Health System Reform

Some Assembly Required Health Reform & Utah

Thank you for inviting me to speak today. The Utah Health Policy Project is a nonpartisan, nonprofit dedicated to creating quality, affordable, comprehensive health care coverage for all people in Utah through research, policy innovation, and civic participation activities. I am a member of UHPPs Speakers Bureau. (you can add a little here about your own background, if you wish) 1

Making Sense of Health ReformHealth reform can feel confusing and overwhelming. You have a lot of questions about what is exactly in the new law of the land and how it affects you and your family. Our presentation today is designed to help you make sense of it all. 2

The need for health reformLets start at the beginning. Why do we need health reform? UHPP has identified 5 main reasons to support health reform. First, to stop denying insurance to Utahns with pre-existing conditions. Second, to give Utahns peace of mind that they can still obtain health insurance even if they lose a job, especially in this economy. Third, to protect those of us with insurance from bankruptcy from a catastrophic medical event. Fourth, small businesses face unique challenges in providing health insurance to their employees and we must remove those barriers to give them more choice and the same competitive advantage as large businesses. When you add all these reasons together (plus many more) the clear conclusion is that the status quo is unsustainable. There is wide-spread bipartisan consensus about the need for health reform. The differences lie in what kind of reform.

Additional Background informationOver the last decade, premiums grew 3 times faster than wages, eating up more of our paychecks Nationwide 46 million people are uninsured, and another 44,000 more people lose their coverage each weekOver 400,000 uninsured in UtahEven families with insurance cannot afford the growing out-of-pocket costs to get the care they need45,000 people die prematurely each year because they do not have insurance In 2006, only 32% of Utah small businesses offer health insurance and that number has further declined in the current recession

3Introducing.Utahs Implementation Station

www.healthpolicyproject.org/NationalReform.html To help you make sense of health reform and find the answers to your questions, weve created a webpage called the Implementation Station. There are tons of great nuts and bolts resources here, including a how does reform affect me section, where we have different categories like I am insured, or I am a small business owner or I am uninsured and for each one we outline the main provisions of the health reform bill that will help you and when they are implemented. On the website, we also have an ask us button if you have specific question, and UHPPs staff will research the answer for you. In addition, we have compiled a list of links to other great resources across the web, if you want to dig in a little deeper. If your friends, family members, colleagues, patients, etc have questions, please refer them to this webpageit really is a useful tool. 4A Uniquely American SolutionBuild on the strengths of our current systemNothing requires you to change your coverage, doctor, or hospital, More choices of quality, affordable plans

Health reform proposes uniquely American solutions. It builds on the strengths of our current system. The vast majority of us will continue to get our health insurance through our employer. Medicare remains for our seniors, Medicaid for low-income vulnerable Utahns. Along those same lines, nothing requires you to change your coverage, doctor or hospital. What reform does do is provide more choices of quality, affordable private health insurance plans. 5Immediate BenefitsThis Year!!Children cant be denied for pre-existing conditionsUp to 35% tax credit for Utah small businessesYoung adults can stay on parents coverage until 26High-risk pool for Utahns w/pre-existing conditions$250 rebate for seniors in the doughnut-hole

Several immediate positive benefits are implemented this year. First, children cant be denied coverage for pre-existing conditions. For example, we met a 16 year old in Orem was denied health insurance for being prescribed a topical gel for her typical teenage acne. That sort of thing will stop. This year.

Second, small businesses who offer health insurance can receive up to a 35% tax credit to help offset those costs. Ill talk more about this a little later in the presentation.

Next, young adults will be able to stay on their parents insurance until they turn 26it doesnt matter if theyre enrolled in school or not. Utah already has a version of this law, but it doesnt apply to all plans. That will change. Also, under the reform, you can even be married and stay on your parents insurance. The only restriction is if you have access to insurance coverage through your employer then you cannot enroll on your parents plan.

Fourth, the reforms set up an interim high-risk pool for Utahns with pre-existing conditions. This pool is for Utahns who are currently uninsured and have been denied insurance because of a pre-existing condition. This pool will run parallel to the high risk pool we already have set up in Utah. Hopefully, however, the premiums will be cheaper.

