1. Patient Protection and Affordable Care Act: Overview for Connecticut Financing Coverage expansions individual mandate employer responsibility insurance reforms Grants, demonstrations November 2010

2. Financing: taxes, fees, & payment adjustments Slower growth of Medicare rates for health care providers (“market basket update”) Taxes on high-income earners, high-cost health plans, some health sector businesses Reductions to Medicare and Medicaid DSH payments Changes to Medicare Advantage Changes in Medicare area wage adjustment for hospitals

3. Coverage Expansions Medicaid expansion All non-elderly adults earning up to 133%FPL Federal tax credits for individuals and families  People earning 133-400%FPL  People with unaffordable or inadequate ESI o Premiums total >9.5% of income or actuarial value <60% Federal tax credits for small businesses  Businesses with <25 FTEs and <$50,000 average annual wages  Credits begin in 2010. After 2013 businesses can receive only two years of assistance.

4. Individual insurance mandate All adults and children must maintain health insurance if an affordable option is available. Penalties for non-compliance: Uninsured will owe the greater of $695 or 2.5% of income above the income tax filing threshold. Affordability: Insurance considered unaffordable if premiums total > 8% of income. All ESI, individual market plans, grandfathered plans satisfy federal insurance mandate.

5. Employer responsibility Businesses with >50 employees must offer insurance that meets these minimum standards:  Employee premiums < 9.5% of income  Actuarial value of > 60%  Free Choice Vouchers (premiums 8 to 9.8% income) OR pay a fee to help defray the cost to taxpayers for subsidies  Employers that offer coverage but have workers who receive federal subsidies pay: o Lesser of $3000 per year per employee who receives federal subsidies or $2000 multiplied by total number of employees  Employers that do not offer coverage pay: o $2000 per FTE, minus first 30 employees

6. Insurance market reforms Eliminates: Rescissions, annual and lifetime coverage caps, exclusions for pre-existing conditions Minimum medical loss ratios: 85% large group, 80% individual and small group markets Community Rating: Age 3:1, tobacco use 1.5:1, additive (i.e. total = 4.5:1) Dependent coverage up to age 26 No cost-sharing for primary care and many preventive services Uniform explanation of insurance benefits

7. Building the evidence-base for reform Support for innovation in:  Quality improvement  Workforce development  Payment reform  Transparency  Service delivery reform and care coordination  Wellness and prevention  Reducing racial and ethnic disparities  Insurance consumer protections PPACA contains more than one hundred demonstration projects pilot programs, & grants More than $22 billion authorized to support these initiatives