Washington Health Benefit Exchange€¦ · 22/07/2020  · Subsidy Study Timeline May 21 CC Session 1: Introduction, Background, Legislation, Timeline June 24 CC Session 2: Review

Washington Health Benefit Exchange

Cascade Care Workgroup - Subsidy Study

July 22nd, 2020

Today’s Objectives

▪ Status update

▪ Timeline

▪ Updated model

▪ Review of initial feedback

▪ Adjustments to model

▪ Wakely model demonstration

▪ Run-through of 3 scenarios

▪ Q&A

▪ Future refinement of model

▪ Funding

▪ Initial presentation of subsidy funding mechanisms

▪ Next Steps

Subsidy Study Timeline

May 21CC Session 1: Introduction, Background, Legislation, Timeline

June 24 CC Session 2: Review Initial Model

July 8 CC Session 2 feedback due.

July 17 Materials distributed for CC Session 3

July 22CC Session 3: Review Model Revisions [Discuss additional scenarios & initiate funding discussion]

July 31 CC Session 3 feedback due.Aug 20 Materials out for CC Session 4

Aug 26CC Session 4: Review Model Revisions [Confirm model/scenarios & review funding estimates]

Sept 4 CC Session 4 feedback due.

Sept 23CC Session 5: Review Initial Draft Report & Finalize Funding Approach

Oct 2 CC Session 5 feedback due

June 24 Meeting Recap

▪ Reviewed subsidy study design

▪ Reviewed initial Wakely model

▪ Discussed model assumptions

▪ Enhanced-APTC scenario

▪ Subsidies for subsidized population up to 400% FPL and non-subsidized between 401-500% FPL

▪ State income limit toggles

▪ Solicited input on initial model

▪ Thoughts on assumptions?

▪ Additional WA specific factors/data/inputs?

▪ Are outputs clear/transparent?

▪ Are additional outputs needed?

▪ Is model useful to inform policymakers?

Stakeholder Feedback

▪ Assumptions & Transparency

▪ General desire for more exposure to underlying formulas

▪ Concerns remained around model boundary limits

▪ Remaining questions regarding impact of COVID-19 on enrollment

▪ Interest in Demographic Data (age, race, ethnicity, gender, county)

▪ Interest in Additional Outputs

▪ Pre/Post-wrap uninsured rates

▪ Subsidy impact on renewal/disenrollment rates

▪ Impact of future market disruptions

▪ Tying subsidies to silver plans

▪ Summary tables displayed by county level

▪ Premium ranges by FPL-band

▪ Side-by-side comparison of multiple scenarios

▪ Total cost by FPL-band

5

Updates to Wakely Model

▪ Refinement of data

▪ Adjustments to uptake <139% and 400-500%

▪ Further review of OFM assumptions

▪ Refinement of Enhanced-APTC distribution model:

▪ Togglable COVID-19 impacts

▪ Togglable subsidy

▪ Full state-income limit subsidy for sub/non-sub

▪ Differential subsidy for non-subsidized

▪ Subsidy only for subsidized

▪ Addition of fixed-dollar PMPM subsidy

▪ Fixed-dollar subsidy for sub and/or non-sub populations

Wakely Model: Inputs Tab

Washington Health Benefits Exchange (WAHBE)

Premium Subsidy Analysis - DRAFT Subsidy Applied As:

Currently Unsubsidized Population Subsidy Includes:

Assumptions/Inputs UsedScenario Selected:

State Premium Subsidy - State Income Limit INPUT Key Adjustments Live Assumption Best Estimate Low Range High Range Notes/Sources:

Percent of FPL Range Income as Percent of FPL

Federal Income

Limit

State Income

Limit

Reduction in

federal income

limit Projection Year 2022 2022 2022 2022

Less than 139% 139% 2.06% 0.00% -2.1% Baseline (without premium subsidy) Projection

139% - 150% 150% 4.12% 2.00% -2.1% Enrollment Changes:

151% - 200% 200% 6.49% 3.50% -3.0% 2020-2021 Enrollment Changes:

201% - 250% 250% 8.29% 4.50% -3.8% Subsidized, On-Exchange 4% 4% -1% 10% Based on May 2020 Enrollment Projection

251% - 300% 300% 9.78% 6.00% -3.8% Unsubsidized, On-Exchange 0% 0% -10% 34% Based on May 2020 Enrollment Projection

