how did we get here? the accountable care act and what it means to health insurance and the health...
TRANSCRIPT
![Page 1: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/1.jpg)
How Did We Get Here? The Accountable Care Act and What It
Means to Health Insurance and the Health Care System
June 14, 2013
Robert LaszewskiHealth Policy and Strategy Associates, LLC
Washington, DC
![Page 2: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/2.jpg)
The health care market is changing.
We are in the midst of a historic shift in the way the business of health care is being done.
It is clear to policymakers, providers, and payers that we are in the last days of fee-for-service reimbursement.
We are moving to a system where providers will be more often at risk for both the cost and quality of care.
We are also moving to a system where individuals will be more responsible and accountable for the cost of their
health care as employers evaluate their historic place in providing benefits.
![Page 3: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/3.jpg)
The Country’s Growing National Debt Will Force Changes in the Way Health Care is Paid
For
![Page 4: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/4.jpg)
On the Current Track, How Federal Resources Would Be Allocated in 2023
![Page 5: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/5.jpg)
And Just As the Health Care Entitlements Become Unsustainable We Have Added to
Them With Passage of the Affordable Care Act (ACA)
• Individuals will be required to purchase coverage.• Medicaid will be expanded for the poorest.• Employers will be required to offer coverage.• Insurance companies will be required to cover
everyone.• There will be minimum standards for health plans.
![Page 6: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/6.jpg)
The Affordable Care Act…
• Will cost $938 billion over 10 years.• Will provide coverage for about 94 percent of
Americans. • 30 million people are eventually expected to gain
coverage––about half in private insurance and half in Medicaid.
• States have the option of running their own health insurance exchange—or letting the feds do it—as well as implementing the Medicaid expansion.
![Page 7: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/7.jpg)
Accountable Care Act (ACA) Implementation:Three Months to Go
• States struggling to make final decisions, or carry out the decisions they’ve already made.
• 17 states were given initial approval to run exchanges—33 either left all of it to the feds or most of it (Partnerships).
• “I am absolutely confident that every state will have an exchange that will be functioning and ready,’ said Gary Cohen [HHS Spokesman], who declined to elaborate on the number or identity of states that could be in for difficulties.”
![Page 8: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/8.jpg)
![Page 9: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/9.jpg)
Insurance Rate Analysis by Actuarial Firm Milliman for Centrist Group “Center Forward”
![Page 10: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/10.jpg)
The Federal Government Provides Families With Health Insurance Exchange Premium
Support Based Upon Their Income as a Percentage of the Federal Poverty Level
![Page 11: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/11.jpg)
Examples of Premium Credits for Single Coverage and a Family of Four
• Subsidies are tied to the second lowest cost Silver plan in each market.
• A single person making 100% of the federal poverty level (FPL), ($11,490) would pay no more than 2% of their income, or $230 per year.
• A family of four at 100% the FPL ($23,550) would be required to pay no more than 2%, or $471 per year, toward the cost of health insurance.
• A single person making 250% of the poverty level ($28,725) would pay no more than 8.05% of their income ($2,312) for single coverage.
![Page 12: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/12.jpg)
Examples of Premium Credits…
• A family of four at 250% of the FPL ($58,875) would be required to pay no more than 8.05% of their income, or $4,739 annually, for a family health insurance plan.
• A single person making 300% of poverty ($34,470) would have to pay 9.5% of their income ($3,274) toward the cost of single coverage.
• A family of four making 300% of poverty ($70,650) would have to pay 9.5% of their income ($6,712) toward the cost of family coverage.
![Page 13: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/13.jpg)
Examples of Premium Credits…
• An individual making 400% of poverty ($45,960) would have to pay 9.5% of their income toward single coverage ($4,366).
• An individual making more than $45,960 would not be eligible for a subsidy.
• A family at 400% of the FPL ($94,200) would have to pay 9.5% of their income ($8,949) toward their premium for family coverage.
• A family of four earning more than $94,200 a year (four times the FPL) would not be eligible for a federal subsidy toward coverage and would pay the full cost of a plan.
![Page 14: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/14.jpg)
Will Employers Remain Committed to Providing Health Benefits?
• Employers with more than 50 employees will pay a fine of $2,000 per worker.
• Any health plan contribution the employer converts to wages would be taxable income (income and payroll taxes) to the worker as well as subject to additional payroll costs for the employer.
• But the wage will increase at the wage rate not at the health insurance cost trend increase which has tended to be two to four times larger.
• The employee will be eligible for premium payment support from the federal government based upon their family income.
![Page 15: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/15.jpg)
Will Employers Abandon Health Benefits?
