While the President’s message was well intentioned – there was a huge difference between where the effort began and where it ended. In the words of a number of insurance executives and even members of the current administration – “You get more but you pay more”. So, what went wrong?
The two goals: 1) Expand access to coverage; and 2) to promote quality were used by the Obama Administration and the Congressional Democratic leadership to help sell the comprehensive healthcare reform law. They stated that access to coverage and higher quality would reduce costs. The amount of savings/expenses became a very contentious part of the policy debate last spring, and obviously continues today. Lets take a look at each of these 2 objectives . . .
Let’s first look at the areas of the legislation that provides increased access to coverage. READ LIST. . . . If you go back to the entire objective – it was to bend the cost curve by expanding access to affordable coverage. There is no debate about expanding access, but there are few – Democrats or Republicans – who believe that the Legislation can or will reduce costs.
There were also a number of initiatives in the legislation that specifically addressed improving health outcomes. They are . . .
With the last few slides as a summary of where we are today, it is apparent that a bill of this size will have its own bureaucracy to implement. While there are many different Departments and Divisions (including the IRS) that will play a role in implementing healthcare reform, the real heavy lifting in falls to the Department of Health and Human Services. Many of these people will become “household names” before too long.
First – let’s begin with the U.S. House of Representatives:In 2008, the Democrat Party had 257 members to the Republican 178 members
The 2010 Election changed the balance in the House. The Republicans now have 239 members to the Democrat’s 190 with 2 races still remaining to be determined. This is a net change of no less than 61 seats.(changed to 2 races)
OK – we saw a lot of blue moving to red. But, what does that really mean and what is the impact:READ LIST . . . .
Moving to the Senate – although the Republican party picked up 6 new seats, the Democrats still hold a majority. However, they did lose their “super majority” or “filibuster proof” status.The States where seats were picked up were: North Dakota, Wisconsin, Indiana,Arkansas, Pennsylvania and New Hampshire.The Democrat Party avoided greater losses by winning several very close races in Illinois, Washington, Nevada and West Virginia.As of Friday 11/12, only the Senate Race was undecided in Alaska.Map was updated 11/27 – all results are settled.
It’s not too soon to look forward to 2012 as actions and behaviors of key Senators will be influenced by whether they are running for re-election in 2 years.23 Democratic Senate seats will need to be defended as well as 2 party independents that tend to vote along Democratic lines. Republicans hold only 10 seats. If they have a net gain of 3 to 4 seats, they will gain control of the Senate.Depending on who’s asking – 2012 is either a long way away, or just around the corner. Regardless, expect quite a bit of positioning among 2012 Senate candidates between now and then with their positions with regards to healthcare reform being critical to their reelection.
The election results are further exacerbated by the upcoming redistricting process. It is estimated that 8 States will be gaining 11 US House seats via the 2010 Census: Washington, Nevada, Utah, Arizona, Texas (4), South Carolina, Georgia and Florida. Some of the States will lose House seats via the 2010 Census: Minnesota, Iowa, Louisiana, Illinois, Michigan, Ohio (2), Pennsylvania, New York, New Jersey, and Massachusetts. Note that most of these states are traditional Democrat Party states.
The challenge of implementing Healthcare reform is just one part of the puzzle. There are many sources of Government oversight. I have listed here a number of the key legislative bodies, regulatory agencies, and other entities that are all potential entry points who are involved in further defining and shaping these initiatives. While reform has played out over the past year and a half on the national stage, much of the details may now reside at the State level.
And many, many questions still remain. READ A NUMBER OF THE ABOVE QUESTIONS . . . .
READ SLIDE(changed middle copy)
Many consider exchanges to simply be a mechanism to administer subsidy’s available to individuals and members of small business’s who are below a certain means test. By HHS’s own estimates, 27 million will be in exchanges by 2017 of which, 22 million of them are without insurance today. That leaves the current private market with respect to distribution opportunities nearly as large as it is today.Another unanswered question is with greater republican control, will funding be approved that will be adequate to subsidize a population of this size.
This concept is based on the experience of Massachusetts which created the Health Connector, an independent state agency that helps citizens chose health care coverage. There are a significant number of questions surrounding these “Navigators”:Will they have to be trained and licensed like Brokers? Will they be salespeople?Will they simply be enrollers? Will they be paid commissions?
The Republicans might initially attempt to pass a bill that will repeal the entire act.…In order to prevent a complete defunding of the Act, the Democrats may agree to compromise on significant elements of the Act. Senate Majority Leader Harry Reid (D-Nev.) is already on record saying that he was "ready for some tweaking" to the reform law.
