Post on 21-Jan-2015
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96th Annual Meeting 2012How will the Supreme Court decide healthcare reform?
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Sponsors
Insurance ProfessionalsInsurance Group
Patient Protection and Affordable Care ActMarch 23, 2010
A New Era for America3
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U.S. Supreme court heard oral argument on the constitutionality of the Affordable Care Act on March 26-28, 2012
U.S. Health Care Spending
About 16% of the U.S. economy (in 1950, 5%)
Estimated $2.24 trillion in 2009
Most health care spending per capita in the world
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Most people are insured through an employer-sponsored plan (177 million Americans, 62% of people are under age 65)
99% of employers with 200 or more employees offer health insurance
78% - 10 to 24 employees
49% - 3 to 9 employees
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Who is Insured?
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Who is Insured (continued)
About 70 million Americans are insured under a “public plan”
Medicare Medicaid
Government spends about 42% of every dollar spent on health care
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Estimated 46 million Americans lack health care insurance (15% of U.S. population)
The Uninsured
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Who Are The Uninsured?
27 million have personal income over $50,000 66% of uninsured have family incomes of $45 - $85,000 14 million are eligible for Medicaid on the Children’s Health
Insurance Program 10 million ‘illegal’ aliens 1/3 are between 18 to 29 years of age In New Jersey, 1,057,000 people (about 15% of the
population) About 650 New Jerseyans lose health care insurance every
day
Insurance Reform and Consumer Protections
Dependent coverage to age 26 (2010) Children with pre-existing conditions cannot be denied coverage (2010) No denial for pre-existing conditions eliminated (2014) No Charge for annual wellness visit (2014) Guaranteed issue policy (2014) Modified community ratio (2014) 80 – 85% medical loss ratio (2014)
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All plans must provide Essential Health Benefits
“Essential Health Benefits” requires minimum set of benefits, with no lifetime of annual coverage limits
Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance abuse coverage Prescription drugs Rehab services and medical devices Preventative and wellness/chronic disease
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“Free” Preventive Care
No Co-pays
No out-of-pockets
No deductibles
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Health Delivery Reforms
Facilitating Accountable Care Organizations. Research on best provider practices Research on comparative evidence outcomes Pilot program that pays for outcomes on flat fee
basis rather than fee for service for treatments Medical IT Standards for extended living arrangements Hospice, home-health reimbursement
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Community Investment
Health Care Clinics
Primary Care Training
Grants to States
Diversity and Cultural Competency
Education Curricula Development in Health Sciences
Food Labeling
Premiums have increased on average 14% per year, for 12 consecutive years
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New Jersey’s Cost Spiral
Premiums have grown 5-times faster than wages since 1999.
2000 – 2010, cost of family policy has gone up 110% in New Jersey.
Average employee contribution has gone up 200% since 2000.
Out-of-pocket and co-payments have gone up 115% since 2000.
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N.J. Employer-Plan Crisis
N.J. Small Employer Benefits Program(2-50 employees)
2011 – 770,000 covered lives
Down 17% from 2000
(Affiliated Physicians and Employers Health Plan has increased 48%)
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Affordable Care Act will provide subsidies and tax breaks to individuals and small employers for the purchase insurance
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The Health Insurance Exchange
Uninsured individuals not eligible for Medicare or Medicaid will be permitted to purchase insurance through state Exchanges (purchasing pools).
Employers with fewer than 100 employees will be permitted to enroll.
Employer eligibility may be expanded in 2017.
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13 states and the District of Columbia, have passed a heath care exchange law
On May 10, 2012 Governor Christie vetoed the N.J. Health Exchange Act.
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Minimum Essential Coverage Requirement
(the Individual Mandate 2014)
A federal requirement that individuals purchase health care insurance or pay penalty up to 2.5% of income as penalty or capped at $95 in 2015 rising to $695 in 2016.
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Hospitals, physicians, insurance companies and others agree that without the Individual Mandate the consumer protection and benefits reforms would ruin the health care market
Will the U.S. Supreme Court declare the Affordable Care Act constitutional?
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Florida v. Dept. HHS
11th Cir. Court of Appeals (2011)
Individual Mandate is unconstitutional
Seven Sky v. Holder
U.S. Court of Appeals – DC (2011)
Individual Mandate is constitutional
Thomas Moore Center v. Oblama
6th Cir. Court of Appeals (2011)
Individual Mandate is constitutional
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What will the Court do?
Uphold the Act in its entirety. Invalidate the Individual Mandate but
leave the rest of the Act intact. Invalidate the entire Act. Dismiss case as premature
Panel Discussion
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The Affiliated Physicians and Employer Health Plan