Big Decisions: How Medicaid Expansion Would Affect Ohioans

• 1. BIG DECISIONS:HOW MEDICAID EXPANSIONWOULD AFFECT OHIOANS 1

2. TODAYS WEBINAR SPEAKERS Col OwensGene KingCathy Levine Senior Attorney forDirector of the Ohio Executive Director of Legal Aid of Poverty Law Center the United Health Southwest Ohio andCare Action Network co-chair of Ohioof Ohio (UHCAN Consumers for HealthOhio) and co-chair Coverageof Ohio Consumers for Health Coverage 2 3. Speaker: Col OwensAFFORDABLE CARE ACT REFORMSALREADY IN PLACE3 4. CHILD COVERAGE ON PARENTS POLICY UNTIL AGE 26 Pre-ACA, children lost coverage on parents policy at 18 orcollege graduation Under ACA, children can stay on until age 26. As of 2011, 97,000 children in Ohio gained coverage under thisprovision of the ACA 4 5. HIGH RISK POOL FOR THOSE WITH PRE- EXISTING CONDITIONS Pre-ACA, no coverage available for persons denied insurancebecause of pre-existing conditions Under the ACA pre-2014, a federally-funded high risk poolprovides coverage to those with such conditions who qualify As of 2012, 3,000 persons in Ohio have had coverage under thisprovision of the ACA 5 6. ABOLITION OF LIFETIME COVERAGE CAPS Pre-ACA, insurance companies could impose lifetime and/orannual caps on insurance coverage Those with serious chronic health conditions could exhaustcoverage early in life and be without insurance The ACA abolishes lifetime caps and limits annual caps In 2011, over 4,000,000 people in Ohio are protected underthis provision of the ACA 6 7. SMALL BUSINESS TAX CREDITS Pre-ACA, small businesses received no help from thegovernment for providing coverage to their employees The cost of coverage has increased dramatically in recentyears Under the ACA, qualifying small businesses are receiving taxcredits for providing coverage In 2011, 107,000 small businesses in Ohio qualified for a taxcredit covering up to 35% of the cost of coverage7 8. MEDICARE PREVENTIVE CARE ANDPRESCRIPTION DRUG COVERAGE Pre-ACA, persons on Medicare paid cost-sharing forpreventive care and paid full cost for prescription drugs inthe donut hole Under the ACA Medicare participants get free preventivecare and the donut hole is eliminated over time In 2011, 937,000 Medicare beneficiaries in Ohio receivedfree preventive care services. In 2012, 117,000 Ohio Medicare beneficiaries received a50% discount on drugs in the donut hole, for a total savingsof $82 million. 8 9. Speaker: Gene KingMEDICAID: OVERVIEW 9 10. MEDICAID Medicaid is a public health insurance program forcertain low-income people 2.2M Ohioans Not all low-income Ohioans are eligible for Medicaid It is administered by the Ohio Department of Job andFamily Services (ODJFS) Medicaid is funded jointly by the state and federalgovernments. Most services are provided at no cost to patients, butsome services have a small co-payment. 10 11. MEDICAID Today, Medicaid eligibility is a two-step (or more) process. The first step is what category the person fits. The second step is income eligibility for that category. Different categories have different income limits. 11 12. MEDICAID INCOME LIMITS Children - - 200% of the federal poverty level Parents - - 90% Pregnant women - - 200% Aged, Blind or Disabled - - 64% For additional information, see:http://jfs.ohio.gov/ohp/index.stm 12 13. Affordable Care Act:Federal Income Eligibility Levels in 2014Private Insurance $92,200* (family of 4) Health Benefit Exchange Optional ACA Medicaid Expansion to 138% $31,809*(family of 4) MedicaidCurrent Ohio Medicaid Eligibility Federal Exchange Eligibility * The 2012 poverty threshold is $11,170 for an individual and $23,050 for a family of four. **Over age 65 coverage is provided through Medicare, not the Exchange.13 14. MEDICAIDCOVERED SERVICESMedicaid provides comprehensive coverage, including: Doctors Inpatient Hospital Prescription medications Dental Vision Mental Health Laboratory tests & X-Rays Nursing Home & Hospice Care http://jfs.ohio.gov/ohp/bcps/FactSheets/hshf.pdf 14 15. Speaker: Cathy LevineBIG DECISIONS: CHOICES FOR OHIO15 16. POST-ELECTION ANALYSISAffordable Care Act is here to stay! Expands Coverage Protects Consumers Promotes MarketFairness 16 17. MEDICAID EXPANSIONAffordable Care Actexpands Medicaidcoverage to everyoneunder age 65 with incomes below138% Federal PovertyLine (FPL) 17 18. SUPREME COURT DECISION Removed penalty for not implementing Some states consider it optional18 19. COSTS OF MEDICAID EXPANSIONYearOhios FederalCost Governments Cost20140% 100%20150% 100%20160% 100%20175% 95%20186% 94%20197% 93%2020+ 10%90%19 20. BENEFITS OF MEDICAID EXPANSIONBoosts our economyCreates jobsPromotes healthier Ohioans 20 21. IMPACT ON HEALTH CARE SYSTEMStabilizes hospitals and health centers serving uninsuredReduces cost-shifting of uncompensated care onto insurance premiumsReduces state spending on health care (includes uncompensated care)Funds ongoing preventative care reducing health care costs in future 75% of health care costs is chronic health conditions21 22. CONSEQUENCES OF NOT EXPANDING MEDICAIDWithout expansion, at least 600,000 Ohioans will be uninsured without ability to pay for health insurance Premiums up to 2% ofincome, modest cost sharingProblems with only Private insurance benefit lessexpanding coverage to comprehensive; non-covered benefits100% FPL(dental, vision, etc.) unaffordable Doesnt save