Kansas Health Care Reform Study KHPA Board Meeting. September 25, 2007

Transcription

1 Kansas Health Care Reform Study KHPA Board Meeting September 25, 2007

2 Objectives for Today Context Describe Scenarios Being Modeled Major Differentiator(s) Key Assumptions Understand Effects of Differentiators/Assumptions ILLUSTRATIVE ONLY 2

3 Context Project Timeline Model Evolution August September October November Straw Man Fine Tune Discuss Completed ILLUSTRATIVE ONLY 3

4 Kansas Health Care Reform Study Objectives Kansas Health Care Reform Option Goals: 1. Provide and protect affordable health insurance for all Kansans in order to ensure appropriate access to health care; 2. Pay for prevention and a primary care medical home in order to improve health outcomes, coordinate care, and drive down health care costs; 3. Promote personal responsibility in order to embrace healthy behaviors and to contribute to the cost of health insurance, based on ability to pay. We have been hired to help with #1 by developing a model which presents options to providing affordable health insurance. This project was developed with the financial support of the United Methodist Health Ministry Fund, Sunflower Foundation, Health Care for Kansans, the REACH Healthcare Foundation, and the Health Care Foundation of Greater Kansas City. ILLUSTRATIVE ONLY 4

5 Review Model Scenarios Baseline Starting Point including SB11 Premium Assistance Program VOLUNTARY 1. Reference Voluntary Waiver Expansion: Children and Adult Expansion up to 250% FPL 2. Affordable Coverage Voluntary Market Reform: Individual/Small Group Reform Business Health Partnership Reinsurance MANDATORY 1. Universal Coverage Mandatory Health Insurance: Health Insurance Exchange Reinsurance 2. The Mountain Mandatory Market Reform: Single Payer Model State-set Plan Design State-Set Provider Reimbursement SEQUENTIAL Multi-Part Health Insurance Reform SB11 Expansion to 150% Connector/Exchange Mandatory <19 yr old Insurance ILLUSTRATIVE ONLY 5

6 Approach and Structure of Model Kansas Health Care Marketplace Market Linkage of the Uninsured Market Linkage Current Coverage 1,600 Number of People (in thousands) 1,400 1,200 1, Insured = 2.1 Million Uninsured = 260, Note: Totals may not add due to rounding and adjustments for overlap 0 Small (<50) Large (>50) Individual Medicaid SB11 Source: CPS 2004/2005 Average ILLUSTRATIVE ONLY 6

7 Baseline Current + SB 11 Baseline Distribution of Coverage 1,400,000 1,323,000 1,200,000 1,000,000 Total = 2.4 Million 800, , , , ,000 Small (<50) Large (>= 50) 186, ,000 19,000 81, ,000 18,000 Individual M edicaid M edicare M ilitary Uninsured Premium Assistance SB11 Source: CPS 2004/2005 Average ILLUSTRATIVE ONLY 7

8 Baseline Current + SB 11 Baseline Expenditures-Total (Millions) $5,000 $4,652 $4,500 $4,000 $3,500 Total = $8.2 Billion Acute Care Expenditures $3,000 $2,500 $2,000 $1,500 $1,000 $500 $- $858 Small (<50) Large (>= 50) $1,126 $631 $265 $293 $351 $65 Individual M edicaid M edicare M ilitary Uninsured Premium Assistance SB11 ILLUSTRATIVE ONLY 8

9 Baseline Current + SB 11 Baseline-Per Member Per Month (PMPM) Wtd Avg = $290 PMPM $1,400 $1,200 $1,162 $1,000 $800 $600 $400 $200 $- $504 $344 $293 $302 $301 Small (<50) Large (>= 50) $212 $112 Individual Medicaid Medicare Military Uninsured Premium Assistance SB11 ILLUSTRATIVE ONLY 9

10 Reference (Voluntary) Major Differentiator Waiver Expansion: Expand Public Programs up to 250% FPL Children/Adults & Childless Adults STRUCTURE 1. Waiver Expansion: Create SPA and/or Waiver for CMS approval and Federal $ s POLICY DECISIONS 1. Program Design: Expand Public Programs 2. Benefits: Medicaid Benefit Package 3. Service Delivery Network: Medicaid Managed Care Program ISSUES State Match & Vehicle Federal Approval Crowd-Out ILLUSTRATIVE ONLY 10

11 Reference (Voluntary) 250% FPL 1,400,000 1,200,000 Comparison of Population after Reference Scenario of 81,000 Baseline Reference Total = 2.4 Million 1,000, , , , , ,000 of 13,000 of 17,000 of 144,000 - Small (<50) Large (>= 50) Individual Medicaid Medicare Military Uninsured Premium Assistance SB11 ILLUSTRATIVE ONLY 11

