A brief overview of the Patient Protection and Affordable Care Act presented to job seekers in the healthcare field in April, 2011.

1. Health Reform 101An Overview for Job Seekers Bob Peters April 4, 2011

2. What You Need to Know – Alphabet Soup & Stuff PPACA ACO MLR Exchanges Insurance Coverage Expansion

3. PPACA PPACA = Patient Protection and Affordable Care Act (HR 3590) No cost controls About 1000 pages with about 1000 “rules to be made by the Secretary” of HHS, IRS, etc. Amends itself, then was amended further by subsequent “reconciliation” bill (HR 4872) Lots of court cases (25+) – decisions seem to follow party lines Kaiser Healthcare News for scorecard

4. ACO ACO = Accountable Care Organization “Organization” can be a provider group, Hospital or payer (HMO/Insurance Company) An “ACO” is accountable for at least 5000 Medicare lives in PPACA, but ACOs can be used in any health plan (Large/small groups, individuals) Objective: to make care more effective & share savings HMO with choice? HMO with no Teeth? Who knows…

5. MLR MLR = Medical Loss Ratio Payer (insurer or employer) must spend at least 80%/85% of premium on care for individual & small group/Large group (& Medicare) What is in “healthcare cost” and what isn’t – it’s really important! May mean the Death of the agent/broker commission model “Wellness” expenses may or may not be “good” Regulated administration/profit – guess what will happen? Who remembers $400 hammers paid for by the Army?

6. Exchanges State (or Federal) run insurance shopping and purchasing “thingy” The Brave New World of health insurance Subsidies and premium come in and go out “Buyers” sign up and pick company/coverage Levels the playing field (???) This is a really, REALLY complex assignment for the state/fed to take on and figure out

7. Insurance Coverage Expansion Adds about 32 million to the roles of insured Depends on “individual mandate” and “play or pay” provisions to force folks into the system Early retirees – reinsurance now (but maybe not next year), then Exchanges The Perfect Storm scenario – AT&T, 3M Most of expansion is in Medicaid Funding comes from BIG cuts in Medicare rates, fees & more fees

8. Some Take Always Broker/agent world is changing – probably for the better in the long run, but current turmoil “Customer Fee” model is better, but will take time to get there ACO rules just issued – lots of work to come for consultants - opportunity knocks! Exchanges – could be THE largest IT project of the decade for someone MLR rule – will change where (and how) money is spent – this could be very bad in the long run – the “cost plus” incentive to increase Healthcare costs

9. Some Take Always This law doesn’t really address the underlying problem of long-term access, cost or quality Uncle Sam giveth (coverage to uninsured) and taketh away (from Medicare payments, fees from lots of players) Former “charity care” and ‘bad Debt” now paid by government; Medicare pay rates decreased. Oh, and what if the law is overturned? To be continued…

10. Questions & Discussion