Health Reform and Public Health in Kansas

Kansas Association of Local Health DepartmentsTopeka, Kansas

January 15, 2013

Suzanne Schrandt, J.D.Kansas Health Institute

Kansas Health Institute

The Kansas Health Institute is an independent, nonprofit health policy and research organization that informs policymakers about important issues affecting the health of Kansans.

Our mission is to inform policymakers by identifying, producing, analyzing and communicating information that is timely, relevant and objective.

Three Primary Components of the ACA

Cost Containment, Payment and Delivery Reform

Quality ImprovementPayment AdjustmentsDelivery Reform Transparency/Financial Relationships

What’s happening in Kansas?

Accountable Care Organizations (ACOs)

ACA Coverage Provisions

Access Guaranteed Issue/Pre-existing condition exclusion Medicaid expansion

Navigation Health insurance exchanges

Cost Rating rules Federal assistance

Responsibility

ACA Coverage ProvisionsGrandfathered New

Large GroupNew

Small GroupNew

Indiv

FI SI Indiv FI SI FI SI Indiv

No lifetime limits

No rescissions

Plain language

Dependent coverage to 26

No annual limits

No PECExclusions

Preventive services

MLR limit

Guaranteed Issue

Rating limits

Largest ACA Impact on Small Group and Individual Market

Health Insurance Coverage, Kansans Under Age 65 (2010-2011)

Source: KHI Analysis of CPS and MEPS data, 2010 - 2011

Coverage Changes Already in Place

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Provision Impact in Kansas

Medical Loss Ratio Rebates

$4 million total, $3.5 million in individual market paid to Kansas consumers under this rule

Preventive services at no cost

529,000 Kansans in private plans and 313,000 Kansans in Medicare have received free preventive care through this

provision

No lifetime limits1.02 million Kansans no longer have lifetime maximum limits

on their health insurance plans

Dependent Coverage to Age 26

As of December 2011, 3.1 million young adults nationwide newly covered by parents’ plans

Public Health

Prevention and Public Health Trust FundEmployer wellness programming and premium/cost contribution adjustmentsNational Prevention and Wellness Strategy

Public Health Spending ACA Public Health Funding March 2010 – January 2013

Source: Kaiser Family Foundation ACA Fund Tracker, January 2013

Public Health Spending in Kansas

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Community and State prevention: $639,000 Tobacco use prevention: $64,000 Public health workforce: $150,000 Detection and response capacity: $964,000 Public health infrastructure: $500,000 Health care data analysis and planning: $577,000 Access to Critical Wellness and Preventive Health

Services: $3,115,000

Source: CCIIO website, retrieved January 14, 2013

Workforce Funding Opportunities

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Public health workforce loan repayment Community Health Workforce grants Rural physician/underserved area

ACA Impact on Public Health System

Health Outcomes Ranking, by County

Source: County Health Rankings and Roadmaps Project, Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute

ACA Impact on Public Health System

Greater access needs Immunizations and other preventive care Rethinking the role of public health

Access

Source: Kansas Hospital Association, 2011 STAT Report

Distribution of Kansas Hospitals, by County

Kansas Health Institute

Primary Care HPSAsJanuary 2012

Source: KDHE Bureau of Community Health Systems, 2012

Medicaid Expansion?Uninsured Kansas Adults, age 19-64, by ACA Eligibility Category

Source: KHI Analysis of 2010-2011 Current Population Survey Data20

Immunizations and other Preventive Services

Essential Health Benefits Health Insurance Coverage, Kansans Under Age 65 (2010-2011)

Source: KHI Analysis of CPS and MEPS data, 2010 - 2011

Contraception Mandate

A New Landscape

Outcome-based payments Collaborative care models Comparative effectiveness research

Questions?

Information for policy makers. Health for Kansans.

Kansas Health Institute