Obama Care: Who is insuring your community

now and why should you care?

Jimmy Kimmel Asks:Obama Care v. The Affordable Care

Act

Improvements

• Guaranteed coverage for people with pre-existing conditions

• Expanded Medicaid to serve more people• Improved access to preventative and primary care• Created the Exchange as a marketplace for small

businesses and individuals• Made insurance reforms

• Network adequacy• Essential health benefits

Health Benefit Exchange: Working in Washington!

The Doorway to Coverage

No SmallBusinesses

in 2014

Exchange:Evaluates income, offers

products, serves as a

payment mechanism

AppleHealth

0-138% FPL

Putting It All TogetherAppleHealth:

Regulated by Health Care Authority

Commercial Plans: Regulated by Office of the Insurance Commissioner

138-400% of FPL

(subsidized)

> 400% FPL no subsidy

Cost Options In the Exchange

High-Deductible “Bronze”

Mid-Deductible “Silver”

Low-Deductible “Gold”

Federal poverty

level

Annual Income

Monthly Tax

Credit

Low High Low High Low High

100% $11,490 0 AppleHealth 137% $15,741 0 AppleHealth 138% $15,856 $207 0 $57 $28 $150 $75 $202 150% $17,235 $203 0 $61 $32 $155 $80 $207 200% $22,980 $136 $43 $128 $99 $222 $147 $274 300% $34,470 0 $178 $264 $235 $357 $282 $409 400% $45,960 0 $178 $264 $235 $357 $282 $409 Premium and subsidy amounts are for a hypothetical 40 year old, single, non-smoker. Income level requirements vary for families.

Exchange Carriers for 2014

• BridgeSpan • Community Health Plan of Washington• Coordinated Care• Group Health Cooperative • LifeWise Health Plan of Washington• Molina Health Care of Washington • Premera Blue Cross • Kaiser Foundation Health Plan of the Northwest• Delta Dental of Washington, Kaiser Foundation Health

Plan of the Northwest, LifeWise, Premera Blue Cross – (Pediatric Dental Only)

Results: 587,000 Have Enrolled

Premera Products Dominate the Exchange Market

Results: Subsidies Help 80% of Consumers in the Individual

Market

Total: 164,062

Results: Most Choose Plans with Medium Deductibles (“Silver

Plans”)

JanetIncome: $23,000

Subsidy: $136Plan: Bronze

Monthly: $43 - $128DanIncome: $15,500Subsidy: $0Plan: Apple HealthMonthly: $0

MikeIncome: $35,000Subsidy: $0Plan: SilverMonthly: $235 - $357

GwenIncome: $46,000

Subsidy: $0Plan: Gold

Monthly: $282- $409

Enrollment is working in rural areas

From the Washington Health Benefit Exchange’s Health Coverage Enrollment Report October 1, 2013-March 31, 2014.

OIC Report: More People Insured Inside

and Outside the Exchange • Washington state has succeeded in reducing the

number of uninsured by more than 370,000.• More people purchased individual plans outside of

the Exchange than inside (171,286 vs. 156,155).• Silver (medium deductible) plans were more

popular inside the Exchange • Bronze (low deductible) plans were more popular

outside the Exchange.

Older Consumers Welcomed the

Exchange

Targeting Young Consumers

Map courtesy Washington State Health Care Authority

Th

ere

’s S

till

Work

to D

o

Small Businesses and The Exchange

Outreach and Enrollment Superstars

Haley Hale, Dayton General Hospital

Erin Brown, Jefferson Healthcare

Wenkie Schultz, Jefferson Healthcare

Melissa Sherwood, Jefferson Healthcare

Jennie Tjemsland, Jefferson Healthcare

Tiffany Hunt, MultiCare Health System

Melissa Fried, MultiCare Health System

Michele Hill, Skagit Regional Health

Angel Abbott, Skagit Regional Health

Verenice Cecena, Skagit Regional Health

Sheena Williams, Skagit Regional Health

Flor Carreon, Skagit Regional Health

Tami Dean, Skagit Regional Health

Korie Holmes, Skagit Regional Health

Teresa McClain, Snoqualmie Valley Hospital

Kayla Carson, Summit Pacific Medical Center

Janet Hanke, Three Rivers Hospital

Collette Carpenter, Valley General Hospital(Monroe)

Benefits to Rural Hospitals• Preliminary data from Q1, 2013

• Operating margins improving • Charity care declining• Net patient revenue from Medicaid

• Colorado Hospital Association Study• Similar results in other expansion states• Parallel decrease in self-pay and charity

care shows previously uninsured patients are now enrolled in Medicaid

• Results similar for urban, rural and CAH

What’s Next?• 17 insurers filed more than 230 proposed health plans for

the 2015 individual health insurance market.• The average proposed rate increase was 8.25%;

uncertainty about future costs• Small business exchange (SHOP) going online• Proactive enrollment activities by hospitals and other

providers still needed• Keeping rural hospitals in networks• How to leverage insurance coverage to create better

community health outcomes• Undocumented residents still uninsured

Key Takeaways

• Whatever you want to call it, your hospital and your community benefit when people are insured

• Charity care and bad debt will not go away, but they are decreasing

• Advocacy matters: Ensuring AppleHealth works for hospitals and patients will help both

• Local partnerships and relationships are key for continuing to enroll residents in health insurance

Thank you!

Chelene Whiteakerchelenew@wsha.org

206/216-2545

Mary Kay Clunies-Rossmarykaycr@wsha.org

206/216-2894