The document summarizes recent changes to US health policies under the Affordable Care Act and how they are being implemented in Colorado. It discusses key provisions that took effect in 2010-2011 such as the pre-existing condition coverage for children, and outlines upcoming provisions in 2014 like the individual mandate and state-based health insurance exchanges. It also reviews related policies around electronic health records, accountable care organizations, and resources for tracking ongoing reforms.

1. Colorado Healthcare Communicators: Communicating Changes in Health Policies Amy Fletcher, amyfletcher media Feb. 23, 2011 (what a difference a year makes)

2. amyfletcher media Former health care reporter, mostly at Denver Business Journal Founded afm in 2009: communications planning/strategy, media relations, writing Clients: health care, lobbyists, nonprofits Today’s info.: ArpegioHealth, Colorado Managed Care newsletter

3. (High-level) overview for today Reform update Federal - Affordable Care Act State - Exchanges, Medicaid expansions, etc. Resources to track reform Questions?

4. Affordable Care Act 1,000-page bill Pres. Obama signed into law March 23, 2010 Designed to: Lower costs - premiums unaffordable, strain on govt. budgets Close holes in coverage - 17 % uninsured, pre-existing conditions How it does it: Private insurance reform and individual mandate Expand public programs (Medicare, Medicaid) Exchanges Experiments in managing care (ACOs)

5. Affordable Care Act: 2010 Phased in through 2019 (2010*, 2011*, 2014*) Implemented in 2010: Colorado high-risk pool, GettingUsCovered: must have pre-existing condition; uninsured for 6 months (gettinguscovered.org) Kids can stay on parents‘ insurance until age 26; eliminated exclusions for pre-existing conditions for kids up to age 19. Certain evidenced-based preventive care covered at no cost.

6. Affordable Care Act: 2011 Insurers must spend at least 85 % of premiums on direct claims costs (vs. administration) Medicare beneficiaries in the “doughnut hole” receive 50% discount on brand-name drugs. Funding for states (including Colorado) to research and plan building “a better health insurance marketplace” and determine how their Exchanges will be operated and governed. (more on this)

7. Affordable Care Act: 2014 + Expands Medicaid to people with incomes up to 133% FPL and provides enhanced federal matching payments for new eligibles. Allows all hospitals to make presumptive eligibility determinations for all Medicaid-eligible populations. Mandate: individuals must have qualifying health coverage (phased-in tax penalty for those without coverage) Creates state-based exchanges, administered by a governmental agency or non-profit organization No refusal based on health status

8. Legal / Congressional challenge Congress divided on ACA (House voted to repeal) Obama said he is open to compromise on some parts, but no major revamping. Meanwhile, U.S. District Judge Roger Vinson in Florida ruled insurance mandate is unconstitutional. Obama Administration said it will appeal. (Also challenged in Virginia).

9. Colorado: Exchanges Online “one stop shop” for information, comparison and purchase. Estimated 300,000 to millions will use eventually. For individuals and small groups. (Larger groups may be allowed in 2017) Stakeholders in Colorado are watching closely developments on structure and governance. (docs, hospitals, etc.) States will set own rules. In Colorado, bill(s) to be introduced in Senate and House (Boyd & Stephens) Opportunity for safety net.

10. Electronic Health Records Health Information Technology for Economic and Clinical Health (HITECH) incentive program. Part of American Recovery and Reinvestment Act of 2009. Medicare: Eligible professionals can receive as much as $44,000 over a 5 years. Medicaid: as much as $63,750 over 6 years. Medicare and Medicaid: eligible hospitals may receive millions for “meaningful use.” CORHIO: info. on incentives, serving to connect through exchanges Will be tied to Medicare payments.

11. Accountable Care Organizations Designed to encourage integrated health systems. A group of health care providers provide coordinated care, chronic disease management to improve the quality of care. Payment is tied to achieving health care quality goals and outcomes that result in cost savings. Starts with Medicare in 2012. Race to form ACOs has begun. Insurers, hospitals, docs are vying to run them.

12. Resources to follow reform Kaiser Family Foundation www.kff.org/healthreform Colorado Managed Care www.hmo-info.com U.S. Dept. Health and Human Services www.healthreform.gov Your national, state trade associations Updates from lobbyist (internal or contract) Media: Ed Sealover (DBJ), Eric Whitney (NPR), Denver Post

13. Thank you Amy Fletcher, principal [email_address] 720-350-3144 Twitter @fletchermedia