Health Reform 201: The Road Ahead for Utah

Transcription

1 Health Reform 201: The Road Ahead for Utah Health Reform 2018: Utah s Way Forward Image source:s Moodboard; JanMiller-Atr-NC-SA; Brittany Randolph September 19, 2018 Randal Serr Utah Health Policy Project x225 randal@healthpolicyproject.org

2 Who is UHPP? Utah Health Policy Project is a non-profit, non-partisan organization advancing sustainable health care solutions for underserved Utahns, through better access, education, and public policy.

3 What about repeal and replace? It didn t happen.

4 What about CHIP funding? Congress funded CHIP for ten years!

5 The penalty was repealed. Individuals are still subject to the penalty for the 2017 and 2018 filing seasons.

6 The penalty was repealed.

7 The penalty was repealed.

8 Health Insurance Options Overview Medicaid - Low-income adults and children PCN - Low-income adults who don t qualify for Medicaid UPP - Low-income adults w employers offer insurance but cost is prohibitive CHIP - Children only ACA - Obamacare, Affordable Care Act (ACA), Marketplace; Adults and children Medicare - Elderly people over 65; People with End Stage Renal Disease

9 U.S. Census: Utah Civilian noninstitutionalized population Almost 12% of Utahns with health insurance buy coverage on the individual market 0.2% 11.8% 9.8% 1.1% 4.4% Employer-based Individual Market TriCare (Military) Medicare Medicaid 73.4% VA Source: U.S. Census Bureau, 2016; American Community Survey 1-Year Estimates

10 How many Utahns signed up for Obamacare? 195,121 or about 6.5% of the population

11 Salt Lake County Individual Marketplace Comparison 2014: 91 Plans 2015: 101 Plans 2016: 74 Plans 2017: 28 Plans 2018: 28 Plans Altius Arches BridgeSpan Humana Molina Select Health Altius Arches BridgeSpan Humana Molina Select Health Humana (6) Molina (3) Select Health (60) Univ. of Utah (5) Molina (5) Select Health (18) Univ. of Utah (5) Select Health (24) Univ. of Utah (4) *statewide Sources: [2014] [2015] Utah On Exchange Rates (accurate as of 10/15/14) [2016] See Plans and Premiums (October 2015) [2017] See Plans and Premiums (October 2016) [2018] 2018 Utah Individual Rates; Utah Dept. of Insurance, as of 9/28/17

12 Who qualifies for subsidies?

13 The Hernandez Family Income: $26,000 (109% FPL) Residence: Salt Lake City, Utah Age: 33,29,11,7 Source: accessed 10/25/17; 2018 Utah Individual Rates, Utah Insurance Department, 9/28/17; Image: Moodboard How much does the Hernandez family pay for health insurance in 2018? Benchmark Silver Benchmark Plan Silver Plan 2017 Monthly Premium: $550 Monthly Subsidy: $502 Pay per month: $48 Deductible: $500 Out of-pocket max: $2,500 Primary co-pay: $5 Kids covered By Medicaid The Hernandez s options for 2018 Median 2018 Bronze U of U Health Plans Healthy Pref. Bronze HSA Median Bronze + SelectHealth Select Value Expanded Bronze 4600 Benchmark Silver U of U Health Plans Healthy Preferred Silver Copay Median Silver SelectHealth - Select Value Silver 4000 Copay Median Gold SelectHealth - Select Value Gold 1500 Monthly Premium: $617 $693 $972 $993 $1,107 Monthly Subsidy: $924 $924 $924 $924 $924 Pays per month: $3 $15 $48 $69 $183 Deductible: $13,300 $9,200 $0 $0 $3,000 Primary co-pay: No charge after deductible $35 $5 $10 $25

14 Joe Smith Income: $18,000 (154% FPL) Residence: Salt Lake City, Utah Age: 25 Benchmark Silver Benchmark Plan Silver Plan 2017 Monthly Premium: $257 Monthly Subsidy: $193 Pay per month: $64 How much does Joe Smith pay for health insurance in 2018? Deductible: $700 Out of-pocket max: $2,000 Primary co-pay: $10 Joe s options in 2018 Median 2018 Bronze U of U Health Plans - Healthy Preferred Bronze HSA Median Bronze + SelectHealth Select Value Expanded Bronze 4600 Copay Plan Benchmark Silver U of U Health Plans Healthy Preferred Silver Copay Source: Utah Individual Rates, Utah Insurance Department, 9/28/17; Image: EdYourdan Median Silver SelectHealth - Select Value Silver 4000 Copay Median Gold SelectHealth - Select Value Gold 1500 Monthly Premium: $288 $323 $454 $464 $517 Monthly Subsidy: $392 $392 $392 $392 $392 Pays per month: $2 $7 $62 $72 $126 Deductible: $6,650 $4,600 $0 $0 $1,500 No charge after Primary co-pay: deductible $35 $5 $10 $25

