Affordable Care Act (ACA) Learning Sessions for Social Sector Leaders & Community Advocates August 17, 2012 Coordinated by Access HealthColumbus Community Advisory Committee Purpose Spread knowledge of federal health care reform in non-profit organizations to improve their ability to serve clients during the implementation of the Accountable Care Act (ACA). Today’s Objectives 1. Improve knowledge on the value of: • American Health Benefits Exchanges • Navigators intended to personally assist consumers in understanding their choices and selecting insurance coverage 2. Inventory learning on barriers encountered when reaching out to vulnerable people
Expansion of Medicaid
Health Benefit Exchanges
Near Universal Insurance Coverage
Affordable Care Act
Improvement Programs (and grants)
Subsidized commercial insurance for middle-income families (market based) Guaranteed Issue & Insurance Mandate
Health coverage sources for Ohioans in 2014
Source: Supreme Court Policy Brief, Health Policy Institute of Ohio, July 2012, http://bit.ly/SjDBca
Health coverage sources for Ohioans in 2014
Source: Supreme Court Policy Brief, Health Policy Institute of Ohio, July 2012, http://bit.ly/SjDBca
Near Universal Insurance Coverage
Health Benefit Exchanges
Affordable Care Act
Improvement Programs (and grants)
Guaranteed Issue & Insurance Mandate
Near Universal Insurance Coverage
Health Benefit Exchanges
Affordable Care Act
Improvement Programs (and grants)
Guaranteed Issue & Insurance Mandate
Near Universal Insurance Coverage
Health Benefit Exchanges
Affordable Care Act
Improvement Programs (and grants)
Guaranteed Issue & Insurance Mandate
Current Exchange Status • 15 Established State Exchange
• 1 Planning for Partnership Exchange • 18 Studying Options • 11 No Significant Activity • 6 Decision Not to Create State Exchange
Supreme Court Ruling
The insurance market reforms and subsidies were upheld and will go into effect.
Insurance market reforms
The 2010 insurance reforms will remain in effect – – – – –
No lifetime limits and restricted annual limits Coverage of dependents up to age 26 No rescissions except for fraud No pre-existing condition exclusions for children Preventive care at no co-pays or cost sharing
Insurance market reforms
The 2011 insurance reforms will remain in effect –
Medical Loss Ratio Limits
–
Medical loss ratios must be at least 85% for large group coverage and 80% for small group and individual coverage.
Premium Rates Review standards (2011).
Premium rates in excess of 10% must undergo heightened review.
Permanent Market Reforms •
The 2014 permanent market reforms were upheld. – –
Guaranteed issuance of coverage Modified community rating of coverage •
• • •
Rates can only vary by age (3 to 1) and smoking status (1 ½ to 1).
No pre-existing condition exclusions Individual mandate Employer mandate
Low Income Subsidies
The 2014 low income subsidies were upheld. – –
Sliding scale subsidies are available at incomes between 100% to 400% FPL At 100% FPL, the cost of coverage will be: $223 per year or $18.50 per month for individuals; or $461 per year or $38.40 per month for a family of 4.
Health Insurance Exchanges
Exchanges were upheld. – –
Each state shall establish a qualified Exchange by January 1, 2014. If a state chooses not to operate an exchange, the federal government will do so.
Exchange Options 1. 2. 3.
An Ohio Exchange A Federal Exchange A Hybrid Exchange – States control plan management including certification of qualified plans – States operate the consumer assistance function – HHS retains authority and approve state partners – States may control reinsurance and Medicaid eligibility determinations
Timeline
Reforms already in effect: – – –
2010 Insurance Benefit Reforms Medical Loss Ratios Premium Rate Review
November 6, 2012 - The Election – –
Change in direction as to implementation Can’t change requirements on insurance companies
Timeline
November 16, 2012 –
States must submit an Exchange Blueprint to HHS, including (1) a Declaration of Intent signed by the Governor and (2) an Application indicating the state’s intentions.
–
A state may submit a “Blueprint” for an exchange which will become operational after 2014, but November 16th is the deadline.
Timeline
January 1, 2013 –
HHS must certify state exchanges that become operational on January 1, 2014.
The state must demonstrate “the ability to satisfactorily perform all required Exchange activities.”
–
Conditional approval can be granted to states making “significant progress” if they will be ready by October, 2013.
–
It is hard to believe a state filing a “Blueprint” after the election could establish a 2014 exchange.
