what vermont s health reform means for n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Your Bottom Line PowerPoint Presentation
Download Presentation
Your Bottom Line

Loading in 2 Seconds...

play fullscreen
1 / 59

Your Bottom Line - PowerPoint PPT Presentation


  • 92 Views
  • Uploaded on

What Vermont’s Health Reform means for. Your Bottom Line. Having trouble?. FAQ available Use the Chat Function We’re here to help!. Joining us on the call. Al Gobeille Member GMC Board. Bram Kleppner Founder & CEO Danforth Pewter. Dan Barlow Policy Director VBSR. Jessica Stone

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Your Bottom Line' - nira


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
having trouble
Having trouble?

FAQ available

Use the Chat Function

We’re here to help!

joining us on the call
Joining us on the call

Al Gobeille

Member

GMC Board

Bram Kleppner

Founder & CEO

Danforth Pewter

Dan Barlow

Policy Director

VBSR

Jessica Stone

Outreach Manager

Small Business Majority

Steve Kimbell

Commissioner

BISHCA VT

Cassandra Gekas

Health Care Advocate

VPIRG

a word from your sponsors
A Word from Your Sponsors
  • Run by & for small business owners
  • Health reform, clean energy, access to capital
  • Jobs, opportunity, cost savings
  • Statewide business trade association
  • Education, public influence, workplace quality
  • Protect natural, human, & economic environment for VT citizens
  • Vermont’s largest environmental & consumer advocacy organization
  • Environment, health care, consumer protection, democracy
  • Voice of Vermonters in public policy
why are we here
Why are we here?
  • Forget politics, let’s talk BUSINESS
  • Separate FACT from fiction
  • Answer your QUESTIONS
  • Two-way COMMUNICATION with decision makers
piecing reform together
Piecing reform together

VT Health Benefit Exchange

Green

Mountain Care Board

Act 48

ACA

they have good questions
They Have Good Questions

Will premiums be more expensive in the exchange?

Reform seems so complicated. How is going to save us money?

Can the government really do this better the free market?

Are we moving too fast? What if this doesn’t work?

Am I going to be forced to buy a plan that I don’t like?

meet bram
Meet Bram

Bram Kleppner is the CEO of Danforth Pewter in Burlington.

the system is broken
The system is broken.

High Cost

Costs are

Unsustainable.

We’re already

spending too much

the system is broken1
The system is broken.

Unfair

Vermont’s small businesses are at a competitive disadvantage

the system is broken2
The system is broken.

Less Value

You’re not getting the bang for your buck

  • Outcomes down, cost up
  • Higher deductibles, higher premiums
the system is broken3
The system is broken.

Unstable

The smaller you are, the greater the risk

a 5 billion failure
A $5 Billion Failure
  • Rising premiums are eating away at profits
  • Health insurance costs are hampering growth and competitiveness
  • Unhappy or unproductive workers stay in jobs for the benefits
  • The un-affordability of coverage is hampering Vermont’s entrepreneurial spirit.
a 5 billion opportunity
A $5 Billion Opportunity

Universal Coverage

Planned Infrastructure

Better Bargaining Power & Less Risk

Predictable Spending

Moving to Green Mountain Care

Health Benefit Exchange

Simplify purchasing

Reduce waste & complexity

Maximize federal funding

Distribute risk

Green Mountain Care Board

Improved Public Health

Pay for quality, not quantity

Transparency & Accountability

and the status quo
And the status quo?

“We deal with uncertainty in these [health care] costs every year.

It’s an unknown and

it’s entirely unsustainable.

You can’t

do much worse.”

– Russ, North Wind Construction

what the @ is an insurance exchange
What the #$&@ is an insurance exchange?
  • ACA Requirement
  • Virtual marketplace
  • Private insurance plans compete

Video Time: Exchange Basics

affordable care act
Affordable Care Act
  • Affordable health coverage for 32mil uninsured
  • Preventative care with no-cost sharing
  • 80c of every dollar toward actual care
  • Reduce deficit $100b by 2020 & $1.3 trillion by 2030

Saves money.

