Agenda - 10-12-2010 - Board of Health Meeting

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DETAILED SUMMARY OF AFFORDABLE HEALTH CARE FOR AMERICA ACT Government responsibility. It is the responsibility of the federal government to ensure that essential health coverage is affordable and available to all Americans by establishing consumer protections and insurance reforms, affordability credits and overseeing a fair marketplace for people to choose among options. MAKING COVERAGE MORE AFFORDABLE: Affordability credits. Provides financial assistance for premiums and cost sharing for individuals and families with incomes up to 400 percent of the federal poverty level (FPL). Affordability credits are offered on a sliding scale such that premiums range from 1.5 percent of income at the lowest tier to 12 percent at 400 percent FPL. Provides additional assistance for households with incomes up to 400 percent FPL by limiting cost-sharing to 3 percent of plan costs at the lowest tier rising to 30 percent of plan costs at 350-400 percent of FPL. Specific out-of-pocket maximums are added to protect individuals at each income tier. Income Premium Limit as Percent of Income Percent of Plan Costs Paid by Families Annual Out-of-Pocket Cap Individual/Family Under 133 - 150% FPL 1.5 - 3% 3% $500/$1000 150 - 200% FPL 3 - 5.5% 7% $1,000/$2,000 200 - 250% FPL 5.5 - 8% 15% $2,000/$4,000 250 - 300% FPL 8 -10% 22% $4,000/$8,000 300 - 350% FPL 10 -11% 28% $4,500/$9,000 350 - 400% FPL 11-12% 30% $5,000/$10,000 Eligibility. Affordability credits are available to American citizens and legal residents whose employers do not offer coverage or whose share ofemployer-sponsored health insurance costs more than 12 percent of their family income. Those eligible for other government health care programs, such as Medicare or Medicaid, cannot receive affordability credits. Establishes a mechanism by which the Commissioner must verify that individuals are citizens or legal immigrants in order to receive affordability credits. Caps out-of-pocket spending and limits. Helps prevent medical bankruptcy by limiting out-of pocket costs to no more than $5,000 for individuals and $10,000 for families; these levels are indexed to inflation. Those receiving affordability credits have lower out-of-pocket caps. Medicaid and CHIP. Expands Medicaid coverage to everyone within income at or below 150 percent FPL ($33,100 per year for a family of 4) who is not eligible for Medicare. Eliminates assets tests for eligibility groups other than for long-term care. Requires States that now cover those above 150 percent FPL to maintain eligibility. States receive full federal funding for costs of expansion populations in 2013 and 2014. Thereafter, States pay 9 percent and the federal government pays 91 percent. CHIP-eligible children move to the Exchange or Medicaid in 2014. Prepared by the Committees on Ways & Means, Energy & Commerce, and Education & Labor October 29, 2009 26