Leni Preston, Chairleni@mdchcr.org(301) 351-9381

© 2012 Maryland Women’s Coalition For Health Care Reform

About the Coalition

• Nonpartisan alliance of individuals and 81 state-wide organizations committed to meeting the health care 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

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

How We Achieve Our Mission

• Educate our members and supporters, elected officials and the public

• Reach out to all potential allies of reform• Engage our members in the reform

issues and debates• Advocate and take action, as a

Coalition and as individuals, to bring quality, affordable health care to every resident in Maryland. 

© 2012 Maryland Women’s Coalition For Health Care Reform

Why Health Care Reform Is Important to Women• 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.

• Women have historically been charged more than men for health insurance.

© 2012 Maryland Women’s Coalition For Health Care Reform

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

Patient Protections: What We Have Gained to DateBy 2011: • 51,868 young adults can stay on their

parents’ health plans• 52,234 seniors got help paying for their

prescription drugs• 1,153,000 individuals gained preventive

care coverage without co-pays or deductibles

• 2,251,000 no longer have to worry about lifetime limits for their care

© 2012 Maryland Women’s Coalition For Health Care Reform

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

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 Options Exchanges.• Qualified health plans – 4 “metal”

levels© 2012 Maryland Women’s Coalition For Health Care

Reform

The Health Benefit Exchange:A Health Insurance Supermarket• 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

Maryland: A National Leader

• Commitment and Leadership

• Effective Process:– Health Care Reform

Coordinating Council;

– Office of Health Care Reform; &

– Health Benefit Exchange Board

• Roadmap

© 2012 Maryland Women’s Coalition For Health Care Reform

Health Benefit Exchange Timeline

© 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 ObamaLandmark ACA Legislation signed into Law 3/23/2010 by President Obama

Maryland’s Health Benefit Exchange Act of 2011• Public corporation/independent unit of state

government • 9-member board• Key goals:

– Reduce number of uninsured– Facilitate purchase and sale of Qualified Health

Plans– Require cultural competency in all operations to

ensure all populations can gain access– Financially self-sustainable– 6 Legislative Studies

© 2012 Maryland Women’s Coalition For Health Care Reform

Creating the Exchange: Stakeholder InputFour Advisory Committees• Operating Model (Market Rules & Risk

Mitigation)• SHOP (Small Business Exchange)• Navigator Program (Marketing & Public

Relations)• Financing

© 2012 Maryland Women’s Coalition For Health Care Reform

Creating the Exchange: Stakeholder Representation

© 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

Health Benefit Exchange Act of 2012

• Active Purchasing• Small Business Health Options

(SHOP)• Navigator Program• Essential Health Benefits• Financing

© 2012 Maryland Women’s Coalition For Health Care Reform

SHOP – What is It?

• Marketplace where small employers & nonprofits (under 50 employees) can purchase insurance.

• Tax credit available through 2016

© 2012 Maryland Women’s Coalition For Health Care Reform

SHOP Proposals

• Create separate SHOP exchange.• Retain small group size at 50 until 2016.• Provide two options:– Employers select metal level &

employees choose among carriers at that level

– Employers select one carrier & employees select the metal level that meets their needs

– Consider additional options in 2016© 2012 Maryland Women’s Coalition For Health Care

Reform

Navigator Program Proposals

• Individual Exchange – CBOs & similar organizations

• SHOP – Producers

© 2012 Maryland Women’s Coalition For Health Care Reform

What to Watch - Navigator

© 2012 Maryland Women’s Coalition For Health Care Reform

Essential Health Benefits (EHB)• HHS: States to Select Benchmark Plan with 10 Categories

of Services– Ambulatory patient services– Emergency services– Hospitalization– Maternity & newborn care– Mental health & substance use disorder services– Prescription drugs– Rehabilitative & habilitative services & devices– Laboratory services– Preventive & wellness services & chronic disease

management– Pediatric, including oral & vision care

© 2012 Maryland Women’s Coalition For Health Care Reform

EHB: Coalition Proposals

• Stakeholder & consumer group to advise HCRCC

• Guidance– Balance benefits in each of the 10 mandated categories.– Specificity in defining health services to ensure

comprehensive care according to national standards.– Require that there be equal actuarial values.– Provide mental health & substance use disorder benefits in

parity.– Do not permit benefit design that discriminates on basis of

age, gender, disability, or expected length of life.

© 2012 Maryland Women’s Coalition For Health Care Reform

What to Watch - EHB

• Our Principals:

© 2012 Maryland Women’s Coalition For Health Care Reform

Resources You Can Use

• Maryland – Health Benefit Exchange

www.dhmh.maryland.gov/healthreform/exchange/index.html

– Department of Health & Mental Hygienewww.dhmh.maryland.gov

– Maryland Health Insurance Plan (MHIP)www.marylandhealthinsuranceplan.state.md.us

– Health Care Reform Coordinating Councilwww.dhmh.maryland.gov/healthreform/index.html

• Federal– Department of Health & Human Services

www.healthcare.gov

© 2012 Maryland Women’s Coalition For Health Care Reform

Stay Informed & Get Involved

• Join the Coalition– Newsletters, Alerts, Member Calls & Webinars– 2012 educational forums: Spring/Summer at

locations to be determined and September 8 – Health Care. Women of Color Get It! in Baltimore

– Facebook and Twitter• Encourage others to join• Learn more about SHIP and your local health

action coalition – www.dhmh.maryland.gov/ship• Share your stories MDHealthCareReform.org

© 2012 Maryland Women’s Coalition For Health Care Reform

© 2012 Maryland Women’s Coalition For Health Care Reform

Leni Preston, ChairPhone: (301) 351-9381E-mail: leni@mdchcr.org Website: www.MDHealthCareReform.org