A Complete Repeal - Republicans may force a vote to repeal for political gain, but it will not even come to a vote in the Democrat controlled Senate, much less gather sufficient votes to overcome an Obama veto.An attempt to repeal specific elements of reform – Elements that are not supported by moderate Democrats such as the 1099 reporting for business transactions, mandatory requirement that people must have health care coverage, additional spending in the law, the additional bureaucratic institutions set up to run health care programs, cuts made to the Medicare Advantage program and Medicare Reimbursements may face repealAttempts to substitute elements of reform with more centrist provisions that can gain moderate democrat votes.Cut off funding for key reform activities such as the Exchanges.Hold hearings to spotlight the imperfections in reform.
So, people wanted change and they got it. Then things changed again.We just ran through the changing landscape and have some idea of what may or may not happen. What can we do now? As brokers and agents, that answer is plenty!READ SLIDE . . . . We have a long way to go but meanwhile, our customers need us now more than ever. Confusion abounds and the more value we show during these difficult and changing times, the greater the likelihood of all brokers and agents continuing to be part of the future of healthcare. BenefitMall and its 600 plus employees are ready to support you in anyway we can. You can bet on it!
Legislative Webinar - December 3, 2010
Beyond the Headlines:<br />Health Care Reform Update and Analysis<br />
The Patient Protection and Affordable Care Act (P.L.111-148)<br />Generally being referred to as PPACA or the Affordable Care Act (ACA)<br />Signed into law by President Obama on March 23, 2010<br />The Health Care and Education Reconciliation Act of 2010 signed March 30, 2010<br />Requires a phasing-in of changes from 2010 – 2018 with key changes taking place in 2014<br />Health and Human Services (HHS) Secretary Sebelius and her staff central to the process<br />
Kathleen Sebelius<br />Donald Berwick<br />Director-designate, Centers for Medicare and Medicaid Services<br />Secretary, Department of Health and Human Services <br />Jay Angoff<br />David Blumenthal<br />Director, Office of Consumer Information and Insurance Oversight, HHS Department<br />National Coordinator for Health Information Technology<br />Carolyn Clancy<br />William Corr<br />Jeanne Lambrew<br />Director, Health and Human Service’s Agency for Healthcare Research and Quality<br />Deputy Health and Human Services Director<br />Director of Health and Human Service’s Office of Health Reform<br />
Understanding the Impact of the Recent Election Results on Health Care Reform<br /><ul><li>To understand what happened
Wisconsin – Assembly and Senate </li></ul>Undecided: New York - Senate<br />Source: NCSL.org<br />
State Legislatures Before the Election<br />Source: NCSL.org<br />
State Legislatures after the Election<br />Source: NCSL.org<br />
State Echo Effect<br />Source: ABCnews.com<br />
2010 U.S. House of Representatives<br />Election Results<br />The redistricting process may result in as many as an additional 25 US House seats for the Republicans.<br />Source: Polidata.org<br />http://www.polidata.org/census/st009nca.pdf<br />
Long Term effects of new Republican Majorities in State Houses<br />Redistricting<br /> <br />Republicans took control of at least 19 Democratic-controlled state legislatures, and haven't controlled as many state legislatures in general since 1928. Currently, legislatures in 44 states are responsible for redistricting.<br /> <br />Source: ABCnews.com<br />
State Governorships Before the Election<br />Prior to the November 2, 2010 Gubernatorial elections, there were 29 Democrat Governors and 21 Republican Governors.<br />Source: Wikipedia.org<br />
State Governorships After the Election<br />Source: WashingtonPost.com<br />
State Insurance Commissioners<br />Appointment/Election Process<br /><ul><li>35 of the 50 State Insurance Commissioners are appointed by their state governors.
11 State Insurance Commissioners hold elected positions.
Four of those were standing for election this year.</li></ul>New Wave of Insurance Commissioners<br /><ul><li>Due to this election, there will be an unusually large influx of new Insurance Commissioners (both Republican and Democrats)</li></ul>Source: InsuranceJournal.com<br />
NAIC Activities Under PPACA<br />Among other responsibilities, the NAIC has held meetings since March developing the following:<br /><ul><li>Uniform Explanation of Coverage
Modifications to the Blank Filing Form</li></ul>Source: InsuranceJournal.com<br />
The Effect of the Election On The NAIC<br />Source: InsuranceJournal.com<br />
Insurance Commissioner Turnover<br />The Large Turnover had One Serious Implication <br />for Brokers and General Agents:<br />The NAIC established a task force to address potential adverse impacts on the role of licensed health insurance agents and brokers resulting from the new federal health care reform law. "With the recent issuance by HHS of the medical loss ratio (MLR) regulations to be imposed on insurers, there is a very real possibility the role of health insurance agents will be impacted in a negative way," said Florida Insurance Commissioner Kevin McCarty. "Health insurance is a complex product and experienced and licensed agents are a valuable resource for consumers. We intend to work with the agent community and our colleagues at HHS to maintain that resource."<br />Source: InsuranceJournal.com<br />
The Implementation ChallengePPACA is just One Part of the Health Care Reform Puzzle: Other Sources of Government Oversight<br />