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Health Care Reform<br />Overview<br />Providers’ View<br />Employers’ View<br />What we all need to watch<br />William Cus...
Agenda<br />Overview of reform<br />What does it mean for providers?<br />What does it mean for employers?<br />What we ne...
Total National Health Expenditures:$’s and as Share of GDP<br />
The Employment-Based Coverage System is Eroding<br />
ESI Benefits Limited for Small Firms<br />
Percentage of Uninsured by Firm Size of Family Head<br />Source: Tabulations of the March supplement to the Census Bureau’...
Overview of Reform:  Major Change Components<br />Medicaid Expansion<br />Changes in Private Coverage<br />Improving Healt...
Major Change Component:  Medicaid Expands Eligibility  (2014)<br />From “Poor AND….” to “Poor”<br />Everyone under 133% po...
Major Change Component  Private Coverage Changes 2010-2013<br />Insurance regulation<br />Expansions for children (no pre-...
Major Change Component:  Private Coverage Changes 2014<br />Community Rating<br />Health Insurance Exchanges<br />Individu...
Overview of Reform:  <br />More  Americans with health insurance coverage<br />
Remaining Uninsured<br />Over <br />Non-citizens (25-35%)<br />Low income populations (100-250% FPL)<br />High income vola...
Overview of Reform:  Financing<br />Insurance Premium Subsidies<br />Medicare Savings<br />+/- 1 trillion<br />+/- 1 trill...
Major Change Component:Improving Health Care Quality<br />Information<br />Focus on collecting, sharing and using<br />Coo...
Major Change Component:Focus on Heath<br />National health strategy council<br />Research & public health innovation<br />...
Provider View<br />Payer mix changes<br />Payment changes<br />Regulatory changes<br />
Providers:  Payer mix changesMore Georgians with health insurance coverage<br />
Providers:  Payment Changes<br />Incentives for integration<br />Accountable Care Organizations<br />Bundled payments<br /...
Providers:  Payment Changes<br />Rate cuts <br />Reduced Medicare Advantage payments<br />Reduction in update formula <br ...
Providers: Regulatory Changes to promote transparency & oversight<br />
Employer View<br />Why anemployer focus<br />What does it mean for employers right now?<br />Employer implications depend ...
Why an Employer Sponsored System?<br />Risk pools -> stabilize premiums<br />↓administrative costs<br />Purchasing experti...
Affordability<br />Declining participation rates<br />Employers shifting more cost to workers:<br />Increases since 2005: ...
What Does Reform Mean for Employers Now?<br />2010 Changes<br />Add in dependents < 27<br />Eliminate lifetime and annual ...
<25 Employees	<br /><50	<br />Employees<br />>50 Employees	<br />>200 Employees<br />Employer Implications Depend upon Num...
<25 Employees	<br />Tax Credits<br />Full Credits<br /><10 FTEs<br />Wages < $25,000<br />Phased out credits<br />10 to 24...
<25 Employees	<br />Tax Credits – 2010:  Examples<br />
State Decisions on Exchanges<br />
American Health Benefit Exchange <br />Individual Coverage<br />Administration of Subsidy<br />Medicaid Enrollment<br />Ch...
Individuals<br />American Health Benefit Exchange <br /><ul><li>Certify, price and rate plans </li></ul>Standardized benef...
<50<br />Employees<br />SHOP Exchange Purchasing<br />Certify, price and rate plans <br />Standardized benefit information...
>50<br />Employees	<br />Pay or Play<br />Penalties if full time workers obtain coverage in the Exchange<br />$2,000 per f...
>200 Employees<br />Employer Must:<br />Auto enroll new workers<br />Employee only <br />Lowest cost plan<br />Employee ca...
What we all need to watch<br />Federal Regulations<br />Benefit Package<br />Exchange regulations<br />Definitions/regulat...
What we all need to watch…..Political developments<br />
Health Care Reform<br />Overview<br />Providers’ View<br />Employers’ View<br />What we all need to watch<br />William Cus...
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TAG Health January Presentation

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    1. 1. Health Care Reform<br />Overview<br />Providers’ View<br />Employers’ View<br />What we all need to watch<br />William Custer, PhD<br />Patricia Ketsche, PhD<br />Institute of Health Administration, GSU<br />
    2. 2. Agenda<br />Overview of reform<br />What does it mean for providers?<br />What does it mean for employers?<br />What we need to watch<br />
    3. 3. Total National Health Expenditures:$’s and as Share of GDP<br />
    4. 4. The Employment-Based Coverage System is Eroding<br />
    5. 5. ESI Benefits Limited for Small Firms<br />
    6. 6. Percentage of Uninsured by Firm Size of Family Head<br />Source: Tabulations of the March supplement to the Census Bureau’s Current Population Survey for 2002 and 2010<br />
    7. 7. Overview of Reform: Major Change Components<br />Medicaid Expansion<br />Changes in Private Coverage<br />Improving Health Care Quality<br />Focus on Health<br />
    8. 8. Major Change Component: Medicaid Expands Eligibility (2014)<br />From “Poor AND….” to “Poor”<br />Everyone under 133% poverty eligible<br />In 2010 ~$20,000 for family of 2<br />Federal Gov’t pays for the expansion through 2016<br />Phase in state payments of 10% for newly eligible<br />
    9. 9. Major Change Component Private Coverage Changes 2010-2013<br />Insurance regulation<br />Expansions for children (no pre-existing conditions) & young adults<br />Rate reviews<br />Preventive Care<br />No lifetime/limited annual benefit caps<br />Medical Loss Ratio<br />Small Employer Tax Credits<br />Targeted to low wage, smaller firms<br />Offset portion of premiums paid<br />Even available to NP<br />
