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Leni Preston, [email protected](301) 351-9381
© 2012 Maryland Women’s Coalition For Health Care Reform
About the Coalition
• Nonpartisan alliance of individuals and 81 state-wide organizations committed to meeting the health care needs of all Marylanders
• National Partners– Raising Women’s Voices –National Women’s Law Center–Open Society Institute - Baltimore
© 2012 Maryland Women’s Coalition For Health Care Reform
Coalition Mission
Work collaboratively with our members and partners to seek solutions and advance reforms to ensure that every resident of Maryland has access to affordable, comprehensive & high quality health care that is always there.
© 2012 Maryland Women’s Coalition For Health Care Reform
How We Achieve Our Mission
• Educate our members and supporters, elected officials and the public
• Reach out to all potential allies of reform• Engage our members in the reform
issues and debates• Advocate and take action, as a
Coalition and as individuals, to bring quality, affordable health care to every resident in Maryland.
© 2012 Maryland Women’s Coalition For Health Care Reform
Why Health Care Reform Is Important to Women• 80% of health care decisions are made
by women (Department of Labor).• In 2008, 1 in 4 women went without
necessary health care services.• Only 13% of plans in individual market
included comprehensive maternity care.
• Women have historically been charged more than men for health insurance.
© 2012 Maryland Women’s Coalition For Health Care Reform
Why It Matters to Maryland Women
• 15% (280,000) are uninsured in Maryland
• 56% are currently employed• A majority are under 200% FPL• 38.7% are Hispanic/Latino• 17.7% are African American• 10.4% are Caucasian
© 2012 Maryland Women’s Coalition For Health Care Reform
Patient Protections: What We Have Gained to DateBy 2011: • 51,868 young adults can stay on their
parents’ health plans• 52,234 seniors got help paying for their
prescription drugs• 1,153,000 individuals gained preventive
care coverage without co-pays or deductibles
• 2,251,000 no longer have to worry about lifetime limits for their care
© 2012 Maryland Women’s Coalition For Health Care Reform
The Patient Protection and Affordable Care ActA 3-Legged Stool:1.Everyone is “in”2.Personal responsibility3.Affordability
© 2012 Maryland Women’s Coalition For Health Care Reform
Affordability in the Affordable Care Act
• Expand Medicaid program: individuals with incomes up to 138% FPL.
• Tax-credits to individuals with incomes between 138% & 400% FPL.
• Tax credits for small businesses.• Creates Individual and Small Business
Health Options Exchanges.• Qualified health plans – 4 “metal”
levels© 2012 Maryland Women’s Coalition For Health Care
Reform
The Health Benefit Exchange:A Health Insurance Supermarket• Exchange will
describe each plan in a standard format– Monthly cost and
co-pays– Plan performance
on quality measures
– Plan ratings by quality and price
• Compare Apples to Apples
• Can’t decide between a Fuji and a Rome? Get help!– Website– Telephone hotline– Navigators
© 2012 Maryland Women’s Coalition For Health Care Reform
Maryland: A National Leader
• Commitment and Leadership
• Effective Process:– Health Care Reform
Coordinating Council;
– Office of Health Care Reform; &
– Health Benefit Exchange Board
• Roadmap
© 2012 Maryland Women’s Coalition For Health Care Reform
Health Benefit Exchange Timeline
© 2012 Maryland Women’s Coalition For Health Care Reform
Source: A Report to the Governor and Maryland General AssemblyMaryland Health Benefit Exchange, December 23, 2011, p. 1
Landmark ACA Legislation signed into Law 3/23/2010 by President ObamaLandmark ACA Legislation signed into Law 3/23/2010 by President Obama
Maryland’s Health Benefit Exchange Act of 2011• Public corporation/independent unit of state
government • 9-member board• Key goals:
– Reduce number of uninsured– Facilitate purchase and sale of Qualified Health
Plans– Require cultural competency in all operations to
ensure all populations can gain access– Financially self-sustainable– 6 Legislative Studies
© 2012 Maryland Women’s Coalition For Health Care Reform
Creating the Exchange: Stakeholder InputFour Advisory Committees• Operating Model (Market Rules & Risk
Mitigation)• SHOP (Small Business Exchange)• Navigator Program (Marketing & Public
Relations)• Financing
© 2012 Maryland Women’s Coalition For Health Care Reform
Creating the Exchange: Stakeholder Representation
© 2012 Maryland Women’s Coalition For Health Care Reform
Source: A Report to the Governor and Maryland General Assembly, Maryland Health Benefit ExchangeDecember 23, 2011, p. 2
Health Benefit Exchange Act of 2012
• Active Purchasing• Small Business Health Options
(SHOP)• Navigator Program• Essential Health Benefits• Financing
© 2012 Maryland Women’s Coalition For Health Care Reform
SHOP – What is It?
