1. Health Care Reform: Get It Right for Maryland Leni Preston, Chair leni@mdchcr.org (301) 351-9381 © 2012 Maryland Women’s Coalition For Health Care Reform

2. Patient Protections: What We Have Gained to Date Ban on pre-existing conditions for children. Children remain on parents coverage until 26. Medicare covers preventative health benefits (no-cost annual checkups and mammograms) & closes the Medicare Part D “donut hole.” August 1 st – New plans must cover preventive services without co-pays and deductibles. Direct access to ob-gyn services. © 2012 Maryland Women’s Coalition For Health Care Reform

3. The Patient Protection and Affordable Care Act A 3-Legged Stool: 1.Everyone is “in” 2.Personal responsibility 3.Affordability © 2012 Maryland Women’s Coalition For Health Care Reform

4. Affordability in the Affordable Care Act 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 © 2012 Maryland Women’s Coalition For Health Care Reform

5. The Health Benefit Exchange: A Health Insurance Supermarket 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 © 2012 Maryland Women’s Coalition For Health Care Reform

6. Maryland: A National Leader Commitment and Leadership Effective Process: – Health Care Reform Coordinating Council; – Office of Health Care Reform; & – Health Benefit Exchange Board Roadmap © 2012 Maryland Women’s Coalition For Health Care Reform

7. Health Benefit Exchange Timeline © 2012 Maryland Women’s Coalition For Health Care Reform Source: A Report to the Governor and Maryland General Assembly Maryland Health Benefit Exchange, December 23, 2011, p. 1 Landmark ACA Legislation signed into Law 3/23/2010 by President Obama

8. Maryland’s Health Benefit Exchange Act of 2011 Public corporation/independent unit of state government 9-member board Key goals: – Reduce number of uninsured – Facilitate purchase and sale of Qualified Health Plans – Require cultural competency in all operations to ensure all populations can gain access – Financially self-sustainable – 6 Legislative Studies © 2012 Maryland Women’s Coalition For Health Care Reform

9. Creating the Exchange: Stakeholder Input Four Advisory Committees Operating Model (Market Rules & Risk Mitigation) SHOP (Small Business Exchange) Navigator Program (Marketing & Public Relations) Financing © 2012 Maryland Women’s Coalition For Health Care Reform

10. Creating the Exchange: Stakeholder Representation © 2012 Maryland Women’s Coalition For Health Care Reform Source: A Report to the Governor and Maryland General Assembly, Maryland Health Benefit Exchange December 23, 2011, p. 2

11. Health Benefit Exchange Act of 2012 Selective Contracting Small Business Health Options (SHOP) Navigator Program Essential Health Benefits Financing © 2012 Maryland Women’s Coalition For Health Care Reform

12. SHOP – What is It? Marketplace where small employers & nonprofits (under 50 employees) can purchase insurance. Tax credit available through 2016 © 2012 Maryland Women’s Coalition For Health Care Reform

13. SHOP Proposals Create separate SHOP exchange. Retain small group size at 50 until 2016. Provide two options: – Employers select metal level & employees choose among carriers at that level – Employers select one carrier & employees select the metal level that meets their needs – Consider additional options in 2016 © 2012 Maryland Women’s Coalition For Health Care Reform

14. Navigator Program Proposals Individual Exchange – CBOs & similar organizations SHOP – Navigators at HBE © 2012 Maryland Women’s Coalition For Health Care Reform

15. What to Watch - Navigator © 2012 Maryland Women’s Coalition For Health Care Reform

16. 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 © 2012 Maryland Women’s Coalition For Health Care Reform

17. EHB: Coalition Proposals Stakeholder & consumer group to advise HCRCC Guidance – Balance benefits in each of the 10 mandated categories. – Specificity in defining health services to ensure comprehensive care according to national standards. – Require that there be equal actuarial values. – Provide mental health & substance use disorder benefits in parity. – Do not permit benefit design that discriminates on basis of age, gender, disability, or expected length of life. © 2012 Maryland Women’s Coalition For Health Care Reform

18. What to Watch - EHB Our Principals: © 2012 Maryland Women’s Coalition For Health Care Reform

19. Resources You Can Use Maryland – Health Benefit Exchange www.dhmh.maryland.gov/healthreform/exchange/index.html – Department of Health & Mental Hygiene www.dhmh.maryland.gov – Maryland Health Insurance Plan (MHIP) www.marylandhealthinsuranceplan.state.md.us – Health Care Reform Coordinating Council www.dhmh.maryland.gov/healthreform/index.html Federal – Department of Health & Human Services www.healthcare.gov © 2012 Maryland Women’s Coalition For Health Care Reform

20. Stay Informed & Get Involved Join the Coalition – Newsletters, Alerts, Member Calls & Webinars – Educational forums: February 22 nd in Frederick – Facebook and Twitter Encourage others to join Share your stories MDHealthCareReform.org © 2012 Maryland Women’s Coalition For Health Care Reform

21. Leni Preston, Chair Phone: (301) 351-9381 E-mail: leni@mdchcr.orgleni@mdchcr.org Website: www.MDHealthCareReform.orgwww.MDHealthCareReform.org