Sheldon Weisgrau Thrive Allen County October 18, 2012.

Health Reform in Kansas:The Affordable Care Act

Sheldon WeisgrauThrive Allen County

October 18, 2012

Health Reform Resource Project 2

Introduction The Problem

◦ Why do we need health reform? The Affordable Care Act (aka “Obamacare”)

◦ What’s really in the law?◦ Specific impacts

Medicaid expansion Seniors and Medicare Rural health workforce

Questions & Discussion

Agenda


Funded by Kansas Grantmakers in Health:◦ Kansas Health Foundation◦ Health Care Foundation of Greater KC◦ REACH Healthcare Foundation◦ Sunflower Foundation: Health Care for Kansans◦ United Methodist Health Ministry Fund

Housed at Kansas Association for the Medically Underserved (KAMU)

Health Reform Resource Project


Assist in public education and consumer and stakeholder engagement related to health reform

Provide technical assistance to consumer and advocacy organizations

Assist Kansas entities in securing grants and programs available under the Affordable Care Act (ACA)



“Best health care system in the world”◦ Widespread medical technology◦ State-of-the-art facilities◦ Advanced research and training◦ Center of development for drugs and medical

devices◦ Lots of money in the system, well-paid

What works?


Access◦ 48.5 million uninsured

365,000 uninsured in Kansas◦ Millions more underinsured◦ Employment-based health insurance declining◦ Maldistribution of providers, other resources

Quality◦ Inconsistent◦ Disparities◦ Patients often don’t receive recommended care

Cost◦ Highest in the world◦ Increasing faster than salaries and inflation◦ Main driver of budget deficits

Why health reform?


Kansas Uninsured

Source: KHI, 2011

2001/2002 2002/2003 2003/2004 2004/2005 2005/2006 2006/2007 2007/2008 2008/2009 2009/20109%

10%

11%

12%

13%

14%


Kansas Uninsured (by County)

Source: KHI, 2012

365,000 uninsured in Kansas = all residents in…

Cheyenne

Sherman

Wallace

Greeley

Rawlins

Thomas

Logan

Wich-ita

Decatur

Sheri-dan

Gove

Scott Lane

Norton

Graham

Trego

Ness

Phillips

Rooks

Ellis

Rush

Smith

Osborn

Russell

Barton

Jewell

Mitchell

Lincoln

Ellsworth

Rice

Republic

Cloud

Ottawa

Wash-ington

Clay

Saline

McPher-son

Dickin-son

Harvey

Marion

Marsh-all Ne-maha

Brown

Riley

Geary

Morris

Chase

PottawatomieJack-son

Wabaun-see

Lyon

Coffey

Osage

Shaw-nee

Doni-phan

Atchison

Jeffer-son

Leavenworth

Doug-las

John-son

Frank-lin

Miami

Ander-son

Linn

Bour-bon

Craw-ford

Chero-kee

AllenWood-son

Neo-sho

Labette

Wilson

Mont-gom-ery

Green-wood

Elk

Chautau-qua

Butler

Cowley

Sedgwick

Sumner

Reno

Kingman

Harper

Stafford

Pratt

Barber

Pawnee

Edwards

Kiowa

Coman-chee

Hodgeman

Ford

Clark

Finney

Gray

Meade

Has-kell

Sew-ard

Kearny

Grant

Stevens

Hamilton

Stanton

Morton

Wyandotte

Greeley + Wallace + Lane + Comanche + Hodgeman + Clark + Wichita + Stanton + Rawlins + Kiowa + Sheridan + Graham + Hamilton + Gove + Cheyenne + Logan + Chase + Elk + Decatur + Trego + Edwards + Jewell + Ness + Morton + Lincoln + Rush + Woodson + Chautauqua + Smith + Osborne + Kearny + Haskell + Stafford + Meade + Barber + Scott + Republic + Rooks + Phillips + Norton + Stevens + Washington + Morris + Gray + Sherman + Harper + Ottawa + Mitchell + Ellsworth + Greenwood + Russell + Pawnee + Wabaunsee + Grant + Kingman + Thomas + Doniphan + Anderson + Clay + Coffey + Wilson + Cloud +