12 Reference (Voluntary) 250% FPL Comparison of Expenditures after Reference Scenario (Millions) Baseline $5,000 $4,500 $4,000 $3,500 $3,000 $2,500 of $275m Reference Total = $8.4 Billion $2,000 $1,500 $1,000 $500 of $51m of $97m $802m of $191m $- Small (<50) Large (>= 50) Individual Medicaid Medicare Military Uninsured Premium Assistance SB11 ILLUSTRATIVE ONLY 12

13 Affordable Coverage (Voluntary) Major Differentiator Individual/Small Group Market Reform Merge & Subsidize w/ Reinsurance Merged Market <250% FPL STRUCTURE 1. Merge Individual/Small Group Markets: Require Community Rating and Guaranteed Issue Require access to Section 125 Add Subsidized Reinsurance Program to Spread Risk 2. Market Clearinghouse Business Health Partnership (BHP) for Combined Market: Provide Seal of Approval to Products Provide Section 125 Assistance POLICY DECISIONS 1. Program Design Market Driven Reform: Change Kansas Insurance Law Require Section 125 for All s Establish Reinsurance Program Determine Reinsurance Funding Determine State Subsidy for those with Income below 250% FPL Empower Business Health Partnership as Clearinghouse ISSUES KS Insurance Law Combined Market Selection v. Level-Playing Field Role/Authority of BHP ILLUSTRATIVE ONLY 13

14 Affordable Coverage (Voluntary) Comparison of Population after Voluntary Connector 1,400,000 Baseline Voluntary Connector 1,200,000 1,000,000 Total = 2.4 Million 800, , ,000 18,000 42,000 of 60, ,000 - Small (<50) Large (>= 50) Individual M edicaid M edicare M ilitary Uninsured Premium Assistance SB11 ILLUSTRATIVE ONLY 14

15 Affordable Coverage (Voluntary) $4,500 Comparison of Expenditures after Voluntary Connector Baseline Voluntary Connector $4,000 $3,500 Total = $8.4 Billion $3,000 $2,500 $2,000 $1,500 $225m of $23m $1,000 $500 of $78m $- Small (<50) Large (>= 50) Individual M edicaid M edicare M ilitary Uninsured Premium Assistance SB11 ILLUSTRATIVE ONLY 15

16 Sequential (Mandatory & Voluntary) Major Differentiator 3 Part Health Insurance Reform Mandatory for Children, Expand SB11, and Connector/Exchange STRUCTURE POLICY DECISIONS 1. Mandatory Health Insurance for Children: To enroll in School, Children < 19 yrs old must show proof of insurance 2. Expand SB 11 to 150% FPL 3. Market Clearinghouse Business Health Partnership for Small Group Market: Allow Sole Prop s and Small Group Require access to Section 125 Add Subsidized Reinsurance Program to Spread Risk for combined market Provide Seal of Approval to Products Maintain Go Bare Provision ISSUES 1. Program Design Market Driven Reform: Establish and Enforce Mandate on Children s Health Insurance Expand SCHIP to 250% FPL Expand SB11 to 150% Affordability & Coverage Standards Change Kansas Insurance Laws Establish Reinsurance Program Determine Reinsurance Funding Subsidize Small Group/Sole Props < 250% FPL Require Section 125 Children s Mandate Combined Market Selection v. Level-Playing Field State Match/Vehicle ILLUSTRATIVE ONLY 16

17 Sequential (Mandatory & Voluntary) $5,000 $4,500 $4,000 $3,500 $3,000 $2,500 $2,000 $1,500 $1,000 $500 $- Comparison of Expenditures after Sequential Plan Scenario (Millions) 24,000 Small (<50) 3,000 Large (>= 50) 21,000 37,000 Baseline Sequential Plan Total = 2.4 Million of 156,000 70,000 Individual Medicaid Medicare Military Uninsured Premium Assistance SB11 ILLUSTRATIVE ONLY 17

18 Sequential (Mandatory & Voluntary) Comparison of Expenditures after Sequential Plan Scenario (Millions) Baseline Sequential Plan $5,000 $4,500 $4,000 $3,500 $3,000 $2,500 $2,000 $1,500 $1,000 $500 $- $110m Small (<50) $7m Large (>= 50) $98m $71m Total = $8.6 Billion of $196m $254m Individual Medicaid Medicare Military Uninsured Premium Assistance SB11 ILLUSTRATIVE ONLY 18

