+ All Categories
Home > News & Politics > Legislative Webinar - December 3, 2010

Legislative Webinar - December 3, 2010

Date post: 12-Jan-2015
Category:
Upload: benefitmall
View: 2,004 times
Download: 0 times
Share this document with a friend
Description:
 
39
Beyond the Headlines: Health Care Reform Update and Analysis
Transcript
Page 1: Legislative Webinar - December 3, 2010

Beyond the Headlines:Health Care Reform Update and

Analysis

Page 2: Legislative Webinar - December 3, 2010

Health Care Reform Law

The Patient Protection and Affordable Care Act (P.L.111-148)

• Generally being referred to as PPACA or the Affordable Care Act (ACA)

• Signed into law by President Obama on March 23, 2010• The Health Care and Education Reconciliation Act of 2010

signed March 30, 2010• Requires a phasing-in of changes from 2010 – 2018 with key

changes taking place in 2014• Health and Human Services (HHS) Secretary Sebelius and her

staff central to the process

Page 3: Legislative Webinar - December 3, 2010

President Obama: Why We Need Reform

Statement made at the White House on June 22, 2010

In reference to an implementation planning

meeting with key insurance executives and regulators, the

President noted:

“It’s reform that brings -- that begins to bring down our government’s long-term structural deficit. It’s reform that

finally extends the opportunity to purchase coverage to the millions who currently don’t have it -- and

includes tough new consumer protections to guarantee greater

stability, security and control for the millions who do have health

insurance.”

Page 4: Legislative Webinar - December 3, 2010

Two Original PPACA Goals

•Attempt to better manage the cost of chronic care

•Reduce ER visits

•Manage hospital readmissions

Bend the cost curve by expanding access to affordable health

coverage

•Reporting requirements

•Improve outcomes

•Reduce medical errors

•Implement wellness programs

Promote quality through a more transparent and

accountable health care system

Page 5: Legislative Webinar - December 3, 2010

Expands Access to Coverage

Requires most U.S. citizens and legal residents to have health insurance coverage

Requires employers to offer health coverage or pay penalties

Requires states to create health care exchanges for individuals and small businesses to obtain coverage (2014)

Expands Medicaid eligibility to 133% of the FPL

Creates a temporary national high risk pool to provide coverage to individuals with pre-existing condition exclusions

Creates temporary employer subsidies for pre-Medicare retiree coverage

Page 6: Legislative Webinar - December 3, 2010

Emphasis on Improving Health Outcomes

Establish National Prevention, Health Promotion and Public Health Council to coordinate federal activities

$7 billion in funding for 2010-2015 prevention, wellness, health screenings and research

Grants for wellness and prevention programs

Permit expanded incentives for wellness programs

National quality improvement strategy to improve patient health outcomes

Page 7: Legislative Webinar - December 3, 2010

Who are the Key Players at the Federal Agency Level?

Kathleen SebeliusSecretary, Department

of Health and Human Services

Jay AngoffDirector, Office of

Consumer Information and Insurance Oversight, HHS

Department

Donald Berwick

Director, Health and Human Service’s Agency for Healthcare Research

and Quality

Carolyn Clancy

Director-designate, Centers for Medicare and

Medicaid Services

David BlumenthalNational Coordinator

for Health Information Technology

Jeanne Lambrew

Director of Health and Human Service’s Office

of Health Reform

William CorrDeputy Health and

Human Services Director

Page 8: Legislative Webinar - December 3, 2010

Understanding the Impact of the Recent

Election Results on Health Care Reform

The Recent Election Results

• To understand what happened

• Where it happened• What it means to your clients• What it means to you

Page 9: Legislative Webinar - December 3, 2010

Key Questions

• Was this past election a Republican tsunami?• Was it a mandate, or simply a temporary restraining order on

the Democrats?

Page 10: Legislative Webinar - December 3, 2010

/

2008 U.S. House of RepresentativesElection Results

Source: WashingtonPost.com

Page 11: Legislative Webinar - December 3, 2010

2010 U.S. House of RepresentativesElection Results

Source: WashingtonPost.com

Page 12: Legislative Webinar - December 3, 2010

What is the impact of the election on the U.S. House of Representatives?

.

•Control the House Ways and Means Committee from which all federal taxation and spending authorizations must originate.

•Attempt to influence domestic policy be refusing to fund significant Democrat Party initiatives including part of PPACA.

•Attempt to further forestall the Obama Administration’s policy initiatives through repeated House investigations and hearings.

The Republicans

will:

•Have difficulty moving forward on its domestic policy without control of the House.

•As a group, be more liberal since 34 Blue Dog Moderate Democrats lost their seats in the 2010 election.

The Democrats will:

Page 13: Legislative Webinar - December 3, 2010

2010 U.S. Senate Election Results

.

.

