Washington Health Benefit Exchange

Transcription

1 Molly Voris, Chief Policy Officer Joan Altman, Associate Director, Legislative & External Affairs Christine Gibert, Associate Director, Policy Washington Health Benefit Exchange State and Federal Updates Exchange Board Meeting December 6, 2018

2 2018 Session Tracked 100+ bills State Landscape 2018 supplemental request approved SHB 2516 housekeeping bill passed with bipartisan support ESHB 2408 passed prevents bare counties; requires SEBB plans to offer an individual product on Exchange in counties they serve Reinsurance failed to pass Upcoming 2019 Session Long session (105 days) Budget year Leadership/committee changes 2

3 State Landscape: Health Care School Employee Benefits (SEB) implementation Behavioral health Western State hospital (Trueblood) Rural health (hospitals/achs) Medicaid (caseload, provider reimbursement rates) Eliminating Hep. C Foundational public health 3

4 State Landscape: Individual Market Consumer-Centered Plans (standard plans) Reduce deductibles, provide more transparent/predictable costsharing; increase access to services Individual Mandate Reduce premiums, improve risk pool Financial Assistance Reduce premiums, improve risk pool, continuity of coverage for churn population Surprise Billing (OIC) Public Option (Rep. Cody) 4

5 Medicaid buy-in State Landscape: Cost, Delivery, Transparency Universal coverage/single-payer Prescription drug monitoring/formulary continuity/pricing transparency Provider networks Pharmacy benefit managers All-Payer Claims Database (APCD) Scope of practice 5

6 Exchange 2019 Legislative Priorities Supplemental & Biennial Budget Request No new GF-state funds, only expenditure authority requested Affordability & Market Stabilization Consumers struggling with affordability and value Ongoing technical assistance being provided on consumer-centered plan design, data for premium wrap modeling, and implementation of an individual mandate Leveraging investment in Washington Healthplanfinder Ongoing discussions with health agencies & State Office of the Chief Information Officer (OCIO) Pay 1 Replacement 6

7 Upcoming Activity Senate Committee Days Dec. 4-5: House Committee Days Dec. 14: Board Leg. Workgroup Mid-Dec: Governor s Budget Released Jan. 8: Board Leg. Workgroup Jan. 14: Session Begins Jan. 23: Olympia Board Meeting & Hill Day Opportunity for Board members to engage with legislators & share legislative priorities 7

8 Federal Landscape Election results Democrats regained control of the U.S. House Republicans remain in control of the U.S. Senate Reduced likelihood of further ACA repeal attempts Health care topics being discussed in Congress: Drug pricing Opioids Pre-existing conditions Affordability Medical device tax Medicare Part D 8

9 Federal Landscape: ACA Activity Congress Lame-duck session Bill needed to fund federal government past Dec. 7 Legal Upcoming litigation (Texas lawsuit; Maryland lawsuit) 9

10 Appendix

11 Background: State-Based Policy Solutions 11

12 What is a Public Option? The public option was also designed to compete with private plans in the exchange and to serve as a policy compromise between a single-payer system and managed competition among private plans. - Helen Halpin, University of California, Berkley School of Public Health a public insurance plan for working-age people that could compete with private insurers and use its bargaining power to push back against drug makers, medical device manufacturers, hospital systems, and other health care providers. Jacob Hacker, Director of the Institution for Social and Policy Studies at Yale University 12

13 Public Option vs. Single-Payer vs. Managed Competition Single-Payer Government-run health insurance system Public Option Public plan that competes with private products Managed Competition Range of activities including selective contracting with carriers, more extensive carrier participation criteria than the federal standards, and/or negotiated price discounts. 13

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15 Washington Health Benefit Exchange Regulations Update Exchange Board Meeting December 6, 2018 Christine Gibert, Associate Policy Director

16 Recent Federal Regulations Exchange Program Integrity Public Charge 1332 Waivers Health Reimbursement Arrangements 16

17 Exchange Program Integrity Proposed HHS rules address three areas: Exchanges required to check for Medicare enrollment twice a year Heightened CMS oversight of Exchanges (e.g., annual audit) Billing and payment requirement changes Significant consumer and carrier impacts: requirement to bill separately for abortion services Does not affect state requirement to provide abortion coverage, only impacts billing Would require carriers to bill consumers separately for the portion of premium attributable to abortion services (under ACA, $1 per enrollee per month) Consumers would receive two separate bills and be required to make two separate payments Significant consumer impact, including potential disenrollment for incomplete payment Significant administrative burden and increased cost for carriers Two bills sent and two payments collected per enrollment; likely increased call center calls Exchange impacts: increased call center volume, impact on Navigators and brokers, training needed, potential disenrollment 17

18 Public Charge Proposed rules from the Department of Homeland Security would make significant changes to the public charge test, applied when an individual applies to become a legal permanent resident Immigration officials look at the totality of circumstances to determine if an applicant is likely to become a public charge Past and current use of public benefits is one of many factors that can support a finding that an immigrant could become a public charge, and no one factor is definitive Receipt of Medicaid benefits is considered when evaluating whether an individual is a public charge Receipt of tax credits for QHP coverage is not considered in the public charge test Exchange consumers may be dropping coverage or opting not to enroll for 2019 as a result of this proposed rule ~25,000 QHP enrollees are lawfully present non-citizens Comments due December 10; final rule will include effective date 18

19 1332 Waivers ACA Section 1332 allows states to waive certain provisions of the ACA as long as coverage continues to meet certain guardrails Loosens the guardrails makes it easier for states to seek 1332 waivers and receive pass-through funding for coverage that is less comprehensive or affordable than ACA-compliant plans E.g., association health plans, short-term limited duration plans Relaxes requirement that states pass specific legislation to receive CMS approval of a waiver Allows states to implement waiver through regulation or executive order Guidance was final when published effective October 24,

20 Health Reimbursement Arrangements Proposed regulation allows all employers small and large to offer HRAs paired with an individual insurance plan HRA contributions used to pay insurance plan premiums and co-pays If employer offers an HRA, employee will lose eligibility for tax credits in a QHP, unless the lowest-cost silver plan premium is more than ~10% of income If lowest-cost silver plan is more than 10% of employee s income, employee can get tax credits if they opt out of receiving the HRA contribution Exchange required to determine affordability of HRAs and eliminate tax credits Adverse selection concerns for individual market large employers with good risk offer large group and self-insured coverage; large employers with bad risk offer HRA and send employees to the individual market Would be effective 1/1/

21 Next Steps Exchange is preparing comments on proposed rules: program integrity, public charge, and HRAs Working closely with Governor s office and OIC on a coordinated Washington response to proposed rules With state partners, exploring options to address the proposed changes regarding billing for abortion benefits 21

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