What will 2017 be like?

Transcription

1 What will 2017 be like? Salt Lake County Individual Marketplace Comparison 2014: 91 Plans 2015: 101 Plans 2016: 74 Plans 2017: 28 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) Molina Healthcare (5) Select Health (18) University of Utah (5) Platinum Gold Silver 1 plan 24 plans 34 plans 0 plans 27 plans 40 plans 2 plans 21 plans 27 plans 0 plans 4 plans 11 plans Bronze Catastrophic 26 plans 6 plans 29 plans 5 plans 19 plans 5 plans 11 plans 2 plans Sources: [2014] [2015] Utah On Exchange Rates (accurate as of 10/15/14) [2016] See Plans and Premiums (October 2015) 1

2 How can insurance premiums 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 The 2 nd -lowest priced Silver plan is known as the Benchmark The Benchmark Silver plan determines premium subsidy levels for the entire marketplace Premiums for a 21 year-old, non-smoker in Salt Lake County Molina Marketplace Silver Plan $ Molina Marketplace Options Silver Plan $ Benchmark Plan Select Value Preference Benchmark Silver 1500 $ Select Value Preference Silver 1500 $ Select Value HealthSave Silver 2500 $ Select Med Preference Benchmark Silver 1500 $ Select Value Preference Silver 3800 Copay Plan $ Select Med Preference Silver 1500 $ Healthy Premier Silver Copay $ Select Med HealthSave Silver 2500 $ Select Med Preference Silver 3800 Copay Plan $ Source: Utah Dept. of Insurance; 2017 Utah Individual and Small Employer Group Rates for Age 21, Non-Tobacco (as of 9/27/2016) 2

3 10/28/2016 In % of Utahns will have access to two or more marketplace insurers 3 insurers 2 insurers 1 insurer Accessible Insurers Molina; SelectHealth; Univ. of Utah Health Plans + + SelectHealth; Univ. of Utah Health Plans SelectHealth % of Utah Population (2014) Utah Population (2014) 80.7% 2,375, % 424, % 142, Gained one insurer in In 2017, average premiums for Bronze and Silver plans increased at similar rates to last year, but Gold premiums jumped 50% 50% 47% 45% 40% 35% 30% 25% 21% 19% 19% 20% 16% 15% 5% 0% 9% 7.4% 10% 3.7% 1.4% Bronze Silver Gold Bronze Silver Gold Bronze Silver Gold Source: Utah Dept. of Insurance; Utah Individual and Small Employer Group Rates for Age 21, Non-Tobacco (as of 9/27/2016) 3

4 In 2017, the benchmark Silver premium increased more than the average Silver premium boosting the impact of subsidies 25% 20% 19% 20% 15% 13% 16% 10% 5% 3% 4% 0% Benchmark % Change % Change % Change Average Benchmark Average Benchmark Average Source: Utah Dept. of Insurance; Utah Individual and Small Employer Group Rates for Age 21, Non-Tobacco (as of 9/27/2016) Average Jack Lives in Salt Lake City 21 years old Makes $18,000 a year Stronger subsidies will reduce premium costs for many consumers in 2017 Silver plan premiums $100 $200 $ Benchmark Subsidy covers $100 $165 Average Silver Plan Subsidy covers $100 Real premium: $99 $ Benchmark Subsidy covers $134 $198 Average Silver Plan Subsidy covers $134 Real premium: $96 $230 Source: Utah Dept. of Insurance; 2016, 2017 Utah Individual and Small Employer Group Rates for Age 21, Non-Tobacco (as of 9/27/2016) 4

5 Who is eligible for premium subsidies? Income as % of the Federal Poverty Level (FPL) 0% 100% 101% 400% NO 63,000 Utahns in the Gap YES Sliding-scale subsidies make insurance more affordable If your income/family size is on this chart, you qualify for a subsidy For 2017, a family of four can earn $97,200 a year and receive a premium subsidy The 2016 FPL guidelines are applied to the 2017 Marketplace plans. These guidelines only apply to the Lower 48 States (Alaska and Hawaii have their own guidelines). Source: Link: 5

