Health Reform 101 The Road Ahead for Healthcare Policy in Utah. February 13, 2016 UAFP CME Conference

Transcription

1 Health Reform 101 The Road Ahead for Healthcare Policy in Utah February 13, 2016 UAFP CME Conference

2 Key Terms ACA or Obamacare Insurance Private insurance plans sold on healthcare.gov with monthly premiums subsidized for some people

3 Three Key Questions 1 Why is the Affordable Care Act (ie. Obamacare) still viewed unfavorably by a majority of Utahns/Americans? 2 Who is benefiting from the Affordable Care Act now and in the future? 3 Will the Affordable Care Act end up like the G.I. Bill, or No Child Left Behind?

4 The new health insurance calendar 2016 Open Enrollment Special Enrollment Open Enrollment JANUARY 1 FEBRUARY 1 OCTOBER 31 NOVEMBER Open Enrollment Special Enrollment Open Enrollment JANUARY 1 FEBRUARY 1 NOVEMBER 1 OCTOBER 31 Next Open Enrollment: Nov. 1, Jan. 31, 2017

5 What is a Qualifying Life Event?.that triggers a Special Enrollment Period

6 What is a Qualifying Life Event? Getting sick Forgetting to sign up for insurance before January 31, 2016 Voluntarily ending insurance coverage Losing coverage that doesn t qualify as minimum essential coverage under the ACA

7 What is a Complicated Case? You couldn t sign up for coverage before January 31 st because of. A serious medical condition or natural disaster An unexpected hospitalization or temporary cognitive disability Medicaid/Marketplace transfer delays Misinformation or misrepresentation by brokers or assistors System errors related to immigration status Victims of domestic abuse A Marketplace system outage, such as Social Security Administration system outage

8 How the ACA changed healthcare (as we know it) Adults under age 26 can stay on their parents insurance plan 29.0% Utah Uninsured Rate Ages 18-26: 18.4% Source: Utah DOH No lifetime caps on insurance payments Insurance offers free preventative care like blood pressure checks, flu shots, and health screenings No one can be denied or priced out of coverage for a pre-existing condition Men and women pay the same for coverage

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10 10/31/13 11/30/13 12/31/13 01/31/14 02/28/14 03/31/14 04/30/14 05/31/14 06/30/14 07/31/14 08/31/14 09/30/14 10/31/14 11/30/14 12/31/14 01/31/15 02/28/15 03/31/15 04/30/15 05/31/15 06/30/15 07/31/15 08/31/15 09/30/15 10/31/15 11/30/15 12/31/15 Utah s ACA sign-ups exceeded 151,000 in , , , , ,000 80,000 60,000 40,000 20,000 - Sources: State-Level Data From from the ASPE January Health Insurance Marketplace Enrollment Report For The 2016 Open Enrollment Period; ; March 31, 2015 Effectuated Enrollment Snapshot; ; HHS/CMS Health Insurance Marketplace; ASPE Issue Briefs: October 1, 2013 April 19, 2014; November 15, 2014 January 16, 2015; HHS News Release, In Utah, 124,142 people are signed up for coverage through the Health Insurance Marketplaces, 2/11/15 HHS News Release, In Utah, 140,221 people are signed up for coverage through the Health Insurance Marketplaces, 2/18/15 ASPE Issue Brief (3/10/15); Marketplace Plan Selection by Age in States Using the HealthCare.gov Platform, By State (1); to (including SEP activity through )

11 Why are people dropping their coverage mid-year? 1) Premium cost 2) Under utilization 3) Paperwork errors Insurance Dropouts Present a Challenge for Health Law New York Times By Abby Goodnough October 11, 2015 Link:

12 Utah s uninsured rate is decreasing but the most recent data indicates a slowdown 18% 17% 16% 15% 14% 13% 12% 11% 10% 9% 8% 9.1% 10.2% 11.6% 16.7% 11.9% 15.7% 16.3% 10.6% 10.7% 16.7% 15.9% 11.2% 10.6% 16.6% 15.7% 14.0% 13.4% 13.2% 15.6% 11.6% 13.3% 13.2% 12.5% 10.3% Q2 UT: Census/SAHIE UT:DOH (BRFSS) UT: Gallup- Healthways Census SAHIE: DOH (BRFSS): Gallup Healthways:

