WA Association of Community and Migrant Health Centers March 26 2013

Washington Health Benefit Exchange

WA ASSOCIATION OF COMMUNITY AND MIGRANT HEALTH CENTERS

MARCH 26 2013

BRAD FINNEGAN

The Affordable Care Act

▪ Changes to private insurance, e.g., oYoung adults on parent’s policies to age 26oProhibit lifetime monetary capsoMinimum spending on medical care (medical loss

ratio)

▪ Closing the prescription “doughnut hole”

▪ Expands coverage and imposes an individual mandate in 2014oExpands Medicaid to 138%* of FPLoExchanges for individuals and small businesses, with

premium tax credits and cost sharing reductions*ACA 133%=138% due to across the board income disregards

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Exchange basics

▪ Individuals >138% of FPL and small groups (2-50)

▪ Tax credits available for individuals 138%-400% of FPL

▪ Cost sharing reductions available for <250% FPL

▪ “Qualified health plan” (QHP) offerings

▪ Metallic tiers of actuarial value

▪ Apples-to-apples comparisons for consumers, one-stop shop

▪ 10 essential health benefits

▪ Navigators, agents/brokers, call center assistance

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Coverage Continuum in 2014

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* Federal Basic Health Plan Option for individuals with incomes between 138% and 200% of the FPL will not be available in 2014.

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Building the Exchange

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• HCA receives one-year $22.9 million grant to design and develop Exchange

• SSB 5445 passed creating Exchange as “public private partnership”

• Governor names Exchange Board members

• Board begins governing authority

• ESSHB 2319 passed

• Deloitte Consulting, LLP, signs on as system integrator

• Exchange names first CEO and moves into new building

• Washington becomes second Level 2 establishment grant recipient, $128 million

• Exchange moves onto own payroll and accounting systems

• WA HBE receives conditionalcertification to operate state based exchange with HHS/CCIIO

• Sustainability plan submitted to Legislature

• Exchange must be certified by HHS

• Additional legislative action taken as needed

• Open Enrollment begins (October 1)

2011

20122013

2014• Coverage purchased

in the Exchange begins

• Open enrollment ends in March.

Exchange Value PropositionConsumer/Employer Public/State

“No wrong door” – Unprecedented access to plans, programs and support

Reduction in uninsured/under-insured and uncompensated care

Certified QHPs with essential health benefits

Enhanced population wellness

Trusted information and customer assistance

Better informed consumers

Ability to compare and purchase plans

Competitive insurance marketplace

Group purchasing power for individuals and small businesses

(2-50)

Single monthly bill and payment for multiple QHP enrollees for small groups

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Individual vs. SHOP Exchange

Individual Exchange

‑ Individuals who are not on public or employer sponsored plans

SHOP Exchange

‑ Small businesses with 2 - 50 employees

‑ Access to QHPs, federal subsidies through APTC and / or CSR, and referral to alternative options (e.g., CHIP)

‑ Employee access to employer sponsored plans with increased choice

‑ Employer ability to define contributions and access to small business tax credits

‑ Initial open enrollment is open to all with some special enrollment periods pending eligibility status

‑ Initial open enrollment is open to all with some special enrollment periods pending eligibility status

Who:

What:

When:

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QHP Logo

QHP Logo

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QHP Logo QHP Logo QHP Logo

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Membership Growth: “New” Members PROJECTED EXCHANGE MEMBER ENROLLMENT (2014 – 2017 YEAR END)

Implications for Providers

▪ Expanded insurance coverage for current and new patients.

▪ Reductions in patient point of service payments (i.e., copayments, cost sharing)

▪ Potential changes in contracts

▪ Potential role in enrolling individuals in insurance

▪ Potential changes in payment

▪ Shop for insurance by provider

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Important Board Policy Decisions

Completed▪ Criteria for qualified health plans (QHPs)▪ Premium aggregation ▪ Consumer Rating System▪ Pediatric Dental Benefits▪ Navigator program▪ Role of agents/brokers

Upcoming▪ Exchange financing/Sustainability

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Key Challenges

▪ Tight timeline – Oct. 1, 2013oFederal dependencies and guidance o IT flight path – scope, schedule and budget

▪ Delivery environmentoCritical inter-agency interdependencies

▪ Managing expectationsoOptions deferred to 2.0 or 3.0oComplex authorizing environment

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http://wahbexchange.org/

Includes information about:▪ Exchange Board

▪ Legislation and grants

▪ Policy discussion

▪ TAC and stakeholder involvement

▪ IT systems development

▪ HHS guidance

▪ Listserv registration

▪ [email protected]

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More on the Exchange

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Appendix

Governance Eleven member, bi-partisan board assumed authority on March 15, 2012

Margaret Stanley – Chair, Retired Executive Director, Puget Sound Health Alliance

Steve Appel – Farmer, Past President of the Washington Farm Bureau

William Baldwin – Partner, The Partners Group

Donald Conant – General Manager, Valley Nut & Bolt, Assistant Professor

Doug Conrad – Professor, University of Washington

Melanie Curtice – Partner, Stoel Rives

Ben Danielson – Medical Director, Odessa Brown

Phil Dyer – Senior VP, Kibble & Prentice, and Former Legislator

Teresa Mosqueda – Legislative & Policy Director, Washington Labor Council

*Commissioner Mike Kreidler – Insurance Commissioner

*MaryAnne Lindeblad – HCA Director

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* non voting, ex officio

Washington Healthplanfinder

Vision: Redefining People's Experience with Health Care

Mission: Radically improving how Washingtonian’s secure health insurance through

▪innovative and practical solutions

▪easy-to-use customer experience

▪our values of integrity, respect, equity and transparency

▪providing undeniable value to the healthcare community (patients, providers, plans)

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http://www.WAHBExchange.org

Includes information about:▪ Exchange Board

▪ Legislation and grants

▪ Policy discussion

▪ TAC and stakeholder involvement

▪ IT systems development

▪ HHS guidance

▪ Listserv registration

▪ [email protected]

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More on the Exchange