The Republican Party picked up six U.S. Senate

seats.

Source: NYTimes.com

Page 14: Legislative Webinar - December 3, 2010

2012 U.S. Senate Election Prospects

.

On November 2, 2012:•Will

have to defend 23 Senate seats including the two held by independents who vote with them.

Democrats

•Hold 10 Senate seats up for grabs in two years.

•Must gain 3-4 Senate seats in 2012 in order to gain control of the Senate.

Republicans

•Should Barack Obama win reelection, the GOP will need four Senate seats to break a Senate tie.

•Should the Republicans win the presidency they will need just three party switches from Democrat to Republican to seize the Senate majority.

Next President

Source: RightPundits.com

Page 15: Legislative Webinar - December 3, 2010

During the November 2, 2010 election,

Republicans and Democrats vied for seats in 87 state legislative

chambers where 6,115 seats were up for grabs.

State Legislative Elections

Source: AmericanThinker.com

Page 16: Legislative Webinar - December 3, 2010

GOP Gains

• Alabama – House and Senate• Colorado – House• Indiana – House• Iowa – House• Maine – House and Senate• Michigan – House• Minnesota – House and Senate• Montana – House• New Hampshire – House and

Senate• North Carolina – House and Senate• Ohio – House• Pennsylvania – House• Wisconsin – Assembly and Senate

Undecided: New York - SenateSource: NCSL.org

Page 17: Legislative Webinar - December 3, 2010

State Legislatures Before the Election

Source: NCSL.org

Page 18: Legislative Webinar - December 3, 2010

State Legislatures after the Election

Source: NCSL.org

Page 19: Legislative Webinar - December 3, 2010

State Echo Effect•State

legislatures will be less likely to support national health care reform

•State legislatures will be less likely to approve comprehensive Exchanges

The immediate impact of these

changes is that, in general:

Source: ABCnews.com

Page 20: Legislative Webinar - December 3, 2010

http://www.polidata.org/census/st009nca.pdf

2010 U.S. House of RepresentativesElection Results

The redistricting process may

result in as many as an additional

25 US House seats for the Republicans.

Source: Polidata.org

Page 21: Legislative Webinar - December 3, 2010

Long Term effects of new Republican Majorities in State Houses

Redistricting 

Republicans took control of at least 19 Democratic-controlled state legislatures, and haven't

controlled as many state legislatures in general since

1928. Currently, legislatures in 44 states are responsible for

redistricting. 

Source: ABCnews.com

Page 22: Legislative Webinar - December 3, 2010

State Governorships Before the Election

Prior to the November 2, 2010

Gubernatorial elections, there

were 29 Democrat Governors and 21

Republican Governors.

Source: Wikipedia.org

Page 23: Legislative Webinar - December 3, 2010

State Governorships After the Election

Source: WashingtonPost.com

Page 24: Legislative Webinar - December 3, 2010

State Insurance Commissioners

Appointment/Election Process

• 35 of the 50 State Insurance Commissioners are appointed by their state governors.

• 11 State Insurance Commissioners hold elected positions.• Four of those were standing for election this year.

New Wave of Insurance Commissioners• Due to this election, there will be an unusually large influx of

new Insurance Commissioners (both Republican and Democrats)

Source: InsuranceJournal.com

Page 25: Legislative Webinar - December 3, 2010

NAIC Activities Under PPACA

Among other responsibilities, the NAIC has held meetings since March developing the following:

• Uniform Explanation of Coverage • Uniform Enrollment Forms• Uniform Definitions• Uniform Group Summary • A Model Act for State Exchanges• Revised Rate Filing Model Act• Medical Loss Ratio Computations• Model Medical Loss Ratio Definitions • Modifications to the Blank Filing Form

Source: InsuranceJournal.com

Page 26: Legislative Webinar - December 3, 2010

The Effect of the Election On The NAIC

The 2010 Election had a profound effect on the NAIC:

As many as 2/3rds of the state insurance commissioners might change.

After the election, half of the NAIC officers either lost their election or may lose their appointment.

Critical States such as Ohio, Pennsylvania, Florida, California, New York, and others will most likely appoint new Insurance

Commissioners.

Source: InsuranceJournal.com

Page 27: Legislative Webinar - December 3, 2010

Insurance Commissioner Turnover

The Large Turnover had One Serious Implication for Brokers and General Agents:

The NAIC established a task force to address potential adverse impacts on the role of licensed health insurance agents and

brokers resulting from the new federal health care reform law. "With the recent issuance by HHS of the medical loss ratio (MLR)

regulations to be imposed on insurers, there is a very real possibility the role of health insurance agents will be impacted in

a negative way," said Florida Insurance Commissioner Kevin McCarty. "Health insurance is a complex product and

experienced and licensed agents are a valuable resource for consumers. We intend to work with the agent community and our

colleagues at HHS to maintain that resource."

