1. COLORADO CONVERSATIONS Federal Health Care Reform

2. Agenda Welcome Introduction to keypads Demographic questions – Who is in the room? Overview of Federal Health Care Reform Provisions & the Impact on Colorado General Questions on Health are Reform Next steps

3. Using your Keypads Simply push the key that corresponds with your answer choice It will turn on when you push a numbered key

4. Your answer will be displayed on the keypad. Let’s say you press 2/B on your keypad: The check mark indicates the answer was received properly. Polling Open Note: after your selection is displayed the screen will go blank

5. As long as Polling is Open, you can change your answer by pressing any other key. Polling Open

6. Practice: What is your general view of the health care legislation Congress passed earlier this year? 1.Love it 2.Hate it 3.Mixed emotions 4.Need more information in order to understand it 5.Other

7. Demographic Questions Who’s in the room?

8. What is your race/ethnicity? 1.American Indian or Alaskan Native 2.Asian 3.Black or African American 4.Native Hawaiian or Other Pacific Islander 5.White 6.Hispanic 7.Unknown 8.More than one race 9.Other

9. What is your gender? 1.Male 2.Female

10. What is your age range? 1.<20 years old 2.20 to 29 years old 3.30 to 39 years old 4.40 to 49 years old 5.50 to 59 years old 6.>60 years old

11. I live in: 1.Denver Metro 2.Front Range 3.Northeast 4.Southeast 5.Mountain 6.San Luis Valley 7.Western Slope 8.Other

12. Are you a… 1.Native of [this town/ county/region]? 2.Native of Colorado? 3.Native of another U.S. state? 4.Native of another country?

13. Some Health Care Questions What is the group’s experience?

14. Do you currently have health insurance? 1.Yes 2.No

15. If you have health insurance, are you happy with your insurance? 1.Yes 2.No 3.Don’t have insurance

16. I know someone who was denied healthcare insurance for a preexisting condition 1.Yes 2.No 3.Not sure

17. FEDERAL HEALTH CARE REFORM Background

18. Federal Health Care Reform: The Basics Projected to cover 32 million Major approaches to coverage include: –Individual mandate –State-based Insurance Exchanges for individuals and small businesses –Expansion of Medicaid to 133% FPL ($14,404 for an individual and $29,327 for a family of four) –Require large employers to offer coverage to employees –Provide tax credits and premium credits for low- income individuals and families.

19. However Approximately 24 million people will remain uninsured in 2014, including an estimated 400,000 in Colorado Primarily, they are: –Undocumented immigrants –Low income workers who can demonstrate that insurance coverage is unaffordable, even with subsidies

20. How concerned are you about the remaining uninsured? 1.Not much 2.Some 3.A lot

21. Medicare Drug Benefit In 2010, a $250 rebate will be available to those Medicare Part D participants who reach the “donut hole.” Approximately 100,000 seniors in Colorado could see significant reductions in the costs of their brand- name drugs in the Medicare Part D program.

22. Changes to Private Health Insurance Effective 6 months following enactment: Insurers are prohibited from denying health insurance due to a pre-existing condition for children under age 18. Individual and group policies must provide coverage for dependent children up to age 26. Prohibit lifetime limits on the dollar value of coverage Prohibit insurers from rescinding coverage except in cases of fraud.

23. Changes to Private Health Insurance, cont. Beginning in 2014: Insurers are prohibited from denying health insurance due to a pre-existing condition for adults. Prohibit individual and group health plans from placing annual limits on the dollar value of coverage. New policies must comply with one of the four federally designated benefit categories.

24. New for Small Businesses Small businesses will receive a 50% tax credit to help pay for coverage Tax-exempt employers (e.g. nonprofits) will receive a 35% credit. Eligibility: –25 full time employees or fewer –average wages under $50,000 –already providing qualified health insurance to their employees and paying for at least half This would help an estimated 68,000 small businesses in Colorado.

25. Do you know of any Colorado small businesses that will benefit from this tax credit? 1.Yes 2.No 3.Not sure

26. In general, do you think that health care reform is good for small business? 1.Yes 2.No 3.Mixed bag 4.Not sure

27. State Role States will create “Exchanges” where individuals and small business can purchase coverage. Individuals and families whose household income falls between 133% and 400% FPL will be eligible for subsidies in the exchange. –400% of poverty is $43,120 for an individual and $88,200 for a family of four

28. State Role, cont. Consumer Operated and Oriented Plan (CO–OP) programs CO-OPs are non-profit, member-run health insurance companies. CO-OPs must be: –governed by members –profits must be used to lower premiums, improve benefits or improve the quality of care for members

29. Do you think CO-OPS will catch on in Colorado? 1.Yes 2.No 3.Not sure

30. Other Coverage Options: Multi- Share Programs (MSPs) An MSP is a basic plan to provide coverage to low-income workers. Usually the employer pays part, the employee pays part, and another part is paid by an outside funder. Under the version of the bill that passed (Senate) MSPs would not satisfy the individual mandate requirement Subsidies for individuals and families cannot be used for MSPs. However, small businesses participating that meet the criteria for the tax credits available starting in 2010 will be eligible to receive those credits.

