cindy zeldin presentation to gccn annual conference executive director, georgians for a healthy...
TRANSCRIPT
Cindy ZeldinPresentation to GCCN Annual Conference
Executive Director, Georgians for a Healthy FutureMay 3, 2013
The Changing Health Care Policy Landscape: Impact on Georgia Consumers and
Implications for the Safety Net
The Big Picture, The Big Opportunity: Covering the Uninsured
Overall, in Georgia: • Nearly two million uninsured (1.86 million); one-fifth of the population and one-fourth of working-age adults
• Georgia consistently ranks in the top 10 among the states in number and percentage of uninsured
• Overall distribution of the uninsured in Georgia by income:• <100% FPL……. 43%• 100-138% FPL… 11%• 139-250% FPL… 23%• 251-399% FPL…. 12%• 400% FPL+ 8%......11%
Source: CPS data, 2-year average ’10 – ‘11 (Kaiser State Health Facts)
<100% FPL
100-138% FPL
139-250% FPL
251-399% FPL
400% FPL+
Why Does Coverage Matter?
• Access to the health care system
•Financial protection against high medical costs
•Overwhelming evidence that insurance facilitates better access to care and better health outcomes; increases productivity; saves lives
•Amenable to public policy intervention
ACA: Overall Approach to Coverage
• Everyone is eligible for something (citizens and most legal immigrants)
•Maintain employment-based health insurance system
•Expand Medicaid for low-income individuals and families (made optional by SCOTUS)
•Restructure the individual and small group health insurance marketplace through exchanges and new regulations
•Individual mandate
“The Marketplace (exchange)”• Transparency
• Competition & Accountability
• Navigation & Assistance
• Information & Tools
• Affordability
Who will be eligible for the marketplace?• Individuals and families who don’t already have access to an
affordable health insurance plan through their workplace (or other coverage such as Medicare)
• Individuals with pre-existing conditions
• Individuals and families with incomes between 100% and 400% of the federal poverty level (FPL) will receive tax credits that can be applied directly to the plan premiums at the time of enrollment
• Children in families with incomes up to 235% of FPL will remain eligible for PeachCare for Kids or Medicaid, depending on their family income level
What will the marketplace do?• Enroll individuals and families into health insurance plans
• Provide information, services, and tools, including a web portal, to navigate consumers through the process of selecting and enrolling in a plan
• Provide an online calculator so consumers can calculate their premiums after factoring in a new tax credit that will be available to make coverage more affordable
• Display information about health plan costs, benefits, and quality and satisfaction ratings in a consumer friendly manner
What will the marketplace do (cont’d)?• Provide a toll-free consumer assistance hotline
• Certify that plans available on the exchange have adequate provider networks
• Certify that plans available on the exchange have at minimum a core set of benefits
• Present plan options in tiers (platinum, gold, silver, bronze) so that consumers can objectively identify which plans are more comprehensive than others and select a plan that best meets their needs
• Provide plain language information on enrollee rights, claims denials, and other consumer protections
Health Insurance Navigators• 78% of the uninsured don’t know about the health insurance
exchange, and when told about it most say they will need help navigating it
• 83% of people who could be eligible for the new Medicaid expansion don’t know about it
• Approximately 800,000 Georgians could be eligible for coverage through the exchange: if the goal were to get all signed up during the initial 6-month open-enrollment period, that would be thousands per day! If Georgia expands Medicaid, even more Georgians will need assistance
• The navigator program will serve as a source of unbiased information and assistance for uninsured consumers
Health Insurance Navigators• Because Georgia is a state with a federally facilitated marketplace,
the U.S. Department of Health and Human Services will operate a navigator program in Georgia
• Navigator functions include:
– Maintain expertise in eligibility, enrollment, and program specifications;
– Conduct public education activities to raise awareness about the Exchange;
– Provide information and services in a fair, accurate, and impartial manner. Such information must acknowledge other health programs (such as Medicaid and the Children’s Health Insurance Program (CHIP));
Navigator functions (cont’d)– Facilitate selection of a Qualified Health Plan;– Provide referrals to any applicable office of health insurance
consumer assistance or health insurance ombudsman established under Section 2793 of the Public Health Service Act, or any other appropriate state agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage; and
– Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Exchange, including individuals with limited English proficiency, and ensure accessibility and usability of Navigator tools, such as fact sheets, and functions for individuals with disabilities in accordance with the Americans with Disabilities Act and Section 504 of the Rehabilitation Act.
Medicaid Expansion
Why Expand Medicaid?
• People with low-incomes disproportionately lack access to job-based health insurance (nationally, 28% of predominately low-wage firms offer v. 77% of predominately high-wage firms)*
• Purchasing a private, individual policy is cost-prohibitive for people with very low incomes
•Medicaid is an existing program; many states have used it as a vehicle to expand coverage for low-income families over the past 20 years
* Source: Kaiser Family Foundation Employer Health Benefits 2012 Survey
Why Expand Medicaid, cont’d?• Improves health access and outcomes:
•Oregon health insurance experiment: Medicaid more likely to have a usual source of care and to get preventive care than their uninsured counterparts (Source: National Bureau of Economic Research)
•New England Journal of Medicine study: states that expanded Medicaid saw lower mortality rates than neighboring states that did not, after controlling for a range of factors (Source: New England Journal of Medicine)
• Reduces the burden of uncompensated care
•Federal funds coming into the health care economy have a stimulative effect: Estimated 70,000 new jobs would be created, annual $8.2 billion in economic activity would be generated, an additional $276 million in tax revenue would be raised each year (GSU economic impact study)
Expanding Medicaid, cont’d
•Creates a new eligibility category for Medicaid based solely on income •Eligible individuals include those with incomes up to 138% FPL ($15,856 for an individual or $26,951 for a family of 3), Medicaid-eligible regardless of “category”
•Estimated 650,000 Georgians could gain coverage
•Expansion initially financed with 100% federal dollars (2014-2016) and then scales down such that by 2020 and thereafter the expansion population is 90% federally financed
Georgia Medicaid Income Limits Today
235%
200% 200%224%
50%
29%
75%
Fe
de
ral P
ov
ert
y L
ev
el
Can’t qualify
250%
200%
150%
100%
50%
Includes PeachCare
Family Size
Annual Income
1 $11,490
2 $15,510
3 $19,530
4 $23,550
100% Federal Poverty Level 2013
138% ACA Medicaid Expansion
Expanding Medicaid, cont’d
•The coverage gap: tax credits for health insurance through the exchange begin at 100% FPL because the lowest-income Americans were to be routed to Medicaid; if states don’t implement the Medicaid expansion, the poorest Georgians will have no affordable coverage options
•This complicates outreach and enrollment efforts: many consumers who knock on the door will be eligible for nothing; this violates the “no wrong door” spirit of the ACA
Implications for the Safety Net•Expectation that many consumers who are accustomed to seeking care in health centers and clinics may still choose those for primary care when they gain coverage
•“Essential community providers”—insurance companies must include ECPs in their QHP networks
•When fully implemented, the ACA will result in coverage gains for a large portion of Georgia’s uninsured; however, many will still remain uninsured
•If Georgia does not implement the Medicaid expansion, large numbers of low-income Georgians will remain uninsured