Last, but not least, Seniors caught in the doughnut holethe gap in prescription drug coverage in Medicare Part Dwill get a rebate this year of $250 to help offset those costs. The goal is to completely close the doughnut hole by 2019 through additional discounts on prescription drugs.

So there you have itlots of exciting benefits for Utahns this year! 6Guarantee Your Insurance is There When You Need It

Health reform guarantees that Utahns will be able to depend on their coverage when they need it. For example, this is the Knight Family from Orem. Both Alan and Diane were small business owners. Within the same year, they both were diagnosed with cancer. Their premiums skyrocketedthey simply could not find an affordable plan anywhere. One quote was more than their mortgage and grocery bill combined. Diane was forced to close her small business that she had successfully run for over 25 year and go work for a local school district just to obtain insurance. Only as part of a large group could they obtain health insurance. Diane says that health insurance is more distressing than the fear of cancer, for their family. Utahns shouldnt have to completely turn their lives upside down simply to obtain insurance. (watch the Knights video story on our website here: http://www.healthpolicyproject.org/StorybankVideos.html)

This is next picture is of Rochelle Wenger, the local rabbis wife. In 2009, Rochelle got really sick, had several surgeries and was in the hospital for several weeks. By May, she hit the $250,000 annual benefit cap on her insurance. So even though she continued to pay premiums every month, her insurance refused to cover any additional items. She racked up more than $30,000 in medical debt, and had to postpone a critical surgery until January 2010 when her benefit cap reset. She wasnt able to count on her insurance when she need it most. Health reform is specifically designed to eliminate heart-breaking, tragic stories like these.

Read Rochelles story here: http://www.healthpolicyproject.org/SBRochelle.html7Guarantee Your Insurance is There When You Need ItInsurers can no longer deny coverage for Utahns with pre-existing conditions (2014)Insurers prohibited from canceling your policy when you get sick (2010)Barring insurers from charging higher premiums because of health conditions or gender (2014)No lifetime or annual benefit limits (2010, 2014)So, lets discuss those solutions. First, starting in 2014, insurers can no longer deny insurance to Utahns with pre-existing conditions. Again, this benefit for children begins this year.

Starting, this year, insurers will no longer be able to retroactively drop your coverage once you get sick. This is a practice called recission. Earlier this year, there was a ton of news coverage about how the insurer Wellpoint was systematically dropping coverage for women who had just been diagnosed with breast cancer. That kind of behavior stops this year.

In 2014, insurers will no longer charge higher premiums based on health status or gender. They will still rate premiums on age, tobacco use, family size, and some geographic factors.

Those annual benefit caps that Rochelle bumped up against will no longer be allowed starting in 2014. The lifetime benefit limit caps will stop this year, in 2010. 8Guarantee Your Insurance Is There When You Need ItInsurance plans cover preventative services with no co-pays (2010)Insurers disclose how much they spend on medical claims vs. admin, advertising & profit (2010)Access to a policy that covers basic services like Rx drugs and preventive screenings (2014)Simplified health insurance administration (2014)

But thats not all! Also, starting this year, your health insurance will fully cover certain preventative services and screenings like mammograms with no co-pays.

In addition, you and I as consumers will finally see some transparency of our insurers. Well know how much they spend on patient care/medical claims versus administration and CEO salaries. Then we are empowered and can pick a health plan that spends more of our premium dollars on our medical care.

Starting in 2014, as consumers well also know that we are buying a policy that covers the services we needlike prescription drugs and rehabilitative care. We wont have to worry about getting caught with junk insurance.

Finally, simplified health insurance administration will make it easier for our doctors to process their bills to insurers and cut down on the confusing paperwork we get sent!

Any questions at this point?9Help Small Businesses & Improve the Economy

The next big piece of reform is helping our small businessesthe engine of our economy. These are just a few faces of the small business owners weve talked to over the past couple years. Most simply cant afford to offer health insurance. And those that do, face double-digit premium increases every year15%, 20%, 25%--that is simply unsustainable and undermining the financial viability of these companies. So how does health reform help?10Help Small Businesses and Improve the EconomyUp to 35% tax credit to offset the cost of offering insurance to employees from 2010-2013Up to 50% tax credit for 2 years through the Exchange (2014)Grants to establish wellness programs (2011)

Right off the bat, small businesses can receive up to a 35% tax credit for their entire 2010 contributions towards purchasing health insurance for their employees.

