The following presentation is brought to you by the Member Firms of United Benefit Advisors in conjunction with the National Association of Health Underwriters - PowerPoint PPT Presentation

Loading...

PPT – The following presentation is brought to you by the Member Firms of United Benefit Advisors in conjunction with the National Association of Health Underwriters PowerPoint presentation | free to view - id: 20c223-ZDc1Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

The following presentation is brought to you by the Member Firms of United Benefit Advisors in conjunction with the National Association of Health Underwriters

Description:

Passage of health care reform in 2009 continues to be the most important ... and self-insured plans (COBRA equivalence); effectively end ERISA preemption ... – PowerPoint PPT presentation

Number of Views:45
Avg rating:3.0/5.0

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: The following presentation is brought to you by the Member Firms of United Benefit Advisors in conjunction with the National Association of Health Underwriters


1
The following presentation is brought to you by
the Member Firms of United Benefit Advisors in
conjunction with the National Association of
Health Underwriters
The following presentation is brought to you by
the Member Firms of United Benefit Advisors in
conjunction with the National Association of
Health Underwriters
2
Health System Reform OutlookOctober 28,
2009Janet Trautwein, CEONational Association
of Health Underwriters
3
Introduction
  • Passage of health care reform in 2009 continues
    to be the most important priority for the Obama
    administration.
  • Momentum is gaining in both the House and Senate,
    but with resistance.
  • Every employer and potentially every citizen in
    America could be directly impacted, depending on
    the breadth of the program.

4
Predicting the future is tough business
  • I think there is a world market for maybe five
    computers.
  • -- THOMAS WATSON, PRESIDENT OF IBM, 1943
  • Barack Obama is not going to beat Hillary
    Clinton in a single democratic primary. Ill
    predict that right now.
  • -- WILLLIAM KRISTOL, DECEMBER, 2006
  • Two years from now, spam will be solved.
  • -- BILL GATES, FOUNDER OF MICROSOFT, 2004
  • I predict the internet will soon go
    spectacularly supernova and in 1996, will
    catastrophically collapse."
  • -- ROBERT METCALFE, FOUNDER OF 3COM, 1995
  • Bear Stearns is fine! Dont move your money
    from Bear!!
  • -- JIM CRAMER, MAD MONEY HOST, MARCH 2008 (6
    DAYSLATER, SHARES PLUNGED 90)

5
Overview of Congressional Action
  • Three House committees with responsibility over
    health care marked up one bill (H.R. 3200) and
    passed different versions out of each committee
    in July
  • Senate HELP committee marked up bill and passed
    it out of committee on July 15
  • Senate Finance Committee passed its mark on
    October 13 by a vote of 14-9 with Senator Olympia
    Snowe (R-ME) as the only GOP supporter
  • Finance and HELP bill being merged for floor
    consideration at the end of the month
  • Potential House floor action on a managers
    amendment to H.R. 3200 likely to follow Senate

6
Key Senate Players
7
Key House Players
8
President Obama
If you like your health plan, you can keep it,
the only thing that will change is that youll
pay less. - President Barack Obama
9
President Obamas Position
  • Key promises
  • Undocumented immigrants will not be covered
  • No public financing of abortions
  • If you like your plan you can keep it
  • Existing coverage will not change, just become
    better and less expensive
  • Public option, if there is one, will be limited
    to small employers and uninsured individuals
  • Bill will not increase federal deficit by one
    penny
  • Bill will cost about 900 billion and be financed
    most through administrative savings and cuts to
    waste, fraud and abuse in the current system
  • Still allowing Congressional lead in negotiations
    but staff is becoming more active behind the
    scenes
  • Main activity is public appearances and the press

10
Congressional Budget Office
  • The CBO is responsible for putting a price tag or
    score on all of the bills
  • Limited to 10 year budget window
  • Limited to the law without changes, actions of
    political appointments
  • Federal government costs only
  • Doesnt include infrastructure costs

11
Key Issues
  • Government-Run Public Plan (or Co-Operative? Or
    Trigger?)
  • Employer Mandate
  • Will you really be able to keep the coverage you
    have?
  • Structure of the Exchange or Gateway
  • Is an individual mandate enforceable?
  • Cost containment
  • Cost of the Plan

12
Public Plan? Co-Op? Trigger? State Option?
  • Concerns about effects on private insurance
    markets
  • Crowd-out, unlevel playing field
  • Cost controls likely grounded in Medicare price
    fixing, which already shifts 1,800 in annual
    premium surcharges to private insurance (family
    coverage)
  • Trigger mechanism possible
  • Non-profit Cooperatives considered as
    alternative
  • State option alternatives from Senators Cantwell
    and Carper

13
Will You Really Be Able to Keep Your Current
Plan?
  • Despite the oft-repeated promise that if you like
    your current health insurance policy you can
    keep it, the bills under consideration all
    contain very strict grandfathering provisions
  • New plan rules include rating restrictions, an
    essential benefits package that is far richer
    than many current plans, new taxes on insurers
    and other aspects of the industry that will be
    passed to consumers, and a weak individual
    mandate
  • New AHIP/PWC study concludes that by 2019 the
    average family will be paying 4,000 a year more
    in premiums than they would without reform

AHIPs CEO Karen Ignagni
14
Is An Individual Mandate Enforceable?
  • Bills require all Americans to obtain specific
    levels of health insurance coverage
  • Intent is goodmany uninsured are young and
    healthy, and inclusion in the insured risk pool
    would stabilize costs
  • Insurance carriers could underwrite policies
    without taking into account preexisting
    conditions and basing rates on health conditions
    if EVERYONE is in the system
  • Questions
  • Costs of subsidies needed to make sure everyone
    can afford coverage
  • What counts as qualified health benefits plan?
  • Is tax system effective enforcement?
  • If enforcement doesnt work, what is the impact
    on costs?
  • Impact on Employer-Sponsored plans?