15 The Peterson Family Income: $44,000 (220% FPL) Residence: Salt Lake City, Utah Age: 24,23,1 How much do the Petersons pay for health insurance in 2018? Benchmark Silver Plan 2017 Benchmark Silver Plan Monthly Premium: $612 Monthly Subsidy: $348 Pay per month: $263 Deductible: $6,000 Out of-pocket max: $2,000 Primary co-pay: $30 The Peterson s options for 2018 Median Median 2018 Bronze Bronze + U of U Health Plans SelectHealth Select Value Healthy Preferred HealthSave Expanded Bronze HSA Bronze 3175 Benchmark Silver U of U Health Plans Healthy Preferred Silver Copay Source: Utah Individual Rates, Utah Insurance Department, 9/28/17; Image: UHPP Median Silver SelectHealth - Select Value Silver 4000 Copay Median Gold SelectHealth - Select Value Gold 1500 Monthly Premium: $688 $821 $1,083 $1,106 $1,234 Monthly Subsidy: $825 $825 $825 $825 $825 Pays per month: $4 $18 $258 $282 $409 Deductible: $13,300 $6,350 $6,000 $7,000 $3,000 No charge after Primary co-pay: deductible $25 $30 $25 $25

16 The Smith Family Income: $42,000 (263% FPL) Residence: Santa Clara, Utah Age: 62,60 How much do the Smiths pay for health insurance in 2018? Benchmark Silver Plan 2017 Monthly Premium: $1,544 Monthly Subsidy: $1,210 Pay per month: $333 Deductible: $4,000 Out of-pocket max: $14,300 Primary co-pay: $35 The Smith s options for Median Bronze U of U - Healthy Premier Bronze HSA Median Bronze + SelectHealth - Select Med Expanded Bronze 4600 Copay Plan Benchmark Silver SelectHealth - Select Med Silver 2500 Source: accessed 10/30/17; 2018 Utah Individual Rates, Utah Insurance Department, 9/28/17; Image: Moodboard Median Median Silver Gold SelectHealth - Select Med SelectHealth Select HealthSave Silver 3100 Med Gold 1500 (HSA Qualified) Monthly Premium: $1,915 $1,816 $2,595 $2,595 $2,904 Monthly Subsidy: $2,246 $2,246 $2,246 $2,246 $2,246 Pays per month: $10 $40 $349 $349 $658 Deductible: $13,300 $9,200 $5,000 $6,200 $3,000 No charge after Primary co-pay: deductible $35 $35 $25 $25

17 Joe Smith Income: $11,000 (<100% FPL) Residence: Salt Lake City, Utah Age: 25 How much does Joe Smith pay for health insurance in 2018? Joe s options in 2018 Median 2018 Bronze U of U Health Plans - Healthy Preferred Bronze HSA Median Bronze + SelectHealth Select Value Expanded Bronze 4600 Copay Plan Benchmark Silver U of U Health Plans Healthy Preferred Silver Copay Source: Utah Individual Rates, Utah Insurance Department, 9/28/17; Image: EdYourdan Median Silver SelectHealth - Select Value Silver 4000 Copay Median Gold SelectHealth - Select Value Gold 1500 Monthly Premium: $288 $323 $454 $464 $517 Monthly Subsidy: $392 $392 $392 $392 $392 Pays per month: $2 $7 $62 $72 $126 Deductible: $6,650 $4,600 $0 $0 $1,500 No charge after Primary co-pay: deductible $35 $5 $10 $25

18 What to expect in 2018 The Trump administration will continue to try and weaken the ACA, but full repeal looks very unlikely Rep. Spendlove s modified Medicaid expansion up to 100% FPL passed in Utah, waiting for federal approval.

19 What to expect in

20 What to expect in 2018 Voters appear ready to approve Medicaid expansion ballot measure new poll shows June 18, percent of Utahns strongly or somewhat support the initiative.

21 Brief History of Medicaid Expansion

22 Current Eligibility Requirements for Medicaid in Utah Adults w/o Children 100% FPL 400% FPL Adults w Children 60% FPL 100% FPL 400% FPL People w/ Disabilities 100% FPL 400% FPL Elderly Persons >65 100% FPL 400% FPL Pregnant Women 100% FPL 400% FPL Children % FPL 200% FPL 400% FPL Children % FPL 200% FPL COVERAGE GAP MEDICAID CHIP Marketplace Subsidies 400% FPL

23 Demographics of Utah s Medicaid Gap Kim Raff for The New York Times

24 32 States, D.C. have Expanded Access to Healthcare Map Courtesy of Advisory Board:

25 Utah s Two Uninsured Rates

26 Utah s Two Uninsured Rates Census data shows a 44% drop in Utah s uninsured rate for people earning less than 138% of poverty 29.9% 31.9% 31.0% 28.3% 26.20% 22.0% 16.8% Utah s uninsured rate has fallen since 2010, but it s twice as high for Utahns living under 138% of the Federal Poverty Level

27 Other State s Experiences Utah Criminal Justice By The Numbers 90% of our DORA population would be eligible for the insurance Estimated savings for medical care for inmates transported to an inpatient facility for 24 hours or more is about $3,000,000 per year for state prison population 2 years of outpatient treatment is about the same cost as a 94 day incarceration (including cost of arrest) or a 19 day hospital stay GOOD FOR BUSINESS Colorado found that 31,074 additional jobs are supported due to expansion GOOD FOR PREMIUMS Marketplace insurance premiums are about 7% lower in expansion states GOOD FOR PUBLIC SAFETY Washington saw 21-33% lower re-arrest rate and correction agencies saved an estimated $5k-$10k for each person treated GOOD FOR HEALTHCARE CONSUMERS Expanding Medicaid cut every dollar a hospital spent on uncompensated care by 41 cents resulting in $6.2 billion reduction in uncompensated care across expansion states CO: Premiums: Public Safety: Healthcare Consumer:

28 What is TAM? TAM (Targeted Adult Medicaid). 4,000 6,000 people Who qualifies for TAM? 1) chronically homeless and 2) those in the criminal justice system needing substance use or mental health treatment qualify.

29 TARGETED ADULT MEDICAID No asset test. 12-month continuous eligibility! It is for people between making less than 5% FPL You must fill out the Medicaid application and a special form. The form has to filled out by an authorized shelter or facility. Turn in the application and form to TAM@utah.gov or fax to For detailed questions, contact Dave Baldwin (dbaldwin@utah.gov)

30 TARGETED ADULT MEDICAID Currently at over 3,000 enrolled UHPP and our team have filled out about half of those applications About 50/50 justice involved and homeless

31 TARGETED ADULT MEDICAID to or fax to

32 TARGETED ADULT MEDICAID

33 TARGETED ADULT MEDICAID State Prison Drug Courts Fourth Street Clinic Road Home Volunteers of America County Jails + County Agencies Adult Parole and Probation Odyssey House - SLC Optum Salt Lake County Salt Lake County Division of Behavioral Health Salt Lake Housing Authority USARA Fortitude Orange Street

34 TARGETED ADULT MEDICAID Challenges & Opportunities

35 Open Enrollment Period for ACA November 1 December 15

36 Special Enrollment Periods

37 Open Enrollment Period for Medicaid All year long

38 What if you fill out false information? For Marketplace, they would have to pay back anywhere from $300 to $2,500 For Medicaid, they would have to pay the cost of insurance and any medical costs

39 What does Take Care Utah help with? Marketplace a.k.a. Affordable Care Act, ACA, Obamacare, exchange, healthcare.gov Medicaid CHIP, PCN, TAM, etc.

40 What if someone started a Medicaid application? Take Care Utah helps finish the application. This could include: Paperwork Helping gather documents Checking case status Calling employers Looking up state policy

41 Utah s Hispanic Population

42 Utah s Hispanic Population Why is the insured rate for Utah s Hispanic Population so low? 1. The application is too complicated 2. Language and cultural barriers 3. Distrust of sharing personal information 4. Not knowing they qualify 5. Policy issues that serve as barriers 6. Need for a system change

43 But, why Take Care Utah??? Of 96 children without case management, 26% enrolled. Of 107 children with case management, 74% enrolled.

44 Navigators make a difference Alicia Hobson, whose attempt to get insurance last year was bungled by bureaucratic mistakes, says she was able to get insured more easily this time around. Feds say more than 109,000 Utahns have signed up for health insurance A navigator from Community Health Connect in Provo, a TakeCareUtah.org partner, met her at the library near her Lehi home, and helped her with some of the questions on HealthCare.gov, she said. January 15, 2015

45 Navigators make a difference But Thompson didn t spend much time on the [healthcare.gov] because it was so difficult to navigate, she said. Nor did she know that Take Care Utah has navigators on hand for free assistance. Waiting on 'young invincibles' April 24, 2016

46 What happens after they get insurance? Take Care Utah follows up with everyone to: 1. Help them find a doctor 2. See if they have any questions 3. Make sure they received their insurance card 4. Address any other barriers to care 5. Help them re-apply or re-certify

47 Website demo takecareutah.org call Image source: Screenshot of

48 Website demo takecareutah.org call Image source: Screenshot of

49 DWS put language on mycase referring applicants to us.

50 Governor Herbert s video

51 QUESTIONS?