The full credit will be available to employers with 10 or fewer employees and average annual wages of less than $25,000. Small businesses employers with fewer than 25 employees and average annual wages of less than $50,000 are eligible for a sliding scale credit. To be eligible for a tax credit, the employer must contribute at least 50 percent of the total premium cost or 50 percent of a benchmark premium.

But wait it gets better from there! The tax credit continues from 2010 to 2013. Starting in 2014, it increases to up to 50% of the premium contribution for eligible employers purchasing coverage through the Exchange for 2 years. Thats real savings you can put towards growing your business or paying higher salaries!

In addition, next year, small businesses can apply for grants to start wellness programs to encourage a healthier and thus more productive workforce. 11

Source: http://smallbusinessmajority.org/tax-credit-calculator

# of FTE employees:_____

Total Annual Wages paid for all employees_____

Total annual employer premium contribution:_____

Are you tax-exempt? Yes No

Results will provide the estimated tax credit youll receive for 2010-2013 and starting in 2014Calculate Your Tax CreditSmall businessesincluding non-profitscan calculate what their tax credit will be here: http://smallbusinessmajority.org/tax-credit-calculator. This is a really useful tool!

Additional Background informationInput the number of full-time equivalent employees (add up the total number of worked by all employees during the year, with a max of 2080 hours per employee), then, divide the total by 2080 and round to the next lowest whole number).

Enter the total annual wages paid per employee (add up all the amounts in Box 1 of every employees W-2 form). Input the total annual employer premium contribution (add up the premium contribution the business pays for each employee. The employer must be paying at least 50% of the total premium cost for every worker).

The IRS has a comprehensive Frequently Asked Questions that explains eligibility more in-depth: http://www.irs.gov/newsroom/article/0,,id=220839,00.html.

12Help Small Businesses: The ExchangeNew online marketplace gives ability to shop for and compare plans apples to apples (2014)Pool risk with other small businesseshave the same competitive advantage as large businessesIncreased choice & competitionInsurers compete on price and qualityCan choose whether or not to use exchangeSmall group market deductibles limited to $2,000 for individuals and $4,000 for families (2014)

But that is not all! In 2014, small businesses will be able to shop for and purchase health insurance through an online marketplace called an Exchange. If you think how Travelocity transformed the way we shop for and buy airplane tickets, this exchange is designed to do the same thing. You can input the criteria of what you are looking for and then compare plans apples to applesall online.

Also, small businesses will be able to pool their risk together through the exchange. So, right now, if you are a small company of just 5, then you are only sharing risk with that group of 5. So if one person gets sickthen everyone in the group really feels those premium increases. That doesnt happen in large groups where there are more people to share risk with. And because of that, the premiums small businesses pay are higher than the average large group. Reforms finally allow small businesses to join together to pool riskthus giving them the same competitive advantage that large businesses have. This is one of the most exciting provisions of health reform.

Having this new marketplace, will increase the number of choices small businesses will have for health insurance, and thus increase competition. . Insurers will compete on price and quality within the exchange. In addition, each plan will be rated bronze, silver, gold or platinum. Small businesses can then pick a levelsay silverand say they will offer that level plan. Then their employees can then go to the exchange and pick a plan that works best for themfinally giving small business employees more choices instead of a one-size-fits all. That means one employee who wants to be part of the IHC network can pick that plan which another in the exact same company can pick a different provider network

Small businesses can choose whether or not to participate in the new exchange. However, there are lots of incentives to encourage them to.

Utah already has an exchange in placethe 2nd one in the nation. We have many of these featuresincluding the online shopping and the ability for employees to pick a plan that works best for them. But we dont yet have several other important elementslike the pooling risk and the tax creditsthat will really save small businesses money. However, this exchange is an important foundation that we can build on in the health reforms and puts us way ahead of the rest of the country.

And lastly, to ensure health care is affordable for small businesses and their employees, deductibles will be limited to $2,000 for individuals and $4,000 for families.

