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ObamaCare vs Governor's Medicaid Restoration Plan

ObamaCare vs Governor's Medicaid Restoration Plan

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Published by tpmdocs
ObamaCare vs Governor's Medicaid Restoration Plan
ObamaCare vs Governor's Medicaid Restoration Plan

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Published by: tpmdocs on Jun 13, 2013
Copyright:Attribution Non-commercial


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Governor Brewer
Medicaid Restoration Plan Restores Arizona Law. It is NOT ObamaCare.
Governor Brewer’
s Medicaid plan is designed to comply with Proposition 204, a mandate overwhelminglyapproved by
 that requires AHCCCS to provide healthcare coverage to Arizona childlessadults up to 100% of poverty.
Governor Brewer’s plan is NOT
Below is a side-by-sidecomparison of some of the key components of ObamaCare versus what
Governor Brewer’s plan entails:
Establishes an Individual Mandate.
This changeleads to new mandates aimed at increasingaccess to affordable healthcare coverage. Only some of these are highlighted below.
Changes to Commercial Insurance Market 
Establishes the Exchange or HealthInsurance Marketplace; enrollmentbegins 10/1/13.-
Adds new benefit requirements forcommercial policies on and off theExchange/Marketplace.-
Adds new cost sharing restrictions forMarketplace policies.-
Extends coverage for young adults in
their parents’ plan until they turn 26
years old.-
Establishes guaranteed issue.-
Prohibits insurance companies fromdenying coverage to children under 19years due to a pre-existing condition.-
Prohibits insurance companies fromrefusing to sell coverage or renewpolicies because of a pre-existingcondition.-
Establishes community rating.-
Eliminates the ability of insurancecompanies to charge higher rates dueto gender or health status.-
Provides tax credits for middle and low-income families to help cover some of the costs of Marketplace coverage.-
Provides tax credits for small businessesto help provide insurance benefits fortheir workers.-
(…continued on the next page)
Governor’s Medicaid
Restoration Plan
Honors the will of Arizona voters
Restores coverage of Prop. 204 childlessadults (0-100% FPL) as passed by  Arizona voters in 2000, impactingestimated 240,000 Arizonans.
Covers an additional 57,000 adults from100-133% FPL so that Arizona canaccess enhanced federal funds for Prop.204 coverage.
Includes a hospital assessment to pay  for the
share of the cost of care for the Prop. 204 population.
With use of hospital assessment,reduces Medicaid pressure on State
budget … making more dollars availab
le for critical services like education and  public safety.
Features circuit breaker that automatically ends the assessment and Medicaid expansion if federal matchingdollars are reduced below an amount established in the legislation.
Obamacare Continued
Provides federal funding forMarketplace navigators, a consumerassistance program.-
Eliminates lifetime limits on insurancecoverage.-
Regulates annual dollar limits oninsurance coverage.-
Prohibits insurance companies thathave excessive or unjustified premiumincreases to participate in the HealthInsurance Exchange.-
Requires all new health plans to covercertain preventive services withoutdeductibles or copays.-
Prohibits insurance companies fromrescinding coverage as a result of finding an error or other technicalmistake on an application.-
Provides consumers with a way toappeal coverage determinations orclaims with their insurance companiesand establishes an external reviewprocess.-
Requires that 85% of premium dollarscollected by insurance companies forlarge employers be spent on health careservices and quality improvement.-
Limits the amount health insurancecompanies can deduct from taxes forofficers, employees, directors andservice providers.-
Requires health plans to begin adoptingand implementing rules for the secure,confidential, electronic exchange of health information.-
Adds a new excise tax on healthinsurance plans valued in excess of $27,500/year, known as
ealth insurance”
 Obamacare Continued
Quality, Payment, Oversight, Funding
Creates the Center for Medicare &Medicaid Innovation to test new waysof delivering care to patients-
Creates special office to improve carecoordination for dual eligibles.-
Increases reporting requirements forquality of care measures for healthplans and state Medicaid programs.-
Increases Medicaid payments forprimary care doctors.-
Provides incentives for providers toform Accountable Care Organizationsand other programs to bettercoordinate care and improve quality-
Adds new screening procedures forhealth care providers to fight fraud andreduce waste in Medicare, Medicaid,and CHIP.-
Adds Medicare reimbursementpenalties for hospitals.-
Includes changes to Medicarereimbursement, including bundledpayment strategies.-
Introduces Medicaid payment changes,including value based purchasing andbundled payments.-
Includes grant opportunities for publichealth initiatives, such as improvingmaternal and child health outcomes.-
Adds a surtax on investment income forhouseholds that make over$250,000/yr.-
Adds individual tax mandates onuninsured individuals.-
Adds a new tax and penalties foremployers with 50+ employees that donot offer health coverage if anemployee qualifies for a health taxcredit.

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