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![Page 1: Maryland Takes Action on Health Care Reform: The Affordable Care Act Leni Preston, Chair leni@mdchcr.org (301) 351-9381 © 2012 Maryland Women’s Coalition.](https://reader035.fdocuments.us/reader035/viewer/2022062314/56649d9f5503460f94a8ae21/html5/thumbnails/1.jpg)
Maryland Takes Action on Health Care Reform: The Affordable Care Act
Leni Preston, [email protected](301) 351-9381
© 2012 Maryland Women’s Coalition For Health Care Reform
![Page 2: Maryland Takes Action on Health Care Reform: The Affordable Care Act Leni Preston, Chair leni@mdchcr.org (301) 351-9381 © 2012 Maryland Women’s Coalition.](https://reader035.fdocuments.us/reader035/viewer/2022062314/56649d9f5503460f94a8ae21/html5/thumbnails/2.jpg)
About the Coalition
• Nonpartisan alliance of individuals and 88 state-wide organizations committed to transforming our health care system to meet the needs of all Marylanders.
• National Partners– Raising Women’s Voices –National Women’s Law Center–Open Society Institute – Baltimore
© 2012 Maryland Women’s Coalition For Health Care Reform
![Page 3: Maryland Takes Action on Health Care Reform: The Affordable Care Act Leni Preston, Chair leni@mdchcr.org (301) 351-9381 © 2012 Maryland Women’s Coalition.](https://reader035.fdocuments.us/reader035/viewer/2022062314/56649d9f5503460f94a8ae21/html5/thumbnails/3.jpg)
Coalition Mission
Work collaboratively with our members and partners to seek solutions and advance reforms to ensure that every resident of Maryland has access to affordable, comprehensive & high quality health care that is always there.
© 2012 Maryland Women’s Coalition For Health Care Reform
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How We Achieve Our Mission
• Educate and engage our members and supporters, elected officials, policy makers and the public
• Reach out to all potential allies of reform
• Advocate and take action, as a Coalition and as individuals, to achieve our shared mission.
© 2012 Maryland Women’s Coalition For Health Care Reform
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Why Health Care Reform Is Important to Women• Caregivers for ourselves, our families &
our communities – historically being a woman has been considered a pre-existing condition.
• 80% of health care decisions are made by women (Department of Labor).
• In 2008, 1 in 4 women went without necessary health care services.
• Only 13% of plans in individual market included comprehensive maternity care.
© 2012 Maryland Women’s Coalition For Health Care Reform
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Why It Matters to Maryland Women
• 15% (280,000) are uninsured in Maryland
• 56% are currently employed• A majority are under 200% FPL• 38.7% are Hispanic/Latino• 17.7% are African American• 10.4% are Caucasian
© 2012 Maryland Women’s Coalition For Health Care Reform
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The Patient Protection and Affordable Care ActA 3-Legged Stool:1.Everyone is “in”2.Personal responsibility3.Affordability
© 2012 Maryland Women’s Coalition For Health Care Reform
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Patient Protections: What We Have Gained to DateBy December 2011:• 46,000 young adults up to age 26 can stay
on their parents’ health plans• 1, 153,000 individuals gained preventive
care coverage without co-pays or deductibles
• Policies purchased or renewed by women after August 1st - 1,042,794 will get additional preventive services
• 872,000 women and 585,000 children no longer worry about lifetime limits for their care
© 2012 Maryland Women’s Coalition For Health Care Reform
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More Patient Protections
• 52,234 seniors got help paying for their prescription drugs
• 553,920 people on Medicare received free preventive services or a free annual wellness visit with their doctor
• Insurance companies now have to spend larger share of your dollars (80%) on health care services – 141,291 Marylanders benefited© 2012 Maryland Women’s Coalition For Health Care
Reform
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Maryland: A National Leader
• Commitment and Leadership
• Effective Process:– HCRCC– OHCR– Health Benefit
Exchange Board
• Roadmap• $157 million – 4
federal grants
© 2012 Maryland Women’s Coalition For Health Care Reform
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Affordability in the Affordable Care Act
• Expand Medicaid program: individuals with incomes up to 138% FPL
• Tax-credits to individuals with incomes between 138% & 400% FPL
• Tax credits for small businesses• Creates Individual and Small
Business Health Exchanges (SHOP)• Qualified health plans – 4 “metal”
levels© 2012 Maryland Women’s Coalition For Health Care
Reform
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Maryland Health Connection:A Health Insurance Marketplace• Exchange will
describe each plan in a standard format– Monthly cost and
co-pays– Plan performance
on quality measures
– Plan ratings by quality and price
• Compare Apples to Apples
• Can’t decide between a Fuji and a Rome? Get help!– Website– Telephone hotline– Navigators
