ACTUARIAL ASPECTS OF MASSACHUSETTS REFORM. Ian Duncan FSA FIA FCIA MAAA. New England Actuaries Club November 2012
|
|
- Antonia Marsh
- 5 years ago
- Views:
Transcription
1 ACTUARIAL ASPECTS OF MASSACHUSETTS REFORM Ian Duncan FSA FIA FCIA MAAA New England Actuaries Club November 2012
2 Agenda 1. History and accomplishments of Massachusetts Reform 2. Actuarial Implications of Massachusetts Reform
3 Introductions Ian Duncan FSA FIA FCIA MAAA. Vice President, Clinical Outcomes & Analytics and Head of Research, Walgreen Co. Chicago. Adjunct Professor at UC Santa Barbara and Adjunct Research Professor, Georgetown Dept. of Health Administration. Board member, Massachusetts Health Insurance Connector Authority. Author of several books and peer-reviewed studies in healthcare management and predictive modeling publication has chapter on Massachusetts Reform. Published 2008 May 2011
4 4
5 Comparison of Massachusetts and US Health Care Reform Laws Massachusetts US Medicaid Expansions Subsidized Coverage Insurance market reforms Health Insurance Exchange Individual Mandate Employer Responsibilities 5
6 Commonwealth of Massachusetts Population: 6.5 million Second highest average per capita income in the US ($51,500 in 2010). Home to 65 universities and colleges (Harvard; MIT; BU; BC; etc.) Home to many famous medical facilities: Mass General; Brigham & Womens; Dana- Farber Cancer Institute, etc. Prior to passage of reform in 2005, Massachusetts had the lowest rate of uninsured in the US (9%) 6
7 Massachusetts Facts High income state. Strong base of employer coverage. Relatively low rate of uninsurance. ~20% of state economy is health care. Uninsured (prior to reform) ~9%. Long history of bi-partisan efforts to expand insurance coverage and introduce reforms. Expansive Medicaid program with 1115 waiver. Well-funded safety net. Strong advocacy groups. Earlier reforms of individual and small group insurance market. Medicaid waiver pays for approximately half of the additional cost of coverage (~ $850 million). The Most Democratic Legislature in the United States 7
8 Major Components of Massachusetts Health Reform Law Subsidize insurance for low and moderate income Medicaid expansions (mostly for children) Commonwealth Care (for adults up to 300% FPL) Flow of funds: Massachusetts Treasury => Connector Authority => insurers Reform the individual health insurance market Merge individual and small group markets Health Insurance Connector /Exchange Commonwealth Choice Products (Gold, Silver, Bronze and Young Adult Plans) Dependent coverage to age 26. Flow of funds: employer (or insured) => insurer. Funds do not flow through the Connector (Connector charges between 2.5% and 4% administrative fee for enrollment/marketing services). Require adults to have insurance if it s affordable Or pay state income tax penalties (between $228 and $1,260 in 2012). 8
9 Massachusetts Connector The Travelocity of Health Insurance Section 125 plans Small Employers Unsubsidized Unsubsidized CommChoice Individual Market Subsidized CommCare 9
10 Subsidized Insurance: Commonwealth Care Household income <300% federal poverty level No employer coverage available Sliding scale premium 5 private health insurers Benefits comparable to employer plans Run by the Connector Percent of Federal Poverty Level Individual Premium Per Month Couple with children: Premium Per Month <151% $0 $ % $39 $ % $77 $ % $116 $ % FPL ~ $31,000 for individual; $62,000 for family of three 10
11 One Stop Shopping at 11
12 Mass 2.0: Standardized Products 12
13 Affordability Schedule for Single Person: Monthly Premium Annual Income Mass 2011 Affordability Scale $0 - $13,538 $0 $13,539 - $16,260 $0 $16,261 - $21,672 $39 $21,673 - $27,096 $77 $27,097 - $32,508 $116 $32,509 - $39,000 $175 $39,001 - $44,200 $235 $44,201 - $54,600 $354 $54,601+ Affordable Same as Commonwealth Care Premium Schedule 13
14 Individual Mandate: The Tax Penalties Penalty Schedule for Failure to Comply with the Individual Mandate per year* per year** per year** per year** per year** per year** % FPL % FPL % FPL Above 300% FPL. Age Above 300% FPL. Age 27+ $219 $210 $204 $228 $228 $228 $219 $420 $420 $456 $456 $456 $219 $630 $624 $696 $696 $696 $219 $672 $624 $792 $864 $996 $219 $912 $1,068 $1,116 $1,212 $1,260 * For Tax Year 2007, the penalty for not having insurance as of December 31, 2007 was $219. ** If the individual is without insurance for all twelve months of the year. 14
15 Result After 4 Years: Lowest Rate of Uninsurance in the Country Massachusetts: Uninsured as % of Population 11.30% 10.4% 10.20% 9.2% 5.4% % 2010 Source: Current Population Survey, , US Census Bureau Source: Massachusetts Division of Health Care Finance and Policy, 2010 Household Insurance survey 15
16 As of December 2010: 412,000 More People Have Health Insurance Than in June 2006 Bridge Program +21,000 Medical Security +32,000 Private Coverage (Individual +34,000 and Employer -27,000) Commonwealth Care (+159,000 ) Medicaid +193,000 Source: Division of Health Care Finance and Policy 16
17 Change in Number of Newly Insured Since Health Reform: December 2008 vs. December , , December 2008 December Private Public March 2010 December 2008: Private =42% of increased coverage December 2010: Private =2% of increased coverage 17
18 Support for Health Reform Among Massachusetts Physicians Support Continuation of MA Reform 75% Believe MA Reform Helped Previously Uninsured 79% Believe MA Reform Improved / Did Not Impact Care Quality 88% Source: Physician Views of the Massachusetts Health Care Reform Law NEJM Oct
19 Crowd-Out Has Not Occurred: No Evidence of Decline in Proportion of Employers Offering Health Insurance 90% 80% 70% 60% 50% 40% 30% 70% 72% 76% 77% 68% 60% 60% 69% % 10% 0% MA Sources: DHCFP and KFF annual survey US 19
