HEALTH COMMITTEE Co-Chairs: Lisa Jafferies Kaiser Permanente Becky Saldivar Rambus

Transcription

1 HEALTH COMMITTEE Co-Chairs: Lisa Jafferies Kaiser Permanente Becky Saldivar Rambus AGENDA Tuesday, November 8, :30 5:00 p.m. Kaiser Permanente Homestead Rd., Bldg.1, 2nd Floor Cupertino, CA Phone Conference Call-in: (661) Pass code: # TIME ITEM WHO DESIRED OUTCOMES / NOTES 3:30 p.m. 3:45 p.m. 4:00 p.m. News / Events / Announcements Welcome and Introductions Approval of Minutes ** Setting the Agenda Information Items Working Council Update* Bill Tracking Update* Meeting with American Beverage Association Success with hospital construction and OSHPD Action Items: Federal Health Care Reform Implementation* Health Benefit Exchange Fit for Work Event Health Committee ROI Update and Work Plan Draft Lisa Brett Emily Committee should review the following document to help inform our Health Care Reform discussion: Roadmap.pdf Emily ROI Where should our focus be on state legislation? 5:00 p.m. Setting the Next Meeting Date/Time Lisa Next Meeting: December 13 th, 2011 Adjourn

2 Silicon Valley Leadership Group Health Committee Minutes Tuesday, September 13, :30-5:00 pm SVB Financial, Santa Clara Participating Members: Lisa Jafferies, Kaiser Melissa Burke, Lucile Packard Children s Hospital Nancy Noe, Johnson & Johnson Patty Fisher, The Health Trust Sylvia Covarrubias, El Camino Hospital Jo Coffaro, Hospital Council Staff: Emily Lam, Leadership Group Brett Barley, Leadership Group Vanessa Lam, Leadership Group Minutes Approved Information Items o The Working Council approved the Health Committee s recommendations to adopt a Sweetened Beverage Tax Framework. Committee talked about messaging on the issue going forward o Staff provided the committee with a bill tracking update. Staff will send the Governor letters on each bill. o Staff provided the committee with a Federal Health Care Reform White Paper on challenges to the law. o Staff provided the committee with a brief on Attorney General Harris brief in support of Federal Health Care Reform. Action Items o There were no action items as the two bills we were scheduled to look at failed to pass through either the Senate or the Assembly. Health Committee ROI o Committee spent the majority of the meeting talking about the annual strategy conference and the Health Committee s work plan. o Committee decided our top priority will continue to be Federal Hath Care Reform focusing on the development of the Health Benefit Exchange and essential benefits at the state level. The Leadership Group will work regional organizations, attend stakeholder session, and weigh in on issues affecting business (regulation, time, and cost). o The second top priority will be Wellness, Prevention, and Let s Move Companies. Staff will work to enroll 100 companies in the Let s Move campaign and hopes to host a Wellness and Prevention Event in February. o The third top priority is Fluoridation. Staff will work with the water board to gain approval for fluoridation and then help to lead a $14 million capital campaign. Next Meeting Nov. 8 th

3 November 3, 2011 TO: FROM: SUBJECT: Health Committee Emily Lam Brett Barley Working Council Approved Health Priorities Issue: On Thursday, November 3 rd the Working Council approved the following Health Care Committee Priorities for These priorities will be presented to the Board of Directors in December. 1. Improve Health Care Reform Implementation: Minimize time and cost burdens on employers while ensuring access to health insurance plans at a reasonable costs 2. Prevention and Wellness: Continue to help employers start or improve wellness programs and offerings including a partnerships with the First Lady Michelle Obama s Let s Move initiative 3. Health education and literacy: Educate member companies on different components of health care reform and top wellness issues including tobacco and obesity mitigation and fluoridation

4 November 3, 2011 TO: FROM: SUBJECT: Health Committee Emily Lam Brett Barley 2011 Health Bill Tracking List Analysis: The Committee was able to move five of the bills it was supporting to the Governor s desk and all five were signed. Health Health Legislation AB 1296 (Bonilla) AB 6 (Fuentes) AB 922 (Monning) SB 335 (Hernandez and Steinberg) SB 51 (Alquist) Last updated: September 9, 2011 Bill Name Position Bill Summary Status Health Care Eligibility Enrollmen, and Retention Act CalWORKS and CalFresh Program Office of Patient Adovcate (formerly Office of Health Consumer Assistance) Medi-Cal: Hospitals: Quality Assurance Fee Health Care Coverage Support Support Support Support Support Creates standardized application forms and renewal procedures for state and county government programs Increases access to and participation in CalFresh by removing barriers and simplifying the application process Eliminate the Office of Patient Advocate and create the Office of Health Consumer Assistance Extends the Hospital Quality Assurance Fee on an emergency basis through June 30, 2012 (1) implement the provision that prohibits a health insurance issuer from establishing lifetime limits or unreasonable annual limits on benefits and (2) require that rebates be provided to consumers whose plans meet the minimum medical loss ratios described in the Affordable Care Act Signed Signed Signed Signed Signed

