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KENTUCKY Cabinet for Health and Family Services
Health Policy in the Affordable Care Act Era
Emily Whelan Parento, JD, LLM Executive Director
Office of Health Policy
KENTUCKY Cabinet for Health and Family Services
Presenta(on Overview
• Kynect, Kentucky’s Health Benefit Exchange
• Kyhealthnow, advancing our state of wellness
• Early Results from ACA Implementa(on
Expanding Access to Coverage and Care for All Kentuckians
Kentucky’s uninsured
640,000 are currently uninsured: • 300,000 may qualify for Medicaid under the new eligibility rules
• 290,000 may qualify for premium assistance through the Exchange
4
Kentucky’s Uninsured • 640,000 esNmated uninsured prior to first open
enrollment period, approximately 17.5% of the populaNon under 65
• 308,000 potenNally eligible for Medicaid under the new rules
• 332,000 potenNally eligible for coverage through health benefit exchange
How Did We Get Here? Impact In Kentucky
Kentucky’s uninsured
640,000 are currently uninsured: • 300,000 may qualify for Medicaid under the new eligibility rules
• 290,000 may qualify for premium assistance through the Exchange
6
Kentucky’s Under 65 Popula(on Uninsured By FPL
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
< 138% FPL 139%-‐399% FPL > 400% FPL
Source: Kaiser Family Founda3on, State Health Facts
Kentucky’s uninsured
640,000 are currently uninsured: • 300,000 may qualify for Medicaid under the new eligibility rules
• 290,000 may qualify for premium assistance through the Exchange
7
Kentucky’s Uninsured By Race/Ethnicity
16%
22%
38%
0%
5%
10%
15%
20%
25%
30%
35%
40%
White Black Hispanic
Rates of Uninsured by Race/Ethnicity
Source: Kaiser Family Founda3on, State Health Facts
White 77%
Black 10%
Hispanic 10%
Other 3%
Distribu(on of Uninsured by Race/Ethnicity
8
Kentucky Health Benefit Exchange Governor Beshear signed an execuNve order which:
• Created the exchange and its administraNve structure
• Organized the exchange under Cabinet for Health and Family Services
• Established an Advisory Board
9
Why a state-‐based exchange?
• Allows for flexibility, including determinaNons of Medicaid eligibility
• Kentucky’s unique economic, health and regional needs • Determine benefits provided in Kentucky’s exchange • Prevent dual regulaNon of the health insurance market, and • Integrate support from interested stakeholders.
10
ENROLLMENT SUCCESS • In the first enrollment year, over 521,000 Kentuckians enrolled in coverage
via kynect, approximately 75% of whom were previously uninsured. • As of January 7, 2015, more than 114,000 individuals have enrolled via
kynect, including renewals and new purchases of QHPs, as well as those newly eligible for Medicaid.
• Reduc(on in the uninsured: Gallup Healthways (summer 2014) found that Kentucky’s uninsured rate dropped from 20.4% to 11.9% in the first half of 2014.
How Did We Get Here? Before ACA
How Did We Get Here? Aeer year 1 ACA
text
kyhealthnow
kyhealthnow 14
• Governor Beshear announced February 20, 2014 • 7 Statewide Health Goals for next 5 years
– Reduce Rate of Uninsured Individuals to < 5% – Reduce Smoking Rate by 10% – Reduce Obesity Rate by 10% – Reduce Cancer Deaths by 10% – Reduce Cardiovascular Deaths by 10% – Reduce % of Children with Untreated Dental Decay by
25% and Increase Adult Dental Visits by 10% – Reduce Deaths from Drug Overdose by 25% and
Reduce the Average # of Poor Mental Days of Kentuckians by 25%
kyhealthnow 15
• Building on the Affordable Care Act – Enrollment in QHPs and Medicaid – Capitalizing on Preventive Services and EHB
• Creating a Long-Term Investment in Kentucky’s Future – Tackling the Major Drivers of Poor Health in Kentucky – Comprehensive Approach to Reduction in Uninsured,
Tobacco Use and Obesity • Health In All Policies
– All of Government Represented in kyhealthnow – Multi-Stakeholder Engagement
kyhealthnow
kyhealthnow 16
kyhealthnow Representative Strategies: Tobacco
• Support for comprehensive state-wide smokefree legislation • Support an increase in tobacco tax • Regulation and taxation of e-cigarettes on par with other
tobacco products • Support legislation banning sale of e-cigarettes to minors • Expansion of tobacco free policies to more executive branch
property • Challenge more school districts to adopt 100% tobacco free
property policies • Increase use of smoking cessation therapy by 50% in 5
years
kyhealthnow 17
kyhealthnow Representative Strategies: Obesity
• State employee plan coverage for Diabetes Prevention Program • Work toward implementing healthier vending and concessions on
executive branch property • More than $30 million in federal funds directed toward pedestrian
and bike paths by end of 2015 • 10 New Trail Towns Certified by end of 2015 • School-based strategies such as support for BMI reporting and
increased physical activity • Engagement with the employer community through development
of initiatives to honor and recognize employers supporting increased physical activity.
kyhealthnow 18
ACA: Early Results • Updated whitepaper re impact of Medicaid expansion to be
released soon – 5300 health care jobs Nov 2013-Nov 2014, with accelerating pace – Thousands more administrative and support positions – Hospitals have received $450 million increase in Medicaid revenue,
which includes only 9 months of expansion payments – Total infusion of approximately $1 billion into Kentucky in 2014 from
Medicaid expansion
• Health impacts: – In Emergency Rooms, 78% drop in charity care, 51% drop in self-pay – Dramatic increase in use of preventive services, such as cancer
screenings and immunizations – Significant increase in utilization of behavioral health & substance use
treatment
kyhealthnow 19
Advancing Our State of Wellness
kynect +
kyhealthnow =
A Healthier, More Economically Competitive Kentucky
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