Business Owner Should Know

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1 WIPP Healthcare Committee Webinar WIPP Healthcare Committee Presentation: Overview of the Healthcare Law: Overview What Every of Business the Healthcare Owner Should Know Law: Important Information Every Thank You Joining Us, The Webinar Will Begin Shortly. Business Owner Should Know 2012 WIPP All Rights Reserved WIPP

2 Before we begin just a few notes: During the presentation lines will be muted so only presenters can be heard. While you are listening please also put your phone on mute Do NOT put your phone on hold please hang up and call back If having trouble viewing the presentation please close out and log in using a different browser If your slides are not moving please refresh or log out & then log back in If you have any questions during the presentation, please feel free to enter them into the discussion box on the bottom left of your screen 2012 WIPP All Rights Reserved WIPP

3 Presenter: Dr. Jaime Torres, DPM, MS Regional Director Region II US Department of Health & Human Services

4 The Health Care Law and

5 The Problem Small businesses paid an average of 18 percent more than big businesses for the same coverage. Insurance companies could take advantage of you and discriminate against the 129 million Americans with preexisting conditions. Premiums had more than doubled over the last decade, while insurance company profits were soaring. Fifty million Americans were uninsured, tens of millions more were underinsured, and those that had coverage were often afraid of losing it.

6 The Health Care Law In March 2010, President Obama signed into law the Affordable Care Act.

7 What the Law Means for You: 5 Things to Know Saves small businesses money through tax credits Helps businesses find better coverage options Builds on employer-based insurance Stops insurance companies from taking advantage of you Makes health care more affordable

8 The Law Saves Small Businesses Money Who qualifies? The New Small Business Tax Credit Businesses and non-profits with 25 or fewer full-time employees and average wages of $50,000 or less. What s the maximum tax credit? The maximum tax credit is 35% of the cost of coverage, rising to 50% in How is it calculated? The tax credit is available on a sliding scale businesses with 10 or fewer full-time employees and average wages below $25,000 receive the full credit.

9 The Law Saves Small Businesses Money In 2010, we paid close to $11,000 for employees health insurance. The tax credit cut our costs by over $2,000. For a small business struggling to keep health coverage, that makes all the difference. We were actually considering dropping our insurance, but the tax credit tipped the balance and helped us maintain coverage. --Matt H. in Montana Go to to learn more.

10 The Law Helps Businesses Find Coverage [Small business tool screen grab]

11 The Law Builds on Employer-based Insurance The average US family and their employer pay $1,000 a year extra in health insurance costs to cover care for the uninsured. If a company has more than 50 employees and chooses not to cover its workers, it may have to pay an assessment to help offset its employees health care costs. Under the law, small businesses with fewer than 50 full time employees will not be required to pay this assessment.

12 The Law Provides Better Coverage Options Beginning in 2014, small businesses will be able to shop in the new Affordable Insurance Exchanges. Exchanges will make it easy to find health plans, enroll your employees, and consolidate billing. Exchanges will allow you to spread your risk across a big pool of workers just like large businesses.

The Law Stops Insurance Companies from Taking Advantage of You It is now illegal for insurance companies to: Deny coverage to children because of a pre-existing condition like

13 The Law Stops Insurance Companies from Taking Advantage of You It is now illegal for insurance companies to: Deny coverage to children because of a pre-existing condition like asthma or diabetes. Put a lifetime cap on how much care they will pay for if you get sick. Cancel your coverage when you get sick by finding a mistake on your paperwork. And more

measles Blood pressure screening Cholesterol screening Tobacco cessation counseling and

14 The Law Increases Your Access to Affordable Care In many cases, you can get preventive services for free: Cancer screenings such as mammograms & colonoscopies Vaccinations such as flu, mumps & measles Blood pressure screening Cholesterol screening Tobacco cessation counseling and interventions Birth control Depression screening And more Visit for a full list.

The Law Makes Health Care More Affordable BEFORE, insurance companies spent as much as 40 cents of every premium dollar on overhead, marketing, and CEO salaries.

