductibles
2,251,000 no longer have to worry about lifetime limits for their care
© Maryland Women’s Coalition For Health Care Reform

10. The Patient Protection and Affordable Care Act
A 3-Legged Stool:
Everyone is “in”
Medicaid Expansion
Qualified Health Plans at Maryland Health Connection
Personal responsibility
Affordability
© Maryland Women’s Coalition For Health Care Reform

11. Affordability in the ACA
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
© Maryland Women’s Coalition For Health Care Reform

12. Individual Responsibility
Individuals must obtain health insurance coverage
When fully phased in penalty is 2.5 percent of income if coverage is not purchased
Exceptions for:
Financial hardship, religious objections, incarcerated individuals, undocumented immigrants, those for whom the lowest cost plan is 8 percent of annual income, and those whose income is below the tax filing threshold
© Maryland Women’s Coalition For Health Care Reform

13. Employer Responsibility
Penalties for employers with more than 50 FTEs
Employer does not offer coverage and one FTE obtains coverage in the Exchange
Employer offers coverage and one FTE obtains coverage in the Exchange
No penalties for employers with less than 50 employees
For low-wage very small employers there is a new tax credit for providing health insurance to employees - 66,000 eligible in Maryland.
© Maryland Women’s Coalition For Health Care Reform

14. The Health Benefit Exchange: Maryland Health Connection
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
© Maryland Women’s Coalition For Health Care Reform

15. Maryland: A National Leader
Commitment and Leadership
Effective Process:
Health Care Reform Coordinating Council;
Office of Health Care Reform; &
Health Benefit Exchange Board
Medicaid Expansion
© Maryland Women’s Coalition For Health Care Reform

16. Health Care Reform Coordinating Council (HCRCC)
Administrative and Legislative Body
Create a Roadmap
Report as basis for 2011 Legislation
State Health Improvement Process
Medicaid Expansion
Determine Essential Health
Benefit Benchmark Plan
Determine Financing Mechanism
© Maryland Women’s Coalition For Health Care Reform

17. 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
© Maryland Women’s Coalition For Health Care Reform

18. Medicaid Expansion: Up to 138% FPL
Approximately 101,000 new enrollees in 2014
Benefit package remains the same
Simplified enrollment process
“No Wrong Door”
© Maryland Women’s Coalition For Health Care Reform

19. © 2013 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
© Maryland Women’s Coalition For Health Care Reform

20. Health Benefit Exchange Timeline
Landmark ACA Legislation signed into Law 3/23/2010 by President Obama
4/12/2011
Governor O’Malley Signed Health Benefit Exchange Act into Law
6/3/2011
Exchange Board 1st 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 Benefit Exchange will be Operational
Source: A Report to the Governor and Maryland General Assembly
Maryland Health Benefit Exchange, December 23, 2011, p. 1
© Maryland Women’s Coalition For Health Care Reform

21. © 2013 Maryland Women’s Coalition For Health Care Reform
Legislation
Maryland Health Benefit Exchange Act of 2011
Maryland Health Benefit Exchange Act of 2012
Maryland Health Progress Act of 2013 SB274/HB228
© Maryland Women’s Coalition For Health Care Reform

22. Health Progress Act of 2013: SB274/HB228
Medicaid Expansion
MHBE financing
MHIP Enrollees
State reinsurance program
Continuity of Care
Final federal certification
© Maryland Women’s Coalition For Health Care Reform

23. The Next Big Thing: Outreach and Enrollment
© Maryland Women’s Coalition For Health Care Reform

24. Connector Entities: Who Are They?
Navigators
Assisters
Application Counselors
Call Center
Captive Producers
Producers
© Maryland Women’s Coalition For Health Care Reform

25. Training and Certification Areas
General knowledge of the ACA and Uninsured in Maryland
Working knowledge of the new HIX eligibility and enrollment system
Cultural Competency and Health Literacy
Medical Assistance Programs
Advanced Premium Tax Credits
Qualified Health Plan Selection
© Maryland Women’s Coalition For Health Care Reform

26. Maryland’s Implementation: Issues Currently Being Tracked
Affordability
Continuity of Care – including women ( % poverty) who become pregnant
Network Adequacy & Essential Community Providers
Stand-Alone Dental Plans/Pediatric Dental Coverage
© Maryland Women’s Coalition For Health Care Reform

27. More Issue Areas To Track
Effective Communications, Outreach & Enrollment
Performance Measures & Data Collection
QHP Quality Ratings
Health Disparities
© Maryland Women’s Coalition For Health Care Reform

28. Stay Informed & Get Involved
Join the Coalition
Newsletters, Alerts, Member Calls & Webinars
2013 educational forums; April 22nd Webinar: Leveraging Health Care Reform: Cultural Competency and Health Literacy Strategies
Facebook and Twitter
Encourage others to join
Learn more about SHIP and your local health action coalition –
Share your stories MDHealthCareReform.org
© Maryland Women’s Coalition For Health Care Reform

29. © 2013 Maryland Women’s Coalition For Health Care Reform
Resources You Can Use
National Partners
Raising Women’s Voices (RWV)
National Women’s Law Center (NWLC)
Open Society Institute -Baltimore
© Maryland Women’s Coalition For Health Care Reform

30. © 2013 Maryland Women’s Coalition For Health Care Reform
Resources You Can Use
Maryland
Health Benefit Exchange
Maryland Health Connection
Maryland Health Insurance Plan (MHIP)
Governor’s Office of Health Care Reform
Federal
Department of Health & Human Services
© Maryland Women’s Coalition For Health Care Reform

31. Kaiser Family Foundation
Health Reform
Hits
Main Street
© Maryland Women’s Coalition For Health Care Reform

32. © 2013 Maryland Women’s Coalition For Health Care Reform
Leni Preston, Chair,
Website:
© Maryland Women’s Coalition For Health Care Reform