301% - 400% 400% 9.78% 7.50% -2.3% Off-Exchange 0% 0% -10% 34% Assumed similar increase as unsubsidized, On-Exchange

401% - 500% 500% N/A 10.00% N/A 2021-Beyond: Annual Change

501% - 600% 600% N/A N/A N/A Subsidized, On-Exchange 4% 4% -1% 10% Based on May 2020 Enrollment Projection

Over 600% Over 600% N/A N/A N/A Unsubsidized, On-Exchange 0% 0% -10% 34% Based on May 2020 Enrollment Projection

Off-Exchange 0% 0% -10% 34% Assumed similar increase as unsubsidized, On-Exchange

Premium Changes:

State Premium Subsidy - Flat PMPM INPUT 2020-2021

Percent of FPL Range Income as Percent of FPL Subsidized PMPM

Unsubsidized

PMPM Gross Premium Change, On-Exchange 2% 2% 6% -2%

Based on May 2020 Enrollment Projection, Best Estimate based on average

premium decrease of 1.8%, adjusted for aging. Assumed lower premium increase

would be associated with higher enrollment estimates

Less than 139% 139% $50 $50 Net Premium Change, On-Exchange, Subsidized 2% 2% 4% 0% Based on average change in FPL used to determine premium limit

139% - 150% 150% $50 $50 Gross Premium Change, Off-Exchange 2% 2% 6% -2% Assume similar to on-Exchange

151% - 200% 200% $50 $50 2021-Beyond: Annual Change

201% - 250% 250% $50 $50 Gross Premium Change, On-Exchange 6% 6% 10% 0% Based on May 2020 Enrollment Projection

251% - 300% 300% $50 $50 Net Premium Change, On-Exchange, Subsidized 2% 2% 4% 0% Based on average change in FPL used to determine premium limit

301% - 400% 400% $50 $50 Gross Premium Change, Off-Exchange 6% 6% 10% 0% Assume similar to on-Exchange

401% - 500% 500% $50 $50 Change in Number Uninsured:

501% - 600% 600% $50 $50 2020-2021 0% 0% 1% -1%

COVID-19 Impact Analysis, https://www.healthmanagement.com/wp-

content/uploads/HMA-Estimates-of-COVID-Impact-on-Coverage-public-version-for-

April-3-830-CT.pdf

Over 600% Over 600% $50 $50 2021-Beyond 0% 0% 1% -1%

Impact of COVID-19 on 2022 Estimates (INCLUDE?) Yes

Enrollment Changes:

Subsidized, On-Exchange 1% 1% -15% 37%

Unsubsidized, On-Exchange 8% 8% 2% 16%

Off-Exchange 8% 8% 2% 16%

Change in Number Uninsured:

2022 with COVID-19 relative to Baseline 12% 12% 48% -2%

State Income Limit

Difference between Federal and State Subsidy

Best Estimate

Wakely Model: Results Tab

Premium Subsidy Analysis - DRAFT

Historical Market Experience and 2022 Baseline Before State Premium Subsidy 2022 Baseline 2019 2020 2022 2020/2019 2022 / 2020

Enrollment

On Exchange Sub 120,511 116,169 128,116 -3.6% 10.3%

On Exchange UnSub 71,318 73,097 78,507 2.5% 7.4%

Off Exchange 37,885 37,885 40,689 0.0% 7.4%

Total 229,714 227,151 247,312 -1.1% 8.9%

% Subsidized 52.5% 51.1% 51.8%

Premiums PMPM

Gross $563 $533 $576 -5.4% 8.0%

Net $294 $322 $342 9.5% 6.2%

2022 Baseline Summary - Before State Premium Subsidy 2022 Summary - After State Premium Subsidy Difference - Before/After State Premium Subsidy

2022 Baseline Enrollment

% Enrollment

with Subsidies

Gross

Premiums

PMPM

Net

Premiums

PMPM

Total Federal

Subsidies ($)

Total State

Subsidies ($)

2022 With State

Subsidies Total Enrollment

% Enrollment with

Federal or State

Subsidies

Gross

Premiums

PMPM

Net Premiums

PMPM

Total Federal

Subsidies ($)

Total State

Subsidies ($) Change Enrollment

% Enrollment with

Subsidies

Gross

Premiums

PMPM

Net Premiums

PMPM

Total Federal

Subsidies ($)

Total State

Subsidies ($)