5

6

7 November 3, 2011 TO: FROM: SUBJECT: Health Committee Emily Lam Brett Barley Federal Health Care Reform Next Steps Issue: The Health Care Committee has been working the past two years on implementation of federal health care reform. Today we would like to talk about the next steps in this process for 2012 and beyond and how the Committee can be involved and weigh in. Analysis: 2012 Uniform Notice Requirements Employers must provide new enrollees with a summary of benefits and an explanation of coverage. The summary must be no longer than four pages in length, a minimum of 12 point font, and should be written in a manner that can be understood by the average participant. The summary should contain key information regarding cost sharing, limitations of coverage, illustrations of common benefits scenarios, and details on where participants can obtain further information Informational Reporting Businesses paying $600 or more annually to property and service providers (including corporations) must file Form 1099s with each provider and the IRS. The regulation seeks to raise additional funds for health reform by tracking unreported income. Modification Notice Employers must provide notice of any material modifications to benefits 60 days before implementation. Non-compliance will result in $1,000 fine per violation. Compliance With Qualify of Care Reporting Self-funded plans and insurers must report annually to the Secretary of HHS and enrollees regarding plan features that improve health outcomes, reduce hospital readmissions, improve patient safety, reduce medical errors, and implement wellness activities Employee Notice Requirements Employers must inform new and existing employees about the state health exchanges and provide information on employee eligibility, free choice vouchers, and premium credits. Employer Retiree Coverage Subsidy Eliminates the tax-deduction for employers who receive Medicare Part D retiree drug subsidy payments.

8 Medicare Part D Tax Deduction Eliminated Tax deduction for employees who receive Medicare Part D retiree drug subsidy payments. New Limit on Contributions Employees may contribute no more than $2,500 annually to a health FSA. Medicare Payroll Tax The Medicare Part A (hospital insurance) payroll tax on wages and self-employement income in excess of $200,000 ($250,000 joint) will increase by 0.9% (from 1.45% to 2.35%). The employer will be required to withhold from individuals but is not required to calculate joint income for withholding purposes. Individuals will be held responsible for the additional tax if amount withheld from wages is insufficient. Health Insurance Exchanges States deadline to seek federal HHS approval of progress to be fully operational in one year Employer Requirements (Pay or Play) Assesses a fee of $2,000 per full-time employee, excluding the first 30 employees, on employers with more than 50 employees that do not offer coverage and have at least one full-time employee who receives a premium tax credit. Employers with more than 50 employees that offer coverage but have at least one fulltime employee receiving a premium tax credit, will pay the lesser of $3,000 for each employee receiving a premium credit or $2,000 for each full-time employee, excluding the first 30 employees. Minimum Essential Coverage Employers must cover a 60% minimum of the cost of minimum essential coverage for employees, as defined by the HHS. Total employee cost for health care coverage should not exceed 9.5% of any employee s household income. Free Rider Penalty If an employee s cost of health coverage exceeds 9.5% of household income, and at least one employee elects to purchase coverage through the state exchange, the employer has failed to provide minimal essential coverage and will be subject to the employer mandate. Employee Wellness Participation Incentives Employers may encourage employees to participate in wellness programs through premium discounts, waivers of cost sharing requirements, or extra benefits of up to 30% of the cost of coverage. Employers must also offer an alternative arrangement for individuals who have difficulty participating due to certain limitations. Free Choice Vouchers If the employee s cost of coverage exceeds 8% of household income (but less than 9.8%), and the employee s household income is less than 400% of the Federal poverty level, then the employer must offer a free choice voucher that the employee may use to

