Health Care Reform in Indiana 10/11/2011 Symposium

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Tricia Brooks, MBA from Georgetown University\'s Center of Children and Families PPACA implementation presentation for Indiana

Tricia Brooks, MBA from Georgetown University\'s Center of Children and Families PPACA implementation presentation for Indiana

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  • 1. Health Care Reform! State of Play: ! Whatʼs at Stake for Indiana?!
TRICIA BROOKS
GEORGETOWN UNIVERSITY HEALTH POLICY INSTITUTE
CENTER FOR CHILDREN AND FAMILIES

INDIANA HEALTH INSURANCE EXCHANGE SYMPOSIUM
OCTOBER 11, 2011

"
  • 2. Why Does America andIndiana Need Health Reform?! Itʼs About Getting Better Results from our Health Care Expenditures!
  • 3. Total Health Expenditure per Capita, U.S. and Selected Countries, 2008 $8,000 $7,538 $7,000 $6,000Per Capita Spending - PPP Adjusted $5,003 $5,000 $4,627 $3,970 $4,063 $4,079 $4,000 $3,677 $3,696 $3,737 $3,353 $3,470 $3,129 $2,870 $2,902 $3,000 $2,729 $2,000 $1,000 $0 Source: Organisation for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: 10.1787/data-00350-en (Accessed on 14 February 2011). Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD estimates. Numbers are PPP adjusted.
  • 4. Total Health Expenditure as a Share of GDP, U.S. and Selected Countries, 2008 18% 16.0% 16% 14% 12% 11.1% 11.2%As Percentage of GDP 10.4% 10.5% 10.5% 10.7% 9.9% 10% 9.0% 9.1% 9.4% 8.5% 8.5% 8.7% 8.1% 8% 6% 4% 2% 0% Source: Organisation for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: 10.1787/data-00350-en (Accessed on 14 February 2011). Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD estimates. Numbers are PPP adjusted.
  • 5. Indiana Spending on Health Care
 2004! Per Capita Health Percent of GDP" Care Expenditures" 16   6000   14.4   $5,383   $5,295   13.3   14   5000   12   4000   10   3000   8   6   2000   4   1000   2   0   0   United  States   Indiana   United  States   Indiana   Source: 2004 Kaiser State Health Facts
  • 6. Life Expectancy Growth Slows;
 US Ranks 37th! 2009"90   2008"80   80   83   82.3   80.4   80.3   78.2   78.6  70   70   77.7  60   60  50   50  40   40  30   30  20   20  10   10   0   0   Japan   United   Germany   Switzerland   United  States   United  States   Indiana     Kingdom   Source: Organisation for Economic Co-operation Source: 2008 Kaiser State Health and Development (2009), "OECD Health Data” Facts
  • 7. Infant Mortality
 Deaths per 1000 Live Births! 8   7.8   7   6.8  7   6.5  6   6  5   4.7   5   4  4   3.5   4  3   2.6   3  2   2  1   1  0   0   Japan   United   Germay   Switzerland   United  States   United   Indiana     Kingdom   States   Source: Organisation for Economic Co-operation Source: 2008 Kaiser State Health and Development (2010), "OECD Health Data” Facts
  • 8. Without Health Care Reform, 
Where Would Indiana Be Heading?!
  • 9. Based on these recent headlines…!
  • 10. 102% Increase in Business Premiums Drop in ESI by 9%! Employer  Spending  on     %  Insured  through  Employer-­‐ Health  Care   Sponsored  Insurance   in  Millions   63.3%   64.0%   +  102.4%   $25,000   62.0%   60.6%   $20,000   +  44.5%   60.0%   57.7%   58.0%   $15,000   56.0%   $10,000   54.0%   $5,000   52.0%   $0   50.0%   2009   2014   2019   2009   2014   2019   Source: B. Garret, et all, “The Cost of Failure to Enact Health Reform: Implications for States,” the Urban Institute, 2009 (Worse Case Scenario)!
  • 11. 150,000 more people are uninsured and unable to pay for health care! Uncompensated  Care  Costs   Number  of  Uninsured   In  Millions  1,000,000   968,000   $2,500     $2,214     950,000   $2,000     904,000   $1,551     900,000   $1,500     $1,163     850,000   820,000   $1,000     800,000   750,000   $500     700,000   $0     2009   2014   2019   2009   2014   2019   Source: B. Garret, et all, “The Cost of Failure to Enact Health Reform: Implications for States,” the Urban Institute, 2009!
  • 12. These trends are why Indiana and America need the 
 Affordable Care Act!