20 Most of the Remaining Uninsured Have Very Low Incomes Details of Uninsured from Mass Tax Filings: 2008 Uninsured part of year (n=156,000) Uninsured Full Year (n=140,000) Paid penalty 17% 17% Nothing affordable 16% 15% Lapse<3 mo 32% -- Income <150% FPL: exempt 31% 63% Appealed penalty 3% 2% Religious/other exemption 1% 3% 20
21 Remaining Uninsured are Disproportionately Young Men 21
22 On Coverage, Massachusetts is Already Far Ahead of Where the US Will Be in Nine Years After National Health Reform Uninsured Rate Pre- and Post-Reform (Among people <65 years old) 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 19% US 8% 3% Mass
23 Actuarial Implications of Reform: the 3 Rs Many of the early and continuing actuarial issues in Massachusetts are focused on attempts to address the unpredictable risk that plans faced in assuming nearly 200,000 previously-uninsured lives. As experience has emerged on these lives, risk management centered around more traditional risk-transfer mechanisms. The initial risk imposed by members without prior experience has been managed by a gainsharing mechanism. Ongoing risk has been managed with Risk Adjusted revenue transfers between plans. Ongoing losses are managed with stop-loss pool. => The 3 Rs: Risk-adjustment, Risk-Transfer and Reinsurance. 23
24 Gainsharing (Risk Corridors) The Connector has operated different corridors/gainsharing arrangements in different years. Recognize that the newly-insured lives represented an unknown risk; Risk Adjustment, while useful for addressing selection between MCOs, did not provide additional revenue to offset a revenue shortfall if claims should exceed the actuarial rate estimates. The Connector also implemented a stop-loss pool to which all participating plans contributed. It is essentially a self-insured arrangement (no new revenue is involved). Claims on (and contributions to) the pool are applied before gainsharing. Only the gain-sharing mechanism involves additional revue; Reinsurance and Risk-adjustment move existing revenue between health plans. 24
25 Gainsharing (Risk Corridors) Gainsharing limits and terms have changed since 2006, but the principles remain fundamentally the same. The most recent gainsharing arrangement works as follows: Aggregate risk sharing corridors apply to all Commonwealth Care Health Plans: Aggregate risk sharing corridors of 4% apply above and below the target medical capitation rate ( Health Plan Full Risk Corridor ); The Connector Authority shares 50% above and below the Health Plan Full Risk Corridor; and The Health Plans return to 100% full risk at 50% above and below the medical capitation revenue (closed-end risk sharing). 25
26 Gainsharing (Risk Corridors) (contd.) Health Plan Liability $ Health Plan Payments $ Health Plan Full Risk Corridor $ $ $ $ $ $ $ $ $ Target Capitation Rate 26
27 Stop-loss (Reinsurance) The Connector operates a stop-loss pool to which all Commonwealth Care Health Plans must contribute. No state money is included (i.e. the pool is entirely self-insured). Health Plans fund the pool at 1.25% of the capitation rate and the pool pays 75% of incurred claims above a $150,000 attachment point. Experience-rating also occurs if the pool runs a surplus or deficit. 27
28 Risk Adjustment Risk Adjustment is just one of the techniques used by The Connector to manage the selection risk of the Commonwealth Care program. The Connector does not fund the Commonwealth Choice program. The number of Connector Commercial members is small and so direct risk mitigation is not an issue; nor is the Connector able to influence pricing or underwriting of Commercial individual and small-group insurance. Initially, lacking claims data, risk adjustment was applied based on age and sex of enrolling members. The relative age-sex factor adjusted the base (Connector established) premium rate. As experience developed claims-based risk factors (using DxCG Medicaid Model) were developed and apply in the most recent year to members with more than 6 months of experience. New entrants continue to be age-sex adjusted. Adjustment calculations are performed by the Connector Authority staff using data provided by MassHealth (Medicaid), the enrollment and billing administrator. 28
29 Risk Adjustment The PMPM capitation rate to be paid to the Health Plan is equal to: Target PMPM x RF HP + Admin. Where: Target = Statewide Medical only Target for the Commonwealth Care Program = $ PMPM [1] (before any adjustment for hospital tax, but includes pharmacy costs) Total Members RF j HP = Σ (Geo i x Plan i x Disc i x Risk i ) / (Total Members) i = 1 Where: Geo i,j = Geographic (region) factor for Health Plan j Member i. [2] Plan i,j = Plan Type factor for Member i in Health Plan j. Risk i,j = Risk factor for Member i in Health Plan j. Disc i is a factor that represents a discount offered by the Health Plan. It does not apply in FY [1] This capitation amount includes prescription drugs, but does not include any adjustment for Health Safety Net (Uncompensated Care) hospital assessment. [2] Note that in Massachusetts, health plans serve multiple geographic regions and offer different plan types. This calculation develops a plan-wide adjustment factor. 29
30 Risk Adjustment Example of calculation of overall adjustment factor Rating Factors Member Plan Type Region Age Gender Plan Type Geographic Risk Total 001 I North 27 F * I North 22 F II North 35 M * II Central 44 F III Central 54 M Avg * Members 002 and 004 had seven or more months of experience during the historic experience period. Therefore, they receive a DxCG risk factor rather than an age/gender risk factor. Example (Member #2): RF i,2 = (1.0619)(0.9468)(0.9970) = Although the payment to this Health Plan in the first quarter of Fiscal Year 2011 was initially $431.58, the payment is retroactively adjusted for the increased Total Average Rating Factor and becomes: $ x $32.00 = $
