Maryland Takes Action on Health Care Reform: The Affordable Care Act

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 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

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 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

© 2012 Maryland Women’s Coalition For Health Care Reform

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