A one city insured community meeting health insurance you can afford august 31 2011
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“ A One City Insured Community Meeting: Health Insurance You Can Afford” August 31, 2011. Health Care Reform & The Health Insurance Exchange. Patient Protection and Affordable Care Act Also known as the Affordable Care Act or “ACA”. The facts about health care reform.

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A one city insured community meeting health insurance you can afford august 31 2011

A One City Insured Community Meeting:

Health Insurance You Can Afford”

August 31, 2011

Health Care Reform & The Health Insurance Exchange


The facts about health care reform

The facts about health care reform


Who will aca impact

  • Small business owners

  • Single parents

  • Married parents

  • Uninsured

  • Underinsured

  • Those insured through their jobs

  • Those with pre-existing conditions (diabetes, high blood pressure, cancer, etc.)

  • Civic association and ANC leaders

  • Community health care advocates

Who will aca impact?


What kind of changes can you expect

  • Your health insurance policy will look different.

    • New benefits and features

    • Easier to understand.

  • The way you purchase insurance will change too

    • Individuals and small businesses will purchase coverage through the District Health Insurance Exchange (DC HIX)- an Internet based one-stop shop for health insurance.

What Kind of changes can you expect?


When does health reform begin

When Does Health Reform Begin?


Consumer protections

  • By 2014, almost everyone will have health insurance

  • You cannot be denied health insurance because you have a pre-existing condition, e.g. diabetes, cancer

    • In place now for children

    • Begins in 2014 for adults

  • Insurance companies cannot put a “lifetime limit” on your health insurance coverage

    • Begins in 2014

  • You cannot be charged more for insurance because you are sick, have a history of being sick or because you are a female

Consumer Protections


Affordable

  • Many people will be eligible for subsidies (financial assistance) for buying health insurance

    • For example, a family of 3 with income less than $73,240 a year will be eligible for a subsidy

  • Some people will have limits in co-pays and total cost-sharing

  • Some prevention services will not require a co-pay at all

  • Employers with less than 25 workers can get a tax credit for offering health insurance

    • Available now

Affordable


Continuity of coverage

Continuity of Coverage


Accessible

Accessible


Health insurance exchanges hix

Where you will shop and buy Health Insurance in 2014 and fully operational by January 1, 2014

Health Insurance Exchanges (HIX)


What is a hix
What is a HIX? and fully operational by January 1, 2014


Principles for the dc hix
Principles for the DC HIX and fully operational by January 1, 2014


Process the consumer experience
Process – the consumer experience and fully operational by January 1, 2014


Information on the hix
Information on the HIX and fully operational by January 1, 2014


Survey

We need your Input on the District’s HIX and fully operational by January 1, 2014

Participate in the Survey at

https://www.surveymonkey.com/s/DCHRICSurvey

Survey


Questions? and fully operational by January 1, 2014


Www healthreform dc gov

For More Information about Health Care Reform and Upcoming Meetings, visit the HRIC website

WWW.HEALTHREFORM.DC.GOV


Appendix

Appendix Meetings, visit the HRIC website


Table of contents

Slide Meetings, visit the HRIC websiteTopic

3 Subsidies for Individuals

4 Prevention Services with No Co-Pays

5 – 7 Changes to the Medicaid Program

8 – 9 Medicare

10 Individual Mandate

11 Exceptions to the Individual Mandate

12 Penalties for Individuals

13 Small Businesses and Tax Credits

14 One Exchange or Two Separate

15 Governance of the Exchange

16 Models of Health Insurance Exchanges

17 Certification of Health Plans

18 – 19 Funding to Support the Exchange

20 Timeline for Start of the Exchange

Table of Contents


Subsidies for individuals

If your income is less than 400% federal poverty level (FPL) then you will be able to get a subsidy if you buy your health insurance through the HIX

Subsidies for Individuals


Prevention services with no co pays

For everyone insured, including those on Medicare, some prevention services will not require any co-payments

Prevention Services with No Co-Pays


Medicaid

Medicaid

Income up to $14,400 for 1 person

Income up to $24,352 for a family of 3


Medicaid1

  • Increase payment for primary care services prevention services will not require any co-payments

  • Create program to increase opportunities for and payment for community-based long-term services (i.e. personal care, homemaker)

  • Create greater access to services for persons with mental health conditions and/or substance abuse disorders

medicaid


Easier to apply for medicaid

Easier to apply for Medicaid


Medicare
Medicare application through the HIX


Medicare1

  • Reduce the amount a person pays for catastrophic coverage application through the HIX

  • Expand coverage to individuals with certain conditions who have been exposed to environmental health hazards

  • Provide a bonus to primary care physicians and general surgeons practicing in underserved areas

medicare


Individual mandate

  • Almost everyone will be required to have health insurance application through the HIX

  • To do that, health insurance must be affordable

    • Changing Medicaid eligibility so everyone under 133% FPL, despite health or family situation, is automatically eligible for Medicaid

    • Putting limits on what insurance companies can charge and not allowing them to deny people insurance coverage if they have health problems

Individual Mandate


Exceptions to individual mandate
Exceptions to Individual Mandate application through the HIX


Penalties for those who do not become insured

Penalties for those who Do Not Become Insured


Tax credits for small businesses

Tax Credits for Small Businesses


One hix or two for the district

One HIX or Two For the District?


Governance of the hix

The District has three choices of who will operate the HIX to their employees

Governance of the HIX

Quasi-

Governmental

Agency

District Agency

Non-Profit

Entity


Models of hix
Models of HIX to their employees


Certification of health plans

Certification of health plans


Funding

Funding


Funding 2015 and beyond
Funding – 2015 and beyond available through 2014

License fee for Navigators

High risk pool funding sources

Qualifying health plan fee

Healthcare/wellness advertisers on HIX

Fee for small businesses

Fee for individuals (HIX users

State sales tax


When will the hix start

When will the HIX Start?


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