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Current Status of Reform Efforts

National Association of Health Underwriters Health Reform Update January 8, 2010 Russ Childers, President Janet Trautwein, CEO Jesse Patton, Legislative Council Chair Susan Rash, Legislative Council Vice-Chair Jessica Waltman, Sr. Vice President of Government Affairs.

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Current Status of Reform Efforts

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  1. National Association of Health UnderwritersHealth Reform UpdateJanuary 8, 2010Russ Childers, PresidentJanet Trautwein, CEOJesse Patton, Legislative Council ChairSusan Rash, Legislative Council Vice-ChairJessica Waltman, Sr. Vice President of Government Affairs

  2. Current Status of Reform Efforts • Bills have passed in House and Senate • Congress will not use formal conference committee to work out differences • Previous bills of this magnitude have held open formal conference committees • Negotiations going on behind closed doors • Process being used called “ping-pong” • Amends bills in each house to make identical

  3. Current Status of Reform Efforts • Democratic leadership will still need 60 votes in the Senate • Although a vote on the final bill will only require 51 votes, the motion to proceed to a vote on the final bill will require 60 • Goal is passage by State of the Union Address (February 2nd) • This goal will be very difficult to achieve

  4. What Needs to be Changed Clarifying the Role of the States • Minimum Loss Ratio Requirements • Structure of the Exchanges • Agent-Broker Language needs to be clarified • Regulatory authority overall

  5. Additional Key Issues • Taxes need to be eliminated or delayed until major reforms begin • Effective dates need to be at least 12 months after enactment • High risk pool funding needs to focus on existing high risk pool and alternative mechanism structures rather than creating new federal entities.

  6. Additional Key Issues • Personal responsibility requirements/individual mandate • Age rating • Insurance pooling requirements • Public Option still in House language

  7. Issues of Concern for You and Your Clients • Employer Mandates and Waiting Periods • Senate language likely to prevail • Employers over 50 must provide coverage or pay $750 penalty per FTE if even one employee is eligible for subsidies • Part-time and seasonal employees excluded • Full time means 30 or more hours per week averaged on a monthly basis

  8. Issues of Concern for You and Your Clients • Employer Mandates and Waiting Periods • Allows maximum 90 day waiting period • Penalties for waiting periods longer than 60 days of $600 per employee • Employees who are not eligible for subsidies can opt out of employer coverage with voucher for full employer contribution if employee share of premiums exceeds 9.8% of household income. • House language much more onerous.

  9. Issues of Concern for You and Your Clients • ERISA • Unclear whether Senate language will prevail • Senate bill retains exclusive federal regulation of self-funded plans • Many new requirements on ALL plans, including new automatic enrollment procedures for employers with more than 200 employees, new notice requirements, and new reporting requirements

  10. Implementation IssuesWhat is effective at Enactment? • Coverage for reconstructive surgery for children with congenital or developmental deformities (House) • All plans in all market segments • Group pre-existing conditions waiting period changes from 6/12 to 1/3. (House) • All plans in all market segments • Pre-existing conditions limitations due to domestic violence are prohibited (House) • All plans in all market segments

  11. Implementation IssuesWhat is effective in six months? • No lifetime limits (at enactment in House) • All new plans (Senate); All plans in House • Restrictions on annual limits • All plans in all market segments • Coverage for specific preventive services with no cost-sharing • All plans in all market segments • Elimination of pre-existing exclusions for children under 19 • All new plans in all market segments

  12. Implementation IssuesWhat is effective in six months? • Extension of dependent coverage to 26 (at enactment in House) • All new plans in Senate; All plans in House • Restrictions on rescission of policies • All new plans in Senate; All plans in House • New appeals process • All new plans in all market segments • No discrimination in coverage or premium based on salary • All group plans

  13. GRIP Program HUPAC Distributions Phone calls, letters, emails and Faxes Consumer/Employer Outreach Social Media Op-Eds and Letters to the Editor Media Outreach Make Your Voice Heard!

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