arkansas’s health insurance marketplace ***** university of arkansas at little rock law review...
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Arkansas’s Health Insurance Marketplace ***** University of Arkansas at Little Rock Law Review Choices and Consequences: Health Policy and the ACA Little Rock, February 28, 2014 ***** Cynthia Crone, Deputy Commissioner Arkansas Insurance Department Arkansas Health Connector Division. - PowerPoint PPT PresentationTRANSCRIPT
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Arkansas’s Health Insurance Marketplace*****
University of Arkansas at Little Rock Law ReviewChoices and Consequences: Health Policy and the ACA
Little Rock, February 28, 2014*****
Cynthia Crone, Deputy CommissionerArkansas Insurance Department
Arkansas Health Connector Division
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Marketplace Advances ACA Goals
• Expand access to affordable, quality care
• Improve quality and efficiency
• Constrain rising costs
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Marketplace Advances Arkansas Goals
• Cover more than a half million uninsured Arkansans with quality, affordable insurance.
• Attract new issuers and competition to AR.
• Support providers to help keep healthcare local.
• Improve economic health of Arkansas.
• Support overall health system improvement efforts aimed at quality and payment transformations.
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Following three years of planning….
The Health Insurance Marketplace in Arkansas is open for business!
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Status of Marketplaces
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State-Based MarketplaceState-Based Marketplace (SHOP only)Partnership MarketplaceFederal Marketplace
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How did we get to where we are?
There have been many steps along the way
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September 2010Arkansas Insurance Department awarded
Federal Exchange Planning Grant.
March 2010 Affordable Care Act signed into law by
President Obama.
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December 2011 Governor Beebe directs AID to pursue
State Partnership Marketplace model.
April 2011 Arkansas legislature declines to enact bill to
establish State-Based Marketplace through AID.
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November 2012 President Obama re-elected. Arkansas elects Republican Legislature --House and Senate.
June 2012 U.S. Supreme Court upholds
ACA individual mandate and rules Medicaid
Expansion is a State choice.
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December 2012 Governor Beebe declares intent for Arkansas to establish a
State Partnership Marketplace (SPM) for 2014 and AID submits SPM Blueprint.
HHS Secretary Sebelius grants conditional approval for Arkansas’s SPM.
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April 2013 Arkansas Legislature approves linking the Marketplace to
the Private Option and to allow for a State-Based Marketplace (SBM) by 2016.
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October 1, 2013Open enrollment for Marketplace plans begins
and runs through March 31, 2014.
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January 1, 2014Coverage in Marketplace plans begins.
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Diverse Partners Working Together
• Government Policy Makers State <–> Federal (Appointed and Elected)State <–> State (Appointed and Elected)
• Policy Makers <–> Non-Government ConstituentsConsumers and Consumer AdvocatesHealth Care ProvidersHealth Care InsurersBusinesses
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• Consumer Assistance and Plan Management Advisory Committees
• Four Level One Establishment Grants to Date
Arkansas Health Connector Staff &
Consultants
Research / Alternatives
Analysis
Steering Committee
Final Recommendation to Commissioner
Consumer Assistance Advisory Committee
Plan Management Advisory Committee
Develop Recommendations with Alternatives
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Inclusive Stakeholder Engagement
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Examples of Arkansas-Specific Plan Management Decisions• QHP approval by Certification vs. Competitive
Bidding
• Maximum 20% Upcharge for Tobacco Use Allowed
• Medicaid Premium Assistance (Private Option) will be offered through High-Level Silver Plan
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Examples of Arkansas – Specific Consumer Assistance Decisions
• Standards for In-Person Assister (IPA) entities and Guides/other assister licensure.
• Standards for Assister Training
• Respond to ongoing feedback and improvement recommendations for outreach/education efforts
• Arkansas Health Connector Resource Center
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AR State Partnership Marketplace Health Insurance Medical Issuers - 2014
• Arkansas Blue Cross and Blue Shield
• Blue Cross and Blue Shield Multi-State
• QualChoice of Arkansas
• Celtic, doing business as Arkansas Health and Wellness Solutions (Ambetter)
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Qualified Health Plansin Arkansas Marketplace - 2014
Metal Level Actuarial Value
Number of Plans*
Gold 80 percent 23
Silver 70 percent 16
Bronze 60 percent 24
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Additionally, 8 catastrophic plans are offered
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Stand-Alone Dental IssuersOffer 24 Plans
• Arkansas Blue Cross and Blue Shield
• Best Life and Health
• Delta Dental of Arkansas
• Dentegra Insurance Company22814
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Premium Limits Based on IncomeINCOME PREMIUM LIMIT
0 - 138% FPL (Medicaid Expansion) 0100 - 138% FPL (non-Medicaid eligible) 2% of income139 – 149% FPL 3 – 4% of income150 – 199% FPL 4 – 6.3% of income200 – 249% FPL 6.3 – 8.05% of income250 – 299% FPL 8.05 – 9.5% of income300 – <400% FPL 9.5% of income
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2013 Federal Poverty Guidelines
FAMILY SIZE 100% 138% 200% 400%
1 $11,490 $15,856 $22,980 $45,960
2 $15,510 $21,404 $31,020 $62,0403 $19,530 $26,951 $39,060 $78,120
4 $23,550 $32,499 $47,100 $94,2005 $27,570 $38,047 $55,140 $110,2806 $31,590 $43,594 $63,180 $126,3607 $36,610 $49,142 $71,220 $142,4408 $39,630 $54,689 $79,260 $158,520
For each Additional person, add $4,020 $5,347 $8,040 $16,080
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Tax Credits at WorkWith an average base individual monthly premium of $259 in Arkansas for second-lowest price Silver plan, these examples show what a 30-year-old non-smoker will pay in monthly premium:
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Annual income Tax credit Out-of-pocket premium cost
$17,235 $202 $57$22,980 $139 $120$28,725 $67 $192
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What about family costs?