Save lives.

affordable care act it s complicated because it s a compromise
Affordable Care Act It’s complicated, because it’s a compromise
  • Federal framework
  • State-driven implementation

States are planning

their exchanges now!

So business input is critical

Feds

Vermont

so what s in it for vermonters
So What’s in it for Vermonters?

Here’s a few to start with:

  • Health plans can’t drop you because you’re sick.
  • Pre-existing conditions
  • Ban of lifetime limits
  • Adults under 26 can stay on parents plan
  • First-dollar coverage for preventative care
  • MLR
what s in it for you
What’s in it for you?

$40 billion in tax credits by 2019

who s eligible
Who’s eligible
  • Fewer than 25 full-time employees
  • Average annual wages <$50,000
  • At least 50% of premium cost
the fine print
The Fine Print…
  • Tax credits on a sliding scale
    • Up to 35% of premium expenses for 2010-13
    • Up to 50% of premium expenses for any two years beginning in 2014
  • Tax credits do not cover premium expenses of owners or their families
  • Cannot be claimed by self-employed
  • Still available for those who filed extensions or as an amendment to 2010 taxes
how to file
How to file
  • Use Form 8941, available at www.irs.gov
  • Use the amount of the credit as part of the general business credit on income tax returns
  • Credit can be reflected in determining estimated tax payments for a year
  • Credit applied towards income tax, not employment tax
  • Tax Credit Calculator: www.smallbusinessmajority.org
vt benefit exchange like a broker but cheaper
VT Benefit ExchangeLike a broker, but cheaper
  • Marketplace to shop for health coverage
    • Purchasing pool to increase buying power and reduce admin costs
    • Small businesses of fewer than 100 workers eligible
  • Private insurance plans compete
    • Improve competition will increase employer choice
    • Exchange will negotiate with insurers on behalf of small business to ensure higher quality and lower costs
  • RAND Study
    • Will expand coverage to 85.9% of small business employees – and increase of 10.5 million workers
vt benefit exchange like a broker but cheaper1
VT Benefit ExchangeLike a broker, but cheaper
  • Price

VT Small Business

  • Quality

Insurance Plans

  • Value

Individual

decoupling from employment
Decoupling from Employment
  • 2014 every American will be required to buy insurance
  • 2014 Employers will be subject to penalty if they don’t provide insurance

There are two important exceptions

  • People aren’t subject to mandate if insurance is unaffordable
  • Employers with fewer than 50 workers are exempt

Dropping coverage may be the better option

a green mountain exchange
A Green Mountain Exchange

Principles

  • Critical mass to reduce admin costs
  • Prevent adverse selection
  • Promote quality coverage
  • Preserve VT standards
  • Hold insurers accountable
  • Streamline paperwork & processing
  • Maximize federal dollars
who s in and who s out
Who’s in and Who’s Out
  • Active purchaser
  • Everyone under 50
    • Reducing of consumer confusions because you’re not having to consider plans from two different markets
  • 50 to 100? The controversy continues
    • Brings us closer to a unified health care system
    • Distributes admin costs
    • Simplification and transparency
    • Gets rid of middle men (broker commissions & association fees) vbsr doesn’t want to be in insurance business – gives us more resources to do other things like workplace quality and
let s talk bronze
Let’s talk bronze
  • Bronze = underinsurance
  • 40% and 60%
  • Deductibles from $2750-$6300 for individual, $5500-$12700 for a family
  • Bronze = financial hardship, forgoing care, collection agencies, more sick days
unanswered questions
Unanswered questions
  • Essential health benefits
  • Multi-state plans

a for profit and non-profit in their exchange that sells plans in at least 30 states

  • Navigators Role of brokers
on the horizon
On the horizon
  • 100 or less, mandatory in 2016
  • Large firms in 2017
  • Self-sustaining – 2016
  • Waivers & Green Mountain Care
back to bram
Back to Bram…
  • Scenario about their business
  • Bring back to 4 points about benefits
slide38
Q&A
  • Use the chat window on the control panel to post your questions now and throughout the presentation.
  • We’ll post responses to all questions we don’t get to following the event.
further reading
Further reading
  • VBSR www.vbsr.org

National HHS website

www.healthcare.gov

  • Small Business Majority: www.smallbusinessmajority.org
green mountain care board
Green Mountain Care Board
  • Improve access to high quality health care services
  • Reduce health care cost growth,
  • Enhance experience of patients & providers.

