The Council of State Governments Policy...
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Transcript of The Council of State Governments Policy...
The Council of State Governments Policy WebinarJune 21st 2012
A little bit about us….
Medicaid Intelligence
• Ongoing surveillance and reporting of state Medicaid activity
• Comprehensive profiles of individual state market and regulatory dynamics:
o Delivery system
o Pharmacy
o Budget and expenditures
• Assessments and assertive predictions on state Medicaid reform, e.g. 1115 waivers
• Development of strategies to assist states respond PPACA implementation, including Medicaid expansion
LEAVITT PARTNERS | A health care intelligence business © 2012 Leavitt Partners | LeavittPartners.com
Insurance Exchange Intelligence
• In-depth analysis of state and market activity with a focus on:
o Legislative activity
o Governance
o Exchange models
• Development of strategies to assist state policy makers:
o Understand the implications of national rule-making
o Plan and conduct stakeholder analysis
o Develop planning documents
• Ongoing tracking of:o Public and private exchange modelso Technical requirements of exchanges and
capabilities of vendor community
LEAVITT PARTNERS | A health care intelligence business © 2012 Leavitt Partners | LeavittPartners.com
Uncertainty - not able to be relied on; not known or definite
The SupremeCourt, Election and
Fiscal Cliff cause anuncertain future for
PPACA
Supreme Court
1) MandateOverturned
2) LawUpheld
3) Everything Else
June 28th….. Maybe?
Election 2012
3 Possible Outcomes…..
Democrat Gridlock
3 Possible Outcomes…..
Democrat Gridlock
Republican Gridlock
3 Possible Outcomes…..
Democrat Gridlock
Republican Gridlock
Republican Sweep
$7.5 Trillion at stake in fiscal cliff
Bush Tax Cuts
Payroll Tax Cuts
Alternative Minimum Tax Patch
$3.3 Trillion
$804 Billion
$505 Billion
Sequestration$1.2 Trillion
RecessionQ1-Q2 2013
Debt90% Debt to GDP
Outcome$4.5-$5.5 Trillion in Cuts/Tax
16 Supreme Court Scenarios
8 Election Scenarios
64 Provision Scenarios
8,192 Unique Scenarios
Scenarios, Simplified….
About Bracketology: Health Reform Bracketology is a fun and instructive exercise that illustrates potential future scenarios in American healthcare. Based on a series of assumptions, each scenario paints a picture of what the future could be and then presents the implications in simpleand easy‐to‐understand terms. The scenarios are developed by professional staff at Leavitt Partners, in consultation with the LeavittPartners’ FuturePanel, a diverse, 14‐member group of health care thought leaders. In addition, surveys are circulated among health industrythought leaders to gauge their perspective on potential outcomes through LP Health Watch. These groups are not unanimous in their opinion,demonstrating the diversity of thought surrounding the future of health reform. Scenarios depict alternative futures—not necessarily desiredfutures—and help senior executives navigate the significant uncertainty that currently exists in American health care.
IM Upheld
IM Overturned
Split Congress
D White House
Split Congress
R White House
2012 Election Outcomes
Supreme Court Decision
Remainder of Law Upheld
Remainder of Law Upheld
IM Overturned
Remainder of Law Overturned
R White House
R Congress
Step 1: Choose a Supreme Court Decision
Start Over © 2012 Leavitt Partners, LLC 801.538.5082 | HealthReformBracketology.com
IM Upheld
Law Upheld
Law Overturned
IM Overturned
Split Congress
Split Congress
R White House
2012 Election Outcomes
Supreme Court Decision
Mandate Overturned
Remainder of Law Upheld
Remainder of Law Upheld
IM Overturned
Remainder of Law Overturned
R White House
R Congress
Step 2: Choose a 2012 Election Outcome
Law Upheld
D White House
BackStart Over © 2012 Leavitt Partners, LLC 801.538.5082 | HealthReformBracketology.com
Split Congress
D White House
R White House
2012 Election Outcomes
Supreme Court Decision
RWhite House
R Congress
Sweep
R‐Gridlock
D‐Gridlock
IM Upheld
Law Upheld
Law Overturned
IM Overturned
Remainder of Law Upheld
Remainder of Law Upheld
IM Overturned
Law Upheld R‐Gridlock
Mandate Overturned
Remainder of Law Overturned
Split Congress
BackStart Over
Step 3: Click “The Future of Health Reform”
© 2012 Leavitt Partners, LLC 801.538.5082 | HealthReformBracketology.com
We believe that Republicans will seek to administratively disrupt and congressionally defund core provisions of PPACA, as well as seek to increase flexibility for other provisions
We believe that Republicans will seek to administratively disrupt and congressionally defund core provisions of PPACA, as well as seek to increase flexibility for other provisions
Scenario: Law Upheld / R Gridlock
BackStart Over
• Republicans will continue to press for wholesale repeal, though some elements of the law that have already gone into effect will be preserved. Repeal will happen through reconciliation.
• Major provisions of PPACA will remain in force, but the Secretary will use his/her discretion to implement innovative changes in the Medicaid program that center on state flexibility (e.g., repealing the MOE, Duals initiatives, etc.).