Any questions about the reforms for small businesses? 13

Helping families afford premiums and out-of-pocket costsThe next main goal of health reform is to help ensure families can afford health insuranceboth the premium and the cost-sharingand that they dont go bankrupt if they get sick. 14Making Insurance More AffordableNew state-based exchange for individuals (2014)Employer doesnt offer insuranceEmployer insurance is too expensiveMembers of CongressPremium tax credits for individuals with incomes between 133% and 400% FPL through individual exchange (2014)Annual out-of-pocket costs capped (2014)

Individuals who cannot get health insurance through their jobor who cant afford their employers planwill be able to shop on a similar exchange for individuals. Because they dont have an employer contribution to help offset the cost of health insurance, low-to-middle income individuals and families will be eligible for new premium tax credits through the exchange. Utahns with incomes between 133% and 400% of the federal poverty level will be eligible.

In addition, in 2014 annual out of pocket costs will be capped for Utahns at the health savings account limits: $5,950 for individuals and $11,900 for families (indexed for inflation). Utahns buying coverage through the exchange will incomes below 400% of the FPL will have their out of pocket costs capped at a lower rate.

Background information

92% of Utahns are concerned about cost1 in 4 families will spend 10% of pre-tax income on health care in 2009With reform, 1medical event wont cause bankruptcy Financial help to small businesses & families who need it most

In the Individual Exchange, reduce the out-of-pocket limits for those with incomes up to 400% FPL to the following levels: 100-200% FPL: one-third of the HSA limits ($1,983/individual and $3,967/family); 200-300% FPL: one-half of the HSA limits ($2,975/individual and $5,950/family); 300-400% FPL: two-thirds of the HSA limits ($3,987/individual and $7,973/family).

Definition of too expensive employer insurance: The employer plan does not have an actuarial value of at least 60% or if the employee share of the premium exceeds 9.5% of income.

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ContainCostsEnsure QualityExpand Coverage3 Pillars of Health ReformHealth policy experts often say there are 3 pillars to reform: containing costs, ensuring quality and expanding coverage. Lets go through and see what the legislation does on each of these pillars. 16Contain Costs5 year grants to states for medical malpractice reform (2011)Pilot projects in Medicaid & Medicare on payment reform including medical home, bundled payment, and accountable care organizations (2012 & 2013)Stronger rate review process: insurers will have to justify premium rate increases (2014)Reduce waste, fraud & abuse in public programs

$50 million has been set aside as grants to states to develop, implement, and evaluate alternatives to current tort litigations. This can include medical review boards, early sorry and compensation policies, and evidence-based practice protection.

Currently incentive providers have to give more care (run more tests, do more procedures) rather than simply to provide quality care. For example, when Intermountain standardized lung care for premature babies, it not only cut the number who went on a ventilator by more than 75 percent; it also reduced costs by hundreds of thousands of dollars a year. Perversely, Intermountains revenues were reduced by even more. Altogether, Intermountain lost $329,000. Thanks to the fee-for-service system, the hospital had been making money off substandard care. And by improving care by reducing the number of babies on ventilators it lost money. Payment reform pilot projects in Medicare and Medicaid will test on how to change those incentives so more hospitals will focus on providing quality care instead of just more care.

Some payment reform policies that will be tested are medical homes, bundled payments and accountable care organizations.

In addition, states will have the opportunity to strengthen their rate review processes. Instead of just rubber-stamping an insurers request to increase premiums, they should have to prove and justify why they need to increase premiums, and give the public an opportunity to comment.

Finally, reducing waste, fraud and abuse in our public programs will also help to curb costs. 17Ensure QualityInsurers must devote at least 85% of premiums to medical benefits rather than to admin costs & CEO salaries OR pay a rebate to enrollees (2011)Reduces Medicare hospital payments for preventable readmissions & infections (2012)Requires reporting of quality indicators by physicians (2011)Minimum benefit standards in the exchange so you arent sold junk insurance (2014)

Like I mentioned earlier, insurers will have to disclose how much they spend on medical claims vs. CEO salaries and if the spend less than 85% on medical claims then their enrollees will receive a rebate!

Medicare will reduce the payments they make to hospitals for preventable readmissions and infectionsagain you dont want to financially reward poor quality care.

Better reporting by physicians will finally give us the data to compare results and see scientifically which treatments work best, when compared with each other. The goal is to increase transparency so you can have the tools to pick where you get your care.