On Exchange On Exchange On Exchange

Less Than 139% 13,039 93.6% $593 $55 $84,215,459 $0 Less Than 139% 15,420 100.0% $587 $36 $98,572,580 $3,406,671 Less Than 139% 18% 7% -1% -35% 17% 0%

139-150% 14,481 96.6% $607 $94 $89,143,479 $0 139-150% 14,523 100.0% $601 $64 $88,346,677 $5,154,059 139-150% 0% 4% -1% -31% -1% 0%

151-200% 42,153 95.2% $588 $131 $231,226,401 $0 151-200% 43,253 100.0% $582 $90 $232,604,076 $22,696,159 151-200% 3% 5% -1% -31% 1% 0%

201-250% 27,493 91.8% $594 $194 $131,790,841 $0 201-250% 28,900 100.0% $585 $125 $133,951,696 $25,778,293 201-250% 5% 9% -1% -36% 2% 0%

251-300% 18,466 84.9% $593 $262 $73,195,984 $0 251-300% 19,064 100.0% $585 $164 $73,290,527 $22,925,500 251-300% 3% 18% -1% -38% 0% 0%

301-400% 25,805 75.7% $556 $300 $79,276,956 $0 301-400% 28,034 100.0% $549 $208 $83,572,361 $31,110,599 301-400% 9% 32% -1% -31% 5% 0%

401-500% 8,987 0.5% $503 $502 $187,883 $0 401-500% 11,663 100.0% $511 $388 $184,918 $17,008,079 401-500% 30% 21925% 2% -23% -2% 0%

501-600% 4,500 0.2% $522 $521 $16,539 $0 501-600% 4,500 0.2% $517 $516 $16,075 $0 501-600% 0% 0% -1% -1% -3% 0%

Over 600% 51,697 2.5% $550 $541 $5,665,089 $0 Over 600% 51,697 2.5% $545 $536 $5,587,049 $0 Over 600% 0% 0% -1% -1% -1% 0%

Off Exchange 40,689 0.0% $592 $592 $0 $0 Off Exchange 39,525 0.0% $586 $586 $0 $0 Off Exchange -3% 0% -1% -1% 0% 0%

Total 247,312 51.8% $576 $342 $694,718,632 $0 Total 256,580 63.2% $569 $295 $716,125,958 $128,079,359 Total 4% 22% -1% -14% 3% 0%

2022 Baseline Summary - Before State Premium Subsidy PMPMs 2022 Summary - After State Premium Subsidy PMPMs Difference - Before/After State Premium Subsidy PMPMs

2022 Baseline Enrollment

% Enrollment

with Subsidies

Gross

Premiums

PMPM

Net

Premiums

PMPM

Total Federal

Subsidies

PMPM

Total State

Subsidies PMPM

2022 With State

Subsidies Enrollment

% Enrollment with

Subsidies

Gross

Premiums

PMPM

Net Premiums

PMPM

Total Federal

Subsidies

PMPM

Total State

Subsidies

PMPM Change Enrollment

% Enrollment with

Subsidies

Gross

Premiums

PMPM

Net Premiums

PMPM

Total Federal

Subsidies PMPM

Total State

Subsidies

PMPM

On Exchange On Exchange On Exchange

Less Than 139% 13,039 93.6% $593 $55 $538 $0 Less Than 139% 15,420 100.0% $587 $36 $533 $18 Less Than 139% 18% 7% -1% -35% -1% 0%

139-150% 14,481 96.6% $607 $94 $513 $0 139-150% 14,523 100.0% $601 $64 $507 $30 139-150% 0% 4% -1% -31% -1% 0%

151-200% 42,153 95.2% $588 $131 $457 $0 151-200% 43,253 100.0% $582 $90 $448 $44 151-200% 3% 5% -1% -31% -2% 0%

201-250% 27,493 91.8% $594 $194 $399 $0 201-250% 28,900 100.0% $585 $125 $386 $74 201-250% 5% 9% -1% -36% -3% 0%

251-300% 18,466 84.9% $593 $262 $330 $0 251-300% 19,064 100.0% $585 $164 $320 $100 251-300% 3% 18% -1% -38% -3% 0%

301-400% 25,805 75.7% $556 $300 $256 $0 301-400% 28,034 100.0% $549 $208 $248 $92 301-400% 9% 32% -1% -31% -3% 0%

