How Health Reform Helps Missouri: Today and in the Future

1. How Health Reform Helps Missouri: Today and in the Future Brian Colby MO Health Advocacy Alliance

2. Health Reform in a Nutshell • Reforms the private insurance market with new consumer protections • Creates new exchanges where uninsured people can purchase coverage, some with subsidies • Expands Medicaid • Medicare: strengthens preventive benefits and drug coverage; stops windfall payments to Medicare Advantage plans

3. Provisions Effective Immediately! • Grants for states to establish consumer assistance and health insurance ombudsman programs • Insurers must justify unreasonable rate hikes; grants available for states to conduct rate review • Qualifying small businesses can receive tax credits for covering their workers this year • Increased funding for community health centers • Increased funding for primary care provider training programs

4. Insurance Market Improvements: Effective 90-Days After Passage • Temporary funding ($5 B until 2014) for covering high-risk individuals • Reinsurance for employers providing coverage to early retirees to help hold down premiums for plan enrollees

5. Provisions Effective July 1, 2010 • New HHS web-based internet portal for consumers and small businesses to look for affordable coverage in their state must be in place

6. Private Insurance Improvements: (Plan Years Starting) Six Months After Passage • Ban on lifetime limits, restriction of annual limits (annual limits outright prohibited in 2014) • Coverage of preventive care with no cost-sharing in new plans • Coverage of adult children until age 26 • No pre-existing condition exclusions allowed for children under 19

7. Private Insurance Improvements: (Plan Years Starting) Six Months After Passage • Stronger protections against unfair rescissions • Internal and external appeals processes • Emergency care: no prior authorization, cost-sharing same for in and out-of-network • OB/GYNs considered primary care providers

8. Provisions Effective in 2011 • Medical loss ratio requirements • Plans must have standardized descriptions (benefits and cost-sharing) • Medicare: Preventive care with no cost-sharing, 50% discount on brand-name drugs in the Part D donut hole (also, $250 rebate for beneficiaries in donut hole in 2010)

9. Provisions Effective in 2011 • No later than one year after passage: Secretary provides grants for state implementation of exchanges • CLASS Act- Voluntary, public long-term care insurance program

10. Full Implementation (2014)-Market Regulation • No denials of coverage based on health status/ pre-existing conditions • No pre-existing condition exclusions • No premiums hikes based on health status

11. Full Implementation (2014)- Exchanges • Can contract exchange responsibilities • Coverage for individuals and small groups, some eligible for subsidies/ tax credits • Standardized, comprehensive benefits • Can operate in more than one state; states can have more than one

12. Full Implementation: Medicaid and Medicare • Medicaid: By 2014, expanded eligibility to 133% FPL nationwide ($14,404/ year for an individual in 2010) • Adults without children eligible everywhere! • Medicare: Donut hole eliminated by 2020

13. Questions? Brian Colby bcolby@mohealthalliance.org Health Care Foundation of Greater Kansas City Missouri Foundation for Health Kaiser Family Foundation