“We are both humbled and honored to work together and with the health care community on behalf of Vermonters at this historic time for our state and this country."

- Anya Rader Wallack, Ph.D., Chair

green mountain care board1
Green Mountain Care Board

Cost

Reduce rate of growth

Reduce unnecessary care

Manage chronic care

Match infrastructure to needs

Fairness

Review insurance rates

Fair financing for GMC

Lower risk, better buying power

Value

Simplify & streamline

Recruit high quality providers

Strong benefit package

Stability

Improve public health

Build budget & stick to it

De-couple from employment

green mountain care board2
Green Mountain Care Board
  • 5 members appointed by Gov with advice & consent of senate
  • Oversees payment reform at all levels
  • Applies to all payers
  • Incorporates Blueprint
  • Overall budgeting with reasonable rate of growth
  • Eliminates cost-shifting
  • Eventually oversees benefits & system budget
how do we control costs
How do we control costs
  • Change the way docs are paid
  • Improve public health
  • Manage most expensive patients
  • Reduce unnecessary care
why payment reform
Why payment reform?
  • Fee-for-service does not

control costs and actually

creates and incentive to generate

greater volume of services

  • Board will design payment models that move away from fee-for-service and toward budgeting – providers get fair payment from all payers with a rate of growth we can afford
cost price x use
Cost = Price x Use

More incentive to manage use (but greater need to monitor quality

Less incentive to manage use

why i m doing this
Why I’m doing this

We could kick all of the insurance companies out of the state right now and it would make a bit of different.

If we don’t control costs, we lose everything

workers employees are paying more
Workers & Employees are Paying More

Worker Contribution

Employer Contribution

$15,073

$13,770

$13,375

Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2009-2011.

one step at a time
One Step at a Time
  • What leverage does the Green Mountain Care Board have?
    • Payment reform pilot projects
    • Hospital budgets
    • Enhanced health insurance rate review
    • Certificate of Need process
  • These broad regulatory powers allow the Board to oversee system wide integration and cost containment
one step at a time1
One Step at a Time
  • Focus on primary care and prevention
    • Blueprint for Health
  • Payment reform pilots
    • Bundled payments
    • Global payments
  • Rate review
    • Solvency
    • Affordability
weighing in
Weighing In
  • The Green Mountain Care Board meets on Tuesdays and Thursdays at 1:00pm and welcomes your participation.
  • Please check our website for details on location of meetings and any changes to the schedule:

www.healthcare.vermont.gov

  • Al.Gobeille@state.vt.us
slide53
Q&A
  • Use the chat window on the control panel to post your questions now and throughout the presentation.
  • We’ll post responses to all questions we don’t get to following the event.
let s recap
Let’s Recap

VT Health Benefit Exchange

Green

Mountain Care Board

Act 48

ACA

round robin on urgency
Round Robin on Urgency
  • The cost of doing is to high
  • Decisions are being made now
  • Business voice is critical
  • We want to maximize your benefit
  • Opponents are organizing
speak up be heard
Speak up! Be heard.
  • Sign on in support
  • Reach out to other business owners
  • Stay tuned for updates
  • Talk to you legislator
slide58
Q&A
  • Use the chat window on the control panel to post your questions now and throughout the presentation.
  • We’ll post responses to all questions we don’t get to following the event.
thank you
Thank you!
  • Run by & for small business owners
  • Health reform, clean energy, access to capital
  • Jobs, opportunity, cost savings
  • Statewide business trade association
  • Education, public influence, workplace quality
  • Protect natural, human, & economic environment for VT citizens
  • Vermont’s largest environmental & consumer advocacy organization
  • Environment, health care, consumer protection, democracy
  • Voice of Vermonters in public policy