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1. Figure 1 Health Care Reform and The NM Health Insurance Exchange Return to KaiserEDU Tutorials

2. Meeting Purpose Figure 1 • Present a brief Introduction into Health Care Reform and Health Exchanges • Sangre de Cristo will be meeting with as many of the local behavioral health collaboratives across the state as possible in order to gather information for the Health Exchange. • Information will be gathered by a combination of focus group discussions and a structured questionnaire. Return to KaiserEDU Tutorials

3. Health Reform: An Overview Figure 1 The Patient Protection and Affordable Care Act (PPACA) of 2010 (Health Care Reform) authorized State Planning and Establishment Grants to help each individual state like NM to establish a “Health Insurance Exchange” By 2014, most people will be required to have healthinsurance Return to KaiserEDU Tutorials

4. Expand health insurance coverage Improve coverage for those with health insurance Improve access to and quality of care Control rising health care costs Figure 2 Goals for Health Reform Return to KaiserEDU Tutorials

5. Promoting Health Coverage Figure 3 Universal Coverage Exchanges (subsidies 133-400% FPL) Medicaid Coverage (up to 133% FPL) Individual Mandate Health Insurance Market Reforms Employer-Sponsored Coverage Return to KaiserEDU Tutorials

6. Expanding Health Insurance Coverage—Early Actions Create temporary Pre-existing Condition Insurance Plan for people with medical conditions who are uninsured To qualify, individuals must be uninsured for six months Federally funded Available in each state until 2014 Allow adult children to remain on their parents’ health insurance policy until age 26 Children do not have to live with parents, nor be students May be married, but spouses and children not eligible Figure 4 Return to KaiserEDU Tutorials

7. Expand Medicaid to all individuals under age 65 with incomes up to 133% of the poverty level ($14,400/individual or $29,300/family of 4) Create new Health Insurance Exchanges where individuals and small employers can purchase coverage Provide premium subsidies to eligible individuals and families with incomes up to 400% of the poverty level ($43,300/individual or $88,200/family of 4) through the Exchanges Expanding Health Insurance Coverage—in 2014 Figure 5 Return to KaiserEDU Tutorials

8. Improving Health Insurance Reform the health insurance market Prohibit insurers from denying coverage or charging people more because they are sick Prohibit insurers from rescinding coverage or placing annual or lifetime limits on coverage Improve benefits for those with insurance Ensure coverage of preventive services with no cost-sharing Establish minimum benefit standards Limit out-of-pocket spending for consumers Figure 7 Return to KaiserEDU Tutorials

9. Employer Requirements and Incentives Larger employers that don’t offer affordable coverage will face penalties of up to $2,000 per full-time worker per year beginning in 2014 Small employers with up to 50 employees will be exempt from penalties Tax credits available for some small businesses that offer health benefits Figure 8 Return to KaiserEDU Tutorials

10. Individual Mandate Figure 9 Individuals will be required to have health coverage that meets minimum standards in 2014 Individual mandate spreads costs among whole population Mandate enforced through the tax system Penalty for not having insurance: greater of $695 (up to $2085 for family) or 2.5% of family income Exemptions for certain groups and if people cannot find affordable health insurance Return to KaiserEDU Tutorials

11. Some Uninsured Will Remain Figure 10 • Congressional Budget Office (CBO) estimates 23 million uninsured in 2019 • Who are they? • Immigrants who are not legal residents • Eligible for Medicaid but unenrolled • Exempt from the mandate (most because can’t find affordable coverage) • Choose to pay penalty in lieu of getting coverage • Many remaining uninsured will be low-income Return to KaiserEDU Tutorials

12. Health Reform and Delivery System Changes Figure 11 Promoting primary care and prevention Improving provider supply Developing new models for coordinating and delivering care Making use of information technology Reforming provider payments to promote quality Return to KaiserEDU Tutorials