• Likely no quick or dramatic change.• After adjusting for the fine, increased payroll costs,
and employee income tax consequences an employee with a middle class family income will not be better off—likely far worse off.
• But likely a different conclusion in the small group market that is already shrinking at a rapid rate.
• An employers commitment to benefits will likely have more to do with how competitive their labor market is.
![Page 16: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/16.jpg)
The Supreme Court Decision• A surprise.• Justices Kennedy, Scalia, Thomas, and Alito wanted to throw the
individual mandate and the entire law out.• The four liberals wanted to uphold all of it and eventually joined
Roberts’ interpretation of the mandate as a tax in order save it. • The Roberts Court upheld the ACA but it did narrow the
Commerce Clause for the Congress by calling the mandate penalty a “tax.”
• And, the Roberts Court narrowed Congress’ ability to “coerce” state policy (“unfunded mandates”) by withholding federal money.
• The states will now have the option of participating in the Medicaid expansion.
![Page 17: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/17.jpg)
Only About Half of the States Will Expand Their Medicaid Programs
![Page 18: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/18.jpg)
Number of People That Would Be Covered Under the ACA’s Medicaid Expansion in States That Brought the SCOTUS Suit
Alabama 351,567
Alaska 42,794
Arizona 105,428
Colorado 245,730
Florida 951,622
Georgia 646.557
Idaho 85,833
Indiana 297,737
Iowa 114,691
Kansas 143,445
Louisiana 366,318
Maine 43,468
Michigan 589,965
Mississippi 320,748
Nebraska 83,898
Nevada 136,353
North Dakota 28,864
Ohio 667,376
Pennsylvania 482,366
South Carolina 344,109
South Dakota 31,317
Texas 1,798,314
Virginia 372,470
Wisconsin 205,987
Utah 138,918
Washington 295,662
Wyoming 28,899
![Page 19: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/19.jpg)
2014 to 2019 Cost for Key States to Expand Medicaid and the Federal Share
Source: Kaiser Commission on Medicaid and the Uninsured
State Total State Medicaid Spend
Total Federal Spend
Total State and Federal
Federal Share of Incremental Cost
Florida $1.2 billion $20 billion $21.2 billion 94%
Louisiana $337 million $7 billion $7.4 billion 96%
Texas $2.6 billion $52 billion $55 billion 95%
Wisconsin $205 million $4.2 billion $4.4 billion 95%
![Page 20: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/20.jpg)
Findings of the Wisconsin Legislative Fiscal Bureau
• Governor Walker’s Medicaid plan would offer those above 100% of the federal poverty level coverage in the new federal health insurance exchange rather than in Medicaid.
• Federal Medicaid expansion under the new health law would cover 84,700 more people.
• Governor Walker’s plan would boost the state budget by $119 million over the next two years even after the cost of adding the additional people to Medicaid under the new health law.
• Accepting the federal Medicaid expansion would save the state an additional $340 million through 2021.
![Page 21: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/21.jpg)
![Page 22: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/22.jpg)
The Health Insurance MarketplaceThe Health Insurance Marketplace
![Page 23: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/23.jpg)
New way to buy health insurance when key parts of the health care law take effect
The Health Insurance Marketplace
Even working families can get help through the Marketplace•Enrollment starts October 1, 2013•Coverage begins January 2014
IntroductionIntroduction
04/11/23 Understanding the Health Insurance Marketplace 23
![Page 24: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/24.jpg)
24A New Way to Get Health Insurance05/09/2013
to
Insurance companies compete for business Offers you choices Easy to use – plain language Apples-to-apples comparison of plans
• Compare all your options side-by-sideo Priceo Qualityo Benefits
How does the Marketplace work?How does the Marketplace work?
![Page 25: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/25.jpg)
To be eligible to join a plan in Marketplace you must• Live in the service area of the plan• Be a U.S. citizen or be lawfully present • Not be in prison (incarcerated)
Who can get coverage from the Marketplace?Who can get coverage from the Marketplace?
