Dan M. Gibson
Executive Director, MASI
February 8, 2011

A brief history of the Patient Protection
and Affordable Care Act.
February 8, 2011


A brief history of the Patient Protection
and Affordable Care Act.
How Health Reform will affect people
and businesses.
February 8, 2011



A brief history of the Patient Protection
and Affordable Care Act.
How Health Reform will affect people
and businesses.
What does this mean for Workers’
Comp?

For years the Rising Cost of Health
Insurance has been a popular political
issue…

The Inflation Rate in Healthcare has
steadily outpaced Regular Inflation…
by as much as DOUBLE…
Healthcare Costs Soar Above
Overall Inflation
John Commins, for HealthLeaders Media, October 22, 2010
The average, per capita cost of providing healthcare services
in the United States rose by 7.32% for the past 12 months
ending in August, a rate of inflation wildly above the 1.1%
overall inflation for the same period, according to new study
by Standard & Poor's.
The new numbers are consistent with a trend that from
August 2000 to August 2010 has seen healthcare inflation
rise 48% while overall Consumer Price Index has risen 26%
for the same period, U.S. Bureau of Labor Statistics data
show.

AS A RESULT, HEALTHCARE
BECAME A PIVOTAL ISSUE IN THE
2008 PRESIDENTIAL ELECTION…

President Obama’s electoral platform identified
the high cost of health insurance, administrative
and overhead costs, and inefficiencies stemming
from reliance on a paper-based system as the
primary factors making health care unaffordable
and inaccessible to many Americans.
www.friedfrank.com

In his inaugural address, President Obama
stated: “That we are in the midst of a crisis is
now well understood . . . . Homes have been
lost, jobs shed, businesses shuttered. Our health
care is too costly.”
www.friedfrank.com

The new President pledged that his
administration “will restore science to its
rightful place and wield technology’s wonders
to raise health care’s quality and lower its
costs.”
www.friedfrank.com

In a joint address to Congress on February 24,
2009, just one month into his presidency,
President Obama lays out his agenda for the
administration. "We can no longer afford to put
health care reform on hold. ... I suffer no
illusions that this will be an easy process," he
says.
U.S. News and World Report

On March 5, 2009, President Obama holds a
health care summit with lawmakers and health
care executives. He warns liberals in his party,
such as the liberal lion Sen. Edward Kennedy,
that costs must be controlled. "We've got to
balance heart and head as we move this process
forward," he says.
U.S. News and World Report

By the end of March, 2009, the nation’s health
insurers say they would no longer deny
coverage to those with pre-existing medical
conditions — if everyone were required to buy
insurance. It is one of many deals with key
health care stakeholders, including hospitals
and pharmaceutical companies, in an attempt to
reach a lasting consensus.
U.S. News and World Report

By the end of October, 2009, House Democratic
leaders combine three committee bills into a
single piece of health care legislation that would
cover 36 million uninsured Americans by 2019.
It includes a public option. House Majority
Leader Steny Hoyer, D-Md., says, “We are one
step further on a long, hard road.”
U.S. News and World Report

By early 2010, several bills have passed various
hurdles, but public opinion continues to be
divided. On February 22, 2010 President Obama
releases his proposal for a complete reform of
healthcare. A summit of Congressional leaders
is held at Blair House three days later.
U.S. News and World Report
Obama signs health-care reform bill
By Scott Wilson
Washington Post Staff Writer
"Today, after almost a century of trying; today, after over a year of
debate; today, after all the votes have been tallied -- health
insurance reform becomes law in the United States of America," he
said. "Today."
Minutes later, sitting at a small desk surrounded by congressional
leaders and some of the Americans whose problems he
highlighted in speeches, Obama turned the most contentious bill
in recent memory into law with his left-handed signature. He used
22 pens to do so, adding what his Democratic supporters say is
another strand in a widening social safety net designed to protect
those living in the world's wealthiest society.
It is now law.

Beginning in 2014 Americans will be required
by law to have health insurance and attach
proof of insurance to their tax returns.
What Does Health Reform Mean for You? - NCPA

If you fail to insure, you will be fined – with the
penalty rising to $695 ($2,085 per family) in
2016 or 2.5% of your adjusted gross income,
whichever is greater.
What Does Health Reform Mean for You? - NCPA

If your employer fails to offer you health
insurance, your employer can be fined as much
as $2,000 per employee per year.
What Does Health Reform Mean for You? - NCPA

The type of insurance you must have –
including co-pays, deductibles and the
employee’s share of the premium – will all be
determined by federal regulations, rather than
by you and your employer.
What Does Health Reform Mean for You? - NCPA

If you are not covered by an employer plan,
Medicare, Medicaid or other government plan, you
will be required to buy insurance in a governmentregulated health insurance exchange, where
competing insurers will offer the governmentmandated health insurance benefit package.
What Does Health Reform Mean for You? - NCPA

How your doctor practices medicine and how
you obtain care are likely to substantially
change.
What Does Health Reform Mean for You? - NCPA

You may be able to buy insurance you cannot now
afford. Beginning in 2014, for example, a couple
with an income of twice the poverty level
(currently $29,000) will be able to buy insurance for
an annual premium no higher than 6.3% of their
income ($1,827).
What Does Health Reform Mean for You? - NCPA