31 Minimum Pricing Medicaid rules require that the Connector RFP provide bidders with an actuariallysound rate range within which they must bid. This rule has the effect of building-in trend because the actuarially-sound rate range is determined based on prior year s cost + trend. For Fiscal Year 2012, this approach would have resulted in increased cost for the Connector and the state. The Connector adopted a novel sound rate range approach that leveraged a development that had occurred 2 years earlier as a consequence of the termination of the Commonwealth Care Program for Aliens with Special Status. Aliens with Special Status are aliens legally admitted to reside in the US who are not eligible for benefits under 1996 Medicare reform legislation. They must achieve a minimum of 5 years of residence in addition to regular rules to be eligible for benefits. This population (numbering about 30,000 at its peak) is a unique subset of the Commonwealth Care program because, unlike the other 150,000 members for whom a 50% federal match is obtained, the 1996 legislation prohibits use of federal funds. 31
32 Minimum Pricing When Massachusetts encountered budget difficulties this population was removed from Commonwealth Care and put into a slimmed-down, lowercost program (The Bridge Program) underwritten by Celticare. Subsequent experience of the AWSS population was significantly lower than that of similarly-situated members in other MCOs. The Connector concluded that one MCO had demonstrated that a lower minimum rate was achievable and this became the minimum in the actuarially-sound range for the 2012 FY bids. Several MCOs bid around the minimum rate (some with more limited networks). Overall result was a flat budget from FY 2011 to FY This steerage of the market continued to FY 2013, where competition between plans resulted in reduction of about 5% in underlying capitation rates. 32
33 3 Rs: Results (contd.) Risk-adjustment (Q1 2012): Plan Rel. Risk Score +5.9% (8.8%) 15.3% 16.1% (2.1%) Net risk adjustment in Q is 3.9%, amounting to a net transfer to the participating plans of $6.8 million. The method of risk-adjustment chosen by the Connector does not result in budget neutrality; in 2012, there has been an influx of older and more risky members which has resulted in an increasing trend in the average risk factor (e.g. the + 3.9% in Q3 2012). The concurrent, budget-neutral approach of the ACA does not allow for this change in the underlying risk profile of the covered population. 33
34 3 Rs: Results Reinsurance (Stop-loss) experience: FY Cum. Loss-ratio 80.7% 137.4% 54.7% 67.1% 101.4% 81.8% Cumulatively the pool has generated a surplus which has been experiencerated back to the plans. Risk Corridor: Gainsharing has operated according to different parameters in different years. Aggregate net payments/(receipts) over the last few years have been in the range 1%-2% of premiums. Gainsharing results for individual plans have been larger, with several plans being reimbursed by the state between 3% and 5%, and on occasion plans reimbursing the state double-digit percentages. 34
35 Closing Thoughts Massachusetts reform was passed in 2006 after many years of negotiation, trial-and-error, with bi-partisan (political) support and support of employers, advocates, providers and payers. Cost control continues to be a challenge, 7 years into reform. Massachusetts reform has been affordable (financially) to the state because of significant subsidies from the US Treasury and from diversion of uncompensated care funds from (direct) payment to hospitals to payment to insurers. After 7 years (and considerable success) we are still discovering ways to improve it. Massachusetts reform was less administratively complicated than ACA, but still requires a $50 million administrative budget. 35
36 Ian Duncan FSA FIA FCIA MAAA Adj. Assoc. Professor Dept. of Statistics and Applied Probability University of California, Santa Barbara
Member Migration and Plan Choice in Massachusetts
Member Migration and Plan Choice in Massachusetts Ian Duncan FSA FIA FCIA MAAA Dept. of Statistics & Applied Probability, University of California, Santa Barbara Stephane Guerrier Dept. of Statistics,
More informationHEALTH REFORM FACTS AND FIGURES FALL 2012
HEALTH REFORM FACTS AND FIGURES FALL 2012 Signed into law on April 12, 2006, the landmark Massachusetts healthcare reform represents a comprehensive effort to complement existing coverage programs. The
More informationREPORT OF THE COUNCIL ON MEDICAL SERVICE. Effects of the Massachusetts Reform Effort and the Individual Mandate
REPORT OF THE COUNCIL ON MEDICAL SERVICE CMS Report -A-0 Subject: Presented by: Effects of the Massachusetts Reform Effort and the Individual Mandate David O. Barbe, MD, Chair 0 0 0 At the 00 Interim Meeting,
More informationMassachusetts Health Insurance Reform Impact on Insurance Markets, Pricing and Profitability - Executive Summary
Massachusetts Health Insurance Reform Impact on Insurance Markets, Pricing and Profitability - Executive Summary August 2016 2 Massachusetts Health Insurance Reform Impact on Insurance Markets, Pricing
More informationFactors Affecting Individual Premium Rates in 2014 for California
Factors Affecting Individual Premium Rates in 2014 for California Prepared for: Covered California Prepared by: Robert Cosway, FSA, MAAA Principal and Consulting Actuary 858-587-5302 bob.cosway@milliman.com
More informationASSESSING THE RESULTS
HEALTH REFORM IN MASSACHUSETTS EXPANDING TO HEALTH INSURANCE ASSESSING THE RESULTS May 2012 Health Reform in Massachusetts, Expanding Access to Health Insurance Coverage: Assessing the Results pulls together
More informationNational Health Reform and You. What You Need to Know About the Affordable Care Act and the Massachusetts Health Connector
National Health Reform and You What You Need to Know About the Affordable Care Act and the Massachusetts Health Connector 2 National Health Reform and You: What You Need to Know Today as many as 40 million
More informationThe Individual Mandate: Theory & Practice
