Health Reform 101An Overview for Job Seekers<br />Bob Peters<br />April 4, 2011<br />
What You Need to Know – Alphabet Soup & Stuff<br />PPACA<br />ACO<br />MLR<br />Exchanges<br />Insurance Coverage Expansio...
PPACA	<br />PPACA = Patient Protection and Affordable Care Act (HR 3590)<br />No cost controls<br />About 1000 pages with ...
ACO<br />ACO = Accountable Care Organization<br />“Organization” can be a provider group, Hospital or payer (HMO/Insurance...
MLR<br />MLR = Medical Loss Ratio<br />Payer (insurer or employer) must spend at least 80%/85% of premium on care for indi...
Exchanges<br />State (or Federal) run insurance shopping and purchasing “thingy”<br />The Brave New World of health insura...
Insurance Coverage Expansion<br />Adds about 32 million to the roles of insured<br />Depends on “individual mandate” and “...
Some Take Always<br />Broker/agent world is changing – probably for the better in the long run, but current turmoil<br />“...
Some Take Always<br />This law doesn’t really address the underlying problem of long-term access, cost or quality<br />Unc...
Questions & Discussion<br />
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Health (Insurance) Reform 101

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A brief overview of the Patient Protection and Affordable Care Act presented to job seekers in the healthcare field in April, 2011.

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  • Health (Insurance) Reform 101

    1. 1. Health Reform 101An Overview for Job Seekers<br />Bob Peters<br />April 4, 2011<br />
    2. 2. What You Need to Know – Alphabet Soup & Stuff<br />PPACA<br />ACO<br />MLR<br />Exchanges<br />Insurance Coverage Expansion<br />
    3. 3. PPACA <br />PPACA = Patient Protection and Affordable Care Act (HR 3590)<br />No cost controls<br />About 1000 pages with about 1000 “rules to be made by the Secretary” of HHS, IRS, etc.<br />Amends itself, then was amended further by subsequent “reconciliation” bill (HR 4872)<br />Lots of court cases (25+) – decisions seem to follow party lines<br />Kaiser Healthcare News for scorecard<br />
    4. 4. ACO<br />ACO = Accountable Care Organization<br />“Organization” can be a provider group, Hospital or payer (HMO/Insurance Company)<br />An “ACO” is accountable for at least 5000 Medicare lives in PPACA, but ACOs can be used in any health plan (Large/small groups, individuals)<br />Objective: to make care more effective & share savings<br />HMO with choice? HMO with no Teeth? Who knows…<br />
    5. 5. MLR<br />MLR = Medical Loss Ratio<br />Payer (insurer or employer) must spend at least 80%/85% of premium on care for individual & small group/Large group (& Medicare)<br />What is in “healthcare cost” and what isn’t – it’s really important!<br />May mean the Death of the agent/broker commission model<br />“Wellness” expenses may or may not be “good”<br />Regulated administration/profit – guess what will happen? Who remembers $400 hammers paid for by the Army?<br />
    6. 6. Exchanges<br />State (or Federal) run insurance shopping and purchasing “thingy”<br />The Brave New World of health insurance<br />Subsidies and premium come in and go out<br />“Buyers” sign up and pick company/coverage<br />Levels the playing field (???)<br />This is a really, REALLY complex assignment for the state/fed to take on and figure out<br />
    7. 7. Insurance Coverage Expansion<br />Adds about 32 million to the roles of insured<br />Depends on “individual mandate” and “play or pay” provisions to force folks into the system<br />Early retirees – reinsurance now (but maybe not next year), then Exchanges<br />The Perfect Storm scenario – AT&T, 3M<br />Most of expansion is in Medicaid<br />Funding comes from BIG cuts in Medicare rates, fees & more fees<br />
    8. 8. Some Take Always<br />Broker/agent world is changing – probably for the better in the long run, but current turmoil<br />“Customer Fee” model is better, but will take time to get there<br />ACO rules just issued – lots of work to come for consultants - opportunity knocks!<br /> Exchanges – could be THE largest IT project of the decade for someone <br />MLR rule – will change where (and how) money is spent – this could be very bad in the long run – the “cost plus” incentive to increase Healthcare costs<br />
    9. 9. Some Take Always<br />This law doesn’t really address the underlying problem of long-term access, cost or quality<br />Uncle Sam giveth (coverage to uninsured) and taketh away (from Medicare payments, fees from lots of players)<br />Former “charity care” and ‘bad Debt” now paid by government; Medicare pay rates decreased.<br />Oh, and what if the law is overturned? To be continued…<br />
    10. 10. Questions & Discussion<br />

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