Washington Health Benefit Exchange

Transcription

1 Washington Health Benefit Exchange HBE Legislative Priorities Exchange Board Meeting January 23, 2019 Joan Altman, Associate Director, Legislative & External Affairs

2 Session Activity Jan. 14: Session began Jan. 15: State of State Address Jan. 16: Presented to Senate Health Committee Jan 22: Presented to House Health Committee Upcoming Cut-Offs: Feb 22 - policy Mar 1 fiscal Mar 13 house of origin 2

3 2019 Legislative Priorities 1. Improve Affordability and Stability in the Individual Market 2. Support for Biennial Budget Request 3. Leverage Washington Healthplanfinder Platform 3

4 1. Improve Affordability and Stability in the Individual Market First ever decline in plan selections issue of greatest concern is affordability Customers have faced significant premium increases, high deductibles, narrowing networks overall value proposition has declined and more people are opting out Highest drops among young adults ( young invincibles ) very concerning with regard to the risk pool; population is becoming older and sicker, which is not sustainable Consumers have difficulty understanding cost-sharing, comparing the value of plans, and accessing benefits Immediate need for state-based policy solutions to help address affordability and choice for our customers 4

5 14 Counties with 1 Issuer Asotin Chelan Clallam Douglas Ferry Garfield Grays Harbor Island Okanogan Pacific Pend Oreille San Juan Skagit Wahkiakum 5

6 Exchange Customer Challenges Choosing Coverage So confusing to understand when deductible, Rx deductible, co-pays kick in and what costs might be. Using Coverage My premiums would be over 15% of my income, with a $6500 deductible. With premiums and deductible I would not be able to afford to even go to the doctor even if I needed to. Affording Coverage Too expensive with little benefit. 6

7 Plans Can Have Similar Premiums and Significantly Different Deductibles Plan premiums are averaged over all counties where a carrier is offering the plan. Deductibles reflect the standard plan. 7

8 Plans Can Have Similar Premiums and Significantly Different Actuarial Values 8

9 Consumers Pay A Significant Amount of Household Income on Health Coverage Subsidy Status Subsidized Non-Subsidized FPL Number of Customers Avg. % of Income Spent on Premium Est. % of Income Spent on Premium and Deductible* % 12,257 6% 14% % 34,878 6% 21% % 22,884 8% 31% % 15,498 9% 31% % 20,983 9% 26% % % OVER % % 76% % 1,208 23% 61% % 1,201 18% 47% % 1,117 15% 37% % 1,934 13% 31% % 7,442 11% 26% % 3,604 10% 21% OVER 600 6,584 4% 9% *Assumes annual deductible is met Excludes customers <139% FPL and customers who did not report income Note: There are several reasons why customers who are otherwise income eligible do not receive federal tax credits most are related to their tax filing status or whether anyone in their family received an offer of a family employer sponsored insurance plan. For example, an entire family is ineligible for the tax credit if one family member was offered an affordable self-only policy through their employer, even if the family policy offered was prohibitively expensive (a problem known as the family glitch ). Lawfully present enrollees (including those who are in the five-year bar for Medicaid) are eligible for subsidies in the Exchange. 9

10 State-Based Options to Address Affordability in the Individual Market Implement Consumer-Centered/Standard Plans (starting PY 2021) Standard plans offered through the Exchange could: reduce deductibles, provide more transparent/predictable cost-sharing, and increase access to services for consumers before the deductible State Exchanges that have implemented: California, Connecticut, District of Columbia, Massachusetts, New York, Oregon, Vermont Leverage State s Purchasing Power to Lower Costs State procured plans offered through the Exchange could provide more affordable premiums, while incorporating standard plan design and best practices regarding quality and value Provide Enhanced Subsidies State-based subsidies offered through the Exchange could promote continuity of coverage and improve the individual market risk pool 10

11 State-Based Options to Address Affordability in the Individual Market Implement State Individual Mandate (w/enforcement) State level requirement to obtain minimum essential coverage, mirrored after the federal requirement, that includes relevant exemptions. Could reduce premiums by providing regulatory certainty and improving the individual market risk pool The following states have adopted: MA, DC, NJ, VT IRS data indicates that 109k Washington residents paid the penalty in 2016, totaling $79M Prohibit Surprise Billing 11

12 2. Support for Biennial Budget Request The Exchange continues to increase its cost effectiveness as compared to the federal eligibility and enrollment platform Beginning in calendar year 2019, the Exchange reduced the carrier assessment by 55%, from $7.46 per member per month to $3.36 per member per month The Exchange is not requesting additional General Fund-State dollars but requires expenditure authority The Governor s proposed budget for the biennium increases Exchange expenditure authority by $4.8 million from the current level budget Even with that increase, the total appropriation is 4.1 percent lower than the biennium 12