Timeline
2012 - 2013 – – –
IT/Consumer Infrastructure established Qualified health plans certified Vendor/partner agreements executed
– –
Agents/Navigators
Operations established Marketing/outreach to consumers
Fall, 2013 –
People begin to enroll in exchanges
Timeline
January, 2014 –
Permanent reforms take effect
–
Low income subsidies start
–
Mandates take effect
–
Coverage through exchanges becomes effective
Examples ď Ź
The Enroll UX 2014 design offers a new standard for public and private health insurance enrollment, and serves as a reference model for a first-class user experience (UX) design for health insurance exchanges.
ď Ź
Massachusetts Health Connector
Navigators in the New Health Benefits Exchange How to create a strong navigator program for our communities Cathy Levine Executive Director, UHCAN Ohio
UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Why do we need Navigators in the Exchange? • Up to 1.5 million uninsured Ohioans • Many do not know they have new options for getting affordable coverage in 2014 • Many do not know how insurance works – how to shop for insurance • Many will not know about the Exchange or how it works • Many will not have access to computer
UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
What is a Navigator? • A guide to help you get where you need to go. • The ACA created a Navigator function to – Inform people about their new insurance options – Help people enroll in their plan of choice – Help people keep their coverage (stay enrolled)
• The Navigator does not choose a plan or influence the choice of a plan. UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Need for Community-Based Navigators • • • • •
Consumer or community-focused non-profits Licensed insurance agents and brokers Industry, trade, professional associations Unions Chambers of commerce, small business groups • Commercial fishing industry organizations • Farming and ranching organizations • Others to reach specific populations UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Duties of Navigator According to ACA • Conduct public education activities about what’s available • Distribute impartial information about plan enrollment and availability of tax credits • Help people enroll in “qualified health plans” • Provide referrals for people with complaints and questions about their health plan • Provide information in culturally, linguistically appropriate manner for populations served UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Consumer Protections through Navigators • Navigators must receive no direct or indirect payments from health insurers • Insurers are explicitly prohibited from being navigators. • Therefore, navigators are funded through grants provided by Exchange funds. UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Who will enroll in Exchange? From Congressional Budget Office study
• Majority will have been previously uninsured
• More than 1/3 haven’t had check-up and will have had difficulty accessing care • Because of tax credits, most will have lower incomes than today’s privately insured • More racially diverse than currently insured • 77% will have high school diploma or less • Languages other than English UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Features of Strong Navigators • Training in Exchange, Medicaid, public programs and private insurance market • Ability to explain eligibility, benefits, cost-sharing, appeals processes to consumers • Have community’s trust to provide correct, clear information • Act in interests of consumer, not insurers • Ability to reach hard-to-reach, poor people • Ability to explain tax-credits and financial impact • Represent diverse organizations to serve diverse people eligible for insurance through Exchange
UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Under Federal Exchange, How is the Navigator program created? • Ohio could request to have a “partnership” – allows Ohio to run Navigator program • Otherwise, federal exchange issues requests for proposals from entities to navigate • How does it all come together? – Still many unanswered questions – Community groups have to organize themselves to participate in meaningful way UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
What’s Next? • UHCAN Ohio is tracking NAIC, federal regulations • Community organizations need to figure out what role they want to play develop joint proposals • Role of Ohio Benefit Bank? United Way? Other big players? • UHCAN Ohio will host phone calls, live meetings to facilitate coordination and participation from diverse communities UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Interested in Further Discussions and Information? • Sign up for our navigation email list • Call us to do presentations and lead discussions for groups you convene • Help us to educate communities about benefits of the Exchange • Let us call on you to give input to policymakers and regulators
UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
UHCAN Ohio’s mission is to achieve high quality, accessible, affordable health care for all Ohioans.
Visit our website for updates!
www.uhcanohio.org Find us on Facebook and Twitter!
UHCAN Ohio @UHCANOhio
Cathy Levine Executive Director 370 S. 5th St Ste G3 Columbus, OH 43215 (614) 456-0060 x222 clevine@uhcanohio.org
Want to learn more about the Affordable Care Act? Health Policy Institute of Ohio - Supreme Court Policy Brief: http://bit.ly/SjDBca Kaiser Family Foundation - A Guide to the Supreme Court's Affordable Care Act Decision: http://www.kff.org/healthreform/upload/8332.pdf Next Learning Session • September 28, 9:30-11:30AM • Focus: Overcoming the outreach barriers identified today