13 Sources: [2014] [2015] Utah On Exchange Rates (accurate as of 10/15/14) [2016] See Plans and Premiums (October 2015) Salt Lake County Individual Marketplace Comparison 2014: 91 Plans 2015: 101 Plans 2016: 74 Plans Altius Health Plans Arches BridgeSpan Humana Molina Healthcare Select Health Altius Health Plans Arches BridgeSpan Humana Molina Healthcare Select Health Humana (6) Molina Healthcare (3) Select Health (60) University of Utah (5) Arches Platinum Gold Silver 1 plan 24 plans 34 plans 0 plans 27 plans 40 plans 2 plans 21 plans 27 plans Bronze Catastrophic 26 plans 6 plans 29 plans 5 plans 19 plans 5 plans

14 Costs for health plans will differ by metal tier <60% 60% 70% 80% 90% Catastrophic Bronze Silver Gold Platinum Lower Premiums Higher cost-sharing Higher Premiums Lower cost-sharing

15 [Chart] Kaiser Family Foundation What are the penalties for remaining uninsured in 2016? $95/adult, $47.50/child $325/adult $162.50/child We Are Here $695/adult $347.50/child Max per family $285 $975 $2,085

16 In Salt Lake County, benchmark premiums rose 13% in 2016 $600 Monthly Premiums* for Benchmark Silver Plan by Age ( ) Salt Lake County $ $494 $424 $436 $400 $350 $300 $200 $100 $112 $115 $131 $197 $202 $229 $209 $215 $244 $301 $309 $- Age (*) Premium costs do not include subsidies Sources: [2014] [2015] Utah On Exchange Rates (accurate as of 10/15/14) [2016] Utah 2016 ACA Individual & Small Group Enrollment and Premium Rates; Utah Dept. of Insurance (October 2015)

17 Premium spread is higher in 2016 than in 2015 $260 Salt Lake County Silver Plan Premiums for 21 year-olds ( ) $240 $220 $200 $ $180 $160 $140 $47 Benchmark Plans (Secondlowest Silver plan) $120 (*) Premium costs do not include subsidies [2015] Utah On Exchange Rates (accurate as of 10/15/14) [2016] Utah 2016 ACA Individual & Small Group Enrollment and Premium Rates; Utah Dept. of Insurance (October 2015)

18 How can premium prices vary? (in billions) 1) Age (new ratio of 3:1) 2) Tobacco use (ratio of 1.5:1) 3) Geography (by counties) Area 1: Cache and Rich Area 2: Box Elder, Morgan, and Weber Area 3: Davis, Salt Lake, Summit, Tooele, and Wasatch Area 4: Utah Area 5: Iron and Washington Area 6: Beaver, Carbon, Daggett, Duchesne, Emery, Garfield, Grand, Juab, Kane, Millard, Piute, San Juan, Sanpete, Sevier, Uintah, and Wayne

19 Who is eligible for premium subsidies? Income as % of the Federal Poverty Level (FPL) 0% 100% 101% 400% NO 53,000 Utahns in the Gap YES

20 Sliding-scale subsidies make insurance more affordable If your income/family size is on this chart, you qualify for a subsidy For 2016, a family of four can earn $97,000 a year and receive a premium subsidy Source:

21 The Hernandez Family Income: $26,000 Residence: Salt Lake City, Utah Ages: Dad : 33 Mom: 29 Kids: 11, rate change: + $4/month Annual income: $26,000 % of poverty level: 109% Benchmark Silver Plan Monthly premium: $458 Subsidy pays: $410 per month The Hernandez s pay: $48 per month Plan Details Deductible: $1000 Out-of-pocket maximum: $1,500 Primary doctor: $5 Specialist doctor: $15 Emergency room care: $150 Generic drugs: $6 Source: Image source: Moodboard

22 The Shumways Income: $44,000 Residence: American Fork, UT Ages: Dad : 24 Mom: 23 Kid: Newborn 2016 rate change: +$1/month Annual income: $44,000 % of poverty level: 222% Benchmark Silver Plan Monthly premium: $537 Subsidy pays: $274 per month The Shumways pay: $262 per month Plan Details Deductible: $2,300 Out-of-pocket maximum: $10,900 Primary doctor: $35 Specialist doctor: $60 Emergency room care: $500 Generic drugs: $10 Source:

23 Mr. and Mrs. Smith Income: $42,000 Residence: Santa Clara, Utah Ages: 60, rate change: + $13/month Benchmark Silver Plan Plan Details Annual income: $42,000 % of poverty level: 267% Monthly premium: $1,188 Subsidy pays: $865 per month The Smiths pay: $323 per month Deductible: $2,500 Out-of-pocket maximum: $13,700 Primary doctor: $35 Specialist doctor: $60 Emergency room care: $600 Generic drugs: $10 Source: Image source: Moodboard