state money22 23. Speaker: Col OwensECONOMIC IMPACT & COSTS OFEXPANSION IN OHIO 23 24. ECONOMIC IMPACT OF FEDERAL MEDICAIDDOLLARS Pre-ACA, Ohio Medicaid expenditures are paid roughly two-thirds federal, one-third state Under the Medicaid expansion, that ratio applies to personseligible but un-enrolled Feds would pay 100% for 3 years for newly eligible personsunder expansion Net effect of expansion on cost, feds would pay an averageof 95% of cost for newly eligible persons over 6 years24 25. ECONOMIC IMPACT OF FEDERAL MEDICAIDDOLLARS (CONT.) Past Ohio studies of economic impact of state Medicaidspending showed a 3.14 multiplier for state dollars invested This meant, for each state dollar spent, $3.14 of economicbenefit was derived, including the receipt of federal matchdollars Policymakers found these studies useful in determining theimpact in their districts on economic activity and jobscreated 25 26. ECONOMIC IMPACT OF FEDERAL MEDICAIDDOLLARS (CONT.) Ohio officials believe a full expansion to 138% FPL will bringinto Ohio over $20 billion federal dollars in five years A current study by Bill Hayes and Anand Desai isdetermining both the economic impact of those federaldollars, including jobs created, and the amount of revenuethey will generate that could be applied toward costs 26 27. ACA IMPLEMENTATION MEDICAID COSTS V.MEDICAID EXPANSION COSTS Confusion exists about the cost of the Medicaid expansionper se Many persons currently eligible will come on Medicaidbecause of the ACA itself: * mandate * penalty * ease of application * reduced stigma * publicity* better coverage * higher insurance rates due to lower variance27 28. COSTS OF MEDICAID IN SFY 2014-15 BUDGET There are 250,000 Ohio parents and children eligible forMedicaid who are not enrolled There are 686,000 Ohio parents and children (mostlychildren) eligible for Medicaid with private insurance Ohio officials expect some number of both groups to comeonto Medicaid because of the ACA implementation, andthey will be covered at the current 2/3 federal 1/3 stateratio28 29. COSTS OF MEDICAID IN SFY 2014-15 BUDGET(CONT.) Difficult to determine for which reason these people woodwork people come on. POINT: cost of many/most of these people will be incurredwith/without expansion In either case, challenge is how to pay for these people atnormal match rate29 30. MEDICAID EXPANSION PAYS FOR NEW ENROLLEES REGARDLESS OF CAUSE Hayes and Desai say $20 billion federal dollars moving throughOhios economy will generate sufficient economic activity andrevenue to pay for state costs of expanded enrollment Sales taxes paid by Medicaid Managed Care Organizations willalso be sufficient to help pay for enrollment costs, if needed Thus: Medicaid expansion is the solution, not the problem. 30 31. Speaker: Gene KingIMPACT OF EXPANSION ON OHIOANS 31 32. OHIOANS BENEFIT FROM EXPANDEDHEALTH COVERAGECommunities and people in every part of Ohio will seeimproved health outcomes and financial benefits if Ohiodecides to expand Medicaid for families and childless adults.Medicaid is a vital component of the health and human servicesystem in Ohio and across the nation.32 33. EVERY OHIOAN Every Ohioan will benefit from the Medicaid expansion. Aslong as we have any uninsured Ohioans, every Ohioan willshare the cost of their care, through cost-shifting, increasedinsurance rates, higher fees for health care, and the costs ofemergency or episodic care rather than preventative care. 33 34. OHIO CHILDREN, ADULTS AND FAMILIES Childless adults Parents Parents of minor or dependent children Children whose parents are uninsured 34 35. OHIOANS WITH CHRONIC HEALTH NEEDS Ohioans with disabilities with income above 64% of the federal poverty level Ohioans with disabilities whose income is below 64% of the federal poverty levelOhioans who use county mental health servicesOhioans with chronic health conditionsOhioans currently in limited Medicaid coverage programs35 36. WHO BENEFITS FROM EXPANSION?Every Ohioan, insured, underinsured or uninsured, whoneeds health care will benefit from the Medicaid expansion.As long as we have any uninsured Ohioans, every Ohioan willshare the cost of their care, through cost-shifting, increasedinsurance rates, higher fees for health care, and the costs ofemergency or episodic care rather than preventative care. 36 37. Speakers: GroupWHAT YOU CAN DO & TIMELINE 37 38. KASICH ADMINISTRATION DECISION Conducting cost/benefit analysis Receiving public input Will announce decision with biennialbudget February 4, 2013 Then, legislature considers 38 39. NEXT STEPS: WHAT YOU CAN DOSign your organization on to the sign-on lettersupporting Medicaid expansion: Go to www.uhcanohio.org or email Betsy Johnson, [email protected] local coalitions: Northeast Ohio Medicaid Expansion [email protected] Southwest Ohio Medicaid Expansion [email protected] 39 40. NEXT STEPS: WHAT YOU CAN DO Share your new expertise with your organization, yournetwork, and your legislators. Shareable Resources: www.advocatesforohio.org/resources 1. Fact sheet on Medicaid expansion 2. Fact sheet on Ohioans affected by Medicaid expansion 3. How to find and talk to your legislators 40 41. QUESTIONS FOR OUR SPEAKERS Unmute your phone to ask a question by pressing *6 or type your question into the text bar. Speakers: Gene King, Col Owens, Cathy Levinewww.advocatesforohio.org41