401-500% 8,987 0.5% $503 $502 $2 $0 401-500% 11,663 100.0% $511 $388 $1 $122 401-500% 30% 21925% 2% -23% -24% 0%

501-600% 4,500 0.2% $522 $521 $0 $0 501-600% 4,500 0.2% $517 $516 $0 $0 501-600% 0% 0% -1% -1% -3% 0%

Over 600% 51,697 2.5% $550 $541 $9 $0 Over 600% 51,697 2.5% $545 $536 $9 $0 Over 600% 0% 0% -1% -1% -1% 0%

Off Exchange 40,689 0.0% $592 $592 $0 $0 Off Exchange 39,525 0.0% $586 $586 $0 $0 Off Exchange -3% 0% -1% -1% 0% 0%

Total 247,312 51.8% $576 $342 $234 $0 Total 256,580 63.2% $569 $295 $233 $42 Total 4% 22% -1% -14% -1% 0%

Updated Wakely Model Demonstration

▪ Updated Enhanced APTC Model

▪ Subsidies for non-sub up to 500% FPL

▪ Toggles for application to unsubsidized population

▪ No subsidy

▪ Total federal & state subsidy

▪ Difference between federal and state subsidy

▪ Fixed-dollar PMPM Subsidy Model

▪ Subsidies for under 300% FPL

***Handing Over to Brittney Phillips with Wakely***

Future Refinement of Wakely Model

▪ Refinement of Wakely Model

▪ Addition of uninsured rate to results tab

▪ Addition of outputs by age / race / ethnicity / county

▪ Modelling tying subsidies to standard plans

▪ Review of subsidy levels and cost estimates within the 3 distribution methods to inform policy recommendations

Funding Goals & Challenges

▪ Goals

▪ Broad-based & sustainable funding source

▪ Funding level sufficient to achieve SB 5526 target

▪ Enabling individuals earning up to 500% FPL to spend no more than 10% of MAGI on premiums

▪ Challenges

▪ State budget constrained from COVID-19

▪ Competing priorities for spending any new revenue

▪ Avoiding assessments that add cost to unsubsidized consumer premiums

Initial Funding Review

▪ Assessments on Fully-insured & Self-insured Health Insurance

▪ Covered Lives Assessments

▪ Claims Taxes

▪ Federal Health Insurance Provider Fee (HIT Tax)

▪ Assessments on Fully-insured Health Insurance

▪ Tax on Carrier Surplus

▪ Premium Taxes

▪ Assessments on Health Insurance & Providers

▪ Colorado Tax/Assessment (2020)

▪ Assessments on Employers

▪ Payroll Taxes

▪ Assessments on Individuals

▪ Individual Mandate Penalty

▪ Capital Gains Tax

Subsidy Study Funding Review

Assessment on

Insurance & Hospitals

WA Covered Lives

AssessmentPALs WSHIP Assessment WA Claims Tax

Federal Health

Insurance Tax (HIT)

WA Carrier Surplus

TaxWA Premium Tax

Colorado Tax /

Assessment

Mass. Employer

Fair-Share

Contribution

Mass. Employer

Medical Assistance

Contribution

Washington Paid

Family & Medical

Leave

Individual Mandate

PenaltyCapital Gains Tax

SB 6062 (2018) -

Cleveland

[HB 2355 - Cody ]

HB 2728 (2020) - Slatter RCW 48.41.090 HB 2901 (2020) - RiccelliSec. 9010 of PPACA, P.L.

111-148

HB 2679 (2020) -

Robinson

[SB 6451 - Frockt ]

HB 2821 (2020) - Cody SB 20-215 (2020) 956 CMR 11 (2007-2014)956 CMR 12 (2014-

Present)RCW 50A.10 SB 5840 (2019) - Cleveland

SB 5222 (2019) -

Hasegawa

Proposed Enacted Enacted Proposed Repealed, effective 2021 Proposed Proposed Enacted Repealed in 2014 Enacted Enacted Proposed Proposed

Entities

AssessedFully-insured Carriers & Third-

Party Administrators (TPA)

Fully-insured Carriers,

Employers that provide

insurance, & Self-funded

Multiple Employer Welfare

Agreements (MEWA)

Disability & Stop-loss insurers,

HCSCs, HMOs, & Self-funded

MEWAs

Fully-insured Carriers, TPAs, &

Employers offering self-funded

coverage

Fully-insured individual, small

group, and large group health

plans, Medicaid managed

care, Medicare Part D, and

Medicare Advantage

Fully-insured Carriers

Fully-insured Carriers &

Managed Care Organizations

(MCO)