31. MSPs in Colorado Colorado has two MSPs: –Health Access Pueblo –CarePoint in the San Luis Valley.

32. Do you think that MSPs should continue in Colorado to serve low- income workers even after 2014? 1.Yes 2.No 3.Not sure

33. Interaction with Colorado Law

34. Federal Health Care Reform and Colorado’s HB 1293-09 Last year the legislature passed the Colorado Healthcare Affordability Act of 2009, which establishes a hospital fee that will be matched by federal funds in order to provide access to health insurance for hundreds of thousands of Coloradans

35. WHAT DOES THE LEGISLATION MEAN FOR COVERAGE IN COLORADO?: MEDICAID EXPANSION Beginning in May 2010, in Colorado Medicaid eligibility for parents of dependent children will increase from 60% FPL to 100% FPL, making coverage available to an additional 27,618 people. In 2012 an additional 119,104 more adults in Colorado will be eligible for Medicaid. In 2014, federal expansion will provide access to Medicaid to another 52,676 adults in Colorado between 101% and 133% FPL. An estimated 63,851 adults at or below 133% FPL will remain uninsured because they lack legal immigration documentation.

36. How does 1293 interact with Federal Reform? Thousands of Coloradans will be covered sooner Colorado will be ahead of many others states in 2014 because 1293 allows us to reduce the number of uninsured over time. – Those states that have higher uninsured rates will have rapidly increasing spending in 2014

37. Impacts and Opportunities for Colorado Communities

38. HOW WILL REFORM AFFECT ACCESS TO CARE? Increase the number of health care providers, including doctors, nurses, and dentists, particularly in rural and other underserved areas. Target rural populations and providers through rural physician training grants to help rural communities with the “grow-your-own” approach. Area Health Education Centers (AHECs) will be expanded to increase access to health care for medically underserved populations, in particular by adding primary care residencies to community-based settings.

39. HOW WILL OUR COMMUNITIES BENEFIT FROM HEALTH CARE REFORM LEGISLATION? New grants, demonstration projects, and programs for communities to expand and improve the delivery of care and to develop best practices for future implementation. The CDC will fund community preventive health activities to reduce chronic disease rates, prevent the development of secondary conditions, and address health disparities. Other new programs and funding opportunities will address workforce shortages, develop and establish new models of care delivery, and increase access to quality health care.

40. Examples of Grants & Demonstration Projects Creating Healthier Communities: Community Transformation Grants & Community-Based Prevention & Wellness Grants Community-Based Collaborative Care Network Program School-Based Health Centers for increased access to clinical preventive services Demonstration Project for Alternative Dental Health Care Providers Primary Care Extension Services

41. Do you think your community should apply for one of the grant opportunities? 1.Yes 2.No 3.Not sure

42. Discussion

43. What is your general view of the health care legislation Congress passed earlier this year? 1.Love it 2.Hate it 3.Mixed emotions 4.Need more information in order to understand it 5.Other

45. Healthcare reform will have a positive impact on my healthcare. 1.Strongly Agree 2.Agree 3.Neutral 4.Disagree 5.Strongly Disagree

46. I know someone who will now be able to get healthcare insurance. 1.Strongly Agree 2.Agree 3.Neutral 4.Disagree 5.Strongly Disagree

47. I believe, by 2014, that the health care access problem will be alleviated. 1.Strongly Agree 2.Agree 3.Neutral 4.Disagree 5.Strongly Disagree

48. Where can I go for more information? U.S. Department of Health and Human Services, healthreform.gov:http://www.healthreform.gov/reports/statehealthrefo rm/colorado.htmlhttp://www.healthreform.gov/reports/statehealthrefo rm/colorado.html National Conference of State Legislatures: http://www.ncsl.org/default.aspx?tabid=17639 http://www.ncsl.org/default.aspx?tabid=17639 Kaiser Family Foundation: http://healthreform.kff.org/http://healthreform.kff.org/ Colorado’s Health Reform Website: www.colorado.gov/HealthReform The Patient Protection and Affordable Care Act: http://frwebgate.access.gpo.gov/cgi- bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3590enr.txt.pdf http://frwebgate.access.gpo.gov/cgi- bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3590enr.txt.pdf Commonwealth Foundation – Implementation Timeline: http://www.commonwealthfund.org/Content/Publications/Other/2010/ Timeline-for-Health-Care-Reform-Implementation.aspx

49. COLORADO CONVERSATIONS