Health Insurance Exchanges and the Changing Marketplace Leanne Gassaway, MHA Regional Vice President West Region, State Advocacy July 31, 2013
End Goal An Efficient, Effective, Competitive and Robust Health Insurance Market Key Elements: Address Affordability Minimize Disruptions Ensure Workability Maximize Coordination Maximize Choice and Competition
2014 Marketplace Changes Guarantee Issue and Defined Enrollment Periods October 1, 2013 March 31, 2014 Individual Purchase Requirements Subsidies for Coverage Available for Persons 100-400% FPL Employer Shared Responsibility (Delayed) Large Group, Adequate Coverage, FTEs, and Penalties Essential Health Benefits 10 Categories of Benefits, AV and Cost-Sharing Adjusted Community Rating Rules & Regions Age, Geography, Family Size and Tobacco Use Health Insurance Exchanges Opening October 1, 2013 Individual and Family Coverage Options SHOP for Small Businesses (1-50)
America s Health Insurance Plans, 2013 Medicaid Expansion-State Implementation of ACA (as of July 2013) WA Implementing ACA Medicaid Expansion (22 plus DC) OR ID MT WY ND SD MN WI MI NY VT NH MA CT ME RI Likely Implementing ACA Medicaid Expansion (2) Not Implementing ACA Medicaid Expansion (13) CA NV UT CO NE KS IA MO IL IN KY OH WV PA MD DC VA NJ DE Unlikely to Implement ACA Medicaid Expansion (10) Undecided /No consensus (3) AZ NM OK AR TN SC NC Pursuing Alternative Options MS AL GA TX LA AK FL HI
America s Health Insurance Plans, 2013 State Implementation of ACA: Exchange Activity (as of July 2013) State-Based Exchanges (16 plus DC) CA WA OR NV ID AZ UT MT WY CO NM ND SD NE KS OK TX MN IA MO AR LA WI IL MS MI IN KY TN AL ME VT NH NY MA CT RI PA NJ OH MD DE DC WV VA NC SC GA Federally-Facilitated Exchange (FFE) (19) Marketplace Partnership Agreements (7) State Partnership Exchanges (7) HHS will run an Exchange in the individual market while the state runs a state-based SHOP Exchange (2) 16 states plus DC, the UT SHOP and NM SHOP are State-Based Exchanges. 33 states plus the UT and NM Individual Market will function under a FFE platform. AK HI FL CA, CO, CT, DC, HI, ID, KY, MD, MA, MN, NV, NM, NY, OR, RI, UT, VT and WA received conditional approval of their statebased Exchanges from HHS. AR, DE, IL, IA, MI, NH and WV received conditional approval to establish partnership Exchanges.
Time is Running Out 62 Days to Open Enrollment
Key Dates May 2013 QHP bids due and HHS & State review begins Summer 2013 Testing; Call Center Live, Navigator Program, Agent & Broker Portal State Review Complete (July 31) Late Summer 2013 Agreements with QHP Issuers finalized, Health Plan Preview Federally Facilitated Marketplace (33 States) Oct 1, 2013 Open Enrollment Begins Jan 1, 2014 Health Plan Coverage Begins Mar 31, 2014 Open Enrollment Ends December 2012 July 2013 QHP Filings due to State Regulators; QHP LOI and Applications Due to SBE June - July 2013 Testing; SBE Hiring and Training Staff; Navigator Designation; Late Summer 2013 QHPs Approved by State Regulators & Certified by SBE, Testing with Health Plans and Fed HUB Oct 1, 2013 Open Enrollment Begins January 1, 2013 Health Plan Coverage Begins March 31, 2014 Open Enrollment Ends State Based Exchanges/Marketplace (16 states plus DC) 8
Technology Challenges Eligibility and enrollment Subsidy administration for new tax credits and costsharing reductions Shopping experience Customer service (pre and post enrollment) Technical integration 9
States in Hyper-drive Branding and web design Stakeholder and implementation teams Focused on operations/build Planning for post 2014 Exchange funding and sustainability Reviewing QHP applications, rates and form filings Schedule for testing Testing with Federal Hub Executing outreach, education and marketing plans
Plans in Hyper-drive HHS and SBEs continue to release the technical criteria and protocols issuers operations teams on countdown Issuers waiting on 1 st round review results for QHP applications, EHBs, AVs and Metal Levels for participation in SBEs, SBMs, SPMs and FFMs Tracking changing rules, outstanding final rules needed (SHOP, Enrollment) and 500+ FAQs Setting up customer service Navigators and anticipating additional guidance and training for In Person Assisters, Application Counselors, Agents and Brokers Preparing Outreach and Education and Marketing
Health Care Spending The Biggest Challenge 2013 and Beyond
Primary Driver of Long Term Debt
Squeezing State Budgets Source: NASBO, 2010 State Expenditure Report, p. 5
Health Care Cost Drivers Demographics Lifestyle Choices Innovation Bias Cost Opacity Medical Liability Fee-for-Service Provider Consolidation Cost Shifting Taxes, Fees, Compliance Costs
Interaction of ACA Provisions Premium Subsidies Transitional Reinsurance Cost-sharing Subsidies Competition Modest Incentives to Purchase Coverage Health Insurance Tax Age Rating Compression Essential Benefit Changes
Health Plans Leading the Way Delivery System and Payment Reform Value Based Benefit Structures Transparency
Under the ACA, you need to have MEC. Pick your QHP which covers EHBs with OOPMs categorized by AV in your SBC. The QHP could be an HMO or PPO with ECPs and must be accredited by NCQA or URAC. You could be eligible for an APTC and CSR depending on your FPL and your MAGI. The QHP may use an ACO, VBID, VBN, or a CDHP with an HSA.