9 purchase coverage through a state health exchange. The voucher must equal the amount the employer would have paid to provide coverage under the employer s plan and will be used to offset the costs of purchasing alternative coverage. No Preexisting Condition Exclusion for Enrollees Employers may not deny coverage due to pre-existing conditions. The provision extends to all individuals. Out of Pocket Limits Employers may not impose greater cost sharing than the current out of pocket limits for high deductible health plans (in 2010, $5,950 for individuals and $11,900 for families). Certification of Health Care Coverage Employers must certify that all full-time employees were offered health coverage. The certification must specify the length of waiting period under the plan, the time period that coverage is available, the premium charged and the employer s shared cost. Health Insurance Exchanges State health benefit exchanges set to be fully operational as a market for individuals and small businesses to buy qualified health plans. Multi-State Health Plans Multi-state health insurance plans will be made available through health benefit exchanges Excise Tax on Expensive Plans Plans that cost over $10,200 for individual coverage and $27,500 for family coverage annually will be subject to an excise tax. Employers that sponsor such plans must pay a 40% tax on the excess value of the coverage. The tax applies to all amounts paid for medical expenses, including dental and vision. The threshold is higher for employers that have a disproportionately older employee population and employees in high-risk professions. Sources The following proved invaluable in the assembly of this business timeline for federal health reform: Anthem Blue Cross Blue Shield of California California Health Care Reform Kaiser Family Foundation Health Care.gov

10 November 3, 2011 TO: FROM: SUBJECT: Health Committee Emily Lam Brett Barley Executive Summary from Bay Area Council Report on Federal Health Care Reform Implementation Full Report can be found at: Executive Summary: California is experiencing a healthcare affordability crisis. Businesses large and small are struggling to pay spiraling healthcare costs. The state government is cutting billions from spending for public healthcare programs that care for children, seniors and the disabled. Families are being forced to make difficult financial choices, and many are going without needed care. The Affordable Care Act (ACA) created a framework that could be used to ratchet down rising health spending, and dozens of state-based proposals aim to improve healthcare affordability. What is missing is a strategic vision for an affordable, high-quality healthcare system for California. This report is aimed at the state s business leaders who have an essential role in shaping that vision, mapping it out, and creating systems for measuring progress toward our goals. The report provides a roadmap laying out the specific actions by healthcare providers, insurers, businesses, governments, and individuals that will improve affordability and access to high quality care in California. Achieving affordability will require quickly building on proven California grown successes in cost control. We must also make the right decisions as we implement federal healthcare reform. One particularly critical task is setting up a successful California Health Benefit Exchange, the new marketplace for purchasing private health insurance. Since controlling costs while improving quality is our ultimate goal, the solution is meaningful consumer choice among healthcare systems that have both the financial incentive and the technical capabilities to maximize health and wellness. 1. Financially Rewarding High-Value Care Payers should move to embrace payment models that maximize health while preserving resources. o California payers should quickly ramp up projects that encourage and reward integrated, high-value care. o Healthcare purchasers should give preference to projects that deliver savings up front.

11 o Policymakers should give maximum flexibility to healthcare providers to develop new models to deliver care to the large, newly insured population. 2. Building a Successful Health Benefit Exchange The California Health Benefit Exchange should be structured as a powerful partner with other payers in promoting delivery system reform. o The Board of the Exchange should focus on developing an efficient, transparent marketplace that fosters competition on price and quality. o The Exchange should partner with other payers to align incentives that will drive reform of the medical delivery system. o The Exchange and the state and federal government should not take actions that would hinder the delivery of high-quality, affordable, integrated care. 3. Focusing on Health Outcomes All payers should aggressively pursue strategies to optimize effective care to make sure patients, especially those with chronic conditions, get the appropriate care at the appropriate time in the appropriate setting. o Purchasers and providers must partner to better manage chronic illness through the use of proven personnel strategies and self-management. o Hospitals in partnership with other providers can reduce health care acquired infections and unnecessary hospital readmissions by scaling successful California pilots in these areas. o Private and public payers and healthcare systems should pursue strategies to utilize comparative effectiveness research to promote high quality, appropriate care. 4. Effectively Engaging Consumers Unleash the power of individuals through access to better information about healthcare and empowering people to make healthier choices about diet and physical activity. o Businesses and other healthcare purchasers should, when feasible, give employees choices between different healthcare networks competing transparently on price and quality. o Healthcare purchasers should adopt proven value-based benefit designs. o Businesses should put in place wellness programs that have shown results. o Californians must take personal responsibility for maximizing their own health and wellness by making healthier choices enabled by policies that expand access to healthy foods and safe communities.