24 Who lives in the Coverage Gap? The Smith Family Income: $21,000 Residence: Orem, Utah Ages: Dad : 35 Mom: 33 Child: 7 Child: 11 No Subsidy Annual income: $21,000 % of poverty level: 89% Expected contribution: 100% Monthly premium (for 2): $482 The Smith s pay: $482 Subsidy pays $0 The Smith s healthcare costs would be 27% of their total income Source: Image source: TVZ Design

25 Window-shop for insurance

26 Image source: WarrenFree Who is signing up for the ACA in Utah?

27 In 2016, 13 of Utah s top 20 ZIP codes for ACA enrollment were outside of Salt Lake County RANK CITY SELECTIONS % INCREASE 1 Lehi (84043) 3,501 19% 2 South Jordan (84095) 3,346 12% 3 American Fork (84003) 2,948 17% 4 Pleasant Grove (84062) 2,931 20% 5 St. George (84790) 2,829 10% 6 St. George (84770) 2,742 11% 7 Draper (84020) 2,624 13% 8 Bountiful (84010) 2,455 5% 9 Spanish Fork (84660) 2,377 24% 10 West Valley City (84119) 2,368 3% 11 West Valley City (84120) 2,345 13% 12 Provo (84604) 2,289 22% 13 Herriman (84096) 2,276 20% 14 Clearfield (84015) 2,258 3% 15 Riverton (84065) 2,255 23% 16 Cottonwood Heights (84121) 2,254 6% 17 Orem (84058) 2,196 24% 18 Orem (84057) 2,193 16% 19 Ogden (84404) 2,189 1% 20 Layton (84041) 2,110 12% Source: 2016 Health Insurance Marketplace Plan Selections by ZIP Code; (Nov. 1, 2015 Jan. 9, 2016);

28 Utah children are enrolling in ACA insurance at 2.67x the national average Source: "State-Level Data From the ASPE January Health Insurance Marketplace Enrollment Report For The 2016 Open Enrollment Period; For the period: November 1, December 26, Utah Enrollment by Age 16% 24% 13% 16% 31% Under U.S. 9% Under 18 27% 26% % % 55-64

29 Premium subsidies make health insurance more affordable Impact of subsidies on actual consumer costs $248 Consumer Cost 21% ACA enrollment by % poverty level 18% 1% 25% 33% Under 100% 100% to 150% 150% to 200% 200% to 250% 250% to 400% Source: Reduction in Average Monthly Premiums from Advance Premium Tax Credits in States Using the HealthCare.gov Platform (1) to (including SEP activity through ) Source: "State-Level Data From the ASPE January Health Insurance Marketplace Enrollment Report For The 2016 Open Enrollment Period; For the period: November 1, December 26, 2015.

30 Half of existing ACA consumers switched health plans in 2016 Origin of all consumers Plan selection by re-enrolled consumers 30% 70% 49% 51% Newly enrolled Switched plan Re-enrolled Same plan Source: "State-Level Data From the ASPE January Health Insurance Marketplace Enrollment Report For The 2016 Open Enrollment Period; For the period: November 1, December 26, Source: "State-Level Data From the ASPE January Health Insurance Marketplace Enrollment Report For The 2016 Open Enrollment Period; For the period: November 1, December 26, 2015.

31 Recent data suggests that Utah is falling behind other states in key health reform metrics Sources: 2013, 2014; Gallup Healthways Well-Being Index (2/24/15); 2Q 2015 US: Gallup Healthways Well-Being Index (7/10/15); 2Q 2015 UT: Gallup Healthways Well-Being Index (8/10/15) ; Smith, Jessica C. and Carla Medalia, U.S. Census Bureau, Current Population Reports, P60-253, Health Insurance Coverage in the United States: 2014, U.S. Government Printing Office, Washington, DC,2015.

32 What ACA enrollment looks like

33 Who are the helpers? Navigator Certified Application Counselor Experts trained to help others evaluate their insurance options on the new insurance marketplace. Image: Paramount Pictures Corporation

34 Where can Utahns find help applying for health insurance? call TCU s trained counselors are ready to help you understand your new options to find affordable health care coverage today

35 Source: Utahns brace for Obamacare enrollment, year 2, by Kristen Moulton, Salt Lake Tribune, 11/11/14; Utahans are still falling through the cracks November 11, 2014 First, the HealthCare.gov website had her application "processing" for two months. Then the exchange needed a form from her employer. When she finally got insurance, it was at a rate far higher than it should have been and she was never given a card or even an address for sending a payment.. It s irritating, because I really tried.

