Federal Reform Timeline
PPACA became law March 23 2010
Sept. 23, 2010 (6 months after signed into law)
GI for children under age 19
Preventive care mandate
Dependent coverage to age 26
Small employer tax credit (up to 35% of employer contribution)
Less than 25 employees
Average wage less than $50,000
Medical Loss Ratio reporting
No less than 85%
Medicare prescription drugs in ‘donut hole’
$250 rebate in 2010
50% coverage 2011 forward
Medical Loss Ratio standards and penalties
80% small group (50 or less) and individuals
85% groups over 50 (100+ in 2014)
If MLR less than target, must rebate to insureds
HAS, HRA, FSA Restrictions
No tax break for over the counter drugs without prescription
CLASS Act—Community Living Assistance Services and Support Act—Repealed
Sept. 23 and after: Summary of Benefits & Coverage (SBC) required, all policies
No more than 4 pages, front and back (applies to Sec. 125, HSA’s also)
‘Comparative Effectiveness’ Tax to fund research
$2.00 per covered lives, starts 9/30/12, sunsets 9/30/19
Tax on High Income Earners ($200,000 sing. /$250,000 joint filers)
3.8% on most investment income
FSA’s $2500 annual limit on contributions
2014 When the real fun begins!
Denial of coverage for pre-existing conditions prohibited
Limits on benefits prohibited
‘Small Group’ up to 99 employees (was up to 50). Strict rating practices.
Employer Mandate for groups over 50
Fine is $2000 per employee per year—do the math
Fine is $695 per individual (3X for family: $2085) do the math!
‘Essential Health Benefits’ must be provided
Health Insurance Exchanges must be established (Cover Oregon)
Subsidies/tax credits available for individuals below 400% of FPL
Tax on Cadillac health plans
Oregon Health Insurance Reform
2012 Legislative Session
Approved Health Insurance Exchange business plan (HB 4164)
Oregon’s exchange called ‘Cover Oregon’
Creates a separate marketplace for individuals and small groups
Goal of Exchange: provide access and choice
Subsidies available for those under 400% of Federal poverty line.
A public corporation like SAIF
Agents an important part of plan………so far.
Organization is scrambling to hit Jan. 1, 2014 deadline.
Must be self sustaining by Jan. 1, 2015 – Federal dollars run out
Community Care Organizations Transformation (SB 1580)
An attempt to transform Ore. Health Plan
Regional CCO’s coordinate medical, dental, and mental health services
Long term plan is to apply this model beyond Medicaid/OHP (Exchange?)
Remains largely below the radar screen
Long term financial health??—2024 no longer sustainable (Medicare Trustees)
Pharmaceutical companies step up to offer 50% coverage in the ‘donut hole’.
Ongoing battle in Congress over physician reimbursement
Questions about ‘Advantage Plan’ reimbursement to carriers
The Road Ahead is a Rocky Road
Federal and State budget crisis
Health Care Reform is a political football
Lack of leadership: political, industry, providers.
Public lack of understanding
Issue of cost of care has not been addressed