1 Safety Net Health Plans and Health Insurance Exchanges National Association of Public Hospitals...
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1 Safety Net Health Plans and Health Insurance Exchanges National Association of Public Hospitals Annual Conference September 20, 2011 Jennifer Babcock
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Transcript of 1 Safety Net Health Plans and Health Insurance Exchanges National Association of Public Hospitals...
1
Safety Net Health Plans and Health Insurance Exchanges
National Association of Public Hospitals
Annual Conference
September 20, 2011
Jennifer Babcock
Agenda ACAP Survey Results – January 2011 What Keeps Us Up At Night• Churn• Tax Reconciliation• Other?
The 2014, The Affordable Care Act, and Safety Net Health Plans• Hopes and Aspirations• Reality• The Long, Hard (And Rewarding) Road• Affordable Care Act Opportunities
2
ACAP Survey Results
January 2011
3
How important is it for your plan to participate in the state insurance Exchange?
Very
impo
rtant
Somew
hat i
mpo
rtant
Not v
ery
impo
rtant
Not im
porta
nt a
t all
Don't k
now
Refus
ed0
5
10
15
20
25
30
25
9
0 0
6
1
Nu
mb
er
of
Pla
ns
4
Has your plan participated in the state’s planning process for the development of an Exchange?
0
4
8
12
10 11
7
2
12
Nu
mb
er
of
Pla
ns
5
To what extent are you concerned that the following might prevent your plan from participating in the Exchange?
Major Concern
Minor Concern
Not a Concern
Not Sure
Number of Plans
Reserves 20 10 8 3
Accreditation 16 11 11 4
Licensing 6 11 21 3 Uncertainty of risk adjustment 21 17 0 4
Uncertainty of reinsurance 9 18 10 4
System changes 16 14 6 5
Network adequacy 10 19 10 2
State statutory restriction 8 14 9 9
6
What Keeps Us
Up At Night
7
Reconciliationof taxes
Eligibility churn
Eligibility “Churn” in Exchange & Medicaid: The Problem in 2014
Medicaid• Within 6 months, 40% of Medicaid enrollees will
experience coverage disruption• After 1 year, 38% no longer Medicaid-eligible;
16% more will have lost and regained eligibility
Exchange • Within 6 months, 30% of adults will experience
disruption in Exchange eligibility• After 1 year, 24% no longer eligible;
19% more will have lost and regained eligibility
Source: Rosenbaum & Sommers, “Issues in Health Reform: How Changes May Move Millions Between Medicaid and Insurance Exchanges,” Health Affairs, February 2011
8
Tax Reconciliation for Low-Income People
Premium tax credits provided in advance and reconciled at end of tax year.
Individuals who received excess advance premium tax credits (based on projected income) must repay (based on actual annual income).• Repayments capped.
Hardship for individuals and families. Impact on ‘goodwill’ toward Exchanges.
9
2014, The Affordable Care Act, and Safety Net Health Plans
10
Hopes & Aspirations
New Business Opportunity!
Meeting the needs of low-income health care consumers in new commercial coverage environment!
11
Hopes & Aspirations
Most ACAP plans are considering service to health insurance Exchanges.
States understand the value of Medicaid plans serving as Qualified Health Plans.
KFF Profile of Medicaid Managed Care Programs in 2010:• Eight states considering requiring Medicaid plans
to serve Exchange.• Seven states considering requiring Exchange
plans to serve Medicaid.
Source: http://www.kff.org/medicaid/8220.cfm
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Reality Stiff competition:• For State & Federal policies that encourage
participation by Safety Net Health Plans• For Exchange business.
New commercial functions will be required, including premium collection, marketing, customer service, others.
Major Stumbling Blocks: • Risk Adjustment/Reinsurance• Reserves• Accreditation• Network Adequacy
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The Long, Hard (And Rewarding) Road Asking the right strategic questions; considering
how existing lines of business will be impacted by ACA changes in 2014• Medicaid expansion to 16-25 million individuals• Medicare SNPs• Other?
Opting to enter Exchange…How?• Independent Qualified Health Plan• CO-OP• Part of multi-state option• Partnership with other community-based plans
Building reserves, capacity, functions
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But at the end of the road… Opportunities!
Medicaid expansion to 16-25 million individuals
Exchange coverage plus substantial subsidies
Basic Health Program
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