Affordable Care Act: A strategy for effective implementation 2012 Budget: $26 million U.S. PIRG October 12, 2012.

Affordable Care Act:A strategy for effective implementation

2012 Budget: $26 million

U.S. PIRGOctober 12, 2012

Objective

1972 – Universal coverage

2010 – Affordable Care Act enacted

Coverage for 95% of all Americans by 2020

What the law does

Improves quality and control costs

Promotes public health

Expands health care workforce

Covers nearly all Americans

Subsidies Exchanges Medicaid expansion Insurance reforms Individual mandate

ACA Coverage Framework

Targeted State

Strategy

Technical

Assistance

MonitoringConsumer Engagement

Successful Implementation in Target States

National Programs

State-Based Programs

Strategy – 2011-2014

AlabamaColoradoMarylandMichiganMinnesotaNew Mexico New YorkOregonRhode Island Virginia

RWJF 10 States

State Health Reform Assistance Network

Princeton University, Woodrow Wilson School

Focus on coverage expansions.

Theory of change: help diverse group of states develop and disseminate successful implementation models

Technical Assistance approach: • Multi-disciplinary team • Operational level technical assistance• Meet states where they are• Peer-to-peer learning• Inform federal policymaking• Sustained and nimble

Consumer Engagement

9

Insurers

Labor

ProvidersBusiness

Political parties

Consumer Engagement

10

Insurers

Labor

Providers

Consumers

Business

Political parties

Consumer Engagement

Health AffairsSeptember 2011

Challenges

• Complexity of the law

• Problems with the law

Remaining uninsured

Medicaid-eligible,

8.5M37%

Undocumentedimmigrants,

5.2 M23%

Exempt from individual mandate,

4.1M 18%

Not exempt from individual

mandate, 5M22%

23 million

Source: Urban Institute’s Health Insurance Policy Simulation Model (HIPSM).

Challenges

• Complexity of the law

• Problems with the law

• Partisanship

Partisanship

219 0 60 0

34 178 0 39

yeas

nays

Ds Rs D/Is Rs

House Senate

This is a problem . . .

Challenges

• Complexity of the law

• Problems with the law

• Partisanship

• Public opinion

• Legal challenges

Supreme Court Decision

• Individual mandate constitutional

• Medicaid expansion constitutional, but now a state option

Challenges

• Complexity of the law

• Problems with the law

• Partisanship

• Public opinion

• Legal challenges

• Budget debate

• Election

Direction on Health Care Awaits Verdict of Presidential RaceBy ABBY GOODNOUGH and ROBERT PEAR

Thursday, October 11, 2012

When Americans go to the polls, they will cast a vote for one of two profoundly different visions for the future of the country’s health care system.

• Partisan rhetoric heightened

• State implementation stalled

• Repeal possible

Election

Progress Establishing Exchanges

Michigan

California

Nevada

Washington

Arizona

Utah

Idaho

Montana

Wyoming

Nebraska

MaineVermont

North Carolina

Georgia

South Carolina

FloridaAlabama

Mississippi Louisiana

Texas

Oklahoma

Pennsylvania

Wisconsin

North Dakota

Ohio West Virginia

South Dakota

Arkansas

Kansas Missouri

Iowa

Illinois Indiana

Alaska

Hawaii

Tennessee

Kentucky

DelawareNew Jersey

Connecticut

Massachusetts

Virginia Maryland

Rhode Island

New Hampshire

States with exchanges by executive order or legislation

State with exchange grants

New York

Minnesota

Colorado

New Mexico

Oregon

Progress Establishing Exchanges

We have heard today that the reason for state inactivity is lack of guidance from HHS.  But [then]one would expect the leading states to be confronting the most barriers and complaining the most loudly. . . In reality, the opposite is true.  Those states are seizing the flexibility afforded them to pursue innovative approaches. Indeed, the primary factor contributing to this variation is the political climate in the states.

Heather HowardTestimony, House Ways and Means Subcommittee on HealthSeptember 12, 2012

Scenarios

Obama wins

Romney winsRepublican Senate

Romney winsDemocratic Senate

Law preserved

Law repealed

Law preserved

Questions

ACA preserved Change or modify strategy? Change states? Leading states? Middle tier? Hopeful? Focus on certain issues? Dissemination approach?

ACA repealed Stick with coverage? Explore what can be preserved, built on? Address other coverage-related issues? E.g., specific

populations? Innovative insurance models? Safety net?

Have a nice day

Andy [email protected]