  • 13. Transforming  the  Health  Care  System   through  The  Affordable  Care  Act   •  Coverage  expansions  –  both  public  and  private   •  Simplified,  streamlined,  coordinated  enrollment   •  Quality  and  cost-­‐containment  measures   •  Workforce  investment  
  • 14. Thanks to the ACA….!
  • 15. 1 million young adults gained coverage in the past year!Including Emily E fromMI. Emily was born withCommon VariableImmune Deficiency,leaving her with virtuallyno immunities. She wasworried about whatwould happen when shegraduated college andwhether she would beable to get coverage. ! Source: Young Invincibles Website!
  • 16. 1.3 million seniors saved anaverage of $517 on prescriptions! Clifton A from MD was one of 1.8 million seniors who got help paying for prescriptions as the ACA phases out the “donut hole.” ! Source: WBAL-TV ! ! o  32,258 Indiana seniors receive discounts averaging $537! o  88,802 received $250 rebate! Source: HHS, www.healthcare.gov!
  • 17. 162,000 children are helped byelimination of pre-existing exclusions!When Mario S from COwas 3, she was diagnosedwith an AVM (arteriovenousmalformation) in her brain.She went through 23procedures to correct theproblem. At 14, Maria wasin good health but shecouldnʼt get coveragebecause of her pre-existingcondition. ! Source: Georgetown Center for Children and Families, “Weathering the Storm” and CBS News !
  • 18. Consumers Gain Many 
 Other Protections!o  10,700 did not see their coverage rescinded!o  20,400 people didnʼt hit their lifetime maximum!o  41 million Americans, including 19 million seniors, received no-cost preventive care!o  More of your insurance premium dollar must go to health care, not overhead, advertising or profits (80% in individual plans/85% in group) !o  Insurers canʼt raise individual or business premiums by more than 10% without justification and scrunity!
  • 19. Significant Investment in 
 Health Care Innovation!o  Workplace health grants!o  Community transformation grants!o  Strengthening community health centers and school based health clinics (IN $1.5 million)!o  Demonstration projects to improve quality and reduce costs!o  Better coordination of care for dual eligibles!o  Payment reform !o  See more at www.healthcare.gov!
  • 20. 544,000 Hoosiers Will 
 Gain Coverage in 2014!  1,000,000     18.00%    870,000     15.9%    900,000     16.00%    800,000     14.00%    700,000     12.00%    600,000     10.00%    500,000     8.00%    400,000      326,000     6.0%   6.00%    300,000      200,000     4.00%    100,000     2.00%    -­‐         0.00%   Before  Health  Reform   A[er  Health  Reform     Before  Health  Reform   A[er  Health  Reform     Source: Urban Institute “Health Reform Across States: Increased Insurance Coverage and Federal Spending on the Exchanges and Medicaid,” March 2011  
  • 21. Significant  Federal  Investment  in     Indiana’s  Health  Care  Economy   Medicaid  Expansion     Exchange  Subsidies,     2014  -­‐  2019   2014  -­‐  2019   (in  millions)   (in  millions)   State     6000   $4,939   Share   5000   $478   4000   $14,255 3000   Federal     94.1% 2000   Share   $8,535   1000   0   Premium    Tax  Credits   Cost-­‐Sharing  Reduc`ons  Source: Kaiser Commission on Medicaid and the Source: Urban Institute “Health Reform Across States:Uninsured, “Medicaid Coverage and Spending in Health Increased Insurance Coverage and Federal SpendingReform: National and State-by-State Results for Adults at on the Exchanges and Medicaid,” March 2011   or Below 133% FPL.  
  • 22. Why do state cost estimates 
 vary so widely?! NaPonal  EsPmates  of  State  Budget  Impacts  Vary  Widely  CBO   CMS   Urban  (H&H)   Urban  (D&B)   Lewin  $20   -­‐$33   21.1   $-­‐40.9   -­‐106.80  Estimates are based on many assumptions:!o  Take-up rates and crowd-out estimates!o  Unknown issues before federal guidance (i.e. 209b)!o  Time periods covered!o  Administrative costs, particularly relating to IT!o  Specific elements of cost, savings and revenues!! Source: Kaiser Commission on Medicaid and the Uninsured, “State Budgets Under Federal Reform: The Extent and Causes of Variations in Estimated Impacts,” February 2011!