36 Predictions for the Future 1) Fixing Utah s Medicaid coverage gap 2) Sustainability of ACA marketplaces beyond ) Trends in plan deductibles and cost-sharing 4) Impact of elections on healthcare reform 5) Trends in Utah morbidity/mortality metrics 6) How healthcare reform affects providers

37 The Role of Providers and Professionals in Health Reform

38 Providers are a trusted source for patients [Chart] Kaiser Health Tracking Poll, August 2013

39 Providers are a trusted source for patients [Chart] Kaiser Health Tracking Poll, August 2013

40 What health professionals can do (1) healthcare.gov (4) Subsidies will make premiums more affordable (5) Navigators will help you sign up No one can be denied or priced out of coverage for a preexisting condition 60% (2) Being sick doesn t matter anymore 70% (in bill ion s) 80% (3) It s private insurance (and it s good insurance) 90%

41 Coverage Gap 101 Fixing Utah s Persistent Healthcare Challenge

42 405,000 Utahns received Medicaid in 2014 Source: Utah Dept. of Health 2014 Medicaid Report (p. 29); 6.4% 4.0% 11.8% 13.8% 5.0% 59.0% Children (age 0-18) Parents Visually Impaired and People with Disabilities Elderly (age 65+) Pregnant Women Primary Care Network (PCN) The largest Medicaid recipient category in Utah are children under age 19 (238,950 recipients) Utah adults without children aren t eligible for Medicaid at any income level

43 Originally, the ACA required Medicaid Expansion AC A in 2010 AC A afte r % 138% 400% 0% 100% 101% 400% Income as % of the Federal Poverty Level Income as % of the Federal Poverty Level In June 2012, the Supreme Court declared Medicaid expansion optional. Utah is among 22 states that have not expanded coverage.

44 What is the Coverage Gap? 63,000 Utahns in the Gap

45 Premium subsidies aren t available for people earning under the poverty line Income as % of the Federal Poverty Level (FPL) 0% 100% 101% 400% NO 53,000 Utahns in the Gap YES

46 Who isn t eligible for Medicaid? People who can t receive Medicaid include adults without kids, parents who earn more than 50% of poverty, and people with unqualified disabilities Many people who don t quality for Medicaid are uninsured and live in Utah s Coverage Gap

47 Who is in the Coverage Gap? Todd Dad grad student has two part-time jobs Wendy Single-mom student child on LDS mission Rachel Mom employee in long-term recovery Parents students full-time workers family care-givers people with disabilities part-time workers veterans women who just gave birth

48 FYI: People in the coverage gap work

49 The national picture states, D.C. expanding Medicaid Utah is one of three states considering expansion Source: The Advisory Board Daily Briefing (11/3/15);

50 Who could be covered in Utah?

51 Utah s coverage gap costs lives each year

52 Source Cost estimates based on Milliman Numbers Revised 12 /17/14 and Dept. of Health Estimates 03/03/15; Taxes Returned data for How does full expansion differ from partial? TYPE Partial Expansion Full Expansion WHO PAYS STATE FEDERAL 30% 70% 10% 90% PEOPLE COVERED TAXES RETURNED* 0% 100% 0% 100% 138% $82 million/year $513 million/year

53 Utah voters support a coverage gap solution

54 Got Questions? Jason Stevenson Utah Health Policy Project x7 RyLee Curtis Utah Health Policy Project x8

55 How do I calculate my MAGI? (in billions) Step #1) Start with gross income (GI) Your adjusted gross income is the money you earned through wages, interests, dividends, rental and royalty income, capital gains, business income, farm income, unemployment and alimony. Step #2) Calculate Adjusted Gross Income (AGI) by subtracting qualified deductions from gross income. AGI is used to determine your tax liability Adjustments can include items like some contributions to IRAs, moving expenses, alimony paid, self-employment taxes, and student loan interest. Source: Zane Benefits -

56 How do I calculate my MAGI? (in billions) Step #3) Add back items excluded from AGI Deductions for IRA contributions. Deductions for student loan interest or tuition. Excluded foreign income. Interest from EE (employee) savings bonds used to pay higher education expenses. Employer-paid adoption expenses. Step #4) The result is your Modified Adjusted Gross Income (MAGI) used to calculate eligibility for premium subsidies on the new insurance marketplaces For most people, MAGI is the same as AGI. Source: Zane Benefits -