Health Care Reform: Get It Right for Maryland Leni Preston, Chair [email protected] (301) 351-9381 © 2012 Maryland Women’s Coalition For Health Care Reform
Dec 26, 2015
Health Care Reform: Get It Right for Maryland
Leni Preston, [email protected](301) 351-9381
© 2012 Maryland Women’s Coalition For Health Care Reform
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 1st – 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
The Patient Protection and Affordable Care ActA 3-Legged Stool:1.Everyone is “in”2.Personal responsibility3.Affordability
© 2012 Maryland Women’s Coalition For Health Care Reform
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
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
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
Health Benefit Exchange Timeline
4/12/2011Governor O’Malley Signed Health Benefit
Exchange Act into
Law
6/3/2011Exchange Board 1st Meeting
9-11/2011 Advisory
Committees Met
1/1/2013 Exchange Must be
Certified by Federal
Government
10/1/2013 Individuals and Groups
Begin Enrolling in Exchange
1/1/2014 Maryland
Health Benefit
Exchange will be
Operational
© 2012 Maryland Women’s Coalition For Health Care Reform
Source: A Report to the Governor and Maryland General AssemblyMaryland Health Benefit Exchange, December 23, 2011, p. 1
Landmark ACA Legislation signed into Law 3/23/2010 by President Obama
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
Creating the Exchange: Stakeholder InputFour 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
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 ExchangeDecember 23, 2011, p. 2
Consultants3%
Local Government3%
Health Insurance In-dustry34%
Community Care Providers and Associations
18%
Community Members and Advocates
21%
Academia12%
Business Owners9%
Advisory Committee Membership by Affili-ation
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
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
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
Navigator Program Proposals
• Individual Exchange – CBOs & similar organizations
• SHOP – Navigators at HBE
© 2012 Maryland Women’s Coalition For Health Care Reform
What to Watch - Navigator
© 2012 Maryland Women’s Coalition For Health Care Reform
Role of Community-
based Organizations
SHOP Exchange Broker Training
& Licensure
Legislative Language
Financing Mechanisms
Navigator
Program
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
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
What to Watch - EHB
• Our Principals:
© 2012 Maryland Women’s Coalition For Health Care Reform
Ensure Consumer
& Stakeholder Participatio
n
Share Relevant
Information Timely
& Effectively
ProvideComplete
&AffordableBenefits
Provide aFull Range
of Preventative Services for Women
Resources You Can Use
• Maryland – Health Benefit Exchange
www.dhmh.maryland.gov/healthreform/exchange/index.html
– Department of Health & Mental Hygienewww.dhmh.maryland.gov
– Maryland Health Insurance Plan (MHIP)www.marylandhealthinsuranceplan.state.md.us
– Health Care Reform Coordinating Councilwww.dhmh.maryland.gov/healthreform/index.html
• Federal– Department of Health & Human Services
www.healthcare.gov© 2012 Maryland Women’s Coalition For Health Care
Reform
Stay Informed & Get Involved
• Join the Coalition– Newsletters, Alerts, Member Calls &
Webinars– Educational forums:• February 22nd in Frederick
– Facebook and Twitter
• Encourage others to join• Share your stories
MDHealthCareReform.org© 2012 Maryland Women’s Coalition For Health Care
Reform
© 2012 Maryland Women’s Coalition For Health Care Reform
Leni Preston, ChairPhone: (301) 351-9381E-mail: [email protected] Website: www.MDHealthCareReform.org