The Individual Mandate: Theory & Practice August 21, 2014 Amanda E. Kowalski, PhD Yale University Nancy Turnbull Harvard University You will be connected to broadcast audio through your computer. You can
More informationHealth Care Reform Update
Health Care Reform Update Presented by David Hayes, FSA, MAAA Consulting Actuary Milliman - Atlanta November 16, 2012 Southeastern Actuaries Conference Fall 2012 Agenda This will be an general session
More informationCRS Report for Congress
Order Code RS22447 May 26, 2006 CRS Report for Congress Received through the CRS Web The Massachusetts Health Reform Plan: A Brief Overview Summary April Grady Analyst in Social Legislation Domestic Social
More informationHealth Care Reform in Massachusetts
Presentation to members of: June 28, 2007 By: Sandra L. Reynolds, Executive Vice President Associated Industries of Massachusetts Agenda Brief background Concept of Shared Responsibility Individuals Government
More informationHealth Care Access Law: Frequently Asked Questions. The Individual Mandate
Health Care Access Law: Frequently Asked Questions The Individual Mandate What is the individual mandate going to mean for me? How much will I have to pay? Residents of Massachusetts will be required to
More informationSelection in Massachusetts Commonwealth Care Program: Lessons for State Basic Health Plans
JULY 2010 February J 2012 ULY Selection in Massachusetts Commonwealth Care Program: Lessons for State Basic Health Plans Deborah Chollet, Allison Barrett, Amy Lischko Mathematica Policy Research Washington,
More informationState Health Care Reform in 2006
January 2007 Issue Brief State Health Care Reform in 2006 Fast Facts Since the mid-1970 s state governments have experimented with a wide variety of initiatives to expand access to health care for the
More informationThe Value of Exchanges
The Value of Exchanges The Role of the Health Connector in Driving towards Value Roni Mansur Chief Operating Officer Massachusetts Health Connector Massachusetts Health Policy Forum January 8, 2013 Boston,
More informationHealth Care Reform 2013
Health Care Reform 2013 Impact on Patients and Physicians Michael T. Doonan Assistant Professor Executive Director Massachusetts Health Policy Forum Director MPP in Social Policy The Heller School for
More informationMassachusetts Risk Adjustment Program: Executive Summary
Massachusetts Risk Adjustment Program: Executive Summary Introduction Wakely Consulting Group, Inc. has been retained by issuers in the Massachusetts market to review the methodology of the Massachusetts
More informationPatient Protection and Affordable Care Act of 2010 (P.L )
Premium Subsidy Established income-based, sliding scale premium subsidies for individuals/families making 133 400% federal poverty level (FPL) to purchase qualified health plans on exchanges; subsidies
More informationMassachusetts Health Care Reform. May 8, 2006
Massachusetts Health Care Reform May 8, 2006 The healthcare status quo is unsustainable Double-digit, annual increases in insurance premiums Half a million uninsured in Massachusetts, 40 million nationwide
More informationMassachusetts Health Reform and the Emerging National Health Reform Opportunity
Massachusetts Health Reform and the Emerging National Health Reform Opportunity UCLA Healthcare Symposium John E. McDonough, DrPH, MPA Health Care For All (www.hcfa.org) February, 2008 Health Care For
More informationTHE HOUSE FY 2014 BUDGET
THE HOUSE BUDGET BUDGET BRIEF MAY 2013 On April 10, the House Ways and Means (HWM) Committee released its Fiscal Year (FY) 2014 budget plan, and on April 24, after three days of debate and amendment, the
More informationACA impact illustrations Individual and group medical New Jersey
ACA impact illustrations Individual and group medical New Jersey Prepared for and at the request of: Center Forward Prepared by: Margaret A. Chance, FSA, MAAA James T. O Connor, FSA, MAAA 71 S. Wacker
More informationKey Indicators: Quarterly Enrollment Update
Commonwealth of Massachusetts Deval L. Patrick Governor Timothy P. Murray Lieutenant Governor JudyAnn Bigby, M.D. Secretary Executive Office of Health and Human Services Key Indicators: Quarterly Enrollment
More informationTHE GOVERNOR S FY2017 BUDGET PROPOSAL FOR MASSHEALTH (MEDICAID) AND HEALTH REFORM PROGRAMS
THE GOVERNOR S BUDGET PROPOSAL FOR MASSHEALTH (MEDICAID) AND HEALTH REFORM PROGRAMS BUDGET BRIEF MARCH 2016 SUMMARY On January 27, 2016, Governor Charlie Baker filed his proposed budget for fiscal year
More information159, , ,805 80,894 72,034 (45.2%) (50.6%) 78,982 (49.4%) 87,295 (54.8%) FY12 Q1 Net: ,802 28,897 28,969 27,376
4/24/212 I. Commonwealth Care Overall Commonwealth Care membership has increased in Q3FY12, compared to Q2FY12 due to the reintegration of the AWSS population. The vast majority of these new AWSS members
More informationThe Impact of the ACA on Wisconsin's Health Insurance Market
The Impact of the ACA on Wisconsin's Health Insurance Market Prepared for the Wisconsin Department of Health Services July 18, 2011 Gorman Actuarial, LLC 210 Robert Road Marlborough, MA 01752 Jennifer
More informationAmerican Health Care Act (House-Passed Bill)
This chart compares the to provisions of both the House-passed and the Senate Discussion Draft, called the. This chart is current as of June 26, 2017. Individual shared responsibility penalty for not having
More informationHealth Care Reform Massachusetts Style
Health Care Reform Massachusetts Style NAHC State Forum February 2010 Almost every American and advocacy group supports some form of Universal Health Insurance. But if it s not their preferred version,
More informationUpdate on Massachusetts Health Care Reform
Update on Massachusetts Health Care Reform Environment for Enactment Timeline for implementation Key Provisions Enrollment Update Brian M. Quigley America's Health Insurance Plans Historical Context Potential
More informationAffordable Care Act: The Wave To The Future Is Here!
