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protectourcareil.org

Housing Action Illinois Conference

Health Care Workshop -Protecting the Affordable Care Act & Medicaid

Dan Rabbitt, Project Manager, Health Policy, Heartland AllianceNadeen Israel, Policy Director, EverThrive Illinois

October 26, 2017

Presentation Goals

u Learn about Medicaid and the ACA

u Discuss their importance for those experiencing homelessness and homeless services providers

u Describe recent federal and state policy changes and attempted changes

u Provide information about what is on the horizon and how you can get involved

Overview of EverThrive IL’s Work

u 1988 – Medicaid for pregnant women

u Policy development and advocacy, education, community empowerment

u Five main initiatives:u Child and Adolescent Healthu Health Reformu Maternal and Infant Mortalityu Healthy Lifestylesu Immunization

u Become a member today!

Overview of Heartland Alliance’s Work

u Anti-poverty and human rights organization

u Wide array of health, housing, and human service programs including health care for the homeless, permanent supportive housing, and affordable housing development

u Policy agenda includes:u Medicaid, SNAP and other public benefitsu Preventing and ending homelessnessu Increasing the minimum wageu Supporting immigrants and refugeesu Criminal justice reform

Protect our Care Illinois

@ProtectILCare Fb.com/ProtectOurCareIL

Uninsured13%

Medicaid17%

Medicare13%

Other Public2%

Private Non-Group

Employer-Sponsored Insurance

Health Coverage

SOURCE:Healthinsurancecoverage:KCMU/UrbanInstituteanalysisof2013datafrom2014ASECSupplementtotheCPS.Healthexpenditures:KFFcalculationsusing2013NHEdatafromCMS,OfficeoftheActuary

Consumer Out-of-Pocket

14%Medicaid

Medicare22%

Other Public and Private

Private Health

Insurance34%

Health Spending

Health Coverage and Spending

Total = 313.4 million Total = $2.5 trillion

Affordable Care Act

▶ No pre-existing condition exclusion allowed for anyone

▶ No lifetime or annual limits on care▶ Cannot charge people more based on their

health conditions▶ Cost of insurance only based on

▶ Age, ▶ Where you live, ▶ Tobacco use

▶ Dependents covered until 26

ACA Strengthened Health Insurance

ACA’s Essential Health Benefits

ACA’s Medicaid Expansion

Dramatic Reduction in the uninsured

u Illinois uninsured rate cut in half from 2013-2016

u Illinois’s insured rate is at a historic high – 93.4%

u 650,000 Illinoisans have health insurance coverage thanks to Medicaid Expansion, about 40% are people of color

u Heartland Alliance’s homeless programs have seen uninsured rate plummet from 85% to 15%

The ACA Works!

ACA Criticism

u Individual mandate

u Lack of participation by insurance carriers

u High deductibles

u Narrow networks

u High premiums (for those who don’t qualify for subsidy)

u ‘If you like your plan, you can keep it’

u Criticism of Medicaid quality and access

u Medicaid should care for the ‘truly needy’

2016 Election

Key Features of Failed Republican Health Care Proposals

Cap/Cut Medicaid

End Medicaid Expansion

Cut Financial Assistance

Less Comprehensive

Health Plans

Increases Costs for Older

Adults

Defund Planned

ParenthoodEnds Mandate Eliminates

$600B in taxes

Impacts of GOP Proposals

Fewer Insured

Less Coverage

Higher Costs

Reversal of ACA Progress

Medicaid Per Capita Cap

ACA Repeal Attempts

u March 24 – postponed House vote

u May 4 – successful House vote 217-213

u July 28 – failed Senate vote 49-51

u September 26 – canceled vote on Graham-Cassidy

u FY18 Budget Reconciliation?

u FY19 Budget?

OBAMACARE

ISTHELAW

OFTHELAND

Advocacy Works! Repeal is dormant, if not defeated!

u Thousands of calls

u Dozens of protests and rallies

u Earned media throughout the state

u Constant social media presence

u Coordination across the state and with national partners

u Over 100 organizations

u Over 1000 individual members

“Let ObamaCare implode”

Deliberate actions to undermine the ACA

u Former HHS Secretary Tom Price’s Anti-ACA Campaign

u Using funds earmarked for “consumer information and outreach” HHS began to air a series of testimonial videos featuring people allegedly “harmed” by the ACA

u Trump Administration announced it would reduce funding for marketplace advertisements and outreach

u Federal marketing cut by 90% from $100m to $10m

u Illinois navigator awardees saw funding cut by 31%, nearly $800,000

u Open enrollment cut in half from three months to six weeks, Nov. 1- Dec. 15

u Shutting down HealthCare.gov website

uWednesday, November 1, 2017 - overnight

uSundays 12am-12pm ET, except on December 10, 2017

u Executive Order: creates a loophole for groups and individuals to buy skimpier health plans

uExpands short-term, unregulated plans

u Ending CSRs for insurance marketplace plans

u Insurers in Illinois assumed CSRs would be cut in their 2018 proposed Marketplace rates

uThis is responsible for big premium increases and potential destabilization down the line

protectourcareil.org www.ilcha.org

What’s Next?

u Strengthening the individual marketuAlexander-Murray Bill

u CHIP and Community Health Centers

u Hands Off Medicaid!uTax Reform and FY18 Budget

u Road to universal coverage

Bipartisanship?!?!?!?!

