Affordable Care Act, In Mississippi and Beyond: where we are & where we’re going.

Linda Dixon Rigsby, Esq.Health Law DirectorMississippi Center for Justice

Corey Wiggins, Program ManagerTineciaa Harris, Community OrganizerMississippi Health Advocacy Program

March 29, 2012

•Major Components•Coverage Expansions•Key Provisions

Background

Patient Protection and Affordable Care Act (ACA)

ACA was enacted March 23, 2010The most significant coverage expansion provisions will take effect in 2014 - - several critical changes are already in effect for children and young adultsProvide coverage 32 million uninsured Americans

Source: Families USA

Major Components

Coverage ExpansionsHealth ExchangesHealth Insurance ReformHealth Care Delivery System ChangesPublic Health and Prevention

Budgetary Impact

Latest projections by the Congressional Budget Office (CBO): Health care reform will reduce the federal deficit by ~$210 billion

Coverage Expansions

Most individuals will be required to have health insurance beginning 2014.

Exceptions for financial hardship or religious convictionIndividuals who can afford coverage but remain uninsured will be charged $95 or 1% of income Penalties rise each year, to $695 or 2.5% in 2016

Medicaid will be expanded to 133% of the poverty level for all individuals under the age of 65.

$14,404 Individual$29,327 family of four

Federal Medical Assistance Percentage (FMAP)

Medicaid expansion will be federally funded0% cost to state in 2014-16State share gradually rising to 10% in 2020

Coverage Expansions

Individuals without employer coverage or who are not eligible for Medicaid will be able to purchase coverage through state-based Health Insurance Exchange.

Small businesses will be able to purchase coverage through a separate Exchange.

Sources of Coverage in Mississippi

Source: An Overview of Health Reform. Center for Mississippi Health Policy and Georgia Health Policy Center, September 2010

What is a Health Insurance Exchange?

A new marketplace for individuals and small businesses to:

Purchase private insurance, with the possible aid of tax credits, or

Be matched to public insurance programs, if eligible

Each state is required to have an Exchange operating by January 1, 2014.

Mississippi Insurance Commissioner designated the MS Comprehensive Health Insurance Risk Pool Association to administer Health Exchange.

Regulations provide flexibility to states, stakeholder engagement is crucial.

Coverage Options in the Exchange

Exchanges are required tooffer health plans infour main benefit levelsbased on thepercentage of expensescovered

Plan Percentage of Expenses

Bronze 60

Silver 70

Gold 80

Platinum 90

Consumer Protections

“No Wrong Door” – apply and get enrolled in all coverage optionsApply online, telephone, in-person, or mailRobust web portal that provides streamlined eligibility and enrollmentNo asset test for most people on MedicaidPromotes plain language and simplified communicationsNavigators to assist consumersOutreach and consumer-friendly education materials

Key Provisions Impacting Children

Protects children’s eligibility levels and enrollment procedures in CHIP until 2019Free preventive care based on Bright Futures standardsAllows young adults to stay on parent’s plan up to age 26Extends Medicaid for foster kids up to age 26 (2014)No denials of coverage to children with pre-existing conditions (adults in 2014)Increases Medicaid reimbursement for primary pediatric care physicians (2013-14) Children currently covered by CHIP between 100% and 133% poverty level will be transitioned to Medicaid

Other Notable Provisions forChildren and Families

Child health quality initiativesPublic health initiativesInvestments in:

community health centersschool-based healthhome visiting programsconsumer assistance

Public Health and Prevention

ACA creates a National Prevention, Health Promotion, and Public Health Council.New prevention and public health fundCommunity and clinical preventionPublic health infrastructureResearch and tracking public health training

Source: Healthcare.gov

Where we are

ACA Timeline

Implementation Date Items ImplementedMarch 23, 2010 ---March 2011

•Authorizes tax credits to small businesses for offering coverage to employees•Gives a $250 rebate to seniors reaching Medicare Part D “donut hole” in 2010

June 2010 •Requires states to have temporary high-risk pools or mechanism for uninsured people with pre-existing conditions

September 2010 •Prohibits insurers from rescinding coverage after a sickness, imposing life time caps, and denying coverage to children with pre-existing conditions•Allows parents to keep children on their policies until age 26

2011 •Requires medical loss ratios of 80 and 85 percent, respectively, for individual/small group and large group plans•Begins a voluntary Long Term Care (LTC) program financed through payroll deductions

2012 •Imposes a new annual fee on drug manufacturers

2013 •Raises the Medicare payroll tax for high-income workers and imposes a new tax on medical device sales

2014 •Requires states to implement insurance exchanges for individual/small business markets (federal funding to states is available from 3/2011 to 1/1/2015•Prohibits insurers from denying coverage based on pre-existing conditions and imposes a new annual fee on health insurers•Imposes a mandate that individuals acquire health insurance coverage or pay, by 2016, the greater of $695 or 2.5 percent of income•Imposes mandates on employers with 50+ workers: offer coverage or by 2014 pay $2000/FT worker (excluding the first 30); if offer unaffordable coverage, pay $3000/employee receiving taxpayer assistance to buy it or a total of $2000/employee, whichever is more (Employers of 50 or fewer workers are exempt.)•Expands Medicaid to those making under 133 percent of the Federal Poverty Level

2018 •Imposes new taxes on so-called "Cadillac" health insurance policies

Shifts in Coverage Projected for MS

Source: An Overview of Health Reform. (2010). Center for Mississippi Health Policy and Georgia Health Policy Center.

