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State Legislative Update

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Worked with coalitions opposing Wal-Mart bills. Followed MA legislation ... Fair Share/ Wal-Mart Bill ... 'Son of Wal-Mart' bill targets all other employers ... – PowerPoint PPT presentation

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Title: State Legislative Update


1
State Legislative Update
  • 2006 Regional Meeting Presentation
  • by
  • Adam Brackemyre, Director of State Affairs
    (Regions 1 2)

2
Regions 1 and 2
  • Background information on Adam
  • State Updates
  • What is NAHU Doing?

3
NAHU Government Affairs
  • NAHU Federal Affairs
  • John Greene, VP of Congressional Affairs
  • Peter Stein, VP of Congressional Affairs
  • Tracy Canada, Manager of Political Affairs
  • NAHU State Affairs
  • Jessica Waltman, VP of Policy Research and State
    Affairs
  • Adam Brackemyre, Director of State Affairs
  • Jennifer Hillert, Director of State Affairs
  • Megan Mamarella, Director of State Affairs

4
What Do We Do for You
  • Participate in industry meetingsNAIC, NCOIL,
    ALEC, NCSL, etc.
  • Draft position statements, analyze and comment on
    proposed legislation or regulations or implement
    a grassroots effort.
  • Brief Capitol Hill staff and committees on
    underwriting and the health insurance market.
  • Testified before Congress six times in the past
    seven years
  • Considered experts on many health care issues
    such as HSAs, the Massachusetts Plan, Medicare,
    and LTC partnerships

5
The New Guy
  • Four years working for health-related trade
    associations
  • Federal Lobbyist for 3 years
  • Health insurance (guaranteed issue, community
    rating)
  • High-risk pools
  • LTC
  • Some state affairs duties, too
  • Followed most states within regions 1 and 2
  • Worked with coalitions opposing Wal-Mart bills
  • Followed MA legislation from the start

6
The New Guy
  • Midwestern roots (Indiana)
  • DePauw University, B.A. Economics
  • George Mason University, M.A. Public Policy (in
    progress)

7
I Work for You
  • Do we need
  • An Operation Shout?
  • An op-ed expressing our views?
  • To follow or watch specific legislation?
  • Information on current law?
  • To work with your state lobbyist?
  • Call or e-mail me
  • I am following your state and want to help

8
Massachusetts
  • In April, Gov. Romney signed major health
    insurance reform
  • The prime reason for the reform was to preserve
    385 million in annual federal Medicaid funding
  • Individual and business mandates
  • The Connector will offer individual policies

9
What We Know
  • The Connector will offer nongroup insurance to
    groups of 1-50
  • The small group market will still exist
  • Subsidies will be provided for those earning less
    than 300 federal poverty level
  • Nobody receiving a subsidy will have a deductible
    (therefore, no HSAs)

10
Connector Commissions
  • If an agent brings risk to the Connector, he or
    she shall be compensated
  • MAHU worked hard to get agent compensation put
    into the legislation
  • Individuals can also buy directly from the
    Connector
  • Reportedly, some carriers will price products
    with and without commissions

11
What We Dont Know
  • Premium Costs (target was 200/mo)
  • Number of Plans Available
  • Deductibles and Co-Pays
  • Agent Commissions (the Connector sets them)
  • Who provides independent advice when someone
    purchasing without an agent has a question or
    problem

12
Massachusetts
  • NAHU is closely monitoring this and working with
    MAHU
  • NAHU sent an informational email to all 20,000
    members
  • Again, the reform left many important issues to
    the regulatory process
  • Even now, we dont know many final details

13
Maryland
  • Fair Share/ Wal-Mart Bill
  • Union-backed legislation that mandates large
    companies to pay a certain percentage of payroll
    on health benefits
  • The larger Fair Share campaign produced bills in
    30 states last year
  • The Maryland Assembly overrode Gov. Ehrlichs
    veto to enact it
  • In July, a federal judge invalided this law

14
Maryland
  • One political observer said a bad idea beat no
    idea
  • Some legislators voted for Fair Share because
    they felt that they had to do something

15
Maryland
  • Son of Wal-Mart bill targets all other
    employers
  • Provide a certain level of health insurance or
    pay a tax
  • The proposal all small employers must spend 4.5
    percent of payroll on health insurance or pay a
    tax
  • Tax for non-profits 3 percent
  • Paying Medicaid would be cheaper than private
    insurance
  • Agents compete with government insurance
  • What happens when legislatures allow Medicaid buy
    in (far below cost)?

16
Maryland
  • By allowing the public to buy into public
    programs, the state will ensure that Medicaid
    costs outpace revenues
  • The system will collapse
  • This opens the door to single-payer

17
City Wal-Mart Legislation
  • Some cities are advancing local ordinances to
    mandate big box retailers to pay a minimum wage
    plus benefits
  • Chicagos bill (other cities have a similar one)
    establishes a 10/hr wage plus 3/hr in benefits
  • Passed the city council
  • Vetoed by Mayor Daley (first veto in 17 years)
  • Veto not overridden (happened 8/13)
  • Target stopped expansion plans

18
San Francisco
  • San Francisco passed a pay or play universal
    health plan
  • Will treat only city residents, including illegal
    aliens
  • Cost estimate 200 million annually
  • Co-pays and premiums are income-based and
    established on a sliding scale
  • 20-99 employees- 1.06 per hr/per employee
  • 100 or more- 1.60 per hr/per employee