15 The Law Makes Health Care More Affordable BEFORE, insurance companies spent as much as 40 cents of every premium dollar on overhead, marketing, and CEO salaries. 60% / 40% TODAY, we have the new 80/20 rule: insurance companies must spend at least 80 cents of your premium dollar on your health care or improvements to care. If they don t, they must repay the money. 80% / 20%

16 The Law Makes Health Care More Affordable Leading experts say the 80/20 rule is already working: Financial analysts noted that health care cost growth was near its all time low, saying it reflects the impact of the industry s adaptation to the health reform [80/20] regulations. In addition, the independent Government Accountability Office found that many insurance companies were responding to the 80/20 rule by reducing administrative expenses and lowering premiums.

TODAY, insurance companies must publicly justify their actions if they want

17 The Law Makes Health Care More Affordable BEFORE, insurance companies could raise your premiums by double digits without justification. TODAY, insurance companies must publicly justify their actions if they want to raise premiums by 10 percent or more. And states have more power to block these hikes.

18 Did You Know The law builds on our private health insurance system. The law gives states significant flexibility in implementing the law. If states can identify their own path to accomplish the same goals, they re free to take it. The law does not add to the deficit. According to the independent Congressional Budget Office, the law is paid for.

19 What is an Affordable Insurance Exchange? An Exchange is a State-based competitive health insurance marketplace where people and small businesses can shop for and buy affordable private health insurance. By 2014, every State will have an Exchange tailored to its local insurance market. Tax credits will be available for many individuals, families and businesses to help them purchase coverage in the Exchanges.

20 What is a Health Insurance Exchange? Individuals Small Businesses STATE HEALTH INSURANCE EXCHANGE The Exchange is a virtual marketplace where approved health insurances plans will be sold online, on the phone and in person Private Health Care Plans All plans sold in the Exchange will cover Essential Health Benefits and have an easy-to-understand summary of benefits & costs. Subsidies, in the form of federal tax credits will be available to people with moderate incomes. These can be used to buy plans in the Exchange. Public Programs The Exchange will screen consumers for eligibility for public health insurance. Navigators Navigators will help consumers find the health care plan they need. They can be: Trusted community leaders Non-profit organizations Agents & Brokers

21 Overview of Exchange NPRM: Small Business Health Options Program (SHOP) SHOPs offer competitive insurance marketplace for small businesses States may choose to keep an upper limit of 50 employees for the first two years, and include businesses with up to 100 employees starting in 2016 States may choose to operate SHOP as a separate program or merge it with the Exchange to offer the same choices to all participants Small businesses become part of a larger risk pool, stabilizing premiums because risk is spread among more people Employees receive better information and have choices that fit their own needs and budgets Employers have simpler way to offer insurance, reducing administrative costs and burden 21

22 Can my business offer employees insurance through an Exchange? Starting in 2014, SHOP or a merged SHOP and individual Exchange will be offered in each State. States can set the size of the small group market up to 50 employees instead of 100 employees until Starting in 2017, States may let businesses with more than 100 employees buy large group coverage through the SHOP. Small employers may be eligible for a tax credit of up to 50% of their premium payments if they have 25 or fewer employees, pay employees an average annual wage of less than $50,000, offer all full time employees coverage, and pay at least 50% of the premium. Employees offered affordable, quality health insurance by their employer, however, are not eligible for premium credits for coverage purchased through the Exchange.

23 Learn More Social Networks

24 Questions? Jaime R. Torres, DPM, MS Regional Director US Department of Health and Human Services Region II 26 Federal Plaza, Suite 3835 New York, New York

25 Pfizer Helpful Answers is a joint program of Pfizer Inc and the Pfizer Patient Assistance Foundation

26 The need for patient assistance programs The Uninsured in the US Total Uninsured in the US (2010): 49.6 million (16.3%) Minority groups disproportionately affected Group % Uninsured White 12% Asian Amer. 18% African Amer. 21% Hispanic 31% Health Impact Nearly half of the uninsured did not fill a prescription in the last year, and 60% had medical problems but did not see a doctor or visit a clinic in the last year 1 in 4 uninsured people don t fill their prescriptions due to costs 50% of uninsured people with chronic conditions skip medicines Result: The uninsured wait until conditions become critical and more complicated and costly to treat Sources: Kaiser Commission on Medicaid and the Uninsured, The Uninsured: A Primer, October 2009 Families USA Fact Sheet Shortchanged by Medical Debt, November 2009 Kaiser Commission on Medicaid and the Uninsured, The Uninsured: A Primer, October 2009 Robert Wood Johnson Foundation: Uninsured Americans with Chronic Health Conditions: Key Findings from the National healthy Interview Survey, May 2005 US Census Bureau: Health Insurance Coverage 2009: Highlights. Received September 10,

