How Health Reform Helps Missouri:

Today and in the Future

Brian Colby

MO Health Advocacy Alliance

Health Reform in a Nutshell

• Reforms the private insurance market with new consumer protections

• Creates new exchanges where uninsured people can purchase coverage, some with subsidies

• Expands Medicaid• Medicare: strengthens

preventive benefits and drug coverage; stops windfall payments to Medicare Advantage plans

Provisions Effective Immediately!

• Grants for states to establish consumer assistance and health insurance ombudsman programs

• Insurers must justify unreasonable rate hikes; grants available for states to conduct rate review

• Qualifying small businesses can receive tax credits for covering their workers this year

• Increased funding for community health centers

• Increased funding for primary care provider training programs

Insurance Market Improvements: Effective 90-

Days After Passage• Temporary funding ($5 B until

2014) for covering high-risk individuals

• Reinsurance for employers providing coverage to early retirees to help hold down premiums for plan enrollees

Provisions Effective July 1, 2010

• New HHS web-based internet portal for consumers and small businesses to look for affordable coverage in their state must be in place

Private Insurance Improvements: (Plan Years Starting) Six Months

After Passage• Ban on lifetime limits,

restriction of annual limits (annual limits outright prohibited in 2014)

• Coverage of preventive care with no cost-sharing in new plans

• Coverage of adult children until age 26

• No pre-existing condition exclusions allowed for children under 19

Private Insurance Improvements: (Plan Years Starting) Six Months

After Passage• Stronger protections against unfair

rescissions• Internal and external appeals

processes• Emergency care: no prior

authorization, cost-sharing same for in and out-of-network

• OB/GYNs considered primary care providers

Provisions Effective in 2011

• Medical loss ratio requirements• Plans must have standardized

descriptions (benefits and cost-sharing)• Medicare: Preventive care with no cost-

sharing, 50% discount on brand-name drugs in the Part D donut hole (also, $250 rebate for beneficiaries in donut hole in 2010)

Provisions Effective in 2011

• No later than one year after passage: Secretary provides grants for state implementation of exchanges

• CLASS Act- Voluntary, public long-term care insurance program

Full Implementation (2014)-Market Regulation

• No denials of coverage based on health status/ pre-existing conditions

• No pre-existing condition exclusions

• No premiums hikes based on health status

Full Implementation (2014)- Exchanges

• Can contract exchange responsibilities

• Coverage for individuals and small groups, some eligible for subsidies/ tax credits

• Standardized, comprehensive benefits

• Can operate in more than one state; states can have more than one

Full Implementation: Medicaid and Medicare

• Medicaid: By 2014, expanded eligibility to 133% FPL nationwide ($14,404/ year for an individual in 2010)

– Adults without children eligible everywhere!

• Medicare: Donut hole eliminated by 2020

Questions?

Brian Colby

bcolby@mohealthalliance.org

Health Care Foundation of Greater Kansas City

Missouri Foundation for Health

Kaiser Family Foundation