ACWA/Joint Powers Insurance Authority 2013 Fall Conference Affordable Care Act: The Wave To The Future Is Here! Presented by: Tom Sher, Alliant Insurance Services, Inc. December 3, 2013 JW Marriott LA
More informationInsurance (Coverage) Reform
Arkansas Health Law Check Up Insurance (Coverage) Reform Create Insurance Marketplaces For individuals & small businesses Expand Medicaid to 138% FPL Arkansas alternative = Private Option, not Arkansas
More informationAffordable Care Act Repeal and Replacement Legislation
Affordable Care Act Repeal and Replacement Legislation Timeline/ Actions to Date In February 2017, draft legislation aimed at repealing and replacing the Affordable Care Act (ACA), or Obamacare, was informally
More informationMassachusetts Health Reform: Where Does It Stand? By Anne S. Kimbol, J.D., LL.M.
Massachusetts Health Reform: Where Does It Stand? By Anne S. Kimbol, J.D., LL.M. For many, the conversation about universal health care and health care reform changed when Massachusetts passed its sweeping
More informationMassachusetts Health Reform
Massachusetts Health Reform National Conference of State Legislatures August 16, 2006 Speaker Salvatore F. DiMasi Highlights of Chapter 58 Covers 95% of the uninsured in 3 years Preserves federal Medicaid
More informationAffordable Care Act: Impact on the Indiana Market
1 Affordable Care Act: Impact on the Indiana Market Seema Verma President SVC, Inc 2 Affordable Care Act Key accomplishment is access ~48.6 million uninsured in America* ~800 thousand uninsured in Indiana*
More informationHealth and Economy Baseline Estimates
Health and Economy Baseline Estimates March 7, 08 Entering the 08 plan year, the health insurance market continues to see increasing and unpredictable costs, large numbers of uninsured individuals, and
More informationThe Affordable Care Act: Opportunities to Influence Implementation
The Affordable Care Act: Opportunities to Influence Implementation Dylan H. Roby, PhD Assistant Professor of Health Policy and Management UCLA Fielding School of Public Health Director of Health Economics
More informationProcurement for Consulting Assistance in Reinsurance, Risk Adjustment and Risk Corridor ( 3R ) Planning
Procurement for Consulting Assistance in Reinsurance, Risk Adjustment and Risk Corridor ( 3R ) Planning (VOTE) Jean Yang Chief Financial Officer Daniel Apicella Manager of Health Care Finance Board of
More informationThe Affordable Care Act; 2014 and Beyond
The Affordable Care Act; 2014 and Beyond Presented by: Lacey Robinson, ACA Certified Vice President & Senior Benefits Consultant Gregory & Appel December 10, 2013 Agenda 2014 ACA Mandates ACA Intention
More informationOpportunities for State Legislators
Health Reform and Women s Health: Opportunities for State Legislators National Conference of State Legislatures Policy Options to Improve the Health of Women of All Ages December 8, 2010 Tracey Hyams,
More informationCOVERED CALIFORNIA: THE GOOD, THE BAD & THE UNDEFINED FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS
1 COVERED CALIFORNIA: THE GOOD, THE BAD & THE UNDEFINED FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS Ann-Louise Kuhns President & CEO California Children s Hospital Association Health Care Reform: The Basics
More informationH E A L T H C A R E R E F O R M T I M E L I N E
H E A L T H C A R E R E F O R M T I M E L I N E On March 23, 2010, President Obama signed the health care reform bill, or Affordable Care Act (ACA), into law. The ACA makes sweeping changes to the U.S.
More informationReport to the Massachusetts Legislature. Implementation of Health Care Reform. Fiscal Year 2009
Report to the Massachusetts Legislature Implementation of Health Care Reform Fiscal Year 2009 October 23, 2009. Table of Contents Table of Contents 1.0 Preface... 1 2.0 Update on the Status of Health Care
More informationMARKET STABILITY WORKGROUP 2.0. Meeting #3 Wednesday, October 31, :30 10:30 a.m. The United Way of Rhode Island
MARKET STABILITY WORKGROUP 2.0 Meeting #3 Wednesday, October 31, 2018 8:30 10:30 a.m. The United Way of Rhode Island UPDATES SINCE OUR LAST MEETING Meeting 2 Follow-ups: Who are the remaining uninsured?