05/09/2013 A New Way to Get Health Insurance 25
![Page 26: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/26.jpg)
05/09/2013 A New Way to Get Health Insurance
LowerIncome
Higher Income
Streamlined Application Streamlined Application
26
![Page 27: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/27.jpg)
Same Application – Different ResultsSame Application – Different Results
04/11/23 Understanding the Health Insurance Marketplace 27
![Page 28: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/28.jpg)
A New Way to Get Health Insurance05/09/2013
Based on family income and size• Premium discount
Family of four with annual income $23,550* – $94,200* or less
And not eligible for certain other insurance coverage like Medicaid
• Lower cost-sharing (like copays) Family of 4 with annual income $58,875*
or less (some other restrictions)
*2013 amounts
Help to Pay Qualified Health Plan CostsHelp to Pay Qualified Health Plan Costs
28
![Page 29: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/29.jpg)
Qualified Health Plans cover Essential HealthBenefits which include at least these 10 categories
Ambulatory patient services Prescription drugsEmergency services Rehabilitative and habilitative
services and devicesHospitalization Laboratory servicesMaternity and newborn care Preventive and wellness services
and chronic disease management
Mental health and substance use disorder services, including behavioral health treatment
Pediatric services, including oral and vision care
Essential Health BenefitsEssential Health Benefits
04/11/23 Understanding the Health Insurance Marketplace 29
![Page 30: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/30.jpg)
Small Business Health Options Program is a Marketplace for small businesses and their employees• Beginning 2014, small businesses will have more
choice and control over health insurance spendingo Choices among Qualified Health Plans to meet
every budgeto Access tax credits for eligible employerso New consumer protections
Small Business Health Options Program (SHOP)
Small Business Health Options Program (SHOP)
04/11/23 Understanding the Health Insurance Marketplace 30
![Page 31: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/31.jpg)
A New Way to Get Health Insurance05/09/2013
Easy Convenient Streamlined
In Person
By Mail
By Phone
Online
How to ApplyHow to Apply
31
![Page 32: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/32.jpg)
A New Way to Get Health Insurance05/09/2013
You can enroll in a Qualified Health Plan during 1. The Initial Open Enrollment Period
• October 1, 2013 – March 31, 2014
2. The Annual Open Enrollment Period• Each year starting in 2014• October 15 – December 7
3. A Special Enrollment Period• Certain situations
Like loss of certain other coverage
When to EnrollWhen to Enroll
32
![Page 33: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/33.jpg)
33A New Way to Get Health Insurance05/09/2013
Help will be available in the Marketplace• Toll-free call center • Website• Help in-person
o Navigators and other trained assisterso Agents and brokers (state’s decision)
Assistance – It’s Available If NeededAssistance – It’s Available If Needed
![Page 34: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/34.jpg)
A New Way to Get Health Insurance
Starting October 1, 2013, you will be able to apply through this site
05/09/2013
Consumer Focused In Plain Language
Now - Sign up for Email and Text Alerts and Get Ready
www.HealthCare.govwww.HealthCare.gov
34
![Page 35: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/35.jpg)
The Marketplace is a new way to find health insurance There is assistance available to help you get the best
coverage for your needs Insurance will continue to be sold outside of the
Marketplace• Purchase from Marketplace not required
The Marketplace is the only place to get the• New premium discounts and cost-sharing reductions
Key Points to RememberKey Points to Remember
05/09/2013 A New Way to Get Health Insurance35
![Page 36: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/36.jpg)
A New Way to Get Health Insurance05/09/2013
Stay Connected• Sign up to get email and text alerts at
signup.healthcare.gov• Updates and resources for partner organizations
are available at Marketplace.cms.gov• Twitter@HealthCareGov • Facebook.com/Healthcare.gov
Want more information about the Marketplace?Want more information about the Marketplace?
36
![Page 37: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/37.jpg)
• Hold for HHS slides
![Page 38: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/38.jpg)
Preparing for the Health Insurance Marketplace:
A View From Wisconsin
June 14, 2013
Wisconsin Entitlement Reforms, Patient Protection, and the Affordable Care Act
38
![Page 39: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/39.jpg)
39
Wisconsin Entitlement Reforms
Governor Walker’s proposed entitlement reforms will: Ensure every Wisconsin resident has access to affordable
health insurance Create a BadgerCare Plus program that is sustainable Help more Wisconsin citizens become independent and rely
less on government health insurance Maintain the health care safety net for those who need it the
most
![Page 40: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/40.jpg)
Current BadgerCare Health Plans
40
![Page 41: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/41.jpg)
BadgerCare Health Plan - 2014
41
![Page 42: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/42.jpg)
42
Wisconsin’s Currently Uninsured
The following is Wisconsin’s uninsured population taken from the Current Population Survey (CPS) estimates for 2011.