Pratt + Linn + Brown + Rice + Marshall and Nemaha + Allen

=365,000+ Kansans without health insurance

Cheyenne

Sherman

Wallace

Greeley

Rawlins

Thomas

Logan

Wich-ita

Decatur

Sheri-dan

Gove

Scott Lane

Norton

Graham

Trego

Ness

Phillips

Rooks

Ellis

Rush

Smith

Osborn

Russell

Barton

Jewell

Mitchell

Lincoln

Ellsworth

Rice

Republic

Cloud

Ottawa

Wash-ington

Clay

Saline

McPher-son

Dickin-son

Harvey

Marion

Marshall Ne-maha

Brown

Riley

Geary

Morris

Chase

PottawatomieJack-son

Wabaun-see

Lyon

Coffey

Osage

Shaw-nee

Doni-phan

Atchison

Jeffer-son

Leavenworth

Doug-las

John-son

Frank-lin

Miami

Ander-son

Linn

Bour-bon

Craw-ford

Chero-kee

AllenWood-son

Neo-sho

Labette

Wilson

Mont-gom-ery

Green-wood

Elk

Chautau-qua

Butler

Cowley

Sedgwick

Sumner

Reno

Kingman

Harper

Stafford

Pratt

Barber

Pawnee

Edwards

Kiowa

Coman-che

Hodgeman

Ford

Clark

Finney

Gray

Meade

Has-kell

Sew-ard

Kearny

Grant

Stevens

Hamilton

Stanton

Morton

Wyandotte


The uninsured are:◦ Less likely to receive preventive and prenatal care◦ More likely to go without medical care or

prescription drugs due to cost◦ More likely to be diagnosed at later stage of

illness◦ More likely to be hospitalized for avoidable

conditions◦ Less likely to receive recommended care◦ Less healthy◦ Earn less◦ Have higher death rates

What difference does health insurance make?


900+ pages, 10 titles1. Access to private health insurance2. Expanded Medicaid coverage3. Medicare reform4. Wellness and prevention5. Health care workforce6. Fraud and abuse7. Access to drugs and biologics8. Voluntary long-term care insurance (CLASS)9. Revenue measures10. Manager’s amendment and reconciliation

Affordable Care Act


Make better health insurance coverage more available and affordable for legal residents

Reform health care delivery and financing to provide better quality and outcomes, more cost effective care

ACA – Intertwined Goals


What it does◦ Builds on the existing system of coverage

What it doesn’t do◦ Does not create “government-controlled” or

“socialized” health care◦ Does not create “death panels”◦ Does not turn the system over to insurance

companies

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ACA Snapshot


Seven-Part Solution1. Premium cost controls2. Short-term incentives to increase coverage3. New rules regarding scope of coverage and

consumer protections4. Individual mandate5. Health Insurance Exchanges6. Employer requirements7. Expanded Medicaid

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ACA – Key Features


Medical loss ratio requirements◦ Insurance companies must spend 80/85 percent

of premiums on medical services and quality improvement

Make available standardized comparable information on available insurance plans◦ http://www.healthcare.gov/

Support to states to create and strengthen insurance rate review

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1. Premium Cost Controls

http://www.healthcare.gov/


Pre-Existing Condition Insurance Plans (PCIP)◦ High risk pools for those uninsured for at least 6

months due to pre-existing condition

Early retiree reinsurance program◦ Federal support to employers who provide

coverage for retirees ages 55-64

Tax incentives for small employers to provide coverage

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2. Short-Term Coverage Expansion


Patients Bill of Rights◦ Prohibits rescission◦ No lifetime dollar limits

Dependents covered through age 26 No pre-existing condition exclusions for

children Guaranteed Issue and Community Rating:

◦ Nobody can be denied coverage or charged more due to pre-existing conditions (effective January 1, 2014)

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3. Scope of Coverage


Mechanism to discourage “free-riders” under guaranteed issue◦ Exemptions under certain conditions

Alternatives◦ Employer/union-sponsored plan◦ Individual insurance through an Exchange◦ Public program (Medicare, Medicaid, etc.)

