ACA Implementation and Impact in Michigan

Transcription

1 ACA Implementation and Impact in Michigan Marianne Udow-Phillips, Director Center for Healthcare Research & Transformation February 21,

2 Health Insurance Coverage in Michigan 2

3 Michigan Health Insurance Coverage 2013 vs Other private/public, Other public 6.76% (VA/TRICARE), 0.59% 2015 Uninsured, 6.08% Medicaid and Duals, 18.77% Employer-based coverage, 49.46% Medicare, 12.50% Direct purchase only, 5.83% 3 SOURCE: CHRT analysis of 2013 and 2015 American Community Survey data

4 Michigan Health Insurance Coverage 2013 vs SOURCE: CHRT analysis of 2013 and 2015 American Community Survey data

5 Healthy Michigan Plan Enrollment Date Total Traditional Healthy Michigan Plan March ,948,872 1,948,872 n/a December ,444,149 1,794, ,282 Change +495, , ,282 SOURCE: Michigan Department of Health and Human Services 5

6 Uninsured Decrease, SOURCE: U.S. Census Bureau, American Community Survey,

7 Employer-based Coverage in Michigan, Percent of Private-Sector Establishments that Offer Health Insurance by Firm Size, Michigan, SOURCE: Medical Expenditure Panel Survey, Insurance Component

8 Percent satisfied Michiganders overall satisfaction with health care coverage has increased post-aca Percentage of Michigan adults who reported being satisfied with their health care coverage, all coverage types, before and after implementation of the Affordable Care Act (ACA) 60% ACA Implemented 57% 55% 50% 51% 52% 45% SOURCE: M. Slowey; E. Ndukwe; M. Riba; and M. Udow-Phillips, Cover Michigan Survey 2015: Health Care Coverage Satisfaction Trend in Michigan (Ann Arbor, MI: Center for Healthcare Research & Transformation, March 2017): Survey Year 8

9 Percentage having problems paying medical bills Fewer Michigan adults had difficulty paying medical bills under the ACA Percentage of Michigan adults that had problems paying or were unable to pay medical bills in the past 12 months, before and after implementation of the Affordable Care Act (ACA) 50% 45% 40% 35% 30% 47% 27% 38% 32% All adults 25% 20% 15% 10% 5% 20% 19% Adults with household incomes less than ~138% of the federal poverty line SOURCE: E. Austic; E. Lawton; M. Slowey; M. Riba; and M. Udow-Phillips, Cover Michigan Survey 2015: Changes in Health Care Cost Barriers under the Affordable Care Act in Michigan (Ann Arbor, MI: Center for Healthcare Research & Transformation, March 2017): 0% Prior to ACA Implementation (2012) First Year of ACA Implementation (2014) Second Year of ACA Implementation (2015) 9

10 Percentage that Delayed Care Fewer Michigan adults delayed seeking needed medical care After implementation of the Affordable Care Act (ACA), fewer Michigan adults delayed seeking necessary medical care in the prior 6 months 35% 30% 25% 20% 29% 25% 22% 23% 22% 21% All Adults 15% Insured Adults 10% *Pre-Post ACA changes shown for all Michigan adults in this figure were marginally statistically significant (p = 0.053) 5% SOURCE: E. Austic; E. Lawton; M. Slowey; M. Riba; and M. Udow-Phillips, Cover Michigan Survey 2015: Changes in Health Care Cost Barriers under the Affordable Care Act in Michigan (Ann Arbor, MI: Center for Healthcare Research & Transformation, March 2017): 0% Prior to ACA Implementation (2012) First Year of ACA Implementation (2014) Second Year of ACA Implementation (2015) 10

11 Percentage Citing Reason for Delaying Care By the second year of the ACA, cost concerns as reason for delaying care decreased Among Michigan adults who delayed seeking necessary medical care in the prior 6 months, with the expansion of the Affordable Care Act (ACA), convenience concerns increased, while cost concerns decreased, as reasons cited for delaying care 70% 60% 50% 40% 30% 20% 60% 64% 49% 38% 23% 32% 23% 35% 37% 22% 33% 32% 10% 0% *Percentages do not add up to 100% within insured or all adult categories since "other" concerns (such as transportation issues) are not shown in this figure SOURCE: E. Austic; E. Lawton; M. Slowey; M. Riba; and M. Udow-Phillips, Cover Michigan Survey 2015: Changes in Health Care Cost Barriers under the Affordable Care Act in Michigan (Ann Arbor, MI: Center for Healthcare Research & Transformation, March 2017): Prior to ACA Implementation (2012) First Year of ACA Implementation (2014) Second Year of ACA Implementation (2015) 11

12 Medicaid Expansion Impact on Michigan s Economy 30,000 new jobs annually $2.3 billion in additional personal spending power Added economic activity generates $150 million annually in state tax revenue Revenue offsets nearly all of state s share of Medicaid expansion costs in SOURCE: Ayanian et al., Economic Effects of Medicaid Expansion in Michigan