Healthcare Changes In Mississippi

Impact on Medicaid in MS

• In 2014, it is estimated that MS will have about 270,000 new Medicaid recipients as a result with Medicaid expenditures of $1.6 billion annually

• From 2014 to 2019, state expenditures for the newly eligible Medicaid recipients will be about $11.4 billion with the Federal government paying 97% of those costs

Source: Health Reform Implication for Employers. (2010).Center for Mississippi Health Policy and Georgia Health Policy Center.

Health Insurance Exchange in MS

It is estimated that about 275,000 individuals will purchase coverage through the exchange in 2014

Approximately 229,000 individuals will be eligible for subsidies paid by the federal government worth $912 million in 2014

Source: Health Reform Implication for Employers. (2010).Center for Mississippi Health Policy and Georgia Health Policy Center.

Health reform implementation in Mississippi

Health reform implementation is on ongoing process at the federal and state level

Establishment of state-based exchanges is major component of state level implementation

Exchange implementation is a highly complex process (Technically and sometimes Politically)

End user friendly (Simple), but complex inner workings (technical)

Health Insurance Exchange

Basic concept is to make it easier to find affordable health plans and to comparison shop

Sort of like shopping online for a hotel room or airline ticket

How?1. Reducing rates by “pooling” the medical risks of people

Individual Mandate

2. Requiring insurance companies to offer certain standard benefits and levels of coverage, so that people have an easier time comparing plans and prices

Establishing Mississippi Exchange

Mississippi Legislative Session 2011House Bill No. 1220

Senate Bill No. 2992

Mississippi Comprehensive Health Insurance Risk Pool Association

Designated as the entity to establish and operate ExchangeExchange “built by Mississippians, for Mississippians”

Funding for ExchangeExchange Planning Grant = $1,000,000Exchange Establishment Grant = $20, 143, 618

Governance: MS Health Insurance Exchange

MS High Risk Pool AssociationBoard include 9 members

4 positions appointed by the MS Commissioner of Insurance2 members from general public1 representative of medical providers1 representative of health insurance agents

3 positions appointed by members of the Association3 positions must be filled with members of the Association

Chair of the Senate Insurance Committee (nonvoting)Chair of the House Insurance Committee (nonvoting)

MS High Risk Pool Association

Why does the board of the Mississippi High Risk Pool Association matter?

Federal requirements for Exchange governance state that individuals who are representatives of health insurance issuers, agents, brokers, or any other individual licenses to sell health insurance cannot make up the majority of voting members of the governing board.

MS High Risk Pool Association

House Bill No. 766 and Senate Bill No. 258611 member board

2 new members appointed by the Insurance CommissionerBoth shall be representatives of medical providers

1shall be a representative of businesses employing fewer than one hundred (100) employees

Advisory Board

Advisory Board

Educated Health Care ConsumersExperience in EnrollmentHard to Reach PopulationsSmall Business & Self-Employed IndividualsState Government Agencies & DivisionsFederally-Recognized TribesPublic Health ExpertsHealth Care ProvidersLarge EmployersHealth Insurance Agents & Brokers2 At-Large

Governance

Why is governance important? Great responsibility and will have address many issues

Political independence and accountabilityPreventing conflicts of interestRules, regulations and laws affecting its operation such as hiring and procurementSources of fundingFinancial reporting requirements

What’s next?•Health Insurance Exchange Implementation•Essential Benefits•Consumer Driven Implementation

Where we’re going

Health Insurance Exchange

By January 1, 2013, the Health & Human Services (HHS) will determine whether each state will have an effective means in place to run an Exchange by January 1, 2014

Exchange ConsiderationsGovernanceNavigatorsExchange Enrollment and OutreachExchange Population

MS Health Insurance Exchange

Building an Exchange in MississippiConsider the demographics of the Exchange population compared to current privately-insured populations

Relatively olderLess educatedLower incomeMore racially diversePreviously uninsured, experience access barriersWorse health

Essential Health Benefits

A set of health care service categories that must be covered by certain plans, starting in 2014HHS issued guidance on EHB in December 2011Allows states to select an existing health plan to set the “benchmark” for the items and services to be included in the Essential Health Benefits package

Ten Categories of Coverage

PPACA Section 1032- the following sections MUST be included in the EHB PackageAmbulatory patient services

Emergency Services

Hospitalization

Maternity and newborn care

Mental health and substance use disorder services, including behavioral health treatment

Prescription drugs

Rehabilitative and habilitative services and devices

Laboratory services

Preventive and wellness services & chronic disease management

Pediatric services, including oral & vision care

Consumer Driven Implementation

Mississippi Affordable Care Act Implementation Project (MACAIP)

DialoguesCommunity Organization Engagement

Findings for a Mississippi DialoguePositive ImpactsChallenges

Consumer Driven Implemenation

Positive ImpactsHealthier MississippiIncrease in MS Health care providersFewer Administrative Barriers

ChallengesStrain on Mississippi Health Care SystemPersistent Access Issues in Rural AreasStruggle to Adopt to Focus on Preventive Care

Contact Information

Linda Dixon Rigsby, Esq.Health Law DirectorMississippi Center for Justicelrigsby@mscenterforjustice.org601-352-2269www.mscenterforjustice.org

Corey WigginsProgram Manager

Mississippi Health Advocacy Programcwiggins@mhap.org

601-353-0845www.mhap.org

Tineciaa HarrisCommunity OrganizerMississippi Health Advocacy Programtharris@mhap.org601-353-0845www.mhap.org