Finally, youll know that the health plan you purchase will cover the things you needlike prescription drugs and preventative careand that you arent being sold junk insurance.

Background information:The law requires all qualified health benefits plans, including those offered through the Exchanges and those offered in the individual and small group markets outside the Exchanges, except grandfathered individual and employer-sponsored plans, to offer at least the essential health benefits package. (Effective January 1, 2014). That package includes hospital and outpatient services, prescription drugs, mental health services, maternity care, rehabilitation and preventive care, but not abortion services

18Expand CoverageMiddle income Utahns, small businesses & the self-employed gain insurance through exchangesAll low-income Utahns up to 133% FPL access Medicaid (2014)CHIP reauthorized until 2019 w/ funding until 2015Expansion of Community Health Centers (2011)

Roughly 30 million Americans will gain insurance, raising our nations uninsured rate from 85% to 95%. Middle-income Utahns, small businesses and the self-employed will gain the most, especially from the new exchanges.

All low-income Utahns with incomes up to 133% of the federal poverty level, will have access to Medicaid. Currently, Medicaid only serves certain catagorieslike children or people with disabilities. So in Utah, if you are an adult with no children, you literally could be penniless and not qualify for Medicaid. Health reform changes that, so all low-income Utahns can qualify.

CHIPthe Childrens Health Insurance Programcreated by our own Senator Hatch will continue. And Community Health Centers will be expandedtheir budgets are set to about double in size. 19Shared ResponsibilityFree-rider provision: Employers with more than 50 employees with an employee who accesses premium tax credits assessed a fee (2014)Small businesses with 50 or fewer employees will not be subject to any of these free-rider fees. Individuals required to purchase insurance (exemptions include financial hardship, uninsured for 8% of income, or income below tax filing threshold

Tax for choosing not to enroll (by year)2014 - $95or1% taxable income2015 - $325or2% taxable income2016 - $695 or2.5% taxable income

Why was the individual mandate included?Without it - difficult to incentivize young, healthy people to buy insurance and help mitigate risk for allEliminate hidden cost shiftingCant do the insurance market regulation without it (premiums for everyone would rise)

20Strengthen Medicare

Does not cut guaranteed Medicare benefits$250 rebate for prescription drugs if incur cost exceeding $2,700 worth of coverage. Medicare copayments will be eliminated for annual check-ups, preventive services and screening

Optional slide depending on audience

There are have been a lot of myths and misinformation about how health reform affects Medicare. So lets set the facts straight. First, reforms absolutely do not cut any guaranteed Medicare benefits. Period. In fact, reforms strengthen Medicare. Starting this year, seniors caught in the doughnut hole will receive a $250 rebate; Reforms should close the doughnut hole by 2019 through discounts on name-brand prescription drugs and subsidies for generic drugs. In addition, co-payments for annual check-ups and preventative screenings will be eliminated Medicaremaking it easier and more affordable for our seniors to get the preventative care they need. 21Strengthen MedicareAnnual wellness visits allow you take steps to stay healthy (2011) Stronger incentives for hospitals to keep you healthyCut subsidies to Medicare Advantage plans; give plans that meet quality standards bonuses (2012) Medicare Advantage plans cannot reduce basic, guaranteed Medicare benefits, but some extras will likely be paired down.

(optional slide)But it doesnt stop there! Medicare will pay for your doctor to sit down with you once a year to create a plan on improving and managing your health. Hospitals will have financial incentives to keep you healthy and avoid preventable infections and readmissions.

A lot of myths and misinformation around Medicare come from this next bullet point. There are actually 2 parts to Medicare. Traditional Medicare is run by the federal government and is fee for service. Medicare Advantage is a program where the government pays private plans to administer Medicare. Currently, for every dollar Traditional Medicare gets, Medicare Advantage is paid $1.14. Thus, they are receiving a 14% subsidy. Reform will cut that subsidy and say private plans: you can be just as efficient as government. For every dollar Traditional Medicare gets, Medicare Advantage will get the same dollar.