Source: InsuranceJournal.com

Page 28: Legislative Webinar - December 3, 2010

The Legislative bodies, regulatory agencies, and associations listed below are all potential entry points to further define, implement

and launch health care reform initiatives.

Federal statute (i.e., Congress)

Federal regulations (e.g., CMS,

HHS)

State statute State regulation

Agency bulletins

Attorney general opinions

Federal and state court decisions

Official office interpretations

Government as purchaser (e.g., OPM)

Government as grant

funder (e.g., AHRQ)

Government research (e.g.,

NIH)

Government associations (e.g., NAIC, NGA, NCSL)

The Implementation ChallengePPACA is just One Part of the Health Care Reform Puzzle:

Other Sources of Government Oversight

Page 29: Legislative Webinar - December 3, 2010

PPA Pressure Points

Establish a level

playing field

Using navigators who can make a

difference

Promoting informed decision-making

Making a realistic financial

commitment

Realizing there are limits to

cost cutting

Establish appropriat

e legal foundation

s

Implement the right

proportions

Ensuring the

availability of clinical resources

Consider other

challenges

Page 30: Legislative Webinar - December 3, 2010

How will all of the terms be define,

regulations drafted, and programs implemented?

How will the high risk pools and other benefits

be paid for (since the economy is still

struggling and we are supporting the war)?

How will Federal and State Programs interface?

Will the new federally-sanctioned

reform programs override private

sector initiatives?

Does HHS and the other federal

agencies have enough resources?

How will the market insurance reforms be

implemented in a meaningful way?

Will the reforms really reduce

costs and improve clinical

outcomes?

Hundreds and hundreds of unanswered questions.

Many, Many Questions

Page 31: Legislative Webinar - December 3, 2010

Funding electronic health record systems

Promoting evidence-based medicine

Establishing more transparency and accountability through more outcomes research

Requiring more quality improvement and patient safety

Promulgating some of the basic insurance reforms

Expanding prevention programs and wellness programs

PPACA Positives

Source: DHHS.gov

Page 32: Legislative Webinar - December 3, 2010

Each State will have the opportunity to establish a Health Care Exchange by January 1, 2014.

If a state declines to create an Exchange, the federal government will operate one within the

state.

An Exchange is envisioned by PPACA to serve as a central marketplace for health care consumers.

Health Care Exchanges

Page 33: Legislative Webinar - December 3, 2010

It is supposed to allow small groups and individuals to access the health

insurance on a large group basis.

Individuals or small businesses

will be able to compare the costs of various health

plans and different types of health

coverage benefits.

Small businesses with 100

employees or less can purchase

health coverage for their

employees in an Exchange.

Beginning in 2017, the states may

allow businesses with more than

100 employees to purchase

coverage in the Exchange.

More on Exchanges

Page 34: Legislative Webinar - December 3, 2010

PPACA was passed with the recommendation that states contract with “Navigators” to provide

information about the available health plans.

The Navigator Concept?

Page 35: Legislative Webinar - December 3, 2010

What will be the impact of the changes in the U.S. House of

this election and the impending 2010 Census-

driven redistricting?

Eric Cantor, the odds on favorite for the post of

Majority whip, has stated that “ he hopes to “put a repeal bill on the floor right away."

Failing that, the Republican Majority may simply choose to refuse to allocate funding

for the implementation of the PPACA…

What is next for Congress?

Page 36: Legislative Webinar - December 3, 2010

While the two sides may differ on the exact definition of “tweaking” the following list may meet with some success at being “tweaked” away.• Revocation of the 1099 Filing Provision that obligates the filing of a

1099 for every transaction in excess of $600.• The individual purchase mandate.• The Medicare Fix in which Medicare was used to keep the stated costs

of the Act below One Trillion Dollars over 10 years. This provision has caused significant concern for seniors who see the cut decreasing the numbers of physicians who would accept a Medicare patient.

Short Term Congressional Fixes

Page 37: Legislative Webinar - December 3, 2010

 • A complete repeal.• An attempt to repeal specific

elements of PPACA .• Attempts to substitute elements of

PPACA with more centrist provisions that can gain moderate democrat votes.

• Cutting off funding for key reform activities such as the Exchanges.

• Holding hearings to spotlight the imperfections of Reform.

  

Republican Options for Combating Reform

Page 38: Legislative Webinar - December 3, 2010

 Must continue to demonstrate value in the ever-changing U.S. health care system

• Bring experience to the table.• Stay current and develop new expertise.• Help carriers become more efficient.• Actively participate in the regulatory rulemaking process.• Stay connected with customer base.• Become part of the solution.

Brokers & Agents Make A Difference

Page 39: Legislative Webinar - December 3, 2010

Thank You


Recommended