1. Health Reform: What It Means to Kansas Communities

3. Health Reform Discussion
What is in the bill?
What is next?

4. Reality #1
We are divided when it comes to support for the new health reform legislation

6. Reality #2
The PPACA is now the law.

7. Health Reform Program Time Line
Medicare Extenders
Dependents Covered to 26
Physician Self Referral Ban
NFP Co-Ops
$$ Medicaid PCP
Administrative Simplification
IOM Summit
MB Reductions
340B Extension
Wage Index Reform
Geographic Variation $$
Guaranteed Issue
Individual and Business Mandates
MB Reductions
Productivity + MB Reductions
Readmission Verification
Medicaid Expansion
<$ HAC
IPAB
Exchanges
FY 2010
Redistribute GME Slots
FY 2011
FY 2012
FY 2013 FY
Accountable Care Organizations
Readmission Penalties
Bundled Pmt Pilot
RAC’s for Medicaid
Hospital Reporting of Charges
Productivity Reductions

8. Health Reform: Key Provisions
Over 10 years will expand coverage to 34 million – 95% of all Americans
State-based health insurance exchanges
Medicaid expansion
133% FPL beginning 2014
Subsidies for families up to 400% FPL
Employer and individual mandates
Will cost $940 billion over the first 10 years.
Tests ways to tie payment of hospitals and physicians to quality improvement.
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.

9. 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).

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

11. Health Reform: Insurance Coverage
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.

12. Health Reform: Insurance Coverage
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.

13. Health Reform: A Deeper Look

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

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

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

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

18. 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

19. Medicare, cont.
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.

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

21. 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.)

22. 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.

23. … 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

24. 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.

25. 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.

26. 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.

27. What Happens Now? Replace and Repeal? Court Challenge
Implementation Issues
Medicare and Medicaid will issue new rules and requirements to implement Health Reform
State—Insurance Exchanges; Medicaid Expansion; Reporting Requirements
Federal--Value based purchasing; Medicare updates; Bundling; ACOs;
Legislative Fix-It List
Our lawmakers have to understand that the economic problems we face are hindering our ability to finance vital operations and to keep up with medical technology or even provide basic patient services.
And these difficult times will no doubt affect your work.
Now you will be asked to provide more than your talent and imagination to turn concrete, glass, wood and plastic into a place of healing, hope and comfort.
During these tough times, you will be asked to do much more with less.
At this point we don’t know where the bottom is, but we will continue to evaluate the situation and make sure our members are armed with the latest information and strategies.

28. What comes next politically?
Democrats
Selling the plan to public
Implementing regulations
Protecting those that took tough votes
Republicans
Premium increases will be blamed on reform law
Overall repeal
Constitutional challenges
Incremental efforts to repeal provisions

29. Beyond health care reform
Medicaid FMAP extension
Medicare physician payment fix
Medicare extenders (rural)
Inpatient PPS Rule 29 29

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

31. Health Reform Questions
Contact Information
(785)