Uninsured Rates Total Population Uninsured # Uninsured %
Total State 5,658,800 558,400 10%
Non-Elderly Population, Age 0-64 4,829,000 553,600 11%
Children, Age 0-18 1,404,900 76,500 5%
Adults, 19-64 3,424,000 477,100 14%
![Page 43: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/43.jpg)
43
Wisconsin Entitlement Reforms
Governor Walker’s proposed entitlement reforms will specifically: Reduce the number of uninsured non-elderly adults by 50%, from 14% to
7%
Provide an estimated 259,198 childless adults and parents and caretaker coverage in BadgerCare Plus
Provide an estimated 692,308 childless adults and parents and caretaker relatives will be covered in the Marketplace
Current Population
Current Uninsured
BC+ Enrolled
Exchange Enrolled
Total Enrolled
Uninsured Post ACA
3,424,000 477,100 92,556 132,025 224,581 252,519
![Page 44: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/44.jpg)
44
PPACA - MAGI
Requires that states use the IRS’ methodology for determining Modified Adjusted Gross Income (MAGI), with certain exceptions, to determine household composition, family size, and income eligibility, thereby eliminating most income deductions and disregards
Will be used as the basis for determining Medicaid, CHIP, and Exchange eligibility for certain populations starting in 2014
MAGI will not be used for determining eligibility for the elderly, blind, and disabled (EBD) population MAGI introduces tax filing status and tax relationships as new factors in determining how households are
tested for eligibility The new rules are highly complex and will require massive systems and operational changes by state
Medicaid agencies between now and January 2014 DHS is developing MAGI based training material and will deliver using a variety of media and face-to-face
meetings DHS enrollment and budget impacts assume that MAGI will have a relatively small impact on the program
The greatest impact related to MAGI for existing members is the introduction of tax relationships into how their household sizes are determined and whose income will be considered. For some families, this will result in greater eligibility, while for others, it will result in loss of eligibility.
In addition, child support payments will no longer be counted as income in the eligibility determination process. About 15 percent of our cases currently have child support income.
![Page 45: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/45.jpg)
45
Overview of Projected Impacts to Medicaid/BadgerCare Plus
BadgerCare Plus Enrollment Impacts An estimated 87,000 parent and caretaker relatives and 5,000 childless
adults will transition to coverage in the new federal marketplace An estimated 84,000 childless adults and 9,000 parent and caretaker
relatives that are currently uninsured will be enrolled in BadgerCare Plus Overall BadgerCare Plus enrollment is projected to stay between 770,000
to 800,000 over the next biennium DHS assumed that the uninsured rate for non-elderly (non-pregnant)
adults would be reduced by 50% - from 14% to 7%. The following take-up rates were used in our modeling: Parents/Caretakers – 25% Childless Adults (new adult group) – 65%
![Page 46: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/46.jpg)
46
Overview of Estimated Marketplace Enrollment
Marketplace Enrollment Estimates An estimated 232,000 parent and caretaker relatives and 460,000
childless adults will enroll in Marketplace Includes transition of people in the current non-group and small group markets Includes transition of existing state and federal high risk pool (HIRSP) members Includes employees from large employers that are estimated to drop coverage
(10% of current ESI coverage) Includes take-up of the currently uninsured (using the same take-up
assumptions as previously noted for BadgerCare Plus) Includes the transition of an estimated 95,000 adults from BadgerCare Plus
Small take-up of children assumed; current uninsured rate for children is 5%
![Page 47: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/47.jpg)
Looking Ahead…
Governor Walker is committed to two goals when it comes to ensuring all Wisconsin citizens have access to affordable coverage:
1. Ensure that existing BadgerCare Plus members that will be eligible to enroll in a QHP have a smooth transition to the Marketplace
2. Reduce the uninsured rate for non-elderly adults by 50% over the next two years
DHS will work side-by-side with all of our existing community partners as well as new partners, Navigators and Certified Application Counselors (CACs).
DHS is already working with Enrollment for Health Wisconsin, Inc. (e4Health) on this front, along with other provider organizations and insurers on ideas for outreach to both of these populations.
DHS is also working closely with CMS on the transition for the BadgerCare Plus members and ways that we can monitor and track members’ transition and enrollment into the qualified health plans offered in the marketplace.
47
![Page 48: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/48.jpg)
Looking Ahead…
Implementation DHS is working closely with the Office of the
Commissioner of Insurance on transition. Key components:
Income Maintenance Offices– Milwaukee Enrollment Services Center
Certified Application Counselors– stakeholders, provider and advocate engagement
Navigators
48
![Page 49: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/49.jpg)
Looking Ahead…
Key Dates: Summer 2013 – Qualified Health Plans in place Late Summer 2013 – “The Marketplace” is unveiled August/September 2013 – DHS and CMS finalize
waiver for childless adults under 100% FPL October 1, 2013 – enrollment in “The Marketplace”
begins
49
![Page 50: How Did We Get Here? The Accountable Care Act and What It Means to Health Insurance and the Health Care System June 14, 2013 Robert Laszewski Health Policy](https://reader035.vdocument.in/reader035/viewer/2022070308/551c1640550346b24f8b56af/html5/thumbnails/50.jpg)
50
Questions