Now, plans that meet certain quality standards will receive bonuses. So the subsidy doesnt go away entirely. Medicare Advantage plans cannot reduce basic, guaranteed Medicare benefits, but the extras that some plans offer, like free gym memberships or free eyeglasses, will likely be paired down. Those decisions are up to the Medicare Advantage plans. 22Young adults will be able to stay on parents insurance until 26 at your parents choice regardless of school enrollment status even if you are married

Cannot have access to insurance through your employer

(Optional slide)

Additional information

Blue Cross Blue Shield of Utah, United Healthcare, Kaiser Permanente and Humana implementing this policy in June for recent graduatesAll others, including Select Health, implement in October

23For Health Care ProvidersRedistribute 65% of unfilled residency slots to primary care or general surgeryExpanded scholarships and loan repayment through National Health Service CorpsAdditional benefits for health care workers in primary care or high need areas

2010(optional slide)Health reforms invests in developing more health care workers and physicians through expanded scholarships, low-interest student loans, loan repayment programs, tax credits, etc. Many of these benefits are targeted at physicians or other providers who want to go into primary care or serve high-need areas, like rural Utah.

To also increase the number of primary care providers, unfilled residency slots will be redistributed to emphasize primary care or general surgery.

Additional informationExpanded scholarships and loan repayment through the National Health Service CorpsAdditional low-interest student loans, scholarships, loan repayment programs for primary care and general surgeryTax relief for health care workers paying state-issued student loans for working in primary care or high need areas

24For Health Care Providers 10% Medicare bonus to all primary care physicians and for general surgeons in rural areas 5% Medicare bonus to mental health providers Increase in Medicaid payment rates for primary care physicians to equal Medicare rates (2013)Medicare practice expense GPCI raised to the national average for frontier states like Utah Bonus payments for voluntary participation in Medicares Physician Quality Reporting Initiative

2011(Optional slide)Medicare is also giving a bonus payment to primary care physicians and general surgeons working in rural areas, as well as a 5% bonus payment to mental health providers.

Medicaid will follow suite shortly thereafter and bring payment rates for primary care physicians in line with Medicare rates.

Currently, Medicare pays hospitals different amounts across the country. So a hospital in Utah is actually paid less than a hospital in Florida. Medicare will adjust that formula, resulting in an increase in for states like Utah.

Finally, physicians can receive bonuses for reporting quality data to Medicare. Collecting this data is the first step to transparency and better competition in the marketplace. 25Financing ReformEliminating the subsidy to Medicare Advantage HMOs (saving ~$150 billion)Excise tax on Cadillac insurance plans (saving ~$150 billion) starting in 2018Increase in the Medicare payroll tax for high income earners starting in 2013Savings in Medicaid and Medicare prescription drug costs ($80 billion)Reduces DSH hospital payments because of newly insured (saving ~$20-40 billion) Fees on certain device manufacturers, insurers, tanning salons and others

Eliminating those subsidies to Medicare Advantage pays for about half of the legislation. Reform is also financed by an excise tax on Cadillac insurance plans. This is actually one of the best cost containment tools in our toolbox. Cadillac plans are the ones that no co-pays and a $500 deductible. And when we are consumers are so totally separated from what our health care actually costs, we tend to use a whole lot more of it than we need. So, this tax disincentives employers from offering them and will help control costs in the long run.

Other payment measures include a Medicare payroll tax on high-income earners, savings negotiated with the pharmaceutical industry. Currently hospitals are paid to treat uninsured patients, but under reform when there are less uninsured, those payments will be decreased. Finally fees on devices and tanning salons make up the last piece.

Additional Information Additional 0.9% Medicare payroll tax on wages >$250,0003.8% tax on unearned income (interest, dividends)

Cadillac health plans is defined as employer-sponsored health plans with aggregate values that exceed $10,200 for individual coverage and $27,500 for family coverage. The tax is equal to 40% of the value of the plan that exceeds the threshold amounts and isimposed on the issuer of the health insurance policy 26Cost Analysis by the CBONet cost of $938 billion over 10 years Reduce the Deficit $140 Billion The First 10 Years & $1.2 Trillion In The Next 10 Years Average premiums will stay the same for the majority of Americans who get their insurance from their jobCosts will go down for those who buy in the exchange and qualify for subsidies

All in all, the legislation is predicted to cost $938 billion over 10 years. The nonpartisan Congressional Budget Office estimates it will reduce the deficit by $140 billion the first ten year and an additional $1.2 trillion in the next decade. Very exciting

Average premiums are expected to stay the same for the majority of us who get our insurance from our jobs. And costs should go down for those who buy through the exchange and qualify for subsidies.

