Return to KaiserEDU Tutorials Figure 1 Health Care Reform and The NM Health Insurance Exchange.

Return to KaiserEDU Tutorials

Figure 1

Health Care Reform and The NM Health Insurance Exchange

http://www.kaiseredu.org/tutorials_index.asp

Meeting Purpose


Figure 1

Present a brief Introduction into Health Care Reform and Health Exchanges

Sangre de Cristo will be meeting with as many of the local behavioral health collaboratives across the state as possible in order to gather information for the Health Exchange.

Information will be gathered by a combination of focus group discussions and a structured questionnaire.


Health Reform: An Overview


Figure 1

The Patient Protection and Affordable Care Act (PPACA) of 2010 (Health Care Reform) authorized State Planning and Establishment Grants to help each individual state like NM to establish a “Health Insurance Exchange”

By 2014, most people will be required to have health insurance


• Expand health insurance coverage

• Improve coverage for those with health insurance

• Improve access to and quality of care

• Control rising health care costs

Goals for Health ReformFigure 2



Promoting Health Coverage

Medicaid Coverage

(up to 133% FPL)

Employer-Sponsored Coverage

Exchanges(subsidies 133-400%

FPL)

IndividualMandate

Health Insurance Market Reforms

Universal Coverage

Figure 3



Expanding Health Insurance Coverage—Early Actions

• Create temporary Pre-existing Condition Insurance Plan for people with medical conditions who are uninsured

– To qualify, individuals must be uninsured for six months

– Federally funded

– Available in each state until 2014

• Allow adult children to remain on their parents’ health insurance policy until age 26

– Children do not have to live with parents, nor be students

– May be married, but spouses and children not eligible

Figure 4



• Expand Medicaid to all individuals under age 65 with incomes up to 133% of the poverty level ($14,400/individual or $29,300/family of 4)

• Create new Health Insurance Exchanges where individuals and small employers can purchase coverage

• Provide premium subsidies to eligible individuals and families with incomes up to 400% of the poverty level ($43,300/individual or $88,200/family of 4) through the Exchanges

Expanding Health Insurance Coverage—in 2014

Figure 5



Improving Health Insurance

• Reform the health insurance market– Prohibit insurers from denying coverage or charging

people more because they are sick

– Prohibit insurers from rescinding coverage or placing annual or lifetime limits on coverage

• Improve benefits for those with insurance– Ensure coverage of preventive services with no cost-

sharing

– Establish minimum benefit standards

– Limit out-of-pocket spending for consumers

Figure 7



Employer Requirements and Incentives

• Larger employers that don’t offer affordable coverage will face penalties of up to $2,000 per full-time worker per year beginning in 2014

• Small employers with up to 50 employees will be exempt from penalties

• Tax credits available for some small businesses that offer health benefits

Figure 8



Individual Mandate

• Individuals will be required to have health coverage that meets minimum standards in 2014

• Individual mandate spreads costs among whole population

• Mandate enforced through the tax system

• Penalty for not having insurance: greater of $695 (up to $2085 for family) or 2.5% of family income

• Exemptions for certain groups and if people cannot find affordable health insurance

Figure 9



Some Uninsured Will Remain

• Congressional Budget Office (CBO) estimates 23 million uninsured in 2019

• Who are they?– Immigrants who are not legal residents– Eligible for Medicaid but unenrolled– Exempt from the mandate (most because can’t

find affordable coverage)– Choose to pay penalty in lieu of getting coverage

• Many remaining uninsured will be low-income

Figure 10



Health Reform and Delivery System Changes

• Promoting primary care and prevention

• Improving provider supply

• Developing new models for coordinating and delivering care

• Making use of information technology

• Reforming provider payments to promote quality

Figure 11



Promoting Primary and Preventive Care

• Increased Medicare and Medicaid payments for primary care providers

• Incentives for new doctors and other health professionals to practice primary care

• No cost-sharing in Medicare and new private plans for certain preventive services and incentives for states to do same in Medicaid

• Funding for population-based prevention activities

Figure 12



Improving Health Care Quality

• Development of a national quality strategy

• Coordinated care through medical homes and other models

• Quality-based payments for health care providers and improved information on provider quality

• Comparative effectiveness research to identify most effective treatments and interventions

• Enhanced data collection to address health care disparities

Figure 13



Containing Health Care Costs

• Greater oversight of health insurance premiums and insurer practices

• Increased competition and price transparency through Exchanges

• Provider payment reforms in Medicare

• Testing of new, more efficient delivery system models in Medicare and Medicaid

Figure 14



Health Insurance Exchanges


Figure 1

• What is a Health Insurance Exchange?

• What is Health Insurance Exchange Supposed to Do?

• How will the Health Insurance Exchange do this?

• What about any behavioral health needs and concerns that I might have?


Health Insurance Exchanges


Figure 1

• Offer a choice of health plans based on cost and quality of benefits

• Provide information to help understand the options available

• Provide “one-stop shopping” to compare, select, and enroll in health plans

• Help eligible individuals receive premium discounts or enroll in other federal or state healthcare programs like Medicaid


Health Exchange Survey


Figure 1

– What will make the New Mexico Health Insurance Exchange useful to you?

– What other services would you like to see in the health insurance plans offered through the exchange beyond those that are required?

– How can the exchange provide clear information that describes the benefits and limitations of the health insurance plans, allowing you to make an informed choice?


Health Exchange Survey


Figure 1

– What would be the most important features you would look for when comparing health insurance plans?

– What are the best ways to inform you about the role of the exchange and the services available (e.g., internet, toll-free call center, customer service center, etc.)?

– Do you believe the exchange will benefit you? Why? Why not?


Future of Health Reform: Legislation Is Just the Beginning

• Implementation will be challenging– Guidance and federal oversight needed

– Resources for infrastructure and capacity building

– Policy and political challenges

• Health reform provides opportunities to improve our health care system– Reduce the number of people who are uninsured

– Make the health insurance system work better for all consumers

– Transform delivery and payment systems to get better value

– Reorient health care to focus on prevention and primary care

Figure 17




Figure 1Let’s Complete the Survey

Please know that your answers will be kept strictly confidential

If you have any Questions

Please let us know.

[email protected]

If you know of someone interested in completing the survey please visit our

Web site atsdcchp.org and click on health

insurance exchange link


mailto:[email protected]

Special Thanks To

Jennifer TolbertAssociate Director

Kaiser Commission on Medicaid and the Uninsured

for KaiserEDU.org

September 2010


Figure 1


Resources

• Kaiser Family Foundation: http://healthreform.kff.org/

• New DHHS consumer website: http://healthcare.gov/

• Alliance for Health Reform: http://www.allhealth.org/

• National Association of Insurance Commissioners: http://www.naic.org

• National Governors Association: http://www.nga.org

Additional KaiserEDU tutorials:

• Health Care Reform: A Retrospective:http://www.kaiseredu.org/tutorials/retrospective-health-reform/player.html

• Health Reform: How Will Medicaid Change?:http://www.kaiseredu.org/tutorials/medicaid-and-health-reform/player.html

• Health Reform and Medicare:http://www.kaiseredu.org/tutorials/Medicare-and-health-reform/player.html

Figure 18


Return to KaiserEDU Tutorials Figure 1 Health Care Reform and The NM Health Insurance Exchange.

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