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4. Individual Mandate


Established by each state by 2014◦ Administered by federal govt if state opts out

For individual and small group markets◦ Expands to larger employers in 2017

Provides web-based one-stop shopping◦ Pooling mechanism for individuals and small

businesses Plans must offer “essential health benefits”

package

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5. Health Insurance Exchanges


May be used to purchase coverage through Exchange◦ Individuals qualify if household income is up to

400% of FPL◦ Businesses qualify if they meet size and salary

requirements

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5. Health Insurance Exchanges – Tax Credits


Large employers (50+ employees) that don’t provide coverage may face penalties. ◦ For example:

Employer does not offer minimal essential coverage to full-time employees; and

At least one employee receives government subsidy to purchase insurance in Exchange

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6. Employer Requirements


By January 1, 2014, Medicaid expands to cover all eligible individuals with income up to 138% FPL

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7. Expanded Medicaid

Household

Size

2012 Annual Federal Poverty Guidelines

(138%)

1 $15,415

2 $20,879

3 $26,344

4 $31,809

5 $37,274

6 $42,739


Private coverage through Exchanges◦ Approx 16 million non-elderly uninsured◦ Most are employed

Expanded Medicaid◦ Approx 16 million non-elderly uninsured◦ Half have income below 50% FPL◦ One-third diagnosed with chronic condition

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Who Gets Covered?


365,000 Kansans currently uninsured (13% of population)

Under ACA:◦ About two-thirds will receive insurance coverage

~60% through expansion of Medicaid ~40% through expansion of private insurance

◦ About one-third remain uninsured

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Who Gets Covered in Kansas?


The Supreme Court Decision


Is the Medicaid expansion unconstitutionally coercive?◦ Yes – The federal government may not make all

Medicaid funding contingent on expanding the program

◦ So, the federal government has no enforcement authority over the expansion

◦ Therefore, expansion of Medicaid is optional for states

The Medicaid Question


130-150,000 new beneficiaries◦ Approx 60% of all Kansans covered under the ACA

New Medicaid spending (2014-2019)◦ Federal: ~ $3.5 billion◦ State: ~ $166 million

Other budget impacts

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Medicaid Expansion: Impact on Kansas


Local impact◦ New revenue for providers◦ Expansion of capacity, services, and jobs

Economic impact Effect of new dollars circulating through state and

local economies

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Medicaid Expansion: Impact on Kansas


Enhances benefit package◦ Covers annual wellness visit

Reduces out-of-pocket costs◦ No deductibles or coinsurance for preventive

services Benefit used by 300,000+ Kansas beneficiaries in

2011◦ Phases out Part D donut hole

40,000 Kansas beneficiaries received average discount of $600 in 2011

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The ACA and Medicare


Reduces rate of cost growth◦ Does not “cut” Medicare funding◦ Phases out overpayment to Medicare Advantage

plans◦ Enables provider payment and delivery system

reforms From “volume-based” to “value-based”

◦ Expands fraud and abuse prevention

Extends program solvency

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The ACA and Medicare


Expansion of home and community-based services

More funding for Aging and Disability Resource Centers (ADRCs)

Programs to enhance quality and patient safety, reduce readmissions

Programs to expand primary care, nursing, geriatric care workforce

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Other ACA Provisions Affecting Seniors


Medicare payment changes for physicians◦ 10% bonus for PC services furnished by PC

practitioners, 2011-2015◦ Reduce geographic practice expense disparities

Medicaid payment changes for primary care◦ Payment at 100% of Medicare, 2013-14

ACA and Rural Health Workforce


Expand National Health Services Corps ($1.5 billion over 5 years)

Primary care resident training in RHCs and FQHCs

Financial assistance/grants for:◦ Dental students likely to work in rural areas◦ Mid-career training for public and allied health◦ Schools training mental health providers likely to

serve high needs populations◦ Family nurse practitioner training programs◦ Expansion of nursing student loan program

ACA and Rural Health Workforce


November 6, 2012◦ If not the ACA, then what?

Establish Health Insurance Exchange?◦ State, federal, or partnership

Medicaid expansion?

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Where do we go from here?


Sheldon Weisgrau, DirectorHealth Reform Resource Project1129 S. Kansas Avenue, Suite BTopeka, KS [email protected]

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Additional information

mailto:[email protected]

Sheldon Weisgrau Thrive Allen County October 18, 2012.

Documents

Transcript of Sheldon Weisgrau Thrive Allen County October 18, 2012.