More informationMaking Universal Health Care Work
University of Oklahoma College of Law From the SelectedWorks of Jonathan B. Forman April 28, 2006 Making Universal Health Care Work JONATHAN B FORMAN, University of Oklahoma Available at: https://works.bepress.com/jonathan_forman/200/
More informationState of California. Financial Feasibility of a. Basic Health Program. June 28, Prepared with funding from the California HealthCare Foundation
June 28, 2011 State of California Financial Feasibility of a Basic Health Program Prepared with funding from the Mercer Contents 1. Executive Summary...1 2. Introduction...4 Background...4 3. Project Scope
More informationHealth Coverage Programs 2018
Health Coverage Programs 2018 Neil Cronin Basic Benefits Training February 13, 2018 1 Affordable Care Act (ACA) changes in MassHealth & Connector in 2014 2 2014 ACA Improvements in MA MassHealth eligibility
More informationSummary of House Discussion Draft, February 10, 2017
Summary of House Discussion Draft, February 10, 2017 This summary describes key provisions of House Discussion Draft, dated February 10, 2017, reported in the media as a plan to repeal and replace the
More informationHEALTH CARE REFORM Focus on Group Coverage Blue Cross and Blue Shield of Minnesota. All rights reserved.
HEALTH CARE REFORM Focus on Group Coverage 2011 Blue Cross and Blue Shield of Minnesota. All rights reserved. Current Insurance Coverage Environment Minnesota United States Uninsured 9% Ot her Public 1%
More informationSenate Health Bill Unveiled
Senate Health Bill Unveiled Thursday, June 22, 2017 Senate Republican leaders today unveiled a draft of legislation the Better Care Reconciliation Act to repeal and replace parts of the Affordable Care
More informationFISCAL YEAR 2014: HOUSE AND SENATE BUDGET COMPARISON BRIEF
FISCAL YEAR 2014: HOUSE AND SENATE BUDGET COMPARISON BRIEF BUDGET BRIEF JUNE 2013 On May 15 the Ways and Means (SWM) Committee released its Fiscal Year (FY) 2014 budget proposal, and on May 23 the full
More informationHealth Insurance Exchange
Health Insurance Exchange Lynn A. Blewett, Ph.D. Professor, Division of Health Policy and Management, University of Minnesota School of Public Health Director, State Health Access Data Assistance Center
More informationWhat Is Next For the Affordable Care Act s Cost-Sharing Reductions?
What Is Next For the Affordable Care Act s Cost-Sharing Reductions? Understanding The Impact on Consumers and Insurance Markets Monday, April 24 th 1:30p.m.-2:15p.m. EDT What Is Next For the Affordable
More informationMassachusetts Health Reform Round Three. Brian Rosman Health Care For All May 1, 2006
Massachusetts Health Reform Round Three Brian Rosman Health Care For All May 1, 2006 Presentation Outline Health Care For All Background Brief History of Massachusetts Reform Round 3 What Was Just Passed
More informationMonitoring the ACA s. Vital Signs. The Affordable Care Act A Progress Report
Monitoring the ACA s Vital Signs The Affordable Care Act A Progress Report Today s Discussion Affordable Care Act Some Foundational Knowledge Affordable Care Act Compliance Requirements Plan Design Reporting
More informationUpdate on the Affordable Care Act. Kevin Shah, MD MBA. Review major elements of the affordable care act
Update on the Affordable Care Act Kevin Shah, MD MBA 1 Goals Review major elements of the affordable care act Review implementation of the Individual Exchange Review the Medicaid expansion Discuss current
More informationQuantifying Tax Credits for People Now Buying Insurance on Their Own
issue brief Quantifying Tax Credits for People Now Buying Insurance on Their Own August 2013 A number of states have recently released information on what premiums will be in the individual insurance market
More informationThe Fiscal Year 2012 Budget: General Appropriations Act (GAA) After the Governor s Vetoes
Budget Brief August 2011 The Fiscal Year 2012 Budget: General Appropriations Act (GAA) After the Governor s Vetoes On July 1, 2011, the legislative Conference Committee released its Fiscal Year 2012 ()
More informationThe Top Five Healthcare Leadership Challenges in the Industry for 2017 JEOPARDY
The Top Five Healthcare Leadership Challenges in the Industry for 2017 JEOPARDY Lyman Sornberger Chief Healthcare Strategy Officer Capio Partners LLC Bethesda Hospital March 31, 2017 1 Presented by: Lyman
More informationACA LEARNING SERIES. Impact on Massachusetts & Implementation Activities to Date. Federal and State Subsidies available through the Health Connector
ACA LEARNING SERIES Impact on Massachusetts & Implementation Activities to Date Federal and State Subsidies available through the Health Connector Massachusetts Health Care Training Forum (MTF) Conference
More informationHealth Care Reform: Be Prepared for 2014
Health Care Reform: Be Prepared for 2014 Your Health Care Reform Team: Moderator Eboni Britt POMCO Group Marketing Manager Co-presenter Jessica Marabella POMCO Group Account Manager Co-presenter Amy Zell
More information11/14/2013. Overview. Employer Mandate Exchanges Medicaid Expansion Funding. Medicare Taxes & Fees. Discussion
Michael A. Morrisey, Ph.D. Lister Hill Center for Health Policy University of Alabama at Birmingham Atlanta Federal Reserve Bank November 14, 2013 Individual Mandate Employer Mandate Exchanges Medicaid
More informationPennsylvania Association of Health Underwriters Advisors and Advocates for Employers, Employees and Health Care Consumers
