Powerpoint from Greg Matis at Community Forum

598 views
471 views

Published on

Greg Matis, Senior Counsel for Intermountain Healthcare, presents information on the Affordable Care Act at the KPCW and Intermountain Park City Medical Center Community Forum on Healthcare Reform. December 2, 2013. These slides are referred to in an accompanying podcast.

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
598
On SlideShare
0
From Embeds
0
Number of Embeds
199
Actions
Shares
0
Downloads
5
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • APTC is based upon second lowest silver plan, but any level can be selected.
  • Powerpoint from Greg Matis at Community Forum

    1. 1. Affordable Care Act Overview Park City Community Forum Jim Santy Auditorium December 2, 2013
    2. 2. Federalism Florida v. Dept of HHS “This case is not about whether the Act is wise or unwise legislation, or whether it will solve or exacerbate the myriad problems in our health care system. In fact, it is not really about our health care system at all. It is principally about our federalist system, and it raises very important issues regarding the Constitutional role of the federal government.” Judge Vinson 2
    3. 3. “The shepherd drives the wolf from the sheep's throat, for which the sheep thanks the shepherd as his liberator, while the wolf denounces him for the same act as the destroyer of liberty. Plainly, the sheep and the wolf are not agreed upon a definition of liberty.” 3
    4. 4. 5 Big Insurance Changes in 2014
    5. 5. Five Big Insurance Changes in 2014 1. 2. 3. 4. 5. Everyone qualifies for coverage Everyone is required to have coverage Some people get financial help Coverage and costs are changing There are new shopping choices (place and products) 5
    6. 6. 1. Everyone Qualifies for Coverage     Guarantee issue/renewal No medical underwriting No Pre-existing condition exclusions Your coverage can’t be denied or delayed because of your health or claims experience  No waiting periods longer than 90 days  Community rating in the Individual and Small Employer markets 6
    7. 7. 2. Everyone is Required to Have Coverage  Well, mostly everyone. Exceptions to the mandate may apply to the following: • • • • Those with religious objections Incarcerated individuals American Indians Those for whom the lowest-cost health coverage is more than 8 percent of household income • Undocumented immigrants • Those with incomes below the filing threshold 7
    8. 8. 2. Everyone is Required to Have Coverage  Penalty starts small • 2014 - $95 per adult, $47.50 per child • Max of $285 per household or 1 percent of the household income  Penalties increase each year • 2016 and beyond - Up to $2,085 per household or 2.5 percent of household income 8
    9. 9. 2. Everyone is Required to Have Coverage Large Employer Mandate • Large Employers (>50 FTEs) penalized for not providing coverage to their full-time employees (30 hrs/week)  Two kinds of penalty: • Failure to offer full-time employees minimum essential coverage; and • Failure to offer full-time employees affordable coverage or provide minimum value.  Delayed a year until 2015 9
    10. 10. 3. Some Get Financial Help  Individual Subsidies • • Advanced Premium Tax Credits Cost-share reductions  Small Employer Tax Credits • • • • Requires low-wage (<$50K), small (<25 employees) workforce Moves from 35% to 50% in 2014 (two years eligibility) Employer must pay a uniform percentage of at least 50% of the premium cost Employer must purchase a Qualified Health Plan on the Marketplace 10
    11. 11. 3. Some Get Financial Help Individual Subsidies Available to those who: • • • • Don’t get insurance through their work Aren’t eligible for a public plan like Medicare, Medicaid, or CHIP Have an annual income that’s between 100-400 of the Federal Poverty Level For a family of four—that goes all the way up to $94,000 a year 11
    12. 12. Calculation of Premium Tax Credit Monthly Maximum Premium Income as a Percent of FPL Max Premium as a Percent of Income Up to 133% 2% $ 25 $ 51 133-150% 3-4% $ 56 $ 115 150-200% 4-6.3% $ 117 $ 242 200-250% 6.3-8.05% $ 187 $ 387 250-300% 8.05-9.5% $ 265 $ 547 300-400% 9.5% $ 310 $ 730 Single Family of 4
    13. 13. Cost-sharing Reduction • Cost-sharing must be reduced for individuals enrolled in a silver plan in the exchange with incomes up to 400% of the Federal Poverty Level (FPL). For 2014: Family Income as a % of FPL AV Level Maximum Out-of-Pocket Single/Family 100-150% 94% $2,250/$4,500 150-200% 87% $2,250/$4,500 200-250% 73% $5,200/$10,400 250-400% 70% $6,350/$12,700 (no reduction) 13
    14. 14. 4. Coverage and Costs are Changing Coverage  Essential Health Benefits (Individual and SE) • • • Preventive Maternity Mental Health and Substance Abuse Treatment  No annual or lifetime dollar limits  Deductible and out-of-pocket costs are capped • • Small employer deductible caps: $2000 single/$4000 family Out-of-pocket maximum: $6350 single/$12700 family 14
    15. 15. 4. Coverage and Costs are Changing Costs  What will cause premiums to rise? • • The coverage changes, e.g., expanded mental health and maternity benefits, first-dollar preventive, essential health benefits More high-risk individuals buying coverage (who were previously uninsured or covered by a high-risk pool) 15
    16. 16. 4. Coverage and Costs are Changing Costs  What will cause premiums to fall? 16
    17. 17. Premiums don’t fall—they only have a lower rate of increase. 17
    18. 18. 4. Coverage and Costs are Changing Typically true. But in this case, costs actually may be lower for those who:  Qualify for new federal subsidies available through the Health Insurance Marketplace  Previously paid high premiums as a result of their health condition or age 18
    19. 19. 5. There are new shopping choices  Medicaid Expansion • • Up to each state to decide Utah decision still pending  Health Insurance Marketplace (fka Exchange) • Utah’s Marketplace is split: with a Federally Facilitated Marketplace (FFM) for Individual coverage; and a stateadministered marketplace for small employers (Avenue H)  New Products • Catastrophic plan for <30’s 19
    20. 20. Federally Facilitated Marketplace: Update
    21. 21. 21
    22. 22. 22
    23. 23. The FFM: Observations 1. There is still plenty of time:  December 23—Deadline for enrolling in 2014 coverage  March 31—Deadline for avoiding a penalty  March 31—Open enrollment deadline 2. Subsidies should drive enrollment—but the big game-changer is continuing functionality problems 3. Breaking news: FFM SHOP delayed a year—Doesn’t affect Utah 4. We are at a critical junction 5. Marketplace has definitely improved 6. Expect more announcements and legislative developments if the improvements are insufficient 23

    ×