6 The Hernandez Family Residence: Salt Lake City, Utah Ages: Dad : 33 Mom: 29 Kids: 11, 7 How much does the Hernandez family pay for health insurance? Annual income: $26,000 % of poverty level: 109% Monthly premium: $550 Subsidy pays: $502 per month The Hernandez s pay: $48 per month Kids on Medicaid Benchmark Silver plan Parent-only coverage Plan Details Deductible: $500 Out-of-pocket maximum: $2,500 Source: Image source: Moodboard Primary doctor: $5 Specialist doctor: $15 Emergency room care: $100 Generic drugs: $3 The Shumway Family Residence: Draper, UT Ages: Dad : 24 Mom: 23 Kid: Newborn How much does the Shumway family pay for health insurance? Annual income: $44,000 % of poverty level: 220% Monthly premium: $612 Subsidy pays: $348 per month The Shumway s pay: $263 per month Benchmark Silver plan Could pay $30/month more for plan with $2,600 deductible Plan Details Deductible: $6,000 Out-of-pocket maximum: $11,400 Source: Image source: Moodboard Primary doctor: $30 Specialist doctor: $65 Emergency room care: $300 Generic drugs: $10 6

7 The Smiths Residence: Santa Clara, UT Ages: 62, 60 How much do the Smith s pay for health insurance? Annual income: $42,000 % of poverty level: 263% Monthly premium: $1,544 Subsidy pays: $1,210 / month The Smith s pay: $333 per month Benchmark Silver plan Subsidy increased by $400 per month over 2016 amount Plan Details Deductible: $3,000 Out-of-pocket maximum: $14,300 Source: Image source: Moodboard Primary doctor: $35 Specialist doctor: $60 Emergency room care: $600 Generic drugs: $15 The Simonsen Family Residence: Alpine, Utah Ages: Dad : 44 Mom: 35 Kids: 11, 7 How much do the Simonsen s pay for health insurance? Annual income: $135,000 % of poverty level: 556% Benchmark Silver plan Monthly premium: $945 Subsidy pays: $0 per month The Simonsens pay: $945 per month Plan premium increased 25% from 2016 Plan Details Deductible: $7,000 Out-of-pocket maximum: $14,300 Source: Image source: Moodboard Primary doctor: $35 Specialist doctor: $60 Emergency room care: $400 Generic drugs: $15 7

8 The Phillips Family Residence: Alpine, Utah Ages: Dad : 35 Mom: 33 Kids: 11, 7 How much do the Phillip s pay for health insurance? Annual income: $21,000 % of poverty level: 86% Monthly premium: $564 Subsidy pays: $0 per month The Phillips pay: $564 per month Kids covered by Medicaid Parents are caught in the Utah Medicaid Coverage Gap Plan Details Deductible: $7,000 Out-of-pocket maximum: $14,300 Source: Image source: Moodboard Primary doctor: $35 Specialist doctor: $60 Emergency room care: $400 Generic drugs: $15 Window-shop for insurance now 8

9 In 2016, 13 of Utah s top 20 ZIP codes for ACA enrollment were outside of Salt Lake RANK CITY SELECTIONS % INCREASE County 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); Utah and Washington counties continue to lead ACA sign-ups in Utah County Salt Lake Utah Davis Weber Washington Cache Tooele Box Elder Iron Summit Uintah Sanpete Wasatch Carbon Grand Open Enrollment #3 (1/9/16) 52,360 32,987 14,263 9,753 10,437 5,672 2,086 2,023 2,380 3,034 1,039 1,272 2, % Change since Open Enrollment #2 (2/22/15) 7.1% 17.3% 9.8% 5.2% 12.4% 8.0% 4.4% 9.4% 12.2% 13.3% 7.1% 7.4% 5.7% County Population (2014) 1,091, , , , , ,343 Sources: [OE2] Plan Selections by ZIP Code in the Health Insurance Marketplace (November 15, 2014 thru February 22, 2015) Enrollment/EnrollmentByZip/rpt_EnrollmentByZip_Apr2015.cfm [OE3] Plan Selections by ZIP Code in the Health Insurance Marketplace: (November 1, 2015 thru January 9, 2016) % 61,598 51,518 47,269 39,105 36,867 28,477 27,714 20,660 9,429 9

10 What ACA enrollment looks like Who are the helpers? Navigator Certified Application Counselor Experts trained to help othersevaluate their insurance options on the new insurance marketplace. Image: Paramount Pictures Corporation 10

11 Where can Utahns find help applying for health insurance? call TCU s trained counselors are ready to help you understand your new optionsto find affordable health care coverage today 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. Source: Utahns brace for Obamacare enrollment, year 2, by Kristen Moulton, Salt Lake Tribune, 11/11/14; 11