If you have a pre-existing condition, you will be
able to buy insurance for the same premium as that
paid by people in good health.
What Does Health Reform Mean for You? - NCPA

Over the next four years, newly created risk pools
will offer subsidized insurance to some of the
people who have been turned down by health
insurers because of a pre-existing condition.
What Does Health Reform Mean for You? - NCPA

If you have a very expensive and continuing health
problem, there will be no lifetime limits on your
health insurance coverage.
What Does Health Reform Mean for You? - NCPA
CBO: Obamacare Would Cost Over $2 Trillion
By JEFFREY H. ANDERSON
The Weekly Standard weekly newsletter.
The CBO’s most recent analysis is out, and it’s not likely to convince wavering
House Democrats to jump to the Obamacare side of the fence. Even the Democrats
are granting that the latest version of their proposed health care overhaul would
cost $69 billion more than the previous version. According to the CBO, this version
would siphon even more money out of Medicare, make even further cuts to
Medicare Advantage, and levy even higher taxes and fines on the American people.
President Obama, Speaker Pelosi, and their allies, are cheerfully citing “ten year”
costs of $940,000,000,000.00 — apparently believing this to be a far more palatable
figure than $1 trillion. But even this colossal tally is like the introductory price
quoted by a cell phone provider. It’s the price before you pay for minutes, fees, and
overcharges — and before the price balloons after the introductory offer expires.




Medicare benefits are likely to decrease while the cost
of Medicare is likely to increase.
Overwhelmed clinics and doctors are likely to get
worse, and the time spent waiting for appointments
and procedures is likely to become unreasonably
long.
The United States currently leads the world in time
spent with the doctor, number of people seeking
preventative care, and accessibility of medical care.
An over-utilized system is likely to crush under the
demand, and overall healthcare is like to suffer.
What Does Health Reform Mean for You? - NCPA



In weighing the costs of complying with Obamacare,
some employers are considering laying off workers
and automating their workplaces.
The cost of automation is cheaper in some cases than
compliance.
This means thousands if not millions of Americans in
time may lose their jobs because of Health Reform.
MASI Fall Conference, Health Care Symposium, October 1, 2010

Availability of care will be an issue. With a large
number of people having new health coverage, doctors
and facilities may be swamped in some areas. The
problem will lead to:
(a) delays in appointments for workers compensationrelated medical treatments and
 (b) less willingness by providers to participate in
occupational medical networks and offer discounts off fee
schedules.

WorkersCompInsider.com

There could be a benefit…. For example, one provision
of the new law allows health insurers to charge smokers
50 percent more for health insurance coverage. Another
provision provides that employees enrolled in a
company wellness program or meeting certain health
standards may obtain a 30 percent reduction in health
insurance premiums. In theory, as a result of these
provisions, employee health will improve, which will
result in fewer workers’ comp claims.
HRHeroOnline.com
Congressman Seeks National Review of State Workers’
Compensation Laws
The Insurance Journal.com
Congressman Joe Baca, D-Calif., has introduced legislation that would authorize the
creation of a National Commission on State Workers’ Compensation Laws.
Baca’s National Commission on State Workers’ Compensation Laws Act would
establish a separate body to evaluate state workers’ compensation laws in order to
determine if they provide an “adequate, prompt and equitable” system for injured
workers.
“More than 35 years have passed since our government took a serious look at the
effectiveness of workers’ compensation laws,” said Rep. Baca. ”Access to proper
benefits and medical care after on the job injuries is a right every American worker
deserves. I am hopeful this legislation will bring us closer to updating and
modernizing our state workers’ compensation laws to ensure they remain effective
in this new century.”
In 1972, a national commission authorized by the Nixon administration made
numerous recommendations and set minimum standards. June 2009
Judge Rules Health Care Law Is Unconstitutional
Published January 31, 2011
FoxNews.com
A U.S. district judge on Monday threw out the nation's
health care law, declaring it unconstitutional because it
violates the Commerce Clause and surely reviving a feud
among competing philosophies about the role of
government.
Judge Roger Vinson, in Pensacola, Fla., ruled that as a result
of the unconstitutionality of the "individual mandate" that
requires people to buy insurance, the entire law must be
declared void.
"I must reluctantly conclude that Congress exceeded the
bounds of its authority in passing the act with the individual
mandate.”

Many large employers, who traditionally have looked
to MASI for help in workers’ comp, are now struggling
to understand the changes now taking place as a result
of Health Reform.

The possible implications of all of this are enormous.
Large employers could be greatly impacted by the
mandatory changes in healthcare – and costs could
escalate considerably.

MASI has decided to increase the focus of its mission.
In addition to being an advocate for self-insured
Workers’ Comp, MASI will now become an advocate
for Self-Insured Health.

The Mississippi Association of Self-Insurers, MASI, is
committed to representing the interests of the self-insured
workers’ comp and health community by promoting
knowledge and providing advocacy in legislative and
regulatory arenas.
Exciting times are
ahead…
Dan M. Gibson
Executive Director, MASI