13 Medicaid Expansion Impact on Michigan Hospitals Uncompensated care in MI hospitals spent fell by nearly 50% from : $627 million, 5.2% of total hospital costs 2015: $332 million, 2.9% of total hospital costs 90% of hospitals saw reductions in uncompensated care in SOURCE: Ayanian et al., Healthy Michigan Plan 2015 Report on Uncompensated Care and Insurance Rates

14 Individual Market Enrollment 2013 individual market enrollment: 344,173 37% increase from 2013 to SOURCES: Kaiser Family Foundation, U.S. Department of Health and Human Services

15 Marketplace Carriers and Plan Choice in Michigan?? Note: Humana will exit all Marketplaces in 2018, impacting 20,000 Michigan members in Genesee, Kalamazoo, Kent, Livingston, Macomb, Monroe, Oakland, Washtenaw, and Wayne counties 15 SOURCE: Michigan Department of Insurance and Financial Services

16 2016 Average National Annual Premium Costs 16 SOURCE: Kaiser Family Foundation: How ACA Marketplace Premiums Measure Up To Expectations/2016 Employer Health Benefits Survey

17 SOURCE: Kaiser Family Foundation, Summary of the Affordable Care Act Additional Significant Provisions of the ACA Health System Reform CMMI programs: Accountable Care Organizations, State Innovation Model Patient-Centered Medical Homes Hospital Readmissions Reduction Program Hospital-Acquired Condition Reduction Program Public Health Prevention and Public Health Fund Workforce Development Community and School-Based Health Centers Community Health Needs Assessments Prevention and Wellness Essential Health Benefits Mental Health Parity expansion Coverage of Preventive Services National Prevention Strategy 17

18 ACA Replacement Options 18

19 Full Replacements House Republicans: A Better Way Young adults can stay on parents plans until age 26 Rep. Tom Price: Empowering Patients First Act Eliminate young adults ability to stay on parents plans until age 26 Burr-Hatch-Upton: Patient CARE Act Young adults can stay on parents plans until age 26 Prohibit pre-existing condition exclusions with continuous coverage Prohibit pre-existing condition exclusions with continuous coverage Prohibit pre-existing condition exclusions with continuous coverage Age adjusted refundable tax credits for individual market coverage Age adjusted refundable tax credits for individual market coverage Age and income adjusted refundable tax credits for individual and small group coverage Expand health savings accounts Expand health savings accounts Expand health savings accounts $25 billion over 10 years to states for high-risk pools Shift Medicaid to block grant or per-capita allotment $3 billion over 3 years to states for high-risk pools Eliminate Medicaid expansion Authorize states to establish highrisk pools with unspecified amount of federal funding Shift Medicaid to per-capita allotment 19

20 Partial Replacement: Cassidy- Collins Patient Freedom Act States can choose to: 1. Keep the ACA s insurance reforms and affordability provisions, with 95% of current tax credit and cost-sharing funding. 2. Implement a new market-based insurance system: autoenrollment of uninsured residents in a basic catastrophic plan with federal funding of health savings accounts. States get 95% of current tax credit and cost-sharing funding. Medicaid expansion states get current federal match amount for Medicaid expansion; non-expansion states get 95% of the federal match they would have received under expansion. 3. Decline the ACA s insurance and affordability provisions and the federal funding offered in Option 2, effectively providing no coverage expansion to residents. 20

21 Proposed Changes to Medicaid Financing 21

22 Block Grants Federal government gives states fixed dollar amount, states pay for all costs above cap Growth is tied to general inflation (less than health care inflation rate) States shoulder increasing costs over time: 22 SOURCE: Center for Budget and Policy Priorities

23 Per Capita Caps Federal government gives states fixed perenrollee payment, states pay for all costs above Children, adults, elderly, people with disabilities could have different caps Payments based on a base year of per-enrollee spending Growth is tied to general inflation (less than health care inflation rate) Somewhat more responsive to enrollment needs than block grants 23 SOURCE: Kaiser Family Foundation

24 Projected Impact on Federal Funding to States Block grant: Decreased federal funding for 49 states Per capita cap: Increased federal funding for 24 states 24 SOURCE: Avalere

25 Impact on Provider Taxes 49 states have a Medicaid-related provider or insurer tax MI: Provider tax revenue covers 25% of state s Medicaid expenses and generates additional federal funding: State collects taxes from providers FY15-16 provider tax revenue: $1.1 billion State uses revenue to spend more on Medicaid services State portion of Medicaid expenditures: $4.3 billion State gets more federal dollars through current match rate Federal portion of Medicaid expenditures: $12.9 billion State pays back providers through increased Medicaid reimbursement rate Block grant/per capita cap prevents states from drawing additional federal funds through provider taxes 25 SOURCES: National Conference of State Legislatures, House Fiscal Agency

26 Center for Healthcare Research & Transformation 2929 Plymouth Road Suite 245 Ann Arbor, MI (734) Website: Follow us on 26