13. Promoting Primary and Preventive Care Figure 12 Increased Medicare and Medicaid payments for primary care providers Incentives for new doctors and other health professionals to practice primary care No cost-sharing in Medicare and new private plans for certain preventive services and incentives for states to do same in Medicaid Funding for population-based prevention activities Return to KaiserEDU Tutorials

14. Improving Health Care Quality Figure 13 Development of a national quality strategy Coordinated care through medical homes and other models Quality-based payments for health care providers and improved information on provider quality Comparative effectiveness research to identify most effective treatments and interventions Enhanced data collection to address health care disparities Return to KaiserEDU Tutorials

15. Containing Health Care Costs Figure 14 Greater oversight of health insurance premiums and insurer practices Increased competition and price transparency through Exchanges Provider payment reforms in Medicare Testing of new, more efficient delivery system models in Medicare and Medicaid Return to KaiserEDU Tutorials

16. Health Insurance Exchanges Figure 1 • What is a Health Insurance Exchange? • What is Health Insurance Exchange Supposed to Do? • How will the Health Insurance Exchange do this? • What about any behavioral health needs and concerns that I might have? Return to KaiserEDU Tutorials

17. Health Insurance Exchanges Figure 1 • Offer a choice of health plans based on cost and quality of benefits • Provide information to help understand the options available • Provide “one-stop shopping” to compare, select, and enroll in health plans • Help eligible individuals receive premium discounts or enroll in other federal or state healthcare programs like Medicaid Return to KaiserEDU Tutorials

18. Health Exchange Survey Figure 1 • What will make the New Mexico Health Insurance Exchange useful to you? • What other services would you like to see in the health insurance plans offered through the exchange beyond those that are required? • How can the exchange provide clear information that describes the benefits and limitations of the health insurance plans, allowing you to make an informed choice? Return to KaiserEDU Tutorials

19. Health Exchange Survey Figure 1 • What would be the most important features you would look for when comparing health insurance plans? • What are the best ways to inform you about the role of the exchange and the services available (e.g., internet, toll-free call center, customer service center, etc.)? • Do you believe the exchange will benefit you? Why? Why not? Return to KaiserEDU Tutorials

20. Future of Health Reform: Legislation Is Just the Beginning Figure 17 • Implementation will be challenging • Guidance and federal oversight needed • Resources for infrastructure and capacity building • Policy and political challenges • Health reform provides opportunities to improve our health care system • Reduce the number of people who are uninsured • Make the health insurance system work better for all consumers • Transform delivery and payment systems to get better value • Reorient health care to focus on prevention and primary care Return to KaiserEDU Tutorials

21. Let’s Complete the Survey Please know that your answers will be kept strictly confidential Figure 1 If you have any Questions Please let us know. • 505-982-8870 • healthexchangeinfo@sdcchp.org • If you know of someone interested in completing the survey please visit our • Web site at • sdcchp.org and click on health insurance exchange link Return to KaiserEDU Tutorials

22. Special Thanks To Figure 1 Jennifer Tolbert Associate Director Kaiser Commission on Medicaid and the Uninsured for KaiserEDU.org September 2010 Return to KaiserEDU Tutorials

23. Resources Figure 18 • Kaiser Family Foundation: http://healthreform.kff.org/ • New DHHS consumer website: http://healthcare.gov/ • Alliance for Health Reform: http://www.allhealth.org/ • National Association of Insurance Commissioners: http://www.naic.org • National Governors Association: http://www.nga.org Additional KaiserEDU tutorials: • Health Care Reform: A Retrospective:http://www.kaiseredu.org/tutorials/retrospective-health-reform/player.html • Health Reform: How Will Medicaid Change?:http://www.kaiseredu.org/tutorials/medicaid-and-health-reform/player.html • Health Reform and Medicare:http://www.kaiseredu.org/tutorials/Medicare-and-health-reform/player.html Return to KaiserEDU Tutorials