Do you know how new health insurance laws will affect you and your family? Probably not. We totally get it.
In fact, our modern healthcare system has become so complicated, most people don’t understand it — even in its most basic forms.
But the September Tech Café will help, as Valerie Clark, president of insurance brokerage firm Clark & Associates, discusses “The Conundrum of the U.S. Healthcare System.”
Clark’s firm specializes in the development of creative health insurance plans for employer groups of all sizes, so she is perfectly equipped to lead this informative, frank and non-partisan discussion about the challenges and possible solutions to the serious issues that all Americans are facing today.
In this presentation, Clark will:
· Talk about how we got where we are with healthcare, where we’re going, and most importantly, how will it affect you and your family?
· Address major law changes and how they have affected access to and the cost of care over the past several decades.
· Explore the history and evolution of the U.S. health insurance marketplace, and the public healthcare programs that cover those who are without private health insurance.
So join us in The Basement for Tech Café. Go to the historic post office in downtown Reno, then head downstairs. Listen, learn, enter to win raffle prizes — and answer your pressing health insurance questions.
On National Teacher Day, meet the 2024-25 Kenan Fellows
NCET Biz Cafe | Valerie Clark, Conundrum of US Healthcare | Sept 2017
1. 775-828-7420 www.clarkandassoc.com
Valerie J. Clark, President
Clark and Associates
Insurance Services and Human Resource Consultants
NCET Tech Cafe
September 20, 2017
The Conundrum of the U.S. Healthcare Syst
3. History of Health Insurance in the U.S.
• 1930’s & 40’s: Blue Cross Blue Shield emerged
• 1940’s & 50’s: unions bargained for benefits for
employees, including tax free & employer
sponsored health insurance
• 1950’s & 60’s: Government programs to cover
healthcare costs expanded.
• 1980’s & 90’s due to increasing cost > managed
care programs, to control cost and
utilization
4. WHAT LAW GOVERNS THE PRIVATE US
SYSTEM?
The Affordable Care Act (ACA) was enacted in March 2010.
Biggest overhaul of the United States’ health care
system since Medicare and Medicaid in 1965
Requires citizens to obtain health care coverage, and
large employers to purchase coverage for employees
Requires insurance companies and employers to
provide consumer protections related to health
coverage, like covering pre-existing conditions and
not charging more for coverage based on an
individual’s gender
5. Goals of the Affordable Care
Act
Increase the quality and
affordability of health insurance
Lower the uninsured rate
Reduce costs of health care
Healthcare for most
6. HEALTHCARE PROVISIONS AND
PAYMENT:
Who Pays? Cash
Private Insurance Programs 2010 law
Private/Public Exchanges 2010 law
Public/Government Programs
Medicare 1965 law
Medicaid 1965 law
CHIP 1997 law
7. HEALTHCARE SPEND
Close to 20% of the US economy
$2.6 Trillion/ Year
Private Health Insurance cover 64% of Americans /
196 million people /
Public/ Government Programs cover 31% of
Americans / 95 million people
8. Private Marketplace
• Variety of options
Plan designs, provide networks,
insurance companies
• Competitive forces lead to
better service and quality
• Providers are generally
compensated better >
appointments easier to
obtain, less waiting
• Possible subsidies on the
Exchange for lower income
• Tax favored premiums for
employers and employees
Private Marketplace
• Can be very expensive for
individuals and employers
Generally premiums are
$500/month for individual
$1400/month for a family
• Plan designs and max out of
pocket are cost prohibitive
$6600 Annually for an individual
$13,200 Annually for a family
• Market place can be difficult
to navigate
• Compliance is very
challenging. Employers > 50
employees MUST offer health
insurance or face steep
penalties
• Premiums are not tax favored
for individuals
12. WHAT DO HEALTHPLANS
COVER? The Affordable Care Act requires that all health
insurance plans cover a comprehensive package
of benefits and services known as essential
health benefits:
1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder
services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and
devices
8. Laboratory services
9. Preventive and wellness services and chronic
disease management
10. Pediatric services, including oral and vision care
13. SUBSIDIES: Exchange
Subsidized coverage is available to some individuals
and families with incomes up to 400 percent of the
federal poverty level (FPL).
-tax credits to help you pay premiums
-reduced out-of-pocket costs
Eligibility for subsidies will depend on your household
income and family size
14. SUBSIDIES: Medicaid
Medicaid is the nation's health insurance program
for very low-income individuals and families.
To qualify for Medicaid long-term care services and
support, individuals must be low-income or must
have incurred health expenses that have caused
them to “spend down” their incomes to Medicaid
eligibility levels.
Nevada: 133% federal poverty level, the poorest of
the poor
15. SUBSIDIES: CHIP
Children’s Health Insurance Program (CHIP)
provides low-cost health coverage to children in
families that earn too much money to qualify for
Medicaid.
The benefits covered through CHIP are different
in each state, but all states provide
comprehensive coverage, including:
Routine check-ups
Immunizations
Doctor visits
Prescriptions
Dental and vision care
Inpatient and outpatient hospital care
Laboratory and X-ray services
Emergency services
16.
17. WHAT IS WRONG WITH THE
ACA?
Cost / Taxes
Individual marketplace instability
Regulation/Compliance
Loss of control
23. What is Right With the ACA:
Guaranteed coverage
No Pre-existing condition exclusion
Coverage to age 26 for children
Preventative care at no cost
Premium and benefit subsidies for low
income
Drop in uninsured population
Lowered the numbers of uninsured
26. 775-828-7420 www.clarkandassoc.com
Recent Happenings in DC
Graham-Cassidy Plan : More power to states
Senate HELP and Finance Committees : Bi-partisan
individual marketplace stability testimony
Forty Hours is Fulltime Act : bipartisan, changes 30
hour benefits eligibility to 40 hour/workweek
Congress Back in Session
Individual Marketplace Deadline for 2018 is Sept 27,
2017
CHIP expires Sept 30, 2017
27. 775-828-7420 www.clarkandassoc.com
Employer Concerns/Target
Reforms ACA Tax Repeal/Delay
Cadillac Tax
Medical Device Tax
Health Insurance Tax
Limit Impact of 1332 Waivers on Group Health Plans
Modify Definition of Full-Time Work from 30 hpw to
40 hpw
Reduce Reporting Requirements for Employers
Improve Health Savings Accounts
Stabilize Individual Marketplace
28. 775-828-7420 www.clarkandassoc.com
How Do I Get Involved?
Get to know and understand your own health plan:
who pays for it? How much is it? How does it work?
Get involved on your Benefits Committee at work?
Association?
Discuss your thoughts and ideas with your employees
or employer?
Reach out to local, state and federal legislators. Tell
them what you want. VOTE!
Talk to your insurance carriers/ benefits consultants/
medical providers in an attempt to understand the
comprehensive nature of healthcare in your location…