Pennsylvania Association of Health Underwriters Advisors and Advocates for Employers, Employees and Health Care Consumers Timeline for Health Care Reform March 26, 2010 The Patient Protection and Affordable
More informationCHIA METHODOLOGY PAPER MASSACHUSETTS TOTAL HEALTH CARE EXPENDITURES AUGUST center for health information and analysis
CENTER FOR HEALTH INFORMATION AND ANALYSIS METHODOLOGY PAPER MASSACHUSETTS TOTAL HEALTH CARE EXPENDITURES AUGUST 2015 CHIA INTRODUCTION Total Health Care Expenditures (THCE) is a measure that represents
More informationMARKET STABILITY WORKGROUP 2.0. Meeting #7 Tuesday, December 18, :30 10:30 a.m. RIPIN, 1210 Pontiac Ave, Cranston, RI 02920
MARKET STABILITY WORKGROUP 2.0 Meeting #7 Tuesday, December 18, 2018 8:30 10:30 a.m. RIPIN, 1210 Pontiac Ave, Cranston, RI 02920 TEN WEEK SYLLABUS RI Market Stability Workgroup Schedule Topic(s) for Discussion
More informationTHE AFFORDABLE CARE ACT: 2014 AND BEYOND
THE AFFORDABLE CARE ACT: 2014 AND BEYOND October 28, 2013 Howard Van Mersbergen, Vice President of Employee Benefits, Christian Schools International Julie Sessions, Principal, Mercer Patient Protection
More informationCENTER FOR HEALTH INFORMATION AND ANALYSIS PERFORMANCE OF THE MASSACHUSETTS HEALTH CARE SYSTEM PRIVATE COMMERCIAL CONTRACT ENROLLMENT COVERAGE COSTS
CENTER FOR HEALTH INFORMATION AND ANALYSIS PERFORMANCE OF THE MASSACHUSETTS HEALTH CARE SYSTEM PRIVATE COMMERCIAL CONTRACT ENROLLMENT COVERAGE COSTS COST-SHARING PAYER USE OF FUNDS TECHNICAL APPENDIX 2018
More informationHealth and Economy Baseline Estimates
Health and Economy Baseline Estimates April 5, 207 Entering the fourth year of the implementation of the Affordable Care Act (ACA), the insurance market continues to see increasing and unpredictable costs,
More informationComparison of the House and Senate Repeal and Replace Legislation
Comparison of the House and Senate Repeal and Replace Legislation Key topic INSURANCE CHANGES ACA Insurance Subsidies ACA Cost-Sharing Subsidies Health Savings Accounts (HSA) Eliminates the ACA s income-based
More informationStuart H. Altman PhD
The U.S. Healthcare Financing System: Where Is It Today and Where Is It Going Stuart H. Altman PhD Sol Chaikin Professor of National Health Policy The Heller School for Social Policy and Management Brandeis
More informationThe Affordable Care Act Update
The Affordable Care Act Update Presented by: The Union Labor Life Insurance Company SOLUTIONS FOR THE UNION WORKPLACE SPECIALTY INSURANCE INVESTMENTS Overview of Presentation 1. 2010 2014 Provisions overview
More informationACA in Brief 2/18/2014. It Takes Three Branches... Overview of the Affordable Care Act. Health Insurance Coverage, USA, % 16% 55% 15% 10%
Health Insurance Coverage, USA, 2011 16% Uninsured Overview of the Affordable Care Act 55% 16% Medicaid Medicare Private Non-Group Philip R. Lee Institute for Health Policy Studies Janet Coffman, MPP,
More informationThe New Responsibility to Secure Coverage: Frequently Asked Questions
The New Responsibility to Secure Coverage: Frequently Asked Questions Introduction The Patient Protection and Affordable Care Act (PPACA) includes a much-discussed requirement that people secure health
More informationEffects of the Affordable Health Care Act
Effects of the Affordable Health Care Act A Focus on Financial, Administrative and Plan Impacts February 27, 2013 Presented By J.W. Terrill Consulting Services Agenda Introduction: Patient Protection &
More informationReport to the Massachusetts Legislature. Implementation of Health Care Reform. Fiscal Year 2012
Report to the Massachusetts Legislature Implementation of Health Care Reform Fiscal Year 2012 December 2012 Table of Contents 1.0 Preface... 4 2.0 Update on the Status of Health Care Reform in Massachusetts...
More informationshared responsibility
A report from the Blue Cross Blue Shield of Massachusetts Foundation. March 2009 shared responsibility Government, Business, and Individuals: Who pays what for health reform? Prepared by: Robert Seifert,
More informationAMA vision for health system reform
AMA vision for health system reform Earlier this year, the American Medical Association put forward our vision for health system reform consisting of a number of key objectives reflecting AMA policy. Throughout
More informationThe Affordable Care Act: Time to Prepare for 2014 and Beyond
The Affordable Care Act: Time to Prepare for 2014 and Beyond Howard Van Mersbergen Vice President of Employee Benefits, Christian Schools International Brian C. Meekhof Benefits Administrator, Christian
More informationSetting Capitation Rates in a Changing Medicaid Market
Setting Capitation Rates in a Changing Medicaid Market Presented by Jenny Gerstorff, FSA, MAAA October 20, 2014 Agenda New Populations State Choices Cost Estimation Inherent Risks Risk Mitigation High
More informationMassachusetts Health Care Reform:
Massachusetts Health Care Reform: Using an 1115 Waiver to Provide Private Insurance to the Uninsured and to Contain Costs Presentation to the National Health Policy Forum Beth Waldman, Medicaid Director
More informationHealth Care Reform at-a-glance
Health Care Reform at-a-glance August 2015 Table of Contents Employer mandate...3 Individual mandate...3 Health plan provisions applying to both grandfathered and non-grandfathered employer plans...4 Health
More informationT R U S T E D A D V I S O R S. Providing Outstanding Client Service Boston /Cambridge/Newport / Providence / Waltham
