housing action illinois...
TRANSCRIPT
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
protectourcareil.org
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
protectourcareil.org
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!
protectourcareil.org
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
protectourcareil.org
Protect our Care Illinois
5
@ProtectILCare Fb.com/ProtectOurCareIL
protectourcareil.org
protectourcareil.org
Uninsured13%
Medicaid17%
Medicare13%
Other Public2%
Private Non-Group
6%
Employer-Sponsored Insurance
48%
Health Coverage
SOURCE:Healthinsurancecoverage:KCMU/UrbanInstituteanalysisof2013datafrom2014ASECSupplementtotheCPS.Healthexpenditures:KFFcalculationsusing2013NHEdatafromCMS,OfficeoftheActuary
Consumer Out-of-Pocket
14%Medicaid
17%
Medicare22%
Other Public and Private
12%
Private Health
Insurance34%
Health Spending
Health Coverage and Spending
Total = 313.4 million Total = $2.5 trillion
protectourcareil.org
Affordable Care Act
8
protectourcareil.org
▶ 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
protectourcareil.org
ACA’s Essential Health Benefits
protectourcareil.org
protectourcareil.org
ACA’s Medicaid Expansion
protectourcareil.org
Dramatic Reduction in the uninsured
protectourcareil.org
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!
protectourcareil.org
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’
protectourcareil.org
2016 Election
protectourcareil.org
2016 Election
protectourcareil.org
Key Features of Failed Republican Health Care Proposals
18
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
protectourcareil.org
Impacts of GOP Proposals
19
Fewer Insured
Less Coverage
Higher Costs
protectourcareil.org
Reversal of ACA Progress
protectourcareil.org
Medicaid Per Capita Cap
protectourcareil.org
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?
protectourcareil.org
OBAMACARE
ISTHELAW
OFTHELAND
protectourcareil.org
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
protectourcareil.org
“Let ObamaCare implode”
protectourcareil.org
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
protectourcareil.org
Deliberate actions to undermine the ACA
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
protectourcareil.org
Deliberate actions to undermine the ACA
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
protectourcareil.org www.ilcha.org
protectourcareil.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
protectourcareil.org
Bipartisanship?!?!?!?!
protectourcareil.org
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
protectourcareil.org
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
protectourcareil.org
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
protectourcareil.org
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
protectourcareil.org
HANDS OFF MEDICAID!
protectourcareil.org
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
protectourcareil.org
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
protectourcareil.org
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
protectourcareil.org
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
protectourcareil.org
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
protectourcareil.org
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
protectourcareil.org
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
protectourcareil.org
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
protectourcareil.org
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
protectourcareil.org
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: [email protected], website: www.heartlandalliance.org, twitter: @HeartlandPolicy
u Nadeen Israel: email: [email protected], website: www.everthriveil.org, twitter: @EverthriveIL
47