Implementing the ACA in Virginia: Where things standAdvocate/Stakeholder WebinarMarch 29, 2012Sponsored by The Commonwealth Institute, The Virginia Poverty Law Center, and Virginia OrganizingPresenters:John McInerney, The Commonwealth InstituteJill Hanken, Virginia Poverty Law Center

Topics

U.S. Supreme Court – ACA argumentsExchange Basics/Implementation of the ACA in Virginia to DateWhat’s Next?

U.S. Supreme Court• 3 Days - 6 Hours of Oral

Argument!• Decision Expected by End of

JuneMarch 26 • Anti-

Injunction Act• Can ACA Tax

Penalties be challenged now?

March 27

• Minimum Coverage Provision

• Is the Individual Mandate Constitutional?

March 28Severability

• If a part of the ACA is unconstitutional, can the rest of the law still stand?

Medicaid Expansion• Is the required

expansion an unlawful abuse of the spending clause provisions of the Constitution?

What is an Exchange?

A new health insurance marketplace.

What is an Exchange?

Like …

only for health insurance.

How it works.

Individuals and small businesses can access and purchase affordable private health insurance.

Premium affordability tax credits available

Significant Medicaid Expansion

Over 500,000 additional Virginians covered through Exchange & Medicaid in Virginia

Basic requirements.Develop Exchange for individuals and small employers

Choose whether to run Exchange, and decide on governance

Certify plans & determine benefit package

Provide consumer assistance

Develop IT infrastructure and enrollment systems (or defer role to the federal government)

Seamlessly coordinate Exchange w/Medicaid & FAMIS

Run Web site with comprehensive plan info on price and quality

Implementation

2010

August • 24 member Virginia Health Reform Initiative Advisory Council named

• Members from business, insurance industry, academia, and providers

• No consumer rep

Fall• Series of meetings on six areas of

health reform:• capacity, Medicaid

expansion, insurance reform, purchaser perspectives, information technology & delivery system reform

December

• Report issued by VHRI to Governor McDonnell

Implementation

2011

$1 million planning grant from HHS

Legislation authorized VHRI to begin Exchange design

VHRI meetings spring/summer 2011

Final VHRI report publicly released in November

• Age 26 provision• No pre-existing for kids• No lifetime limits• New appeals procedures• Rescission prevention

Implementation

2012

Governor opposed to immediate action

Several bills filed, none successful

Time to create state-run Exchange growing short

Behind but not alone.41 states have introduced Exchange authorizing legislation

Map created by TCI, using data compiled by the Center on Budget and Policy Priorities (CBPP)

Behind but not alone.Yet, only12 states and D.C. have enacted Exchange authorizing legislation

Map created by TCI, using data compiled by the Center on Budget and Policy Priorities (CBPP)

Behind but not alone.22 states, including Virginia, have pending/tabled legislation

Map created by TCI, using data compiled by the Center on Budget and Policy Priorities (CBPP)

What’s next.

VHRI

Essential Benefits Plans: Report Issued• Comments Due to VHRI on

April 4, 2012

Exchange Development• More meetings expected on

Exchange Planning

What’s next.

DSS Gatewa

y Project

Online customer portal for• Online applications• Customer accounts• Self-service capabilities

• Reporting changes• Renewing benefits• Checking eligibility for

other benefits

Will serve as platform for the Exchange

Testing underway

State Legislation

SB 496 (Sen. Watkins)• Only “survivor” of 2012 session• Substitute adopted on 2/13 carried over to 2013• Off session meetings are expected• Special Session after Supreme Court ruling?

State Legislation

Exchange Structure• We want independent Quasi – Governmental entity

(VHRI recommendation)• Full focus on Exchange• No real or perceived conflict with other functions• Role and input for all stakeholders

SB 496 puts Exchange in a new division of State Corporation Commission (SCC)

State Legislation

Governance• We want strong consumer representation and no

voting member with conflict of interest on governing Board

• SB 496 creates Advisory Committee• 7 members appointed by SCC• Includes “consumer representative”, “consumer

advocate”, “representative of qualified health plan”

• Recommendations require majority votes • Ultimate authority rests with Division Director and

SCC Commissioners

State Legislation

Public Access to Meetings and Information• We want public rulemaking, open meetings, freedom

of information, comprehensive website• SB 496 was amended to include all of above

Funding the Exchange• We want all insurers (in and out of Exchange) to help

pay for operations• SB 496 was amended to do this

State Legislation

Market Rules and Adverse Selection• We want protections to avoid adverse selection• We want provisions to address market instability

(VHRI recommendation)• SB 496 requires same premiums inside and outside of

the Exchange, but does not include other protections

State Legislation

Navigator Program• We want community based organizations and non-

profits to participate as Navigators without licensure• We want Navigators to assist with Medicaid/FAMIS

outreach and enrollment too• SB 496 was amended to eliminate licensure, mention

CBOs, & include education/enrollment for Medicaid/FAMIS

State Legislation

Coordination with Medicaid & FAMIS• We want Exchange to streamline access to all

programs• SB 496 amendments clarify relationships and require

Exchange to enroll eligible people in other programs

Services• SB 496 prohibits abortion coverage in Exchange plans

or optional riders except for rape, incest, life of mother

Q&A/Resources

Virginia Health Reform Initiativewww.hhr.virginia.gov/initiatives/healthreform

www.healthcare.gov

The Commonwealth Institutewww.thecommonwealthinstitute.org/health/

Thank you for attending!