13 Support for Biennial Budget Request 13

14 Support for Biennial Budget Request 14

15 Biennial Decision Packages New expenditures included in the proposed budget include: Federal Requirement IV&V - Funding to support new federal Independent Validation and Verification (IV&V) requirements ($558,000) Cloud Software Costs - Additional funds for costs associated with modifying Washington Healthplanfinder and other significant Exchange applications ($1.3 million). In SFY 2019, HPF moved from a server environment to a cloud platform, which requires that software products are kept current. System Integrator Procurement - One-time funding needed for our system integrator re-procurement ($2.9 million) 15

16 3. Leverage Washington Healthplanfinder Platform Washington Healthplanfinder (HPF) is a health portal that one in four Washingtonians use to obtain health coverage HPF was primarily built with an investment of more than $300 million from the federal government HPF is one of the newest technology platforms in Washington and is scalable, sustainable and a practical option for eligibility and enrollment functions HPF is connected to over 40 external State, Federal and Private data sources which allow it to validate and augment information provided by applicants In addition to being a federally compliant platform, the HPF system has robust, modern account management, security, data collection, dashboards, and a mobile application and correspondence functionality that can be leveraged 16

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18 2019 Session: Individual Market Public Option (HB 1523/SB 5526) Gov. Request Implements standard plans, state procured QHP, subsidy study Surprise Billing (HB 1065/SB 5031) OIC Request Prohibits balanced billing by out-of-network providers/facilities for certain services provided at an in-network setting COFA Dental Program (HB 1218/SB 5274) State Individual Mandate Imbed ACA Consumer Protections All-Payer Claims Database (APCD) Single Payer/ Trust Bills 18

19 Public Option Bill (HB 1523, SB 5526) Sec 1 Directs HBE to design standard plans Available on HPF starting Jan 1, 2021 Starting Jan 1, 2025 all Exchange plans are standardized Sec 2 Requires data submitted to HBE to inform std plan design to be exempt from public disclosure Sec 3 Directs HCA to contract with 1+ carriers to offer public option plans which: Have a standard plan design Incorporate best practices re: quality and value Caps rates for providers and facility at Medicare rates Sec 4 Directs HBE to develop a plan to implement and fund premium subsidies for Exchange customers up to 500% FPL The plan must include an assessment of CSRs Report due to legislature by Nov. 15,

20 Appendix

21 Washington s Uninsured Rate Source: OFM Research Brief (Dec. 2018) 21

22 Washington s Uninsured Rate Source: OFM Research Brief (Dec. 2018) 22

23 Methodology: this graph represents the annual change in rate for continuing plans on the individual market as approved (rather than requested) by OIC. The average rate changes are weighted by observed enrollment as of March of the earlier year and expected enrollment for the following year. The rate increase in 2018 reflects the impact of termination of CSR payments and federal reinsurance payments. The proposed average rate increase for 2019 is 13%. 23

24 2018 Exchange Customer Deductibles 80,000 70,000 70,548 60,000 # Enrollees 50,000 40,000 30,000 20,000 50,113 43,651 22,162 31,751 50,146 10,000 - <$1000 <$ <$ <$ <$ >$9000 Deductibles Range Deductibles are for individual and family plans after cost-sharing reductions have been applied. 24

25 Actuarial Value In health insurance the actuarial value is the estimated percentage of a typical policyholder's medical bills that an individual plan is expected to pay The actuarial value is considered a good baseline for the coverage most policyholders will receive most of the time The Affordable Care Act set permissible actuarial values for the differing levels of coverage Metallic Level Permissible Actuarial Value Bronze 56% 65%* Silver 66% 72% Gold 76% 82% Platinum 76% 92% *Bronze plans may have an AV up to 65% if they offer at least one service before the deductible or are a high deductible health plan

26 Passed 2018 Session Recap: Individual Market SHB 2516 ( housekeeping bill ) passed imbeds HBE operations into state law ESHB 2408 passed prevents bare counties in 2020; requires SEBB plans to offer an individual product on Exchange in counties they serve HB passed imbeds ACA preventative services mandate into state law SB (COFA medical program) passed provides state subsidized QHP coverage for COFA residents Did Not Pass HB 2355 Reinsurance SB 6084 State individual mandate SB 5586 Prescription drug cost transparency 26

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