What s next for rural & public health?

Transcription

1 What s next for rural & public health? February 1, 2017 Arizona Grantmakers Forum Daniel Derksen, M.D., Director University of Arizona Center for Rural Health Professor & Chair of the Community, Environment & Policy Department Daniel Derksen MD, Director Arizona Center for Rural Health University of Arizona Health Sciences Updated November 1, 2016

2 Popular ACA Provisions Expanding coverage 91.4% covered Covering to age 26 on parents plan Covering pre-existing conditions Prohibiting coverage limits What s Unpopular about ACA? Levying tax penalty if no insurance coverage Insurers dropping plans & increasing rates

3 Medicaid + Marketplace Gain Post-ACA Enrollment Gain from Sept 2013 thru Oct 2016 UNITED STATES Medicaid+CHIP Million Age <26 Parents Plan Million Marketplace Million Effectuated Enrollment (paid premiums) 91.4% Americans with health insurance Million Gained Coverage since % or 27 Million Uninsured in Accessed 01/25/17: 1. Medicaid + CHIP Report thru Oct 2016: 2. Age <26 Parents Plan : 3. Effectuated Marketplace Enrollment:

4 31 States + DC Expanded Medicaid Over Half (16) Are Republican Governor States: AK, AR, AZ, IA, IN, KY, MD, MI, MT, ND, NH, NJ, NM, NV, OH, VT 16.4M Medicaid Enrollees Accessed 01/25/17:

5 2016 Medicaid CHIP Medicare Enrollment 37% US Pop on Medicaid, CHIP, Medicare 37% US population (122/323M) Million on Medicaid/CHIP in Million on Medicare in M Dual: on both Medicaid+Medicare Accessed 01/23/17 at:

6 How Arizona Cut Its Uninsured AHCCCS AZ Medicaid <133% FPL ($32,319 Family of 4) July-Sep 2013 to Oct 2016 Net Gain AZ MARKETPLACE % FPL ($32,319-$97,200 Family of 4) OE-3 Effectuated Enrollment* Mar 31, ,000 AZ <26 Parents Plan +70, ,000 Arizona Total: +850,000 KidsCare/CHIP restored 09/2016: +13,000 Eligible Arizona Children Age <19 years between % FPL Accessed 01/25/17 at: 1. AZ KidsCare/CHIP: 2. AHCCCS/Medicaid: 3. Effectuated Enrollment (pd premium):

7 Arizona Uncompensated Care Trends for Hospitals AZ Expanded Medicaid/AHCCCS AZ ACA Marketplace Created AHCCCS Prop 204 Frozen 07/08/2011 AHCCCS Prop204 Childless Adult Coverage Restored KidsCare/CHIP Restored

8 Arizona s Hospitals 2013 to 2016 Uncompensated Year Care % % % % % Avg Operating Margin % % % % % Source: AzHHA Nov 2016 Financial Results Fiscal trends correlate with coverage losses and gains: 7/2011 freeze childless adult Prop 204 AHCCCS enrollment 1/2014 restoration of Prop hospital assessment 1/2014 ACA Marketplace + Medicaid expansion 9/2016 restoration KidsCare/CHIP

9 U.S. Job Growth Pre & Post ACA Job Growth Since 2010 Decline in Uninsured 2009 v Job Growth

10 Uninsured Decline by Race & Ethnicity Post-ACA Hispanic +4 Million Insured Black +3M White +8.9M

11 The Nominated Players Sen. Tom Price MD Secretary HHS Seema Verma, MPH House Speaker Director CMS Paul Ryan Helped Gov. Pence Obtain from CMS Healthy Indiana Plan Medicaid 1115 Waiver

12 Block Granting Medicaid 74 Million Americans on Medicaid/CHIP Medicaid/CHIP spending $500 billion and growing Half of those covered are children Two-thirds of the cost: disabled, long term care Advantages: allowing state innovation, control, and flexibility: eligibility, benefits, cost sharing Disadvantages: shifting cost/risk to states & enrollees, unreliable fed funding, creates anxiety for governors! Middle Path: Allowing state flexibility, innovation through Medicaid 1115 Waivers (ex. AZ, Indiana)

13 Start by doing what s necessary; then do what s possible; & suddenly you re doing the impossible Francis of Assisi