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Syn cing chronic disease advocacy boutin

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  • * The median percentage of a budget assigned to necessities was estimated by Gruber and Perry, April 2011. ** The ACA sets threshold levels for maximum premiums, above which people will receive subsidies. At 250% FPL, the maximum premium is 8.1% of income. *** The ACA sets reduced out-of-pocket maximums for people with limited income. A Rand study estimated total out-of-pocket spending related to kidney disease was nearly $9,000 in 2004.
  • FROM: BMS20060104_Quality Presentation_Revised_sm
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    • 1. SYNCing Chronic Disease Advocacy with State Health Care Reform Implementation Marc Boutin Executive Vice President & COO National Health Council© National Health Council
    • 2. The mission of the National Health Council is to provide a united voice for people with chronic diseases and disabilities.
    • 3. Timeline for Implementation© National Health Council
    • 4. Federal Activities Final Deadline for Approval Exchange or Conditional Exchanges ProposedAffordable Care Rule Approval of State Begin Exchange Rule Act Passed Expected Exchange Plan 2014 ReleasedMarch 23, 2010 Late 2011 January 1, 2013 July 20112010 2011 2012 2013 2014 Pursue Legislation or Executive Order File Exchange to Implement an Exchange Plan Establish Governing Boards Operational Planning & ImplementationState Activities Plan Bids Open Submitted Enrollment
    • 5. ACA: Minimum Essential Benefits  The ACA creates 10 categories of essential benefits that plans must cover beginning in 2014:  Ambulatory patient services  Prescription drugs  Emergency services  Laboratory services  Hospitalization  Preventive and wellness  Mental health and services and chronic disease substance abuse services management  Rehabilitative and  Maternity and newborn care habilitative services and  Pediatric services devices© National Health Council
    • 6. ACA: Minimum Essential Benefits  The essential benefits requirements also place limits on patient costs » Limits out-of-pocket costs to $5,950 for individuals » Limits deductibles for small group plans to $2,000 for individuals and $4,000 for families  Premium based on actuarial value of cost of benefit© National Health Council
    • 7. ACA: Minimum Essential Benefits  Platinum 90%  Gold 80%  Silver 70%  Bronze 60%© National Health Council
    • 8. © National Health Council
    • 9. At 250% FPL: Family of Four, One Person with Kidney Disease Annual Income (Gross) $55,875 Subtract the cost of taxes, child Median Necessities* care, food, housing, transportation, (at 71%) – $39,671 and miscellaneous expenses of 10% $16,204 Subtract ACA-defined maximum premium for family at 250% FPL Maximum Premiums** – $4,500 (compared to ~$8,000 for a silver plan with no subsidy) $11,704 Subtract reduced out-of-pocket maximum due to 250% FPL OOP Maximum*** – $5,950 (compared to $11,900 with no subsidy) $5,754 Divide by 12 for estimate of Per Month remaining funds in monthly budget ÷ 12 ~ $480Actuarial analysis performed for NHC byActuarial Research Corporation and Avalere Health
    • 10. Room in Household Budget for Health Care? Necessities + Reported Necessities + Necessities + Premium + 90th Income (% Necessities Premium + Median Premium Percentile OOP poverty level) OOP Cost Cost <Poverty 17.30% 17.30% 17.30% 17.30% 101–150 7.50% 8.40% 8.50% 10.80% 151–200 3.70% 7.60% 9.00% 17.50% 201–250 3.00% 5.70% 8.80% 26.20% 251–300 1.10% 5.30% 6.90% 24.20% 301–350 0.70% 4.20% 5.30% 17.50% 351–400 1.20% 3.50% 3.90% 12.50% 401–450 0.50% 2.70% 3.70% 15.30% 451–500 0.40% 3.60% 4.70% 12.00% >500 0.20% 0.60% 0.60% 2.50%(c) Jonathan Gruber and Ian Perry, The Commonwealth Fund
    • 11. Regulatory Opportunities Coverage/Cost Protections/Patient Services Oversight© National Health Council
    • 12. Essential Health Benefits: A Pathway Forward Broad Definition of Covered Services ― Specific List of Exclusions© National Health Council
    • 13. Essential Health Benefits: A Pathway Forward Broad Definition of Covered Services + Statutory Requirements ― Specific List of Exclusions
    • 14. Separate Rulemaking Will Address Additional TopicsDetailed requirements on federal “fall-back exchange” in states that fail to establish an exchange will likely be covered in subregulatory guidance
    • 15. “Very few of the groups we spoke with took the time to be as thoughtful about their priorities, to understand both the scope and limitations of the legislation, and to research the implications of what they were asking for. “ from U.S. Department of Health and Human Services e-mail© National Health Council
    • 16. Marc Boutin Executive Vice President & COO National Health Council mboutin@nhcouncil.org© National Health Council

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