19 Universal Coverage (Mandatory) Major Differentiator Mandate on Individuals and s for Health Insurance Pay or Play Mandate for All Kansans STRUCTURE 1. Existing /Carrier Model: Mandate Individuals to Have and s to Offer Health Insurance Require Section 125 through all s Add Subsidized Reinsurance with Funds from Combined Carriers and State 2. Compliance/Exemption Process: Affordability Set at 10% of Income Enforcement for Non-Compliance Establish Religious Exemptions Establish Income/Age Exemptions POLICY DECISIONS 1. Program Design Market Driven Reform: Establish and Enforce Individual and Mandate Change Kansas Insurance Law Set Pay or Play Standards and Enforcement for Individuals and Businesses Set Minimum Coverage Standards Set Exemption Process Establish Reinsurance Determine Reinsurance Funding Subsidize Individual/Small Group < 250% FPL ISSUES Achieving a Mandate ERISA and Federal Law KHPA Pay or Play Provisions ILLUSTRATIVE ONLY 19

20 Universal Coverage (Mandatory) 1,400,000 Comparison of Population after Universal Coverage Baseline 164,000 Universal Coverage 1,200,000 1,000,000 Total = 2.4 Million 800, , , ,000 99,000 of 66,000 46,000 of 247,000 4,000 - Small (<50) Large (>= 50) Individual M edicaid M edicare M ilitary Uninsured Premium Assistance SB11 ILLUSTRATIVE ONLY 20

21 Universal Coverage (Mandatory) $5,000 Comparison of Expenditures after Universal Coverage Baseline $663m Universal Coverage $4,500 $4,000 $3,500 Total = $8.7 Billion $3,000 $2,500 $2,000 $1,500 $1,000 $500 $438m of $379m $88m of $333m $13m $- Small (<50) Large (>= 50) Individual M edicaid M edicare M ilitary Uninsured Premium Assistance SB11 ILLUSTRATIVE ONLY 21

22 The Mountain (Mandatory) Single Payer Major Differentiator Single Payer All Kansans must receive Health Insurance through the Kansas Health Insurance Program STRUCTURE 1. Market Maker Single Payer: Single Combined Health Care Market for All Kansans Require Community Rating Require Guaranteed Issue Capture Existing Funding Sources 2. Compliance/Exemption Process: Affordability Set at 10% of Income Enforcement for Non-Compliance Establish Religious Exemptions Establish Income/Age Exemptions POLICY DECISIONS 1. Program Design State Driven Reform: Establish Individual Mandate Change Kansas Insurance Law Elimination of Carriers State-Controlled Benefits State-Controlled Reimbursement Set Pay or Play Standards and Enforcement for Individuals Set Exemption Process Subsidize Individuals < 250% FPL Amount of Program Administrative and Provider Administrative Savings ISSUES Achieving a Mandate ERISA and Federal Law State-Controlled Health Care Market ILLUSTRATIVE ONLY 22

23 Mountain (Mandatory) Single Payer Comparison of Population after The Mountain Baseline 1,400,000 1,200, ,000 Total = 2.4 Million The Mountain 1,000, , , , ,000-99,000 Small (<50) Large (>= 50) of 65,000 45,000 of 247,000 4,000 Individual Medicaid Medicare Military Uninsured Premium Assistance SB11 ILLUSTRATIVE ONLY 23

24 Mountain (Mandatory) Single Payer Comparison of Expenditures after The Mountain Baseline $5,000 $4,500 $4,000 $3,500 $3,000 $2,500 of $150m The Mountain Total = $7.4 Billion $2,000 $1,500 $1,000 $500 $- $170m Small (<50) Large (>= 50) of $513m $11m of $12m of $45m of $335m $6m Individual Medicaid Medicare Military Uninsured Premium Assistance SB11 ILLUSTRATIVE ONLY 24

25 Summary of Total Dollars by Plan Total Health Care Expenditures by Reform Plan Baseline Reference Voluntary Sequential Universal The Mountain $9,000 $8,800 $8,600 $8,400 $8,241 $8,430 $8,365 $8,586 $8,732 $8,200 $8,000 $7,800 $7,600 $7,400 $7,375 $7,200 $7,000 Total Expenditures (Millions) ILLUSTRATIVE ONLY 25

26 Summary of Population Changes by Plan Change in Population by Reform Plan Sm. Lg. Individual Medicaid Uninsured Premium Assistance 300, , ,000 0 (100,000) (200,000) (300,000) Reference Voluntary Sequential Universal The Mountain ILLUSTRATIVE ONLY 26

27 Summary of Change in Spending by Plan Change in Spending by Reform Plan Self State Federal $800 $600 $400 $200 $0 ($200) ($400) ($600) ($800) ($1,000) ($1,200) Reference Voluntary Sequential Universal The Mountain ILLUSTRATIVE ONLY 27

28 Next Steps Update Scenarios based on today s feedback from Board Finalize Scenarios for Legislative Report Feedback from RWJ SCI Meeting in Chicago Finalize Report and Presentation for November 1 st Legislative Oversight meeting ILLUSTRATIVE ONLY 28