ronnie smith ea to the deputy medical center director

Ronnie SmithEA to the Deputy Medical Center Director

OVERVIEW OF HEALTH REFORM AND CURRENT VA EFFORTS

VSO/Congressional UpdateSeptember 16, 2013

VETERANS HEALTH ADMINISTRATION

Affordable Care Act (ACA) Key Provisions• ACA, also known as the health care law, was created to expand access to affordable

health care coverage to all Americans, lower costs and improve quality and care coordination.

• The Individual Mandate Provision of ACA requires all individuals to have health coverage that meets the minimum essential standard, qualify for an exemption or make a payment when filing taxes if they have affordable options but remain uninsured.

• Establishment of Health Insurance Marketplaces where individuals and small businesses can compare policies and premiums, and buy insurance coverage. Some individuals, based on their income, may be eligible for lower costs on health insurance premiums and out-of-pocket copays.

• Under the Medicaid expansion provision of ACA, Oregon and Washington have opted to expand Medicaid eligibility to up to 138% of the Federal Poverty Level

• Establishment of demonstration projects known as the Accountable Care Organizations which will manage services for a given population and share in savings generated by meeting quality targets and reducing costs. 2


Essential Health Benefits

• Essential Health Benefits are items and services in 10 categories that must be included in plans sold through the health insurance marketplaces.

1. Ambulatory patient services2. Emergency services3. Hospitalization4. Maternity and newborn care5. Mental health and substance use disorder services, including behavioral

health treatment6. Prescription drugs7. Rehabilitative and habilitative services and devices8. Laboratory services9. Preventive and wellness services and chronic disease management, and10.Pediatric services, including oral and vision care

• Levels of coverage for these benefits will vary from plan to plan.3


Premium Tax Credit – Illustrative Example

• Paid directly to health plan to offset the health insurance premium cost. • Based on individual/family income, up to 400% of the Federal Poverty Level.• Based on sliding scale with lowest income households paying smallest share

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Health Insurance Premium Contribution After Premium Tax CreditBased on Percent of Federal Poverty Level and Family Size

Percent of FPL (2013)

Premium as a

Percent of Annual

Income

Individual Family of Four

Income

Max Annual Premium

Contribution Income

Max Annual Premium

Contribution100% 2.0% $11,490 $230 $23,550 $472150% 4.0% $17,235 $690 $35,325 $1,413200% 6.3% $22,980 $1,448 $47,100 $2,968250% 8.1% $28,725 $2,313 $58,875 $4,740300% 9.5% $34,470 $3,275 $70,650 $6,713350% 9.5% $40,215 $3,820 $82,425 $7,830400% 9.5% $45,960 $4,366 $94,200 $8,948


Individual Mandate Requirement

• Individuals and families who do not have qualifying health coverage beginning in January 2014 must make a payment when filing their taxes.

• The flat rate payment is phased in for the first three years (2014-2016)• Payment increases after 2016 with a cost-of-living adjustment

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Payment - Larger of the following:

Flat-rate

Year Individual FamilyMaximum Share of Household Income

2014 $95 $285 1.0%

2015 $325 $975 2.0%

2016 $695 $2,085 2.5%


ACA Implications for Veterans• Enrollment in VA health care, CHAMPVA or Spina Bifida

programs meet the minimum essential coverage standard. – CHAMPVA provides coverage to families of Veterans who are 100% disabled or the families

of active duty service members who died during service.

– Spina Bifida program provides coverage for a select subset of Korean War veterans’ families

• OR has roughly 130k VA enrollees, WA has 188k enrollees.

• There are an estimated 1.3 million enrollment eligible Veterans without insurance nationwide. There are an estimated 26,200 enrollment eligible Vets in OR without insurance, 10,900 are in Medicaid and 15,300 are uninsured. WA has 57,300, 28k in Medicaid and 29,300 uninsured.

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ACA Implications for Veterans

• Vets may become eligible for Medicaid through the expansion. An estimated 15,800 VA enrolled OR veterans are enrolled in Medicaid, this number is expected to increase to 31,300 in the expansion. WA has 23,300 in Medicaid, projected to move to 36k under the expansion.

• Since enrollment meets the standard for coverage under the law, Veterans that are enrolled are not eligible for assistance in purchasing insurance.

• Increased options have implications for VA in the areas of outreach and communications. Veterans may decide to leave the VA system for a family insurance plan and more insurance assistance. 57,900 Oregon VA enrollees would be eligible for tax credits, 77,800 in Washington.

• Veterans will expect VA to be able to assist them in understanding their options and deciding what’s best for them and for their families.