• Republicans will try to reform Medicare, likely through a Medicare exchange and increasing the eligibility age, but will be met with opposition from Democrats. IPAB will remain a target for repeal.
• Delivery reform will continue at the current pace with some provisions being shelved due to budgetary constraints and HHS capacity.
• Exchanges will be implemented as prescribed with additional administrative flexibility granted to states unable to meet the statutory deadline. The Federally Facilitated Exchange will be scaled back.
• Minor modifications will be made to select insurance reform provisions while reforms like guaranteed issue and community rating will stay in effect.
• The premium subsidy will likely be reduced to 250%‐300% of the FPL.
15%
70%
10%
Work w/ D's Admin Tacticsto Slow Imp
ModifyCurrent Regs
In this scenario, what tactic will Republicans use to disrupt PPACA?
The Breakdown by
© 2012 Leavitt Partners, LLC 801.538.5082 | HealthReformBracketology.com
High Likelihood of Disruption
Low Likelihood of Disruption
Hig
h D
egre
e of
Ch
ange
Low
Deg
ree
of
Chan
ge
Medicaid ExpansionMedicaid MOE
Medicaid Demonstrations
Payment Reform
Exchanges
Premium Subsidies
Republican Sweep
Mandate Overturned
High Likelihood of Disruption
Low Likelihood of Disruption
Hig
h D
egre
e of
Ch
ange
Low
Deg
ree
of
Chan
geRepublican
Sweep
Republican Gridlock
Payment Reform
Medicaid Demonstrations
ExchangesPremium Subsidies
Mandate Overturned Medicaid Expansion
Medicaid MOE
Medicaid Demonstrations
Exchanges
Premium Subsidies
Medicaid Expansion
Medicaid MOE
High Likelihood of Disruption
Low Likelihood of Disruption
Hig
h D
egre
e of
Ch
ange
Low
Deg
ree
of
Chan
ge
Republican Gridlock
Mandate Overturned
Payment Reform
Medicaid Demonstrations
ExchangesPremium Subsidies
Medicaid Expansion
Medicaid MOE
High Likelihood of Disruption
Low Likelihood of Disruption
Hig
h D
egre
e of
Ch
ange
Low
Deg
ree
of
Chan
geRepublican
Gridlock
Democrat Gridlock
Mandate Overturned
Payment Reform
Medicaid Demonstrations
ExchangesPremium Subsidies
Medicaid Expansion
Medicaid MOE
Exchanges
Medicaid Expansion
Medicaid MOEMedicaid Demonstrations
High Likelihood of Disruption
Low Likelihood of Disruption
Hig
h D
egre
e of
Ch
ange
Low
Deg
ree
of
Chan
ge
Democrat Gridlock
Mandate Overturned
Payment Reform
Premium Subsidies
Exchanges
Medicaid Expansion
Medicaid MOEMedicaid Demonstrations
High Likelihood of Disruption
Low Likelihood of Disruption
Hig
h D
egre
e of
Ch
ange
Low
Deg
ree
of
Chan
ge
Individual MandatePremium Subsidies
Payment Reform Exchanges
Republican Sweep
LawUpheld Medicaid Expansion
Medicaid MOE
Medicaid Demonstrations
High Likelihood of Disruption
Low Likelihood of Disruption
Hig
h D
egre
e of
Ch
ange
Low
Deg
ree
of
Chan
geRepublican
Sweep
Republican Gridlock
LawUpheld
Individual Mandate
Premium Subsidies
Individual MandatePremium Subsidies
Payment Reform
Medicaid ExpansionMedicaid MOE
Medicaid Demonstrations
Medicaid Expansion
Medicaid DemonstrationsMedicaid MOEExchanges
Exchanges
High Likelihood of Disruption
Low Likelihood of Disruption
Hig
h D
egre
e of
Ch
ange
Low
Deg
ree
of
Chan
ge
Republican Gridlock
LawUpheld
Individual Mandate
Payment Reform
Medicaid Expansion
Medicaid DemonstrationsMedicaid MOE
Premium Subsidies
Exchanges
High Likelihood of Disruption
Low Likelihood of Disruption
Hig
h D
egre
e of
Ch
ange
Low
Deg
ree
of
Chan
geRepublican
Gridlock
Democrat Gridlock
LawUpheld
Payment ReformExchanges Medicaid Demonstrations
Medicaid MOE
Premium Subsidies
Individual Mandate
Medicaid Expansion
Individual Mandate
Medicaid Expansion
Medicaid DemonstrationsMedicaid MOE
Premium Subsidies
High Likelihood of Disruption
Low Likelihood of Disruption
Hig
h D
egre
e of
Ch
ange
Low
Deg
ree
of
Chan
ge
Democrat Gridlock
LawUpheld
Payment ReformExchanges
Individual Mandate
Medicaid Expansion
Medicaid DemonstrationsMedicaid MOE
Premium Subsidies
“So what do we do? Anything. Something. So long as we just don’t sit there. If we screw it up, start over. Try something else. If we wait until we’ve satisfied all the uncertainties, it may be too late” – Lee Iacocca
A health care intelligence business
299 South Main, Suite 2300Salt Lake City, Utah 84111
LeavittPartners.com
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