19
Maine
  • Maine passed The Dirigo Health Act in 2003
    authorizing a new program that would
  • Save everyone money by enrolling all 130,000
    uninsured in Dirigo within 5 years
  • Reduce health insurance costs
  • Lower-income workers receive subsidies
  • Savings are identified, recaptured and sent back
    to the program
  • The process of identifying savings is
    controversial and may be reformed

20
Maine
  • Two years later, program should have 50,000
    uninsured enrolled, but
  • Sales are 90-95 behind schedule
  • 93 million spent to save 5.4 million bad
    debt
  • The majority of Dirigo enrollees were previously
    insured

21
Maine
  • Maine has a regulatory environment similar to
    Massachusetts
  • Small group 1-50
  • Expensive individual market (rates to increase
    20)
  • Dirigo reform offered little market reform
  • Mandates and rating laws still apply
  • We learned subsidizing an expensive policy
    design doesnt save money

22
Vermont
  • Catamount Health
  • High-deductible private insurance
  • Subsides available up to 300 FPL
  • Chronic Care Initiative (thru Medicaid)
  • If 96 are not insured by 2010, then the
    legislature will consider an individual mandate

23
Vermont
  • Employers will pay a quarterly assessment
    equaling 1 per day per total number of full-time
    equivalent (FTE) employees, if the employer
  • Does not offer health insurance
  • Only offers health insurance to some employees
    (assessment is on those who are not eligible for
    an employers insurance)
  • Has uninsured employees
  • The employer may exempt a maximum of eight FTEs
    from the assessment in fiscal years (FY) 2007
    2008 six in FY 2009 and four in FY 2010

24
New Jersey
  • Governor Corzine will shortly unveil a plan to
    substantially reduce the number of uninsured
  • Stated that by increasing state spending by 15
    million, the plan will cover 750,000 uninsured
    residents
  • Very few details have been released
  • NAHU is very concerned about this

25
New Jersey
  • Were waiting for the final details
  • NAHU has begun drafting op-ed and can place them
    when necessary
  • The proposal will probably contain business
    mandates, so we will have strong allies

26
California
  • In California, the House and Senate passed SB
    840, which would have established a single-payer
    system for California
  • The proposal was not funded and was not enacted
  • Vetoed by the governor

27
TennCare Reforms
  • Access TN High Risk Pool
  • Cover Kidscreates SCHIP program in TN
  • Cover TN
  • Voluntary partnership among the state, individual
    and willing employer
  • Available guaranteed-issue to previously
    uninsured with household income up to 250 FPL
  • Plans are portable and cover basic services
  • Plans are estimated at 150 per month and vary
    based on age, tobacco use and obesity

28
Trivia
  • The programs first year costs were 3 billion
  • The legislative body predicted that 24 years
    later, the program would cost 12 billion
  • The cost will not be greater than our present
    (inefficient) and wasteful fee-for-service
    system Legislator
  • Any guesses?

29
Medicare
  • 1966 cost 3 billion
  • 1990 cost 107 billion
  • Cost was 700 percent higher than projected
  • Medicare A grew at 15 percent/ year
  • 1975 budget increase spending by 30 percent
  • Medicare B followed the same growth patterns

30
Single-Payer Problems
  • Overpromise and overspend
  • Set prices below demand demand explodes
  • Cut reimbursement and raise taxes (Medicaid)
  • Ration by some means
  • Waiting lists?
  • Limited prescription access?

31
Single-Payer Budgeting
  • Tax revenues will be thrown into one pot
  • Health care dollars will compete with education,
    law enforcement, etc
  • The system will always be underfunded
  • Thus, people will wait for treatment

32
Englands National Health Service
  • By 2008, NHS patients will have to wait no more
    than 18 weeks for hospital treatment.
  • The '18 week pathway' will cover the entire
    waiting time from a GP's referral to the start of
    treatment.
  • To help NHS organizations meet the target, a new
    framework has been published. It includes details
    of national projects to speed up waiting times,
    and outlines the key responsibilities of all
    healthcare staff.
  • Five years ago, it was not uncommon to wait six
    months for an outpatient consultation and
    eighteen months for inpatient treatment.
  • Patients can now expect maximum waits of 26 weeks
    for inpatient appointments and MRI and CT scans,
    and a maximum wait of 13 weeks for a first
    outpatient consultation.

33
Hey Wait a Minute
  • One million Britons are waiting for admission to
    National Health Service hospitals and shortages
    force the NHS to cancel as many as 100,000
    operations each year
  • In Canada more than 800,000 patients are
    currently on waiting lists for medical procedures

  • Roughly 90,000 New Zealanders are facing similar
    waits
  • In Sweden, the wait for heart surgery can be as
    long as 25 weeks, while the average wait for
    hip-replacement surgery is more than a year

Source Michael Tanner The Great Wait National
Review Online 9/13/06
34
Single Payer
  • Why I bring this up
  • NAHU is preparing for single payer proposals for
    next year
  • We have formed a committee and I am participating
    (Single Payer Truth Squad)
  • The Fall elections look to be favorable for
    government-directed health care fans
  • Look for ballot proposals (California)
  • Were following PA and CT closely

35
Contact information
  • If you would like to reach me
  • Phone (703) 276-3808
  • Email abrackemyre_at_nahu.org
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