august: aca learning session on exchange, and navigators
DESCRIPTION
Aug ACA Learning SessionTRANSCRIPT
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Affordable Care Act (ACA) Learning Sessions for Social Sector Leaders & Community Advocates
August 17, 2012
Coordinated by Access HealthColumbus Community Advisory Committee
Purpose Spread knowledge of federal health care reform in non-profit organizations to improve their ability to serve clients during the implementation of the Accountable Care Act (ACA). Today’s Objectives 1. Improve knowledge on the value of:
• American Health Benefits Exchanges • Navigators intended to personally assist consumers in understanding their
choices and selecting insurance coverage 2. Inventory learning on barriers encountered when reaching out to vulnerable people
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Affordable Care Act
Near Universal Insurance Coverage
Guaranteed Issue &
Insurance Mandate
Improvement Programs
(and grants)
Health Benefit
Exchanges
Expansion of Medicaid
Subsidized commercial
insurance for middle-income
families (market based)
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Source: Supreme Court Policy Brief, Health Policy Institute of Ohio, July 2012, http://bit.ly/SjDBca
Health coverage sources for Ohioans in 2014
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Health coverage sources for Ohioans in 2014
Source: Supreme Court Policy Brief, Health Policy Institute of Ohio, July 2012, http://bit.ly/SjDBca
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Affordable Care Act
Near Universal Insurance Coverage
Guaranteed Issue &
Insurance Mandate
Improvement Programs
(and grants)
Health Benefit
Exchanges
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Affordable Care Act
Near Universal Insurance Coverage
Guaranteed Issue &
Insurance Mandate
ImprovementPrograms
(and grants)
Health Benefit
Exchanges
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Affordable Care Act
Near Universal Insurance Coverage
Guaranteed Issue &
Insurance Mandate
Improvement Programs
(and grants)
Health Benefit
Exchanges
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Current Exchange Status
• 15 Established State Exchange
• 1 Planning for Partnership Exchange
• 18 Studying Options
• 11 No Significant Activity
• 6 Decision Not to Create State Exchange
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Supreme Court Ruling
The insurance market reforms and subsidies
were upheld and will go into effect.
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Insurance market reforms
The 2010 insurance reforms will remain in
effect
– No lifetime limits and restricted annual limits
– Coverage of dependents up to age 26
– No rescissions except for fraud
– No pre-existing condition exclusions for children
– Preventive care at no co-pays or cost sharing
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Insurance market reforms
The 2011 insurance reforms will remain in
effect
– Medical Loss Ratio Limits
Medical loss ratios must be at least 85% for large group
coverage and 80% for small group and individual
coverage.
– Premium Rates Review standards (2011).
Premium rates in excess of 10% must undergo
heightened review.
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Permanent Market Reforms
• The 2014 permanent market reforms were
upheld.
– Guaranteed issuance of coverage
– Modified community rating of coverage
• Rates can only vary by age (3 to 1) and smoking status
(1 ½ to 1).
• No pre-existing condition exclusions
• Individual mandate
• Employer mandate
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Low Income Subsidies
The 2014 low income subsidies were upheld.
– Sliding scale subsidies are available at incomes
between 100% to 400% FPL
– At 100% FPL, the cost of coverage will be:
$223 per year or $18.50 per month for
individuals; or
$461 per year or $38.40 per month for a family
of 4.
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Health Insurance Exchanges
Exchanges were upheld.
– Each state shall establish a qualified Exchange by
January 1, 2014.
– If a state chooses not to operate an exchange,
the federal government will do so.
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Exchange Options
1. An Ohio Exchange
2. A Federal Exchange
3. A Hybrid Exchange
– States control plan management including
certification of qualified plans
– States operate the consumer assistance function
– HHS retains authority and approve state partners
– States may control reinsurance and Medicaid
eligibility determinations
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Timeline
Reforms already in effect: – 2010 Insurance Benefit Reforms
– Medical Loss Ratios
– Premium Rate Review
November 6, 2012 - The Election – Change in direction as to implementation
– Can’t change requirements on insurance companies
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Timeline
November 16, 2012 – States must submit an Exchange Blueprint to
HHS, including (1) a Declaration of Intent signed by the Governor and (2) an Application indicating the state’s intentions.
– A state may submit a “Blueprint” for an exchange which will become operational after 2014, but November 16th is the deadline.
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Timeline
January 1, 2013 – HHS must certify state exchanges that become
operational on January 1, 2014. The state must demonstrate “the ability to satisfactorily
perform all required Exchange activities.”
– Conditional approval can be granted to states making “significant progress” if they will be ready by October, 2013.
