Federal Health Reform: What’s in it for New York?

Federal Health Reform:What’s in it for New York? [ Presentation Location, etc. ] [ Date ] [ Name and Contact Info of Presenter ]

Why do we need reform?The Problem: Rising costs and many uninsured • Working people can’t find affordable coverage • 2.8 million (15%) New Yorkers currently lack health insurance (50 million in US). • 50% of uninsured adults in New York work full-time jobs. • 1 in 3 New Yorkers say they or a family member postponed medical care or a prescription last year because of a lack of money or insurance. • 800,000 employees of small businesses lost coverage in the past decade • Insurance prices have outpaced wages • Between 2000 and 2009, health insurance premiums in NY grew by 92%, while median earnings only rose by 14%. • The average annual cost of insurance in the individual market in NY is over $12,000 for an individual, more than $24,000 for a family. • Employers are cutting back health benefits, or dropping them altogether.

Who are New York’s Uninsured? NY’s Uninsured by Income NY’s Uninsured by Employment Status

Rising Premium Costs

What’s in the ACA?

For Small BusinessesNo requirement to offer coverage • Fewer than 50 employees: • Not requiredto offer coverage • 50+ employees: May be penalized or required to provide vouchers if they don’t offer coverage, of if the coverage offered isn’t affordable to their workers and the employees end up getting subsidized coverage on the individual Exchange. • 200+ employees: Must automatically enroll employees in health plans (employees can opt out).

For Small BusinessesTax Credits • For firms with < 25 full-time employees with average salaries < $50,000/year • 285,000 small businesses eligible in New York State • That’s more than 80% of firms with < 25 workers • Credit of up to 35% of firms health insurance costs

For Small BusinessesAffordable Insurance Exchanges • One-stop web portal • Picture kayak.com • Lower costs (est. 5 - 22% lower in small group market) • Large pool of buyers • Tools to compare plans • Streamlined billing • Firms don’t have to work through the Exchange. Small Business Exchange INSURANCE PLANS EXCHANGEChoiceComparisonBillingTax Credits SMALL BUSINESSES

State Dept. of Financial Services now reviews and approves premium increases before they go into effect. • Plans must now spend 82 cents out of every premium dollar on enrollees’ health costs For Small BusinessesRate Review • You can file comments on rate increases before they are approved • Reduced rate increases last year by 4.5% on average, saving New Yorkers $400 million www.dfs.ny.gov/insurance/health/prior_app/prior_app.htm companyprofiles.healthcare.gov

Effect of ACA’s Premium Subsidies For The UninsuredSubsidies to make coverage affordable • Family of four in Rochester making $46,000 / year • Now premiums cost: $2,066 per month • After 2014 premiums will be: $242 per month • Family of three in Queens making $57,000 / year • Now premiums cost: $2,268 per month • After 2014 premiums will be: $451 per month • Single adult in Albany making $17,000 / year • Now premiums cost: $905 per month • After 2014 premiums will be: $57 per month

For The UninsuredThe Bridge Plan • Affordable insurance for uninsured people with pre-existing medical conditions • Available now, to be phased out in 2014 once Exchanges available • More than 3,000 New Yorkers enrolled • For more information: • www.ghi.com/nybridgeplan/index.html • 1-866-NY-EZ-APP (693-9277)

For The InsuredNew Protections • Plans must cover preventive care with no cost sharing • No more lifetimebenefit caps • No more unreasonably low annualbenefit caps • Right to appeal when you disagree with your health plan • No more pre-existing condition exclusions after 2014 • Already in effect for minors

For Young Adults (& Parents)Young Adult Coverage • Young adults less than 26 years old can get covered through their parents’ insurance. • Don’t have to be in college • Can be married • In NY, people between 26 and 29 can pay more and keep coverage through their parents’ employer (will cost more). • Since passage of the ACA, 2.5 million more young adults gained coverage • Rates of young adults with coverage increased from 66% to 69% in 2010 • Young adults were the only group (by age) to gain coverage last year

Preventive care with no copays or co-insurance • “Donut Hole” for prescriptions closing by 2020. Seniors already receive discounts while in donut hole. • Seniors saved $2.1 billion in 2011. For SeniorsMedicare • By 2014, Medicare Advantage plans must spend at least 85¢ of every $1 on health care for seniors • New measures to reduce costs and fight fraud

For All New YorkersAssistance for Small Businesses and Consumers

ACA “Triple Play” • Megan Schley, • Circleville, New York • Bridge Plan • Dependent (up to age 26) Coverage • Consumer Assistance Program—That US!

More Resources • Health Care For All New York: www.hcfany.org • Community Health Advocates: www.communityhealthadvocates.org • Hotline: (888)614-5400 • HHS Information: www.healthcare.gov • Congressional Budget Office: http://www.cbo.gov/publications/collections/health.cfm • Kaiser Family Foundation: http://healthreform.kff.org/ • Community Catalyst: http://www.communitycatalyst.org/ • ACA: www.healthcare.gov/law/full/index.html

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Federal Health Reform: What’s in it for New York?