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Riley: Exchanges: A New State Composition
 

Riley: Exchanges: A New State Composition

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    Riley: Exchanges: A New State Composition Riley: Exchanges: A New State Composition Presentation Transcript

    • Exchanges: A New State Composition NASHP 23rd Annual State Health Policy Conference October 4-6, 2010 Governor’s Office of Health Policy and Finance Trish Riley, Director www.maine.gov/gohpf
    • Goals for Exchanges
      • Distribute insurance to individuals and small employers with more transparency
      • Coordinate eligibility and facilitate tax credits and employer vouchers
      • Set standards and implement policies around health insurance
      • Increase portability and choice
      • Improve outreach and education
      • Reduce system costs and improve quality of health care
      Riley 1
    • Functions of an ACA Exchange
      • Determine and Coordinate Eligibility
      • Create Standardized Benefit Categories
      • Enroll Individuals and Businesses
      • Certify Qualified Health Plans
      • Customer Service (Call center & more)
      • Establish Website (Quote generation, plan selection & cost calculator)
      • Assign Quality Ratings
      • Reward Quality
      • Set up a “Navigator” Program
      • Pay Broker Commissions
      Riley 2
    • Context for Reform
      • 2014 – New Environment – New Opportunity
            • Individual & business mandates
            • Affordability via subsidies (Non-group)
            • Nationalizes eligibility 0 – 400%
              • Re-think Medicaid & how it works in Exchange environment
      Riley 3
    • Medicaid & An Exchange [ Near Universal Access - delink health & welfare eligibility ] 400% FPL
      • Churning – On/Off ?
      • Redetermination ?
      133% Medicaid [ Eligibility for other social services ] 0% FPL (MAGI) Riley 4
      • Insurance Reforms in Place
        • “Tricks of the Trade” to lower costs eliminated
          • High deductibles
          • Waiting Periods
          • Lifetime & annual limits
          • Benefit limits
          • No Pre-Ex
      Riley 5
      • Raises Issue – what are the new tools to achieve affordability?
      • - Exchange as market leader
        • ■ Pools Buying Power
      • ■ Effect of National plans
      • ■ Payment Reform
      • ■ Plans In & Out of Exchange?
      • - Navigator vs. Broker
      • ■ Who will represent consumer & drive hard
      • bargains?
      • ■ Who will help small business?
      • ■ How will navigators be held accountable?
      Riley 6
    • Small Business in New Environment
      • Maine’s Dirigo Health Agency
        • Subsidized coverage for individuals, self-employed and small business employees
        • Voucher program for part-time workers
      • What does small business want?
        • Low price
        • Simplicity / ease of participation
      Riley 7
    • Small Business in New Environment (cont’d)
      • What do they get in Exchange?
        • Tax credits (2 Yrs.)
        • Transparency & comparability
        • Potential for lower costs
        • Incentives to drop coverage?
          • No mandate
          • Low wage employees only get subsidy as individual
          • Free choice voucher – How will small business react?
        •  Opportunities to incentivize small employer participation
      8 Riley
      • Maine’s Planning Effort
          • Steering Committee
          • Advisory Council on Health Systems Development
          • Jt. Select Committee on Health Reform
      • Preliminary Recommendations Re: Exchange
          • 1 for ME (Individual & Small Business)
          • Quasi- or independent agency
          • Leverage existing state infrastructure
      • www.maine.gov/healthreform
      Riley 9