15
Employer Mandate
  • House Bill and Senate HELP Bill include outright
    mandates for employers to provide employees with
    coverage
  • Employers told what kind of coverage to offer, to
    whom they must offer it (including part time
    employees), and how much they have to pay
  • Would affect fully insured and self-insured plans
    (COBRA equivalence) effectively end ERISA
    preemption
  • If employers dont comply with every specific of
    the mandate, they are fined, and the fine does
    not go toward the cost of coverage for employees
  • Exemptions for small employers (to a certain
    degree) from the mandate. President Obama
    promised employers of less than 50 will be exempt
  • Senate Finance Committee does not impose a direct
    mandate on employers to provide coverage. It
    requires employers of more than 50 people to pay
    a fine for low income employees who arent
    offered affordable coverage and instead obtain
    subsidized coverage through the exchange

16
Whats An Exchange?
  • Modeled after 2006 reforms enacted in
    Massachusetts
  • Aim is competition among plans on price of
    coverage and minimizing variations of benefits
  • Intended to provide consumers / employers with
    transparent information about costs and covered
    benefits, as well as a plan performance and
    subsidies
  • The House bill would establish one big national
    exchange, while the Senate bills establish
    separate exchanges at the state level
  • The House and Senate HELP bills have an
    underlying purchasing pool component to the
    structure, but the Finance bill exchanges use a
    portal structure
  • Exchange participation is currently limited to
    individuals and smallgroups, except in the
    Senate Finance proposal
  • Could result in higher costs for employers if
    young, healthy opt out of employer plans for
    government plan

17
Bending the Cost Curve???
  • All of the bills contain efficiency improvements,
    payment reforms and a greater focus on wellness
    and prevention
  • Almost all of the provisions targeted at public
    programs, not the private market
  • None include substantive tort reformwould extend
    jurisdiction over the bills to the Judiciary
    committees
  • Senate HELP and Finance bills include
    improvements to employer wellness programs,
    rating for wellness factors and tax incentives
    for employers that provide qualified wellness
    programs to their employees
  • Senate Finance mark is the most serious attempt
    to constrain rising health care costs to date,
    with provisions on disease prevention and
    wellness, improving the quality and efficiency of
    health care and value-based purchasing

18
Cost Factor
  • CBO cost analysis of H.R. 3200 is 1.3 trillion
    dollars over 10 years
  • Not deficit neutral and relative to current law,
    the proposal would probably generate substantial
    increases in federal budget deficits during the
    decade beyond the current 10-year budget window.
  • House bill is financed by 400 billion in
    Medicare cuts, tax on high-end (expensive)
    employer sponsored plans and an income-tax
    surcharge on the wealthiest of Americans.
  • Senate HELP bill also scores over 1 trillionno
    payment mechanism was included since this is not
    a committee with financial jurisdiction

19
Cost Factor
  • Senate Finance bill score currently hovers around
    840 billionscore is just an estimate because
    its not in legislative language
  • The Finance bill is funded with an excise tax on
    most expensive plans, and new taxes on health
    insurance plans, prescription drugs, and medical
    device manufacturers
  • The excise tax is based on an arbitrary number
    that does not take geography or the higher costs
    experienced by older or sicker groups into
    consideration
  • The excise tax may be calculated based on health,
    dental, supplemental benefits and FSAs
  • New taxes on health insurance plans, drugs, and
    devices will be passed on as increased premiums.

20
So . . Where Are We Now?
  • Senate Finance and Health, Education, Labor and
    Pensions (HELP) committees bills are being
    merged for floor debate. House is doing the same
  • New push for public option in Senate
  • All bills under consideration in both the House
    and Senate impose significant government
    regulation and oversight of employer sponsored
    plans

21
So . . Where Are We Now?
  • Public concern about record deficit and added
    cost of health care reform, hopefully, may shape
    final legislation
  • Divisive opinions of liberal vs. centrist
    Democrats in both the House and Senate on issues
    such as a public option and financing could pose
    a roadblock to passage
  • Republicans are united in opposition to all
    bills, except Senator Snows qualified approval
    to Senate finance bill

22
What Can You Do?
  • Be informed of issues being debated and positions
    of your Congressional representatives on these
    issues. New developments occur daily
  • Get involved. This legislation will affect not
    only you, but generations to come
  • Call and write letters to your Congressional
    representatives to share your opinions. Email is
    fine, but letters have more impact
  • For updates visit the NAHU website at
    www.nahu.org

23
Questions and Wrap-Up
24
Thank you for your participation in this
important presentation. United Benefit Advisors
(UBA) and the National Association of Health
Underwriters (NAHU) are leaders in ensuring that
millions of Americans have the health care
coverage they need to access quality health care
and are committed to helping shape policies that
guide positive health care reform. If you have
questions or need additional information
regarding your benefits strategy, contact your
local UBA Member Firm at www.UBAbenefits.com
Thank you for your participation in this
important presentation. United Benefit Advisors
(UBA) and the National Association of Health
Underwriters (NAHU) are leaders in ensuring that
millions of Americans have the health care
coverage they need to access quality health care
and are committed to helping shape policies that
guide positive health care reform. If you have
questions or need additional information
regarding your benefits strategy, contact your
local UBA Member Firm at www.UBAbenefits.com
About PowerShow.com