Alexander-Murray Bill

GOODu Funds CSRs through 2019

u Provides $106 million for outreach and marketing for plan years 2018 and 2019

u Retains protections for essential health benefits and pre-existing conditions

LESS GOODu Difficult to lower premiums

for plan year 2018

u Loosens ACA waiver requirements (Section 1332 Waivers)

u Allows catastrophic ‘copper plans’ for those over 30

Prospects for Alexander Murray

u Bipartisan support in the Senate

u Support from moderates in the House

u Currently opposed by House Leadership and the Administration

u Needs to be included in a must pass bill like disaster funding or FY18 funding

Children’s Health Insurance Program

u Provides health insurance for nearly nine million children each year across the US

u Federally-funded, state-administered block grant, works with Medicaid

u Funding expired September 30

u States will start running out of money the end of the year

Community Health Centers

u Provides health care to 24 million across the country

u Serve patients regardless of their ability to pay and provide financial assistance

u Face a 70% reduction in funding

u Grant cycles begin January 1, 2018

HANDS OFF MEDICAID!

FY18 Budget: Tax and Entitlement Reform

u Senate passed its FY18 Budget and the House is likely to approve

u FY18 Budget allows for Budget Reconciliation legislation that only requires 51 votes in the Senate

u It allows up to $1.5 trillion in deficit financed tax cuts

u Could pay for even bigger tax cuts with cuts to Medicaid, Medicare, or other safety net programs

FY18 Budget: Tax and Entitlement Reform

u House expected to release legislative language in early November

u House Ways and Means Committee will have markupsuRep Peter Roskam (IL-6, R) uRep Danny Davis (IL-7, D)

u Plan to pass full House before the year is outu Concurrent markups in Senate Finance

Road to Universal Coverage

u Strengthen the ACA

u Expand Medicaid/ACA to include most immigrants

u Medicaid buy-in (likely state level)

u Medicare buy-in (federal)

u Public option

u Single payer

u We have a budget!

u We are still $1.5 billion out of balance

u We have a backlog of $15 billion in past bills

Still need more revenue!

Illinois State Health Policy

u Managed Care Transition

u Integrated Eligibility System (IES) Phase Twou Electronic access to applications and eligibility determination

u Behavioral Health Transformation Section 1115 Medicaid Waiver

Illinois State Health Policy

Illinois Behavioral Health Transformation Medicaid Section 1115 Waiver

u Supportive Housing Pre-Tenancy and Tenancy Services

u Supported Employment Services

u Reentry Services

u New Substance Abuse Services

u Integrated Health Homes

u First Episode Psychosis Bundled Services

u Support in Building Capacity

u Rule 132 Reform

Questions regarding Supportive Housing Benefit in Illinois

u Planning on a number of pilots:

u Geographic – Chicago, Cook County, rural, suburban, etc.

u Population based – youth, families, single adults, etc.

u Certain systems – DCFS, DOC, HMIS, etc.

u Provider certification process

u Role of managed care

u Payment structure – per diem or bill for each service

Current prognosis not great for Waiver approval

Medicaid Supportive Housing Funding

Advantagesu Federal-state partnership is

more stable than state only funding

u Opportunities for scaling

u Opportunities for innovation

Disadvantagesu Certification process

u Required billing, IT, medical records systems

u Contracting with MCOs

u Delays and difficulties in billing and obtaining reimbursement

Impact and Opportunities

u Medicaid expansion is essential and must be protected!u Changes in Medicaid manage care and IES Phase II could be

beneficial but may also cause more confusionu EverThrive IL partnered with HFS to do a two-part webinar series

on the changes coming up in Medicaid Managed Care and the implementation of IES Phase II -1st Webinar is Nov. 2nd, 12:30pm –2:30pm

u Consider expanding Medicaid enrollment assistance at your programs

u Stay engaged with Protect Our Care Illinois and other advocates

Thank you and Get Involved!

u Follow Us on Social Media: Twitter @ProtectILCareFacebook https://www.facebook.com/ProtectOurCareIL/

u Use our materials at: www.protectourcareil.org under “Resources”

u Join POC-IL: http://protectourcareil.org/index.php/email-sign-up/

u Dan Rabbitt: email: drabbitt@heartlandalliance.org, website: www.heartlandalliance.org, twitter: @HeartlandPolicy

u Nadeen Israel: email: nisrael@everthriveil.org, website: www.everthriveil.org, twitter: @EverthriveIL

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