12 Wednesday, December 7, 2016 Utah Cultural Celebration Center Speakers and panel discussions will include: The Affordable Care Act: Will a New President Make a Difference? A Fresh Look at Utah s Diversity: How has Health Reform Helped Disparities Groups and Where We Are Still Falling Short? How Can we Tackle Persistent Poverty Without Addressing Access to Health Care? Coverage Gap 101 Fixing Utah s Persistent Healthcare Challenge 12

13 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 63,000 Utahns in the Gap YES 405,000 Utahns received Medicaid in % 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 Source: Utah Dept. of Health 2014 Medicaid Report (p. 29); 13

14 Originally, the ACA required Medicaid Expansion ACA in 2010 ACA after % 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 19 states that have not expanded coverage. The national picture states, D.C. expanding Medicaid Source: The Advisory Board Daily Briefing (1/13/16); 14

15 What is the Coverage Gap? 63,000 Utahns in the Gap $10,080 $20,160 $80,640 $11,880 $47,520 How far does an income of $833* a month go in Utah? $833 Sara s monthly income $450 $125 $66 $72 $25 $20 $15 $50 Average rent for 1-bedroom apt. Grocery bills (Ramen noodles) Car insurance Gas (10 miles/day) Clothing/Sundry items Utilities (gas, water) Entertainment (DVDs) Savings/Debt The cheapest unsubsidized Bronze-level health insurance plan for a 25 year-old in Salt Lake County is $199 a month -or more than 20x than what Sara has leftover each month. $10 for everything else *Equal to an income of $10,000 a year, or 86% of the federal poverty level 15

16 How Will Healthy Utah be Implemented? Private Market Plans Higher Cost- Sharing Work Requirements Enrollees would be placed in Private Market Plans Employer Sponsored Insurance Avenue H Medically Frail can opt in to traditional Medicaid Under 100% FPL ($11,500 for single adult) Medicaid Rates % FPL ($15,500 for single adult) Maximum 2% of Income ~$15 premium Opt-in program: $50 copay for non-emergent use of ER, with $5/per adult reduction in premium Similar to employment and training requirements to receive TANF in Utah Automatic referral to DWS: Register as job seeker Complete online workshops Keep an online job search log Source: 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 Source Cost estimates based on MillimanNumbers Revised 12 /17/14 and Dept. of Health Estimates 03/03/15; Taxes Returned data for

17 H.B. 437, the Expansion Bill that Could Pass Who pays for HB 437? State Funds Fed Funds $31.2M in FY18 + $72.8M in FY18 Total Funds = $104M in FY18 Because HB 437 does not cover all Utahns up to 133% FPL, this bill will receive 70% federal funding, and Utah residents will have to pay 30% of the costs. 7,000 Newly Eligible Adults Without Children (12-Month Continuous Medicaid) Who Is Eligible Under H.B. 437? 10,000 Newly Eligible Adults Chronically homeless individuals; 3,000 Newly Eligible Adults With Children (Traditional Medicaid) If funding is available, an individual in the justice system thru probation, parole, or court-ordered treatment If funding is available, an individual in need of substance abuse or mental health treatment. Updated Eligibility Requirements for Medicaid Cohort A: Up to 6,000-7,000 adults without children. Priority given to 1) Homeless; 2) Justice-involved ; 3) Substance abuse and/or mental health 50% 55% Source: Utah Dept. of Health, MillimanConsensus Numbers Reflect Enrollment in 2017 Cohort B: Up to 3,800 parents with dependent children earning up to 55% FPL 17

18 Who Does it Cover? Who Does it Leave Out? Lesley, a single mother with two kids who earns $10,000 a year. She was previously ineligible for Medicaid because she earned above the 40% FPL threshold. But she is now eligible because HB 437 raised the income threshold to 55% FPL. Dianna a single person in Ogden who s in her early 20s and working part-time through a temp agency due to health issues. She is ineligible for coverage because she doesn t have children, is not homeless, is not being released from prison, and doesn t suffer from a behavioral health illness. Robert, a single male who recently left incarceration with a history of mental illness who earns under $594 annually. Jose is a full-time student with a part-time job. Jose suffers from back pain, but can t afford the medical tests to get diagnosed. He s trying to break the cycle of intergenerational poverty (his father was incarcerated and his mother died from a drug overdose) by working and going to school, but HB 437 can t help him because he is not homeless or being released from incarceration. June, a single woman with no income, who has been homeless and living on the street for at least one year, or has experienced at least four episodes of homelessness within the last three years. Utah s coverage gap costs lives each year 18

19 Got Questions? Jason Stevenson Utah Health Policy Project x23 Laura Holdrege Utah Health Policy Project x28 19