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Federal Healthcare Reform Overview. Bonita Sorensen, MD, MBA Director, Volusia County Health Department. Federal Healthcare Reform Enacted March 23, 2010. The Bill is the “framework” for Healthcare Reform Many details of the plan still need to be developed Purpose of Reform:

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Federal Healthcare Reform Overview


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    1. Federal Healthcare Reform Overview Bonita Sorensen, MD, MBA Director, Volusia County Health Department

    2. Federal Healthcare ReformEnacted March 23, 2010 • The Bill is the “framework” for Healthcare Reform • Many details of the plan still need to be developed • Purpose of Reform: • Increase the number of insured • Reduce healthcare costs • Focus on quality and better value • Pay for Performance • How Many will be Covered? • An additional 32 million people are expected to gain coverage

    3. 2010 • $250 “rebate” for seniors in the Medicare “donut hole” ($2,830 – $6,440) • Discounts continue through 2020 to eliminate “donut hole” • Temporary high risk insurance pools are created for Uninsurable • Employer early retiree assistance is made available (reinsurance)

    4. 2010 • In September, new insurance plans address: • Pre-existing conditions in children • Cancellation of coverage for illness • Annual and lifetime caps • Preventive care (new group and individual) (MA + MC free) • Dependent coverage up to 26 years of age

    5. 2010 • Tax credits become available for small (up to 25 EEs and wages under $50,000) employers • Consumer assistance: appeals process, website, ombudsmen • Reduces Medicare payments to hospitals, home health, nursing homes, and Hospice • Indoor tanning tax (10%) • Tax relief and expand loan repayment plans for healthcare providers

    6. 2011 • Additional funds for Community Health Centers are made available (11 Bil over 5 year) • Physician compare website for quality • Out of pocket costs for Medicare and Medicaid preventive services eliminated • Large pharmaceutical companies begin financial contributions proportional to market share ($2.3 Billion) • Health Insurance Benefit disclosure on W-2 forms

    7. 2011 • 10% Medicare bonus for PCPs and surgeons (if in shortage areas) through 2015 • Reduces Medicare Advantage Plans in high-cost areas. • Seniors in “donut hole” receive 50% discount on brand names and 17% on generics

    8. 2012 • Pharmaceutical companies must report when samples given to MDs • Some Medicaid payment (bundled) pilot programs begin for episodic care and hospitalizations • Medicare provides incentives for Accountable Care Organizations (ACOs) for physicians • Hospital payment penalties for “readmissions” • CLASS Act - Community living assisted service and support

    9. 2013 • Medicaid rates for PC raised to Medicare rates • Flexible spending accounts $2,500 maximum and reduces deductible medical expenses • Medicare payroll tax increased for “high” earners (>$200,000 individual/$250,000 family) • 3.8% tax imposed on unearned income for “high” earners • 2.3% excise tax on medical devices (not glasses or hearing aids)

    10. 2014 • Medicaid income eligibility expands to 133% of the federal poverty level • $14,404 in annual income for an individual (2009) • $29,327 in annual income for a family of four (2009)

    11. 2014 • Health exchanges in each state open - Federal subsidies for families making up to 400% of the FPL are made available • $43,320 in annual income for an individual • $88,200 in annual income for a family of 4 • Also limits on out-of-pocket expenses ($5,950 individual) and deductibles ($2,000 individual) • Coverage levels: Bronze (60%), Silver, Gold, Platinum (90%), and Catastrophic (for exempt or under age 30 persons)

    12. 2014 • Most individuals required to obtain health insurance or pay a fine - Family: 1% of income in 2014 up to 2.5% in 2016 - Individual: $95 in 2014 and $265 in 2016 • Large businesses (50-200) subject to fines if employees qualify for health care subsidies = 2,000 x (# EEs – 30)

    13. 2014 • Annual assessments to insurance companies begin to help offset costs of Reform • Insurance companies barred from: • Denying coverage for pre-existing • Charging higher fees based on gender • Imposing annual limits on coverage

    14. 2015 • Independent Payment Advisory Board created • Medicare provider payment changes may be made to meet savings targets, doctors paid on value rather than volume • Hospital payments for Safety Net hospitals start to be reduced

    15. 2017-2018 • “Cadillac” health plans begin to be taxed at 40% excise tax on policies >$10,200 individual and $27,500 family • States may permit large employers to participate in insurance exchange plans 2020 • ”Donut hole” eliminated (25% co-pay for all drugs)

    16. Public Health Benefits • Prevention and Public Health fund—up to $2 Billion annually • Health disparity data collection • Nutritional labeling of chain restaurants, retail and vending • Oral health dollars • Adult vaccine dollars • Breast feeding breaks in workplace • Demonstration grants for transformation, obesity, epidemiology

    17. The Good News • 2,449,000 Floridians gain coverage • 565,000 Florida Medicare folks avoid “donut hole” • 21,000 Small Business Associations in Volusia receive tax credits • 92,000 Volusians gain coverage

    18. The Good News • More transparency by insurance companies • More protections from insurance companies • More funding for healthcare students • Patient-orientation in medical home model

    19. The Challenges: • New physician ownership of hospitals banned • Independent Payment Advisory Board created who can control reimbursement • Payments to physicians and hospitals reduced • Pay for performance/outcome rather than service