Pfizer Helpful Answers: helping patients in need get access to Pfizer medicines Pfizer Helpful Answers (PHA) is a family of assistance programs for the uninsured and underinsured who need help

27 Pfizer Helpful Answers: helping patients in need get access to Pfizer medicines Pfizer Helpful Answers (PHA) is a family of assistance programs for the uninsured and underinsured who need help getting Pfizer medicines. These programs provide Pfizer medicines for free or at a savings to patients who qualify. Some programs also offer reimbursement support services for people with insurance. PHA is the largest and most extensive patient assistance program in the industry over 100 Pfizer medicines covered including our newest and established products. Millions of prescriptions provided to patients in need every year: 2011 Data Patients Helped Rx s Distributed WAC Value 1.1 million 7.8 million $1.5 billion

MAINTAIN : Medicines Assistance for Those who Are In Need The newest employee-driven program under the Pfizer Helpful Answers umbrella, and the latest example of Pfizer s commitment to addressing the

28 MAINTAIN : Medicines Assistance for Those who Are In Need The newest employee-driven program under the Pfizer Helpful Answers umbrella, and the latest example of Pfizer s commitment to addressing the growing and changing needs of uninsured patients Designed specifically to help newly unemployed people Who is eligible for the Pfizer MAINTAIN Program? Individuals and their immediate family members are eligible for this program if they: Became unemployed on or after January 1st, 2009 Were prescribed and taking Pfizer medicines for at least 3 months prior to becoming unemployed and enrolling in the program Lack prescription coverage Can attest to financial hardship Where and when will enrolled patients receive their medicines? Pfizer will typically process the application within 2 to 3 weeks Enrolled patients will receive a 90-day supply of medicine for up to one year, or until they become insured, whichever comes first 28

The Partnership for Prescription Assistance 1-888-4PPA-NOW www.

org More than 475 prescription assistance programs covering over

launched the program in partnership with health care, physician

organizations, including: American Academy of Family Physicians,

Public Prescription Programs For example: Private Prescription

29 The Partnership for Prescription Assistance PPA-NOW www. pparx. org More than 475 prescription assistance programs covering over 2,500 medicines America s pharmaceutical research companies launched the program in partnership with health care, physician and patient advocacy groups 1,300 local and national member organizations, including: American Academy of Family Physicians, National Association of Chain Drug Stores, NAACP Medicaid CHIP Public Prescription Programs For example: Private Prescription Assistance Programs For example: Health Clinic Referrals Refers patients to free/low cost health clinics nearest to patient s zip code + Over 180 Other 29

Patient advocate resources available www.pfizerhelpfulanswers.

30 Patient advocate resources available Click on: Advocate Corner tab on toolbar on left hand side of home page to get access to resources that can help Order or download PHA materials: Community outreach kit Tear pad Take-one display Wallet card PPA brochure Create information sheets Obtain data about the uninsured Sign up for a free newsletter 30

Contacts to Remember 1-866-706-2400 www.

com Pfizer Patient Assistance Programs 1-888-4PPA-NOW

31 Contacts to Remember Pfizer Patient Assistance Programs PPA-NOW A gateway to all programs Patient Savings program 31

32 Get Involved! WIPP Questions? Contact WIPP Staff Small Business Policy Analyst: Matt Boyle (415) Membership Coordinator: Hannah Starkel (415) WIPP All Rights Reserved WIPP WIPP, Inc. does not guarantee the accuracy, completeness, or timeliness of the information provided in this Healthcare Committee presentation. WIPP, Inc. is not responsible for and expressly disclaim all liability for damages of any kind or nature, whether direct or indirect, including but not limited to, consequential, compensatory, actual or incidental, arising out of the use, reference or reliance on information provided in the Healthcare Committee courses.

The Health Care Law and

The Health Care Law and Office of the Regional Director Community Resource California-Based, extensive travel to AZ, NV, Indian Country, and HI. Day-to-day, week-to-week, month-to-month Educate the public