    10. 10. Major Change Component: Private Coverage Changes 2014<br />Community Rating<br />Health Insurance Exchanges<br />Individuals<br />Small employers<br />Individual Mandate<br />Subsidies for those without employer coverage<br />“Pay or Play” for employers with 50+ workers<br />
    11. 11. Overview of Reform: <br />More Americans with health insurance coverage<br />
    12. 12. Remaining Uninsured<br />Over <br />Non-citizens (25-35%)<br />Low income populations (100-250% FPL)<br />High income volatility<br />Frequent moves between Medicaid and insurance subsidy categories<br />Remaining uninsured are likely to be younger and healthier than those currently uninsured <br />
    13. 13. Overview of Reform: Financing<br />Insurance Premium Subsidies<br />Medicare Savings<br />+/- 1 trillion<br />+/- 1 trillion<br />Fees, Taxes and Penalties<br />Medicaid<br />
    14. 14. Major Change Component:Improving Health Care Quality<br />Information<br />Focus on collecting, sharing and using<br />Coordinated Care<br />Focus on integration<br />Pay for provider quality<br />Bonuses<br />Penalties<br />
    15. 15. Major Change Component:Focus on Heath<br />National health strategy council<br />Research & public health innovation<br />Mandatory preventive care benefits<br />Funding for state/community based wellness initiatives<br />
    16. 16. Provider View<br />Payer mix changes<br />Payment changes<br />Regulatory changes<br />
    17. 17. Providers: Payer mix changesMore Georgians with health insurance coverage<br />
    18. 18. Providers: Payment Changes<br />Incentives for integration<br />Accountable Care Organizations<br />Bundled payments<br />Incentives for Medical Homes<br />Value based purchasing<br />Reimbursement tied to quality<br />Expanded beyond inpatient hospitalizations<br />
    19. 19. Providers: Payment Changes<br />Rate cuts <br />Reduced Medicare Advantage payments<br />Reduction in update formula <br />Cuts to DSH funding<br />Infrastructure for future payment innovation<br />Center for Medicare and Medicaid Innovation<br />Independent Medicare Payment Advisory Board<br />
    20. 20. Providers: Regulatory Changes to promote transparency & oversight<br />
    21. 21. Employer View<br />Why anemployer focus<br />What does it mean for employers right now?<br />Employer implications depend on size<br />
    22. 22. Why an Employer Sponsored System?<br />Risk pools -> stabilize premiums<br />↓administrative costs<br />Purchasing expertise in HR<br />Tax exclusion of premiums <br />Over $250 billion in subsidy of private coverage<br />BUT…….<br />
    23. 23. Affordability<br />Declining participation rates<br />Employers shifting more cost to workers:<br />Increases since 2005: <br />Inflation 12%<br />Wages 18 % <br />Overall premiums 27 % <br />Employee contributions 47% <br />Source: Kaiser HRET Survey<br />
    24. 24. What Does Reform Mean for Employers Now?<br />2010 Changes<br />Add in dependents < 27<br />Eliminate lifetime and annual benefit limits <br />Eliminate pre-ex restrictions for children<br />Cover preventive case without cost sharing<br />Exemption: Grandfathered plans<br />2011 changes<br />Limits on use of FSA/HSA for OTC medications<br />Report value of health care benefits on W-2 <br />2012 changes<br />Additional 1099 reporting<br />
    25. 25. <25 Employees <br /><50 <br />Employees<br />>50 Employees <br />>200 Employees<br />Employer Implications Depend upon Number of Workers (FTEs)<br />
    26. 26. <25 Employees <br />Tax Credits<br />Full Credits<br /><10 FTEs<br />Wages < $25,000<br />Phased out credits<br />10 to 24 FTEs<br />Wages to $50,000<br />Credit as share of premium:<br />2010-2014: 35% <br />2014-2015: 50% <br />
    27. 27. <25 Employees <br />Tax Credits – 2010: Examples<br />
    28. 28. State Decisions on Exchanges<br />
    29. 29. American Health Benefit Exchange <br />Individual Coverage<br />Administration of Subsidy<br />Medicaid Enrollment<br />Choice of Plans<br />Quality Information<br />
    30. 30. Individuals<br />American Health Benefit Exchange <br /><ul><li>Certify, price and rate plans </li></ul>Standardized benefit information<br />Administration of Individual Subsidy<br />
    31. 31. <50<br />Employees<br />SHOP Exchange Purchasing<br />Certify, price and rate plans <br />Standardized benefit information<br />Administer small business tax credits<br />
    32. 32. >50<br />Employees <br />Pay or Play<br />Penalties if full time workers obtain coverage in the Exchange<br />$2,000 per full time worker (exclude first 30) if no coverage offered<br />$3,000 per worker obtaining the subsidy if coverage offered that is not sufficiently generous<br />High cost sharing<br />High employee premiums<br />
    33. 33. >200 Employees<br />Employer Must:<br />Auto enroll new workers<br />Employee only <br />Lowest cost plan<br />Employee can still opt out or change selection<br />
    34. 34. What we all need to watch<br />Federal Regulations<br />Benefit Package<br />Exchange regulations<br />Definitions/regulations for<br />ACOs<br />Bundled payments<br />Pay for performance<br />State Decisions<br />Exchange structure and functions<br />Insurance market regulation<br />Medicaid<br />Eligibility and Enrollment Processes<br />Provider incentives and payments<br />Workforce strategy<br />
    35. 35. What we all need to watch…..Political developments<br />
    36. 36. Health Care Reform<br />Overview<br />Providers’ View<br />Employers’ View<br />What we all need to watch<br />William Custer, PhD<br />Patricia Ketsche, PhD<br />Institute of Health Administration, GSU<br />
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