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With an average base monthly premium of $874 for a family of four (two adults age 40 with two children) in a second-lowest cost silver plan, these examples show monthly costs:
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Annual income Tax Credit Out-of-pocket premium cost
$35,325 $756 $117$47,100 $627 $247$58,875 $479 $395
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Premiums Vary by Age
Age Monthly average premium without tax credits
0-20 $15330 $28440 $32050 $44860 $680
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Seven rating areas in Arkansas
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Issuers/Plans per Service/Rating Area
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Central - 1 Northeast - 2 Northwest - 3 South Central - 4
Medical 4/41 3/17 4/41 3/17
Dental 4/12 3/10 3/10 4/12
Southeast - 5 Southwest - 6 West Central - 7Medical 2/11 2/11 4/35
Dental 3/10 3/10 4/12
Rating areas are identified by their geographic area and their assigned number. The number of low dental plans is the same as the number of high dental plans.
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Regional variancesPremiums without tax credits
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Central NorthEast
NorthWest
South Central
SouthEast
SouthWest
West Central
Adult (age 40)
$328 302 343 290 290 292 3272 adults, 2 children
971 892 1,013 856 860 869 970
Child(age 0-20)
158 144 164 138 141 142 158
Adult (age 64)
770 709 804 681 680 686 767
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What is covered?
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Essential Health Benefits• Outpatient Services• Hospitalization• Emergency Services• Maternity and Newborn Care• Mental Health and Substance Use Disorder Treatment• Prescription Drugs• Rehabilitative and Habilitative Services/Devices• Laboratory Services• Preventive, Wellness, and Chronic Disease
Management• Pediatric Services, Including Oral and Vision Care
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Enrollment Options – Individual Market
How?• Internet• Phone• In-Person• Mail
Who can help?• Agents and Brokers• Guides• Navigators• Certified Application
Counselors
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Who can help?(as of February 20, 2014)
Producers 1,396
Guides 515
CACs 219Navigators 26
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What about business coverage?• The Small Business Health Options Program
(SHOP) is part of the Marketplace: - For employers with 50 or fewer employees - Only way for small employers to get tax
credits- Employer shared responsibility is not required for employers with fewer than 50 employees.
• One SHOP Issuer in 2014 (BCBS) – three plans.22814 UALR 32
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Outreach and EducationBroad multi-media “Get Informed” campaign across Arkansas July 1 – September 30, 2013
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http://www.arhealthconnector.org
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Outreach and Education• Speakers’ Bureaus/Marketplace Assisters
• Funding for continuing outreach and education contract (Get Enrolled Phase) after Sept. 30, 2013 denied by Legislature.
• ARHealthConnector.org website re-directed to AID-AHC web page.
• Enrollment events.22814
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http://ahc.arkansas.gov/
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Steady progress for Arkansans with incomes >138% FPL
(Open Enrollment until March 31, 2014)
Marketplace eligible
Tax credit eligible
Selected non-Private Option plan
0 10,000 20,000 30,000 40,000 50,000
Oct.1-Feb.1Oct. 1-Dec.28
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Preparing for 2015 Plan Year
• Certification Standards
• Assister Continuing Education and Re-licensure
• Continued cooperation with SBM Board on transition information/issues
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New Challenges
Compromise on Insurance Department appropriation bill to:
• Eliminate outreach and promotional programs by the AID to educate consumers about their options for coverage.
• Eliminate the In-Person Assister program
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Why compromise?
• A way to draw votes for the Private Option.
• The possibility of more than 100,000 low income Arkansans losing their new health care coverage.
• Private Option helps improve the “risk pool” for the Marketplace as a whole, keeping premiums down.
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Meanwhile …We are doing everything we can to get the word out at enrollment events throughout Arkansas
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501-683-3634www.ARHealthConnector.org
855-283-3483www.healthcare.gov
800-318- 2596
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