• Marketplace where small employers & nonprofits (under 50 employees) can purchase insurance.
• Tax credit available through 2016
© 2012 Maryland Women’s Coalition For Health Care Reform
SHOP Proposals
• Create separate SHOP exchange.• Retain small group size at 50 until 2016.• Provide two options:– Employers select metal level &
employees choose among carriers at that level
– Employers select one carrier & employees select the metal level that meets their needs
– Consider additional options in 2016© 2012 Maryland Women’s Coalition For Health Care
Reform
Navigator Program Proposals
• Individual Exchange – CBOs & similar organizations
• SHOP – Producers
© 2012 Maryland Women’s Coalition For Health Care Reform
What to Watch - Navigator
© 2012 Maryland Women’s Coalition For Health Care Reform
Essential Health Benefits (EHB)• HHS: States to Select Benchmark Plan with 10 Categories
of Services– Ambulatory patient services– Emergency services– Hospitalization– Maternity & newborn care– Mental health & substance use disorder services– Prescription drugs– Rehabilitative & habilitative services & devices– Laboratory services– Preventive & wellness services & chronic disease
management– Pediatric, including oral & vision care
© 2012 Maryland Women’s Coalition For Health Care Reform
EHB: Coalition Proposals
• Stakeholder & consumer group to advise HCRCC
• Guidance– Balance benefits in each of the 10 mandated categories.– Specificity in defining health services to ensure
comprehensive care according to national standards.– Require that there be equal actuarial values.– Provide mental health & substance use disorder benefits in
parity.– Do not permit benefit design that discriminates on basis of
age, gender, disability, or expected length of life.
© 2012 Maryland Women’s Coalition For Health Care Reform
What to Watch - EHB
• Our Principals:
© 2012 Maryland Women’s Coalition For Health Care Reform
Resources You Can Use
• Maryland – Health Benefit Exchange
www.dhmh.maryland.gov/healthreform/exchange/index.html
– Department of Health & Mental Hygienewww.dhmh.maryland.gov
– Maryland Health Insurance Plan (MHIP)www.marylandhealthinsuranceplan.state.md.us
– Health Care Reform Coordinating Councilwww.dhmh.maryland.gov/healthreform/index.html
• Federal– Department of Health & Human Services
www.healthcare.gov
© 2012 Maryland Women’s Coalition For Health Care Reform
Stay Informed & Get Involved
• Join the Coalition– Newsletters, Alerts, Member Calls & Webinars– 2012 educational forums: Spring/Summer at
locations to be determined and September 8 – Health Care. Women of Color Get It! in Baltimore
– Facebook and Twitter• Encourage others to join• Learn more about SHIP and your local health
action coalition – www.dhmh.maryland.gov/ship• Share your stories MDHealthCareReform.org
© 2012 Maryland Women’s Coalition For Health Care Reform
© 2012 Maryland Women’s Coalition For Health Care Reform
Leni Preston, ChairPhone: (301) 351-9381E-mail: [email protected] Website: www.MDHealthCareReform.org