The New Health Law: What It Means for

New Hampshire

About NH Voices for Health• A network of advocacy organizations, consumers & small businesses committed to expanding access to quality, affordable health care• Representing 200,000 consumers statewide• Our activities:• Convening stakeholders• Sharing information and promoting a public dialog• Expanding the state’s advocacy capacity• Advancing savvy and meaningful policy changes on the state and federal level

Patient Protection & Affordable Care Act: A Historic Milestone

• A century in the making• Builds on & strengthens our current health care

system• Strengthens and expands coverage options• Makes coverage more affordable• Makes coverage more stable & higher quality• Invests in health care cost control, quality,

workforce, public health & equity

Strengthening and Expanding Coverage Options

• Strengthens public programs• Medicaid – Federal funding for expanded

eligibility and improved reimbursement• Medicare – Improved preventive care, closing

the donut hole and extending the solvency of the trust fund

• CHIP / Healthy Kids Silver – Extended & increased federal funding

• Streamlined enrollment

Strengthening and Expanding Coverage Options

• Expands access to private coverage• Can keep the coverage you have• Access regardless of health status / history• Extended family coverage for young adults• Improved access / choice through the Exchange• Web portal

Making Coverage More Affordable• Reigns in excessive and wasteful costs– Promotes preventive care & efficiency– Strengths premium rate review– Limits administrative spending

• Makes premium charges more equitable

• Reducing cost shifting

Making Coverage More Affordable

• Provides assistance for working families and small businesses– Individual premium subsidies & cost-sharing

assistance– Small business tax credits & grants

Making Coverage More Stable & Higher Quality

• No benefit limits• No rescissions• Cost-sharing limited & no cost-sharing for

preventive services• Waiting periods limited• “Essential health benefits” package• Transparency of information

Shared Responsibility

• Based on the notions that:– The system works best when everyone is in it–We have an employer-based coverage system

• Must purchase coverage if it’s affordable to you– Various exemptions and waivers

• Expectation that employers provide coverage– Does not apply to small employers

Other Investments

• Health care cost control • Health care quality• Health care equity• Public health• Health care workforce

Example: Personal Story

• Your child is now a young adult, but unable to get a job that provides health coverage and they do not qualify for public coverage. You are worried because your son or daughter requires regular medical attention.

Under the New Health Law …

• The new health law allows young adults to stay on parent’s plans up to age 26

• Expanded eligibility reimbursements may allow them to enroll in subsidized plans on their own (including cost-sharing)

• New regulations prohibiting insurance companies from denying coverage based on pre-existing conditions will ensure they are able to access potential health plans

Example: Personal Story

• Your child has a chronic illness which makes them more susceptible to health problems. Your primary insurance has cost sharing at 80/20 but your family is concerned about being able to afford frequent visits to the doctor and/or hospital.

Under the New Health Law …

• Free preventative care (which will help lower additional visits to the hospital, especially for those with weakened immune systems)

• Cost-sharing provisions• The end of discrimination based on pre-existing

conditions gives families more flexibility to change insurers to a plan that might be a better fit

The New Health Law:What It Means for Alcohol and Other Drug Problems

Patient Protection & Affordable Care Act:• An unprecedented understanding that addiction is a

disease • That this chronic condition deserves effective

treatment as part of regular healthcare• That access to substance abuse services must be

increased, integrated and universal• And is our opportunity to close the addiction

treatment gap for the many men, women, and adolescents who need help in New Hampshire -- and do not receive it.

A Revolutionary Opportunity

• Private Insurance reimbursement• Medicaid reimbursement• Recovery Support services reimbursement• INTEGRATED CARE

Private Insurance

Health Insurance Exchange• Required to offer mental health and substance

use disorder services• Required to be at parity per MHAEPA of 2008

federal law

Policy opportunities

• Provider readiness – moving from stand alone system to integrated system with multi-payors

• Prevention – integrated into primary care and public health policy

• Integration of treatment – bi-directional with mental health and physical health

• And then the Medicaid expansion population …

Medicaid Coverage

• Current Medicaid Program• Expansion of Medicaid• Medicaid Managed Care in NH

Current Medicaid Services in NH

• Medicaid is “diagnosis blind”• Does not include alcohol and other drug

prevention, intervention, treatment or recovery support services• Does not include specialty trained

providers, MLADCs and LADCs are not reimbursable

Medicaid Managed Care in NH

• Bids due December 16, 2011• Contract operational July 1, 2012• Should have alcohol and other drug services

at parity to medical• Current advocacy focused on inclusion in

contract language

Medicaid Expansion

• 2014 Affordable Care Act Expansion of Medicaid to “healthy adults” under 133% of federal poverty guidelines• Requires alcohol and other drug services to

be provided at parity• Will cover previous non-participants in

health care

• Will require a resiliency and recovery-oriented system of care • Will require lessons learned from

implementation of managed care of alcohol and other drug services• Will require provider integration to

effectively serve multi-morbid clients• Will require vigilance and advocacy for

effective implementation

Next Steps: The Work Continues• Public education– People can only benefit from the new health

law if they know what’s in it– People support the law when they know the

details

• How you can be involved– Letters to the Editor, op-eds– Talk to your colleagues, patients, family

Next Steps: The Work Continues• Decisions continue to be made– Federal & state level challenges– Federal & state level implementation

• How you can be involved–Work with New Futures & NH Providers to

attend meetings– Attend hearings, contact elected officials– Share your experiences!

For More Information…• New Futures: www.new-futures.org

Amy Pepin, Policy Director, apepin@new-futures.org or 603-225-9540

• NH Voices for Health: www.nhvoicesforhealth.org mailing lists for updates and public meetings

• HealthReform.gov learn about the law and search coverage options

• Kaiser Health Reform Gateway: www.healthreform.kff.org learn about the law