obama care: who is insuring your community now and why should you care?
TRANSCRIPT
Obama Care: Who is insuring your community
now and why should you care?
Jimmy Kimmel Asks:Obama Care v. The Affordable Care
Act
Improvements
• Guaranteed coverage for people with pre-existing conditions
• Expanded Medicaid to serve more people• Improved access to preventative and primary care• Created the Exchange as a marketplace for small
businesses and individuals• Made insurance reforms
• Network adequacy• Essential health benefits
Health Benefit Exchange: Working in Washington!
The Doorway to Coverage
No SmallBusinesses
in 2014
Exchange:Evaluates income, offers
products, serves as a
payment mechanism
AppleHealth
0-138% FPL
Putting It All TogetherAppleHealth:
Regulated by Health Care Authority
Commercial Plans: Regulated by Office of the Insurance Commissioner
138-400% of FPL
(subsidized)
> 400% FPL no subsidy
Cost Options In the Exchange
High-Deductible “Bronze”
Mid-Deductible “Silver”
Low-Deductible “Gold”
Federal poverty
level
Annual Income
Monthly Tax
Credit
Low High Low High Low High
100% $11,490 0 AppleHealth 137% $15,741 0 AppleHealth 138% $15,856 $207 0 $57 $28 $150 $75 $202 150% $17,235 $203 0 $61 $32 $155 $80 $207 200% $22,980 $136 $43 $128 $99 $222 $147 $274 300% $34,470 0 $178 $264 $235 $357 $282 $409 400% $45,960 0 $178 $264 $235 $357 $282 $409 Premium and subsidy amounts are for a hypothetical 40 year old, single, non-smoker. Income level requirements vary for families.
Exchange Carriers for 2014
• BridgeSpan • Community Health Plan of Washington• Coordinated Care• Group Health Cooperative • LifeWise Health Plan of Washington• Molina Health Care of Washington • Premera Blue Cross • Kaiser Foundation Health Plan of the Northwest• Delta Dental of Washington, Kaiser Foundation Health
Plan of the Northwest, LifeWise, Premera Blue Cross – (Pediatric Dental Only)
Results: 587,000 Have Enrolled
Premera Products Dominate the Exchange Market
Results: Subsidies Help 80% of Consumers in the Individual
Market
Total: 164,062
Results: Most Choose Plans with Medium Deductibles (“Silver
Plans”)
JanetIncome: $23,000
Subsidy: $136Plan: Bronze
Monthly: $43 - $128DanIncome: $15,500Subsidy: $0Plan: Apple HealthMonthly: $0
MikeIncome: $35,000Subsidy: $0Plan: SilverMonthly: $235 - $357
GwenIncome: $46,000
Subsidy: $0Plan: Gold
Monthly: $282- $409
Enrollment is working in rural areas
From the Washington Health Benefit Exchange’s Health Coverage Enrollment Report October 1, 2013-March 31, 2014.
OIC Report: More People Insured Inside
and Outside the Exchange • Washington state has succeeded in reducing the
number of uninsured by more than 370,000.• More people purchased individual plans outside of
the Exchange than inside (171,286 vs. 156,155).• Silver (medium deductible) plans were more
popular inside the Exchange • Bronze (low deductible) plans were more popular
outside the Exchange.
Older Consumers Welcomed the
Exchange
Targeting Young Consumers
Map courtesy Washington State Health Care Authority
Th
ere
’s S
till
Work
to D
o
Small Businesses and The Exchange
Outreach and Enrollment Superstars
Haley Hale, Dayton General Hospital
Erin Brown, Jefferson Healthcare
Wenkie Schultz, Jefferson Healthcare
Melissa Sherwood, Jefferson Healthcare
Jennie Tjemsland, Jefferson Healthcare
Tiffany Hunt, MultiCare Health System
Melissa Fried, MultiCare Health System
Michele Hill, Skagit Regional Health
Angel Abbott, Skagit Regional Health
Verenice Cecena, Skagit Regional Health
Sheena Williams, Skagit Regional Health
Flor Carreon, Skagit Regional Health
Tami Dean, Skagit Regional Health
Korie Holmes, Skagit Regional Health
Teresa McClain, Snoqualmie Valley Hospital
Kayla Carson, Summit Pacific Medical Center
Janet Hanke, Three Rivers Hospital
Collette Carpenter, Valley General Hospital(Monroe)
Benefits to Rural Hospitals• Preliminary data from Q1, 2013
• Operating margins improving • Charity care declining• Net patient revenue from Medicaid
• Colorado Hospital Association Study• Similar results in other expansion states• Parallel decrease in self-pay and charity
care shows previously uninsured patients are now enrolled in Medicaid
• Results similar for urban, rural and CAH
What’s Next?• 17 insurers filed more than 230 proposed health plans for
the 2015 individual health insurance market.• The average proposed rate increase was 8.25%;
uncertainty about future costs• Small business exchange (SHOP) going online• Proactive enrollment activities by hospitals and other
providers still needed• Keeping rural hospitals in networks• How to leverage insurance coverage to create better
community health outcomes• Undocumented residents still uninsured
Key Takeaways
• Whatever you want to call it, your hospital and your community benefit when people are insured
• Charity care and bad debt will not go away, but they are decreasing
• Advocacy matters: Ensuring AppleHealth works for hospitals and patients will help both
• Local partnerships and relationships are key for continuing to enroll residents in health insurance
