California Education Coalition for Health Care Reform. National Heath Care Reform Affordable Care Act

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1 California Education Coalition for Health Care Reform National Heath Care Reform Affordable Care Act Ruben Ingram, Executive Director, SEAC & Kathy Rallings, Benefits Specialist, CTA Who is CECHCR? Association of California School Administrators California Association of School Business Officials California County Superintendents Educational Services Association California Federation of Teachers California School Boards Association California School Employees Association California Teachers Association Community College League of California School Employers Association of California 2

2 Stronger Together Management and labor working together Of the education community By the education community For the education community 3 About The Law Signed into law March, Puts in place health insurance reforms to Hold insurance companies more accountable Lower health care costs Guarantee more choices Enhance quality of health care

3 New Consumer Protections 2010 Must provide coverage for children with preexisting conditions No lifetime limits on essential benefits * Annual limits will be restricted* External appeals process State consumer assistance No rescissions for minor errors Improving Quality and Lowering Costs Small business tax credits Relief for seniors prescriptions No cost sharing for preventive care* Wellness and disease management Reducing health care fraud Early retirees* Partnership for Patients*

4 Increasing Access Uninsured with pre-existing conditions Young adults* Primary care workforce States to allow more on Medicaid Better payments for rural providers Community health centers Insurance companies unreasonable rate hikes Grandfathered Plans Collectively Bargained by Enactment To Qualify Cannot: Changes in annual benefit limits Elimination of benefits for certain conditions 5% increase to employee share of premium Increases of 15% plus medical inflation to deductibles More then a $5 or 15% adjusted for medical inflation on co-pays 8

5 Grandfather Plans Exceptions No cost sharing for preventive care Patient protections Limit on deductibles in 2014 Only 35% will retain this status by First Renewal on or After September 23, 2010 Coverage for dependents d under age 26 AB 36 (tax conformity) Elimination of lifetime limits Elimination of annual limits $750, $1.25 Million $2 Million Completely banned Jan

6 Early Retiree Reinsurance Program Chronic or high cost claims between $15,000-$90, Medi Care eligible Approved Plan Sponsors 2014 or 5 Billion Reductions in: Premiums Deductibles Co-pays Other out-of-pocket costs Accountable Care Organizations 2012 for Medicare Voluntary participation Patient centered Restructure payments Shared savings Measurements to improve quality Improved coordination & communication

7 Partnership for Patients: Better Care, Lower Costs GOALS BY % decrease in preventable hospital-acquired conditions 60,000 lives saved Reduce hospital readmissions by 20% 1.8 million patients would not suffer complications Potential Savings of $35 Billion California Health Benefit Exchange First in the nation In place by 2014 Governing Board Kimberly Belshé Diana S. Dooley, Chair Paul Fearer Susan Kennedy VACANT (Senator Steinberg to appoint) Pending bills to make Exchange Work

8 California Health Benefit Exchange Est. 2.4 million Californians eligible Subsidy based on family income Under 400% FPL Unaffordable employer based 9.5% of income 60% actuarial value Not eligible for Medi-Cal May opt out of employer-based coverage if cost is between 8% and 9.8% of income. Actuarial Examples

9 Individual Mandate 2014 Tax penalty Hardship waiver Sets minimum standards Establishes floor for negotiations Limit on waiting periods to 90 days Employer Penalties Firms with 50 or more FTEs No coverage offering $2,000 per full-time employee At least one employee receives subsidy 1 st 30 except Unaffordable offering $3,000 per employee receiving a subsidy

10 Maximum Out of Pocket Employee Only

11 Family Coverage Taxes Report value of benefits on W-2 Includes employer contributions to HSA, MSA or FSA excludes dental and vision % tax on INSURERS $10,200 single $27,500 family Adjusted for age, CPI, and gender Employers must report annually to the IRS

12 California Statutes and Proposals SB1088 (Price) Conformed California state law regarding 26 year olds AB52 (Feuer) Rate Regulation Pending Exchange bills AB1296 AB714 AB792 How You Can Stay Informed Good sources of information: Heath and Human Services The Commonwealth Fund Kaiser Family Foundation California HealthCare Foundation The California Endowment Physicians for a National Health Program UC Berkley Labor Center For additional information and links to various health care websites: 24

13 Questions or Comments? 25