– It is hard to believe a state filing a “Blueprint” after the election could establish a 2014 exchange.
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Timeline
2012 - 2013 – IT/Consumer Infrastructure established
– Qualified health plans certified
– Vendor/partner agreements executed Agents/Navigators
– Operations established
– Marketing/outreach to consumers
Fall, 2013 – People begin to enroll in exchanges
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Timeline
January, 2014 – Permanent reforms take effect
– Low income subsidies start
– Mandates take effect
– Coverage through exchanges becomes effective
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Examples
The Enroll UX 2014 design offers a new standard for public and private health insurance enrollment, and serves as a reference model for a first-class user experience (UX) design for health insurance exchanges.
Massachusetts Health Connector
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UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Navigators in the New Health Benefits Exchange
How to create a strong navigator program for our communities
Cathy Levine Executive Director, UHCAN Ohio
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UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Why do we need Navigators in the Exchange?
• Up to 1.5 million uninsured Ohioans
• Many do not know they have new options for getting affordable coverage in 2014
• Many do not know how insurance works – how to shop for insurance
• Many will not know about the Exchange or how it works
• Many will not have access to computer
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UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
What is a Navigator?
• A guide to help you get where
you need to go.
• The ACA created a Navigator
function to – Inform people about their new insurance options
– Help people enroll in their plan of choice
– Help people keep their coverage (stay enrolled)
• The Navigator does not choose a plan or influence the choice of a plan.
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UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Need for Community-Based Navigators
• Consumer or community-focused non-profits
• Licensed insurance agents and brokers
• Industry, trade, professional associations
• Unions
• Chambers of commerce, small
business groups
• Commercial fishing industry
organizations
• Farming and ranching organizations
• Others to reach specific populations
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UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Duties of Navigator According to ACA • Conduct public education activities about what’s
available
• Distribute impartial information about
plan enrollment and availability of tax
credits
• Help people enroll in “qualified health plans”
• Provide referrals for people with complaints and questions about their health plan
• Provide information in culturally, linguistically appropriate manner for populations served
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UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Consumer Protections through Navigators
• Navigators must receive no direct or indirect payments from health insurers
• Insurers are explicitly prohibited from being navigators.
• Therefore, navigators are funded through grants provided by Exchange funds.
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UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Who will enroll in Exchange? From Congressional Budget Office study
• More than 1/3 haven’t had check-up and will have had difficulty accessing care
• Because of tax credits, most will have lower incomes than today’s privately insured
• More racially diverse than currently insured
• 77% will have high school diploma or less
• Languages other than English
• Majority will have been previously uninsured
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UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Features of Strong Navigators
• Training in Exchange, Medicaid, public programs and private insurance market
• Ability to explain eligibility, benefits, cost-sharing, appeals processes to consumers
• Have community’s trust to provide correct, clear information
• Act in interests of consumer, not insurers
• Ability to reach hard-to-reach, poor people
• Ability to explain tax-credits and financial impact
• Represent diverse organizations to serve diverse people eligible for insurance through Exchange
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UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Under Federal Exchange, How is the Navigator program created?
• Ohio could request to have a “partnership” – allows Ohio to run Navigator program
• Otherwise, federal exchange issues requests for proposals from entities to navigate
• How does it all come together?
– Still many unanswered questions
– Community groups have to organize
themselves to participate in meaningful way
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UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
What’s Next?
• UHCAN Ohio is tracking NAIC, federal regulations
• Community organizations need to figure out what role they want to play develop joint proposals
• Role of Ohio Benefit Bank? United Way? Other big players?
• UHCAN Ohio will host phone calls,
live meetings to facilitate
coordination and participation
from diverse communities
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UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Interested in Further Discussions and Information?
• Sign up for our navigation email list
• Call us to do presentations and lead discussions for groups you convene
• Help us to educate communities
about benefits of the Exchange
• Let us call on you to give input
to policymakers and regulators
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UHCAN Ohio
@UHCANOhio
Cathy Levine Executive Director
370 S. 5th St Ste G3
Columbus, OH 43215 (614) 456-0060 x222
UHCAN Ohio’s mission is to achieve
high quality, accessible,
affordable health care for all Ohioans.
www.uhcanohio.org
Visit our website for updates!
Find us on Facebook and Twitter!
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Want to learn more about the Affordable Care Act?
Health Policy Institute of Ohio - Supreme Court Policy Brief: http://bit.ly/SjDBca
Kaiser Family Foundation - A Guide to the Supreme Court's
Affordable Care Act Decision: http://www.kff.org/healthreform/upload/8332.pdf
Next Learning Session • September 28, 9:30-11:30AM • Focus: Overcoming the outreach barriers identified today