27State-Federal Partnership

Health reform can, must and should be a federal-state partnership. Regulating health care is currently shared by both the state and the federal government. The state has responsbility for the individual and small group markets, plus part of Medicaid. The feds oversee Medicare, large employers and part of Medicaid. Health reform preserves this partnershipand in fact depends on it for its success.

Fun Fact: Do you know which picture is the U.S. Capitol and which is Utahs Capitol? Answer: Left pictures is U.S. capitol and the picture on the right is Utahs Capitol. 28Create & run the exchanges (Utah already has the 2nd exchange in the nation) Strengthen Utahs rate review processStrengthen consumer health assistanceContinue payment reform & All Payer DatabaseMedical malpractice reformWellness Initiatives and Programs

Utahs Important RoleThe state has an immense amount of responsibility and flexibility within the reforms. As our state has already been studying health reform for that last 3 years, we are in a good position to begin implementing and building on the federal reforms.

Utah can choose to create and run the new exchanges, and there is an immense amount of flexibility in how we design the exchange We can strengthen our rate review process so insurers actually have to justify their premium increases instead of having them just be rubber-stamped.

Right now, if you need help finding coverage or help understanding your insurance, who can you call? There really isnt an easy answer. We need to strengthen our Consumer Assistance infrastructure so that if you and I need helping fighting a claim denial or finding coverage, we have someone to turn to.

In addition, as part of Utahs reforms we have developed very promising pilot projects on payment reform with diabetes and pregnancy. We also have an All Payer Database that allows us to collect and analyze claims data so we can being to measure quality and price. This tool will be key to developing cost containment policies down the road

As I mentioned before, medical malpractice reform is entirely left up to the states. Finally, Utah can lead the way in developing wellness programs and intiatives. The best cost containment policy is to help Utahns be healthy.

29How does this help Utah families?Insurance no longer dictates career choicescan work for a company with small risk pool or start own business Can count on insurance when you need it mostMore choice and transparency so can pick a health plan that works best for youInsurance companies must now compete on price and quality, not cherry-picking So, to summarize, health reformthe new law of the landwill help Utah families. The insurance reforms means that insurance will no longer dictate Utahns career choices. Diane can keep her small business. Utahns with pre-existing conditions can now start their own businesses and not be denied insurance. Utahns like Rochelle can count on their coverage when they need it.

More chance and transparency, especially through the new exchanges, help you access a plan that works best for you and your family

Finally, reforms mean insurance companies will now compete on price and quality instead of who can cherry-pick out the healthiest people.

30Q & A

Thank you!Questions?31Next StepsHelp educate your family, friends and colleagues about what is the bill and what is notInvite UHPP to come speak at your next event!Sign-up to receive email and updates from UHPPUrge our Governor and Legislature to properly implement the reforms and take advantage of the state flexibility and new responsibility Participate in our statewide conference calls on implementationThank you for taking the time to listen to our presentation. We know that your friends, family, colleagues probably have lots of questions as well about what is the bill and what is not. Please refer them to our implementation station website (www.heallthpolicyproject.org). You can also invite us to come give this presentation to your next professional association meeting, book club, or any other meeting.

Ive passed around a sign-up sheet. Well send you periodic email updates with new resources weve posted on our website or announcements about upcoming public events. Plus, well keep you informed in how health policy continues to develop in our state. Please also write down your home address, so we can look up which state legislative district you live in.

Over the next year, our State Legislature and Governors office will have to makes lots of decisions on implementation. We need your help encouraging them to implement health reforms and take advantage of the flexibility and new responsibility.

Finally, well be organizing statewide conference calls and other events that really delve in deeper into the different elements of health reform. Wed love to have you participate in those and get your feedback and input.

32Thank You!

Thank you for inviting UHPP to present. As a nonpartisan, nonprofit, we hope to be Utahs resource for breaking down the nuts and bolts of federal health reform and implementing the new law of the land. Ultimately, health reform is a process and the only way to ensure success is for you to get involved and help us work towards achieving the goal of quality, affordable coverage for all Utahns. Thank you 33