© 2012 Maryland Women’s Coalition For Health Care Reform
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Maryland Health Connection Timeline
4/12/2011Governor O’Malley Signed Health Benefit
Exchange Act into
Law
6/3/2011Exchange Board 1st Meeting
9-11/2011 Advisory
Committees Met
1/1/2013 Exchange Must be
Certified by Federal
Government
10/1/2013 Individuals and Groups
Begin Enrolling in Exchange
1/1/2014 Maryland
Health Connection
will be Operational
© 2012 Maryland Women’s Coalition For Health Care Reform
Source: A Report to the Governor and Maryland General AssemblyMaryland Health Benefit Exchange, December 23, 2011, p. 1
Landmark ACA Legislation signed into Law 3/23/2010 by President Obama
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Maryland Health Connection
• Public corporation/independent unit of state government
• 9-member board• 7 Principles– Access– Affordability– Sustainability– Stability– Health Equity– Flexibility– Transparency
© 2012 Maryland Women’s Coalition For Health Care Reform
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Creating the Exchange: Stakeholder InputExchange Advisory Committees• Navigator • Continuity of Care • Plan Management • Exchange Implementation OHCR Advisory Committees• Essential Health Benefits • Finance & Sustainability • Communications
© 2012 Maryland Women’s Coalition For Health Care Reform
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Stakeholder Representation - 2011
© 2012 Maryland Women’s Coalition For Health Care Reform
Source: A Report to the Governor and Maryland General Assembly, Maryland Health Benefit ExchangeDecember 23, 2011, p. 2
Consultants3%
Local Government3%
Health Insurance In-dustry34%
Community Care Providers and Associations
18%
Community Members and Advocates
21%
Academia12%
Business Owners9%
Advisory Committee Membership by Affili-ation
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Decisions To Date: Essential Health Benefits Benchmark for Qualified Health
Plans
Ambulatory services Emergency services
In-patient hospital services Prescription drugsLaboratory services Maternity &
newborn careRehabilitative and habilitative servicePediatric, inc. oral & vision
Preventive/wellness services & chronic disease m’ment
Mental health and substance use disorder treatment
© 2012 Maryland Women’s Coalition For Health Care Reform
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Decisions To Date:Plan Management Insurance Carriers: Certification
Standards –# of QHPs at 4 “metal” levels Carrier
Certification for Qualified Health Plans (QHP)
– Data Collection – Provider Network• MH/SUD Parity • Essential Community Providers
© 2012 Maryland Women’s Coalition For Health Care Reform
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Decisions To Date: Navigator Program
Navigator Entities & Individual Navigators – Conduct public education and outreach– Distribute fair and impartial information that is
culturally & linguistically appropriate for all populations
– Facilitate enrollment in health plans – Medicaid & subsidized insurance
– Provide referrals for grievances, complaints and questions
SHOP – SHOP navigators – licensing/training through MIA –
receives compensation from Exchange– Authorized brokers can sell in and out of the Exchange
– compensated by carriers © 2012 Maryland Women’s Coalition For Health Care
Reform
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Issues To Watch
• Financing –self-sustaining by 2015• Continuity of Care – “churn” & transitioning between plans
• Affordability • Pediatric & Adult Dental & Vision • Communications
© 2012 Maryland Women’s Coalition For Health Care Reform
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Relationship of Health Improvement Efforts
Federal Health Care
Reform/ACA
Maryland Health Care
Reform
SHIP-Local Action
Health Equity
Cultural Competenc
y
Health Literacy
Affordability
Continuity of Care
Workforce Diversity & Developme
nt
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Resources You Can Use: State & Federal
– Maryland Health Connection www.marylandhealthconnection.gov
– Exchange Stakeholder Website www.dhmh.maryland.gov/healthreform/exchange/index.html
– Department of Health & Mental Hygienewww.dhmh.maryland.gov
– Health Care Reform Coordinating Councilwww.dhmh.maryland.gov/healthreform/index.html
– Department of Health & Human Serviceswww.healthcare.gov
© 2012 Maryland Women’s Coalition For Health Care Reform
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Stay Informed & Get Involved
• Join the Coalition & Encourage Others to Join – Newsletters, Alerts, Member Calls & Webinars– Information/Resources: September 8th Women
of Color Health Care Reform Conference– Host or Attend Health Care Reform Events
• October 27 – NAMI-MD • October 28 – Prince George’s County Commission
for Women – Women’s Legislative Conference
• Facebook and Twitter• Share your stories
www.mdhealthcarereform.org
© 2012 Maryland Women’s Coalition For Health Care Reform
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© 2012 Maryland Women’s Coalition For Health Care Reform
Leni Preston, ChairPhone: (301) 351-9381E-mail: [email protected] Website: www.MDHealthCareReform.org