T R U S T E D A D V I S O R S Providing Outstanding Client Service Boston /Cambridge/Newport / Providence / Waltham www.kahnlitwin.com Health Care Reform Overview Applicable Large Employer Determination
More informationSession 22 IF, ACA Transitional Solvency Risks. Moderator/Presenter: Samuel C. Vorderstrasse, FSA, MAAA
Session 22 IF, ACA Transitional Moderator/Presenter: Samuel C. Vorderstrasse, FSA, MAAA Presenter: Armen Garnikovich Akopyan, ASA, MAAA 2016 SOA Health Meeting Sam Vorderstrasse, FSA, MAAA Armen Akopyan,
More informationCommonwealth Care & Commonwealth Choice. MTF Presentations April 2012
Commonwealth Care & Commonwealth Choice MTF Presentations April 2012 Agenda Commonwealth Care Bridge & Aliens with Special Status (AWSS) Commonwealth Care: Open Enrollment 2012 Commonwealth Choice: Non-Group
More informationCommonwealth Care FY2013 Procurement
Commonwealth Care FY2013 Procurement Jean Yang Chief Financial Officer Jen Flint Manager of Operations, Commonwealth Care Daniel Apicella Manager of Health Care Finance Board of Directors Meeting February
More informationSeal of Approval: Product Strategy Evolution and Current State
Seal of Approval: Product Strategy Evolution and Current State ASHLEY HAGUE Deputy Executive Director, Strategy and External Affairs AUDREY GASTEIER Director of Policy and Outreach BRIAN SCHUETZ Director
More informationISSUE BRIEF. Massachusetts-Style Coverage Expansion: What Would it Cost in California? Introduction. Examining the Massachusetts Model
Massachusetts-Style Coverage Expansion: What Would it Cost in California? Introduction Massachusetts enactment of legislation (H 4850) to extend coverage to all residents has received much attention in
More informationThe Shocking Truth Behind ACA Premium Changes: It s Complicated
The Shocking Truth Behind ACA Premium Changes: It s Complicated Audrey L. Halvorson, FSA, MAAA Chair, Rate Review Practice Note Work Group Cori E. Uccello, FSA, MAAA, MPP Senior Health Fellow May 17, 2013
More informationThe Affordable Care Act (ACA)
The Affordable Care Act (ACA) An Overview by the Kaiser Family Foundation NBC News Editorial Roundtable June 26, 2013 1. The Basics of the Affordable Care Act (ACA) Expanded Medicaid Coverage Starting
More informationData and Analysis for Monitoring Health Reform in Massachusetts
Data and Analysis for Monitoring Health Reform in Massachusetts State Health Access Data Assistance Center (SHADAC) Workshop Jean Yang Massachusetts Health Connector April 30 - May 1, 2012 Outline Overview
More informationAffordable Care Act and Covered CA: Where We are One Year Later. Wonha Kim, MD, MPH, CPH, FAAP
Affordable Care Act and Covered CA: Where We are One Year Later Wonha Kim, MD, MPH, CPH, FAAP Senior Research Scholar, LLU Institute for Health Policy and Leadership Assistant Professor, Pediatrics, Preventive
More informationKey Medicaid, CHIP, and Low-Income Provisions in the Senate Bill Patient Protection and Affordable Care Act (Released November 18, 2009)
Key Medicaid, CHIP, and Low-Income Provisions in the Senate Bill Patient Protection and Affordable Care Act (Released November 18, 2009) On November 18, 2009, the Senate released its health care reform
More informationData on the Individual Mandate
Massachusetts Health Connecr and Department of Revenue Data on the Individual Mandate Tax Year 211 May 214 Contents Key Findings... 4 Introduction and Background... 6 Methodology... 8 Results... 9 Overview
More informationU.S. HEALTH-CARE REFORM: THE PATIENT PROTECTION AND AFFORDABLE CARE ACT
C The Journal of Risk and Insurance, 2010, Vol. 77, No. 3, 703-708 DOI: 10.1111/j.1539-6975.2010.01371.x U.S. HEALTH-CARE REFORM: THE PATIENT PROTECTION AND AFFORDABLE CARE ACT Scott E. Harrington ABSTRACT
More informationMASSHEALTH: THE BASICS
MASSHEALTH: THE BASICS PREPARED BY CENTER FOR HEALTH LAW AND ECOMICS UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL Webinar: May 29, 2014 INTRODUCTION ELIGIBILITY AND ENROLLMENT SPENDING WEBINAR OVERVIEW MassHealth:
More informationA Basic Comparative Review of Healthcare Systems, Identifying. Opportunities
A Basic Comparative Review of Healthcare Systems, Identifying Transformations and Business Opportunities Steven G. Ullmann, Ph.D. Professor and Director, Center for and Programs in Health Sector Management
More informationEXPERT UPDATE. Compliance Headlines from Henderson Brothers:.
EXPERT UPDATE Compliance Headlines from Henderson Brothers:. Health Care Reform Timeline Health Care Reform Timeline This Henderson Brothers Summary provides a timeline of the of key reform provisions
More informationHere are some highlights of the revised Senate language released July 13:
The Better Care Reconciliation Act of 2017, Version 2.0 July 17, 2017 On July 13, Senate Republican leaders released a second working draft of the Senate version of H.R. 1628, the American Health Care
More informationHealth Care Reform. Navigating The Maze Of. What s Inside
Navigating The Maze Of Health Care Reform What s Inside Questions and Answers on Health Care Reform Health Care Reform Timeline Health Care Reform Glossary Questions and Answers on Health Care Reform I
More informationIOM Workshop The Impact of the Affordable Care Act on U.S. Preparedness Resources and Programs
IOM Workshop The Impact of the Affordable Care Act on U.S. Preparedness Resources and Programs Session I Opportunities and Challenges within Financing Changes Jack Ebeler Health Policy Alternatives, Inc.
More information