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.

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

2. 775-828-7420 www.clarkandassoc.com

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

9. Common Health Insurance
Terms

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

17. WHAT IS WRONG WITH THE
ACA?
 Cost / Taxes
 Individual marketplace instability
 Regulation/Compliance
 Loss of control

18. Family Premiums Past and
Projected: 1999-2019

19. Deductibles vs Insurance
Premiums vs Wages vs
Inflation

20. CONTRIBUTORS TO COST
Demographics-aging population
Medical Technology
Consumer Demand
Prescription Drugs
Behavior and Lifestyle Choices
Uninsured Population/Cost
Shifting
Compliance with Regulation

22. Life Expectancy Increases since
1960

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

24. Insured Population: 1963-
2015

25. ACA / What is Happening in
DC ?

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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…

29. 775-828-7420 www.clarkandassoc.com
Thank you! Any
questions?
Valerie J. Clark, President
Clark and Associates
Insurance Brokerage Services, and
Human Resource Consultants