Presentation on Health Care Reform as presented by Delegate Jeannie Haddaway-Riccio at the Talbot GOP Health Care Forum on Wednesday, September 16th, 2009. May also be viewed at: www.votehaddaway.com

1. Maryland, the US and Abroad
Presented by Delegate Jeannie Haddaway-Riccio
September 16, 2009

2. • Quality of Care
• Access to Care
• Affordability

3. • Economy
• Innovation/Future Trends
• Sustainability of Policies & Programs
• Personalized vs. Generalized Medicine

4. Federal Proposal
The Decision Makers:
 House Committees
 Energy & Commerce
 Education & Labor
 Ways & Means
 Rules
 Senate Committees
 Health Education Labor & Pensions (HELP)
 Senate Finance (the Gang of Six)
 Congressional Budget Office (for “Scoring”)
 Administration
 White House, OMB & HHS

5. Baucus Proposal: Overview
• $856 billion proposal over ten years
• $349 billion in new taxes
• 35% excise tax on the most expensive insurance plans
• Tax on insurance companies and medical device manufacturers
• $507 billion in cuts to govt programs
• Individual Mandate (Personal Responsibility Requirement)
• Tax penalties for non-compliance
• $750 per individual and $1,500-$3,800 per family
• Health Insurance Exchange
• No public option but sets up non-profit coops to compete with
private insurers
• Conducted on a state by state basis
• Medicaid expansion

6. Baucus Proposal: Employers
 Large Employers:
• New tax on businesses who self-insure
• Small Employers:
• Defined as 50 or more employees
• Starts January 1, 2013
• Tax credits provided to small business
• May not be enough
• 2008 Maryland experiment – this did not work
• Must meet federally mandated level of benefits OR
pay a tax to the gov’t
• Reimbursement of 100% of the subsidy per employee

7. Baucus Proposal: Insurers
• Levels established
• Platinum, Gold, Silver and Bronze
• Individual & Small Group Market must provide platinum or
gold level benefits
• No deductibles or copayments for preventative care
• List of “must cover” items
• Insurance Reforms
• No more pre-existing condition exclusions
• New taxes

8. Baucus Proposal: Consumers
  46 million Americans lacking coverage could be
covered
  Portability - if you don’t like your employer’s plan,
you can choose another plan
  / Health exchange could create competition, but
what about states with few choices?
  Changes flexible spending accounts & limits
contributions
  New taxes in bad economic times
  No med-mal reform
  Tax credits might not be enough

9. Baucus Proposal: Political Issues
 States Rights
• Working out differences in mandates
• Working out funding for Medicaid expansion and cuts
 Social & Ethical Issues
• Federal subsidy + Federally mandated benefits =controversy
• (abortion, end of life decision making, assisted suicide)
• Immigration
 Partisan Politics, Committee Politics &
Inner Party Politics
 Three versions of the bill + Rules Committee = ?
 Tax Issue – even some Dems don’t like
 Public option
Source: www.barackobama.com, Health Reform’s Effect on You, U.S. News & World Report, by Bernadine Healy, M.D.,
August 2009;, The Heritage Foundation, National Conference of State Legislatures, Washington Post)

11. •Started in 1995
•Now have 99% enrollment
(vs. 59% covered under private insurance before)
•Components of NH1
•Mandatory enrollment
•Single-payer system
•Run by government agency
•Premium rates tied to payroll/salaries
•Contributions shared by employer, employee and gov’t
(Source: Bureau of National Health Insurance)

12. •Every “customer” has an IC Card
•Outside of the card
•Name
•ID Number
•Birth date
•Photograph
•Internal Chip
Source: Bureau of National Health
Insurance in Taiwan •Basic data
(contact info, emergency, etc.)
•Basic healthcare data
(allergies, prescriptions, etc.)
•Health Administration Data
(how you pay, have you paid)

13. Formula based cost:
•(monthly income) x (premium rate ) x
(share of contribution) x (number of dependents)
•
Example:
Mr. Chen is a private sector employee with a monthly income of
$918 (USD) and he has two dependents:
$918 x 4.55% x 30% x 2 = $38/month
(Source: Bureau of National Health Insurance in Taiwan)

14. Government: Employers:
$2.8 billion $4.4 billion
Total Population:
Insured:
23 Million
$4.4 billion

15. •Government deficit – currently operating in the red
•$1 billion debt in Taipei alone
•Specialty care is hard to come by
•The more money you have, the better care you can
afford
•Private sector innovation is limited
•Government reimbursements are still out of line
•Medical students are studying in fields that provide the
highest reimbursements
•Considering a premium hike (politically unpopular)

17. • Would create the "Maryland Health Insurance Pool"
•Would merge individual and small group markets together
•Would provide premium subsidies to low-income residents;
•Would expand Medicaid eligibility
•Non-parents up to 200% of the federal poverty line
•Parents up to 300% of poverty
(Source: www.healthcareforall.com)

18. Total cost to the State:
$15.5 billion
Primary funding sources:
•2.0% payroll tax ($13.3 billion)
•alcohol tax increase ($1 billion)
•tobacco tax increase ($516 million)
(Source: www.healthcareforall.com)

19. If I were queen for a day

20. Best of Both Worlds Package
 Consumer driven  Reimbursement Reform
 Health Insurance Exchange –  Adopt recommendations of
private insurers only Gov’s Task Force on Health
Care Access and
 À la carte options
Reimbursement
 Insurance would be portable  more competitive and more
 Med-mal reform equitable (rural vs. urban)
 Recruitment tools  Enhance Medicaid
 Loan forgiveness reimbursements starting
in shortage areas
 Rural residency program

21. Best of Both Worlds Package
 E-records  Incentives, Inducements &
 Coop would help offset Education for Wellness
costs; help with  Healthy lifestyles
interoperability  Health disparities
 Private company or  Future Care Reforms
companies contracted to
design one software system  Increase the number of
nursing graduates
 Smart Cards
 Increase/enhance nursing
 Basic health information school facilities
 Debit card-like for HSAs  Better coordination
between health and mental
health; co-occuring
disorders

22. Best of Both Worlds Package
 Proposed legislation in 2006 Regular Session
 HB1412 - Eckardt & Haddaway
 May have legislation next session with similar
components

23. My Contact Info
Delegate Jeannie Haddaway-Riccio
32 S. Washington Street, Suite #1
Easton, Maryland 21601
(410) 820-8043
jeannie.haddaway@house.state.md.us
MD Legislative Information:
www.mlis.state.md.us