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Enrollee Reliance on VA Health Care• Enrollees have other options for health care

– 77% of enrollees have some type of public or private health care coverage in addition to VA

– 54% have 1 other source, 20% have 2 other sources, and 3% have coverage through 3 or more sources in addition to VA

• The following graph shows impact on demand for VA health care services

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2011 Survey of Enrollees

Medicare Medigap Medicaid Tricare Private Insurance

40.7%29.5%

43.3%33.6% 30.4%

Mean Reliance with InsuranceOverall Mean RelianceOverall Mean Reliance without Insurance Cover-age

78%

47%38%


Drivers of Enrollee Utilization of VA and Non-VA Health Care Services

Enrollees who were more likely to utilize VA health care services and less likely to utilize non-VA health care:

• Report using VA services to meet most or all of their health care needs• Plan to use VHA in the future as primary source of health care• Indicate a greater understanding of VA health care benefits • Are OEF/OIF/OND Veterans• Have a greater VA disability rating

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Drivers of Enrollee Utilization of VA and Non-VA Health Care Services (Continued)

Enrollees who were more likely to utilize non-VA healthcare and were less likely to utilize VA health care services:• Have household incomes of greater than $50,000 • Report being employed full-time• Have Medicare or other non-prescription drug coverage• Are Female• Are Married• Enrolled in VHA after the 1996 priority-based system was instituted• Have greater perceptions of availability of non-VA doctor• Reported that they would use VA only if they had no other source of health care• Think Veterans who can afford non-VA sources of health care should leave VA to

those who really need it

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National Primary Reason for Planned Future Use

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Primary Care

Backup Care

Safety Net

Prescriptions SpecializedCare

Other No Plans to Use VA

47%

10%

8%

17%

3% 3%

9%

42%

11%

11%

13%

3% 2%

14%

43%

13%

13%

11%

3% 2%

13%

45%

13%

12%

8%

4% 1%

14%

48%

13%

12%

8%

4% 1%

12%

2005 2007 2008 2010 2011

Note: Don't Know/Refused not included* Denominator is enrollees with Private Insurance** Denominator is enrollees with Medicare


VA’s Key Messages• VA wants all Veterans to receive health care that improves their health

and well-being.– VA will assist Veterans and other beneficiaries to determine their eligibility for VA health

care and other health coverage options.

• If enrolled in VA health care, a Veteran does not need to take additional steps to meet the health care law coverage standards.

– The health care law does not change VA health benefits or Veterans’ out-of-pocket costs.

• Veterans and other beneficiaries not currently enrolled in VA health care can apply for enrollment at any time.

– Applications are accepted online at www.va.gov/healthbenefits/enroll, by phone at 877-222-VETS, by mail, or in person at a VA medical facility.

• VA will continue to provide Veterans with high quality, comprehensive health care and benefits they are earned through their service.

• Veterans’ family members and Veterans not eligible for VA care may secure coverage through the Marketplace.

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VA Outreach Efforts

• 7/17 Launch VA Landing Site www.va.gov/aca - interactive website with ACA information for enrolled and non-enrolled Veterans and family members, and link to healthcare.gov

• 7/31 Began Direct Mail to 8.5m enrolled Veterans– Expected completion at end of September

• 8/6 Launch press release• Print/Online/Media Communications

– Social media (Facebook, Twitter, Blogs)• 8/30 Began Direct Mail to non-enrolled Veterans• In-Person Communication Tools

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http://www.va.gov/aca


Outreach Campaigns

• Collaboration with other Federal agencies and partners– HHS, DoD, DOL, SBA; State Governors and State Veterans Agencies

• Leverage partnership opportunities– VSOs, NGOs, MSOs, Veteran small business owners, grantees– Met with Cover Oregon’s marketing/communications team

• VA Central Business Office and VHA Policy and Planning are partnering with VISNs to outreach to certain non-enrolled Veteran groups.– High Potential Targets:

• Under age 65, particularly young adults• Low and moderate income• Enrollment eligible, e.g., Service-connected, Vietnam Veterans• Declining or stable markets

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VA’s ACA Landing Page -- va.gov/aca

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VA’s ACA Landing Page -- va.gov/aca

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VA Health Benefit Explorer

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VA Health Benefit Explorer

• Guides Veterans to answer questions about their service and VA status

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VA Health Benefits Explorer -- Results

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VETERANS HEALTH ADMINISTRATION 20


Resources

• VA’s Landing Page www.va.gov/aca• ACA Communication Resource Center

https://cbomssp.hec.med.va.gov/acacomm• For additional questions / information about VA and ACA

[email protected]• For information on ACA and the Marketplace, visit the HHS website:

www.healthcare.gov• Portland VAMC webpage www.portland.va.gov• Washington Healthplanfinder www.wahealthplanfinder.org ; Customer

Support Center 1-855-923-4633.• Cover Oregon www.coveroregon.com ; Toll-free number 1-855-268-3767

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http://www.va.gov/aca

https://cbomssp.hec.med.va.gov/acacomm

mailto:[email protected]

http://www.healthcare.gov/

http://www.portland.va.gov/

http://www.wahealthplanfinder.org/

http://www.coveroregon.com/

ronnie smith ea to the deputy medical center director

Documents

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