EANJ’s 96th Annual Meeting 2012

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Healthcare, ACA, PPACA, Obamacare

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EANJ’s 96th Annual Meeting 2012

  1. 1. 96th Annual Meeting 2012 How will the Supreme Court decide healthcare reform? 1
  2. 2. Sponsors Insurance Professionals Insurance Group 2
  3. 3. Patient Protection and Affordable Care Act March 23, 2010 A New Era for America 3
  4. 4. U.S. Supreme court heard oral argument on the constitutionality of the Affordable Care Act on March 26-28, 2012 4
  5. 5. U.S. Health Care Spending About 16% of the U.S. economy (in 1950, 5%) Estimated $2.24 trillion in 2009 Most health care spending per capita in the world 5
  6. 6. 6
  7. 7. Who is Insured? Most people are insured through an employersponsored plan (177 million Americans, 62% of people are under age 65)  99% of employers with 200 or more employees offer health insurance  78% - 10 to 24 employees  49% - 3 to 9 employees 7
  8. 8. Who is Insured (continued) About 70 million Americans are insured under a “public plan”  Medicare  Medicaid Government spends about 42% of every dollar spent on health care 8
  9. 9. The Uninsured Estimated 46 million Americans lack health care insurance (15% of U.S. population) 9
  10. 10. Who Are The Uninsured?  27 million have personal income over $50,000  66% of uninsured have family incomes of $45 - $85,000  14 million are eligible for Medicaid on the Children‟s Health Insurance Program  10 million „illegal‟ aliens  1/3 are between 18 to 29 years of age  In New Jersey, 1,057,000 people (about 15% of the population)  About 650 New Jerseyans lose health care insurance every day 10
  11. 11. Insurance Reform and Consumer Protections  Dependent coverage to age 26 (2010)  Children with pre-existing conditions cannot be denied coverage (2010)  No denial for pre-existing conditions eliminated (2014)  No Charge for annual wellness visit (2014)  Guaranteed issue policy (2014)  Modified community ratio (2014)  80 – 85% medical loss ratio (2014) 11
  12. 12. All plans must provide Essential Health Benefits “Essential Health Benefits” requires minimum set of benefits, with no lifetime of annual coverage limits         Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance abuse coverage Prescription drugs Rehab services and medical devices Preventative and wellness/chronic disease management 12
  13. 13. “Free” Preventive Care No Co-pays No out-of-pockets No deductibles 13
  14. 14. Health Delivery Reforms  Facilitating Accountable Care Organizations.  Research on best provider practices  Research on comparative evidence outcomes  Pilot program that pays for outcomes on flat fee basis rather than fee for service for treatments  Medical IT  Standards for extended living arrangements  Hospice, home-health reimbursement 14
  15. 15. Community Investment  Health Care Clinics  Primary Care Training  Grants to States  Diversity and Cultural Competency  Education Curricula Development in Health Sciences  Food Labeling 15
  16. 16. New Jersey‟s Cost Spiral Premiums have increased on average 14% per year, for 12 consecutive years 16
  17. 17. N.J. Employer-Plan Crisis  Premiums have grown 5-times faster than wages since 1999.  2000 – 2010, cost of family policy has gone up 110% in New Jersey.  Average employee contribution has gone up 200% since 2000.  Out-of-pocket and co-payments have gone up 115% since 2000. 17
  18. 18. N.J. Small Employer Benefits Program (2-50 employees) 2011 – 770,000 covered lives Down 17% from 2000 (Affiliated Physicians and Employers Health Plan has increased 48%) 18
  19. 19. Affordable Care Act will provide subsidies and tax breaks to individuals and small employers for the purchase insurance 19
  20. 20. The Health Insurance Exchange Uninsured individuals not eligible for Medicare or Medicaid will be permitted to purchase insurance through state Exchanges (purchasing pools). Employers with fewer than 100 employees will be permitted to enroll. Employer eligibility may be expanded in 2017. 20
  21. 21. 13 states and the District of Columbia, have passed a heath care exchange law On May 10, 2012 Governor Christie vetoed the N.J. Health Exchange Act. 21
  22. 22. Minimum Essential Coverage Requirement (the Individual Mandate 2014) A federal requirement that individuals purchase health care insurance or pay penalty up to 2.5% of income as penalty or capped at $95 in 2015 rising to $695 in 2016. 22
  23. 23. Hospitals, physicians, insurance companies and others agree that without the Individual Mandate the consumer protection and benefits reforms would ruin the health care market 23
  24. 24. Will the U.S. Supreme Court declare the Affordable Care Act constitutional? 24
  25. 25. Florida v. Dept. HHS 11th Cir. Court of Appeals (2011) Individual Mandate is unconstitutional Seven Sky v. Holder U.S. Court of Appeals – DC (2011) Individual Mandate is constitutional Thomas Moore Center v. Oblama 6th Cir. Court of Appeals (2011) Individual Mandate is constitutional 25
  26. 26. What will the Court do?  Uphold the Act in its entirety.  Invalidate the Individual Mandate but leave the rest of the Act intact.  Invalidate the entire Act.  Dismiss case as premature 26
  27. 27. Panel Discussion 27
  28. 28. The Affiliated Physicians and Employer Health Plan 28

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