Health Reform and the

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Health Reform and the Minnesota Health Insurance
Exchange
ANNA ODEGAARD SEIU
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Todays Agenda

• Health Reform Overview
• Minnesota Health Insurance Exchange
• Critical Decisions
• Q A

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Three Questions

• 1. What are some problems with our current
  healthcare system?
• 2. Who benefits in our current healthcare system?
• 3. Who makes decisions in our current healthcare
  system?

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Health Reform Overview
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The ACA regulates the insurance industry to
protect patients.

• Eliminates exclusions for pre-existing conditions
• Extends dependent coverage up to age 26
• Eliminates lifetime and annual limits on benefits
• Prohibits rescission
• Guarantees comprehensive benefits
• Protects you from unreasonable rate increases

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The ACA Eliminates Exclusions for Pre-existing
Conditions

• Before the ACA, insurers could
• Refuse to insure you if you were already sick
• Charge you more for insurance if you were sick
• Refuse to pay for conditions you had before
  buying insurance
• Now, plans that cover children can no longer deny
  coverage or charge more for sick children.
• Starting in 2014, these protections will be
  extended to Americans of all ages.

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The ACA Extends Dependent Coverage up to Age 26

• Your children can join or remain on your plan
  even if they are
• Married
• Not living with you
• Attending school
• Not financially dependent on you
• Eligible to enroll in their employers plan
• 2.5 million young people have already gained
  coverage due to this provision.

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The ACA Eliminates Lifetime Annual Limits on
Benefits

• Before the ACA, many health plans set
• Lifetime limits
• Annual limits
• You were required to pay the cost of care over
  those limits.
• Under the ACA
• Lifetime limits are already prohibited
• Annual limits will be phased out by 2014

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The ACA Prohibits Rescission Except in Cases of
Fraud.

• Rescission means cancelling your insurance.
• Before the ACA, an insurer could rescind your
  coverage at any time if you made a mistake on
  your application.
• Now, an insurer cant rescind your coverage
  because you made an honest mistake.

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The ACA Guarantees Comprehensive Benefits.

• Starting in 2014, all insurance plans in the
  individual and small group market must cover
  Essential Health Benefits in ten categories
• Ambulatory services 6. Prescription Drugs
• Emergency services 7. Rehab services
• Hospitalization 8. Laboratory services
• Maternity and Newborn care 9. Preventive/Chronic
  Disease
• Mental health and substance use 10. Pediatric
  services

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The ACA prioritizes prevention.

• The ACA requires health plans to cover some
  preventive services at no cost, including
• Blood pressure, diabetes and cholesterol tests
• Well-child visits from birth to age 21
• Some cancer screenings
• Flue and pneumonia shots
• Many others (see healthcare.gov for full list)

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The ACA Protects You from Unreasonable Rate
Increases

• The nations major health insurers are barreling
  into a third year of record profits Yet the
  companies continue to press for higher premiums,
  even though their reserve coffers are flush with
  profits and shareholders have been rewarded with
  new dividends.
• -New York Times, Health Insurers Making
  Record Profits as Many Postpone Care. May 13,
  2011.

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The ACA Protects You from Unreasonable Rate
Increases

• The ACA cant prevent premium increases. But it
  does
• Grant 250 million to states to fight
  unreasonable rate increases
• Require insurers to submit justification for rate
  increases over 10
• Require plans in the Exchange to submit all rate
  increases for review

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The ACA requires most people to buy health
insurance.

1. This is called the Individual Mandate.
2. This spreads risk over a larger and healthier
   population.
3. It means insurers can afford the cost of other
   reforms (like covering people regardless of their
   health status) without raising everyones
   premiums.
4. It also means tax payers wont have to cover cost
   of uncompensated care.

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Something to be very proud of
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And a whole lot of other stuff
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• Health Reform in Minnesota
• Critical Decisions

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Health Reform Critical Decisions

• Will Minnesota adopt full Medicaid Expansion?
• What will happen to the MNCare population?

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Health Reform Critical Decisions

• Minnesota should adopt full Medicaid Expansion to
  138 of the Federal Poverty Level.
• Individual lt 15,000
• Family of 4 lt 32,000

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Health Reform Critical Decisions

• Federal Funding for full Medicaid Expansion
• 100 first 3 years
• 98 next 3 years
• 90 after 2020

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Health Reform Critical Decisions

• The Basic Health Plan
• Minnesota should take this opportunity to improve
  on the MNCare program for those up to 200 FPL.
• Basic Health Plan should make insurance
  affordable for everyone in the MNCare population.

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Minnesota Health Insurance Exchange
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What is an Exchange?
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What is an Exchange?

• An Exchange is an online marketplace for health
  insurance plans.
• Exchanges will
• make health insurance more affordable and more
  accessible
• enable people to make more knowledgeable choices
  about their health insurance

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What is an Exchange?

• On the Exchange web site you can
• Determine eligibility
• Compare health plans
• Enroll in a public or private health plan

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What is an Exchange?

• 1.2 million Minnesotans will use the Exchange by
  2016
• Individuals who dont get insurance through their
  employer because its not offered or not
  affordable
• Employees of small businesses
• People who are eligible for public health
  insurance programs

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Why do we need a Health Insurance Exchange?
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Consumer-friendly features

• Insurance will be more affordable
• Premium tax credits
• Cost-sharing subsidies
• Small business tax credits

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Consumer-friendly features

• Premium Tax Credits for people with household
  income up to 400 of the Federal Poverty Level
• Individuals up to 45,000
• Family of 4 up to 92,000
• Cost-sharing subsidies for people with household
  income up to 250 of the Federal Poverty Level
• Individuals up to 28,000
• Family of 4 up to 58,000

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Consumer-friendly features

• Tax credits for small businesses
• lt 25 employees
• lt 50,000 average salary

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Consumer-friendly features

• Insurance will be more accessible
• Single streamlined application
• Real-time eligibility determination
• Plan comparison tools

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• Minnesota Health
• Insurance Exchange
• Critical Decisions

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Critical Decisions

• Will the Exchange be an Active Purchaser?
• How will the Exchange be governed?
• How will the Navigator system work?

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Critical Decisions

• A Clearinghouse Exchange allows all health plans
  that meet minimum federal standards to be offered
  on the Exchange.
• An Active Purchaser Exchange leverages the
  collective purchasing power of all Exchange
  enrollees to strike a better deal with insurers.

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Critical Decisions

• An Active Purchaser Exchange can
• Negotiate for lower prices and better coverage
• Establish a competitive bidding process
• Offer a manageable number of health plans

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Critical Decisions

• California requires its Board to engage in Active
  Purchasing
• The board shall seek to contract
• with carriers so as to provide health
• care coverage choices that offer the
• optimal combination of choice,
• value, quality, and service.
• -California AB 1602

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Critical Decisions

• How will the
• Exchange be
• governed?

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Critical Decisions

• Of the 16 states that have Exchanges
• 7 prohibit representatives of insurers or brokers
  from serving on the Board of Directors
• 6 allow or require representatives of insurers or
  brokers to serve on the Board of Directors
• 3 have not addressed this issue

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Critical Decisions

• The Navigator
• Program

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Critical Decisions

• The Navigator program should serve
• 300,000 previously uninsured
• People with language or culture barriers
• People with disabilities
• People who haven't been able to afford insurance

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Critical Decisions

1. Full Medicaid Expansion to 138 FPL
2. Basic Health Plan for MNCare population
3. Active Purchaser Exchange
4. Conflict-free Exchange Board
5. Community-Based Navigator Program

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Q A
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• Anna Odegaard
• anna.odegaard_at_seiuhealthcaremn.org