1. Health Reform: What It Means to Our Community
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2. Health Reform: Key Provisions
Provides coverage to 32 million uninsured people by 2019.
Changes insurance rules.
Builds on existing employer- and government-sponsored insurance programs.
Tests ways to tie payment of hospitals and physicians to quality improvement.
Will cost $940 billion over the first 10 years.
Expands access to coverage to 32 million individuals by 2019 through a combination of public program expansions and private section health insurance reforms.
Cost about $940 billion over its first 10 years, according to the Congressional Budget Office.

3. Health Reform: Paid For By …
Medicare and Medicaid payments reductions to hospitals - $134 billion over 10 years.
Taxes on medical devices, which increase costs for hospitals and consumers.
Higher Medicare taxes for the wealthy.
New taxes on expensive health insurance.
Fees to drug manufactures and health insurers.
Financial penalties to those without health insurance.
Hospitals across the nation will see reductions in Medicare and Medicaid payments of $134 billion over 10 years.
PPS hospitals will see reductions of $112 billion (in market basket updates) over 10 years (nationally). Health Reform reduces Medicare and Medicaid payments to hospitals by $22 billion over 10 years (nationally).

4. About Health Care Coverage
10 Things to Know
Health Reform:
10 Things to Know
About Health Care Coverage

5. Health Reform: The Top 10
1. No lifetime benefit limits and no annual limits on coverage. 2. Coverage cannot be denied based on health status. 3. Dependent adult children can stay on parents’ health policy until age No insurance coverage exclusions for pre-existing conditions beginning in Mandates coverage of preventive care.

6. Health Reform: The Top 10
6. Coverage cannot be cancelled when someone becomes sick. 7. Limits insurers’ ability to set premiums based on health status and other factors. 8. Creates a new marketplace called an insurance exchange to help people find insurance. 9. Provides subsidies to help people buy insurance through the exchanges. 10. Requires all Americans to have health insurance.

7. Health Reform: A Deeper Look

8. Buying coverage on your own
What Does Reform
Mean for Me?
Employer-sponsored or
Buying coverage on your own

9. Employer Coverage
Most individuals with coverage through their employers should not see substantial changes.
The bill includes incentives for your employer
to offer insurance.

10. Buying Coverage on Your Own
Individuals who purchase their own insurance coverage may:
Be eligible for coverage through insurance exchanges.
Qualify for tax credits to help purchase coverage.
Will discuss insurance exchanges in a moment (more on slide 16.)

11. Medicare Beneficiaries
What Does Reform
Mean for Me?
Medicare Beneficiaries

12. Medicare
Individuals with traditional Medicare coverage should not see substantial changes, but will receive some additional benefits.
Additional benefits will include:
Free preventive screenings such as colonoscopies and mammograms.
A free annual physical or “wellness” visit.
Discounts for brand-name prescription drugs.
A 50% discount on brand-name drugs while in the “doughnut-hole” coverage
gap.
However, individuals with Medicare Advantage plans may see changes in their benefits depending on how their insurance company responds to reduced funding for this type of plan.

13. Individuals without Insurance
What Does Reform
Mean for Me?
Individuals without Insurance

14. Uninsured
Beginning in 2014, all U.S. citizens and legal residents must have coverage or pay a penalty.
Uninsured individuals will have access to coverage through
insurance exchanges.
Subsidies will be available to help low-income individuals buy
private health insurance.
Will discuss insurance exchanges in a moment (more on slide 16.)

15. Uninsured
Eligibility for Medicaid is expanded to low-income individuals.
Starting in 2010, a high-risk insurance pool will be available to individuals with pre-existing conditions and early retirees those 55 or older but not yet eligible for Medicare.
Every state must set up an exchange by 2014.
The high-risk pool expires in 2014 when exchanges and rules to prevent insurers from excluding individuals with pre-existing conditions are in place.

16. … Think of it as an Orbitz or Travelocity for health care plans.”
Insurance Exchanges
“Small companies and individuals who don’t have insurance through work will be able to purchase insurance through newly created marketplaces, known as insurance exchanges, created and regulated by states.
… Think of it as an Orbitz or Travelocity for health care plans.”
- USA Today

17. Note: Employers are not required to provide coverage.
What Does Reform
Mean for Me?
Large Employers or
Small Businesses
Note: Employers are not required to provide coverage.

18. Large Employers
Large employers – businesses with 101* or more employees – will be fined if their employees purchase health care coverage through the new exchanges and receive federal help to pay their premiums.
* States have the option to treat business with 51 or more employees as large and 50 or fewer employees as small.
(1) LARGE EMPLOYER.—The term ‘‘large employer’’ means, in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least 101 employees on business days during the preceding calendar year and who employs at least employee on the first day of the plan year.
(2) SMALL EMPLOYER.—The term ‘‘small employer’’ means, in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least 1 but not more than 100 employees on business days during the preceding calendar year and who employs at least 1 employee on the first day of the plan year.
(3) THE STATE HAS THE OPTION TO TREAT 50 EMPLOYEES AS SMALL.—In the case of plan years beginning before January 1, 2016, a State may elect to apply this subsection by substituting ‘51 employees’ for ‘101 employees’ in above paragraph 1 and by substituting “50 employees’ for ‘100 employees’ in above paragraph 2.

19. Small Employers
Small businesses are eligible for subsidies to offer insurance and have access to the exchanges.
Employers with 10 or fewer employees who earn, on average,
less than $25,000 a year can get a 50% tax credit for
providing health insurance.
Employers with 25 or fewer employees who earn, on average,
less than $50,000 can receive a partial tax credit.

20. Health Reform: What Happens Next?
Medicare and Medicaid will issue new rules and requirments to implement Health Reform.
Hospitals will continue to work with congress to fix portions of Health Reform that provide barriers to the delivery of health care in local communities and eliminate portions that make it impossible for hospitals to provide care.
Consumers should evaluate the changes in their insurance plans and tax requirements based on their income and coverage.

21. Resources
Kaiser Family Foundation: Federal government: AARP: Robert Wood Johnson Foundation: National Association of Insurance Commissioners: Kansas Insurance Department:
More information on health reform can also be found at

22. Health Reform: What It Means to Our Community
Questions or
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