Fully-insured Carriers &

Hospitals

Employers w/ 11 or more FTEs

that does not make a fair-

share contribution to

employee premiums

All employers w/ 6 or more

employeesEmployers & Employees

Uninsured Washington

Residents

Washington Residents earning

capital gains

Type of

AssessmentAssessment on covered lives Assessment on covered lives Assessment on covered lives Claims Tax

Fee on health insurance

premiums

Non-profit Carriers = Fee on

excessive surplus For-

profit Carriers = Tax on

depreciation deductibles

Premium Tax

Carrier Fee = percentage of

annual premiums Hospital

Assessment = annual $20

million

Employer Assessment Employer AssessmentEmployer & Employee Payroll

PremiumsIndividual Mandate Penalty Capital Gains Tax

Tax / Fee %

Assessment on entity's

covered lives as a fraction of

total covered lives in WA,

necessary to equal $200

million total (estimated at $5

pmpm)

Assessment on entity's

covered lives as a fraction of

total covered lives in WA,

necessary to equal program

expenses

Assessment on entity's

covered lives as a fraction of

total covered lives in WA,

necessary to equal program

expenses (estimated at $0.68

pmpm - 2019)

1% on all paid claims

Fee on 50% of net premiums

between $25 and $50 million

and 100% on net premiums

above $50 million (~2.2% of

premiums). Based on insurer's

market share.

Non-profit Carriers = Payment

of 3% of all Surplus above

600% RBC For-profit

Carriers = 3% tax of all

depreciation deductibles

2.2% (2021) & 1.5% (2022-on)

Non-profit carriers = 1.15% of

annual premiums For-

profit carriers = 2.1% of annual

premiums Hospital

Assessment = $20 million

$295 or the sum of a Fair

Share Employer Contribution

and the Per Employee Cost of

Unsreimbursed Physician Care

(whichever was less)

0.36% of all wages up to the

Massachusetts unemployment

insurance taxable wage base

(~$50 per employee per year

in 2014)

2019-20 total premium rate of

0.4% of wages, with review for

annual adjustments beginning in

2021. ~1/3

paid by employers & ~2/3 paid

by employee

2.5% of an individual's annual

income or $695, whichever is

greater, capped at the avg

bronze premium in WA

8.5% of the inidivudal's

Washington capital gains

Dedicated Uses Reinsurance

Partnersnhip Access Line &

Psychiatry Consulation Line @

UW (to fund non-Medicaid

portion of calls)

WSHIP Program

Administration

Premium assistance for

individuals w/ income btwn

133-500% FPL, enrolled in a

QHP

Federal Advance Premiunce

Tax Credits

Subsidies for unsubsidized &

Foundational Public Health

Low-income health insurance

programs

Reinsurance / Subsidies for

subsidized population /

Subsidies for unsubisizided

population

In par t - Subsidized low

monthly-premium insurance

through ConnectorCare

program

In part - Subsidized low

monthly-premium insurance

through ConnectorCare

program

Paid Family & Medical Leave

Admin of penalty / outreach to

uninsured / activities to increase

availability of health insurance

or affordability of premiums

Funding for a Universal Health

Care trust program

State Revenue$200 million (yr 1) & ~$160

million (yr 2-on)Indeterminate $28 million (2019)

Indeterminate - Mechanism to

track claims or assess

TPAs/Employers

-

~$57 million /yr in excess

surplus [although true

amounts unknown ] Tax

amounts = unkown

$291 million (2021) & $199

million (2022-on)

$54.9 million (2021) / $104.4

million (2022) / $109.7 million

(2023)

- -

Employer Contribution = ~$213

million / yr

Employee contribution = ~$367

million / yr

Indeterminate - Commonwealth

fund estimated a potential for

$165 million in revenue based on

2019 data

~$1.3 billion annually

Federal Revenue $40 million /yr - - - $15.5 billion (2020) -

$97.4 million (2021) & $66

million (2022-on), used to

offset taxes on MCOs

~$88 (2021) - $175 (2023)

million- - -

None proposed, but 1332

possibility given reduction in

premiums

-

Expenditures $200 million / yrIndeterminate ($510,000 in

2020)$29 million (2019) - - -

(Offsets to

PEBB/SEBB/Medicaid costs)

$182.4 million (2021) up to

$314.8 million (2023)- - - - -

Administrative

Costs

Differs annually,

between$120,000 to $400,000

- OIC

$294,000 /yr$1.9 million (2019)… = 4.8% of

total expenses- - $109,000 - OIC - $2.8-$4.2 million - - - - -

Other NotesRequired establishment of a

TPA registration program &

federal 1332 waiver

- -

Premium assistance is set on a

sliding scale by HCA and must

be applied-for

-

Concerns expressed around

getting to a dollar-figure

based on RBC. May need to

adjust assessment calculation.

HCA has questions around

whether the FMAP/dedicated

use of funds align with CMS

policies.

Federal match based on 1332

waiver- - -

Commonwealth Fund projects a

15% reduction in premiums

(based on 2019 data)

-

Other

State/Federal

Activity

Federal - Transitional

Reinsurance Covered Lives

Assessment (2014-2016)

- -Vermont - Health Care Claims

Tax (32 V.S.A. 243)- -

Washington - Insurer Premium

Tax(RCW 48.14.020) Vermont -

Insurance Premiums Tax (32

V.S.A. 211)

- - -Oregon - PFML Payroll Tax (HB

2005 (2019))

Federal - ACA Individual

Mandate (2014-2018)-

CASCADE CARE - SUBSIDY STUDY - FUNDING MODEL REVIEW

Assessments on Fully-insured & Self-funded Insurance Assessments on Fully-insured Insurance Assessment on Employers Assessment on Individuals

This chart is provided in accordance with HBE's work "to develop a plan to implement and fund premium subsidies" pursuant to ESSB 5526 (2019). The chart provides an overview of assessments, fees, premiums, and taxes that have been proposed or enacted in Washington, in other states, or at the federal level.

*The level of assessment, revenues, and expenditures are provided for illustrative purposes where available, and are not meant to constrain the modelling of a state subsidy funding mechanism. This chart is not intended to be an exhaustive list of all funding options available to policymakers. *

https://www.wahbexchange.org/wp-content/uploads/2020/07/Subsidy-Study-Funding-Model-Review.pdf

Stakeholder Considerations

▪ Model Review

▪ Are there any remaining concerns around model assumptions?

▪ Are the model toggles easy to understand and utilize?

▪ Are there any specific enhanced-APTC, U-curve, or fixed-dollar PMPM subsidy levels HBE should review? (i.e. specific income limits or dollar amounts)

▪ Funding Review

▪ Are there additional types of funding HBE should consider in its research?

▪ Are there other state/federal examples for funding HBE should research?

▪ What funding sources are of greatest interest to you? Why?

Next Steps

▪ Refining model

▪ Analyzing additional outputs

▪ Developing initial subsidy recommendations

▪ Additional financing analysis

▪ Begin cost-sharing reduction analysis

▪ Begin individual mandate study

Appendix

SB 5526 – Subsidy Study

NEW SECTION. Sec. 6. (1) The Washington health benefit exchange, in consultation with the health care authority and the insurance commissioner, must develop a plan to implement and fund premium subsidies for individuals whose modified adjusted gross incomes are less than five hundred percent of the federal poverty level and who are purchasing individual market coverage on the exchange. The goal of the plan is to enable participating individuals to spend no more than ten percent of their modified adjusted gross incomes on premiums. The plan must also include an assessment of providing cost-sharing reductions to plan participants and must assess the impact of premium subsidies on the uninsured rate.

(2) The Washington health benefit exchange must submit the plan, along with proposed implementing legislation, to the appropriate committees of the legislature by November 15, 2020.

(3) This section expires January 1, 2021.

Individual Market Assessment

ESSB 6168 – Sec 214

(10) $100,000 of the general fund—state appropriation for fiscal 5 2021 is provided solely for the exchange to contract with an independent actuarial consultant to conduct an assessment of the impact of a state requirement that individuals enroll in health coverage. The assessment shall consider the effects of this requirement on revenue, individual market enrollment, individual market premiums, and the uninsured rate. The exchange shall submit assessment findings to the chairs of the health committees of the legislature no later than December 15, 2020.

Updated Information & Resources Available https://www.wahbexchange.org/about-the-exchange/cascade-care-2021-implementation/

Subsidy Study Materials• Workgroup Meeting Materials• Stakeholder Feedback• Research and Data • Financing Information • Wakely Report

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