  • 23. Health  Reform  Will  Boost   State  Economy    •  Federal  and  state  investment  •  Increased  purchase  of   insurance  by  individuals  •  Savings  in  uncompensated  care   offset  state  costs  and  other   direct  service  costs  •  Direct  economic  impact   •  Jobs  and  wages   •  Spending  and  taxes   •  More  financially  stable  families  
  • 24. States are Moving Forward!
  • 25. Not Using Planning Grants!
  • 26. Exchange Activity in the States!Legislative Activity" Other Paths" Federal Grants"o  15 States o  4 Executive o  7 Innovator (-2)! Enacted! Order! o  50 Planning (-3)!o  4 Pending! o  7 Study o  17 Establishment!o  2 Existing! Commissions! •  8 where legislation stalled! •  2 states in 26 states filing lawsuits! •  More applied at end of September!
  • 27. Can Indiana risk waiting for legal challenges to overturn ACA?!District Court (26)" Appeals Court (8)"o  3 determined some parts of o  Upheld only that individual law unconstitutional! mandate is unconstitutional ! •  FL overturned all of law as non-severable! o  Vacated lower court decision ! •  VA overturned only individual o  4 upheld dismissals! mandate! o  2 pending ! •  PA ruled parts •  Oral arguments scheduled! unconstitutional!o  6 ruled law constitutional!o  9 dismissed for lack of Supreme Court to hear the standing/procedural! case this term ""o  8 pending! o  Ruling likely by mid-2012.! Source: http://www.kaiserhealthnews.org/Stories/2011/ March/02/health-reform-law-court-case-status.aspx!
  • 28. What Should Indiana 
 Be Doing Now?!
  • 29. Determine Governance Structure!o  New or existing state agency, quasi-state agency or non-profit organization! •  Majority of governing body cannot have conflict of interest!o  Apply for tier 2 establishment grant! •  3 more rounds quarterly until June 29, 2012! •  Provides all implementation operational costs through 2014!
  • 30. Evaluate Basic Health Option!o  Builds on public programs for those with income 133-200% FPL! •  Potential to build on HIP with changes!o  Funded by 95% of premium tax credits, cost-sharing reductions!o  Potential advantages! •  Minimize transitions between programs! •  More affordable, comprehensive for consumers!
  • 31. Create a Strong Process forOngoing Stakeholder Engagement!o  Required by proposed regulation and as a condition of funding!o  Planning, implementation, evaluation and on-going!o  More than surveys, forums and disclosure!o  It should be a partnership between state, industry, consumers, providers and other stakeholders!
  • 32. Coordinate with Medicaid/CHIP!o  Single, streamlined application!o  Exchange establishes eligibility for all Insurance Affordability Programs! •  Medicaid, CHIP, BHP, Exchange Premium Tax Credits and Cost-Sharing Reductions!o  Single eligibility system or shared eligibility service!o  Data matches to confirm eligibility! •  Federal Data Services Hub!o  Single web-portal with real-time decision! •  Also access over phone, in-person, via mail!
  • 33. Develop IT Infrastructure!o  Unprecedented but time-limited federal financial participation! •  90% development costs – Medicaid (ends 2015) with 75% for ongoing operational costs! •  100% Exchange infrastructure (3 more rounds)! •  Expedited review process! •  Waiver of certain cost-allocation rules across programs!o  Complex, time-consuming project to execute!
  • 34. What happens if Indianadoesnʼt move forward?!
  • 35. There Will Be a Federally-Run Exchange in Indiana!o  The federal exchange will conduct eligibility and enrollment activities for Medicaid/CHIP!o  Indiana will lose the opportunity to finance a state-of-the art, consumer-friendly, data- driven IT infrastructure that will enhance the efficiency and accuracy of existing health programs!
  • 36. States Need Exchanges!o  ….Even if the courts or Republicans succeed at unraveling the law, companies and states are likely to keep moving ahead with exchanges because they recognize that individual insurance shoppers and small businesses have long been at a disadvantage, lacking the negotiating power of large companies that can demand better prices. ! Former HHS Secretary Mike Leavitt! "Any number of events could interrupt" the development of exchanges, he said. "But, wed still have the problem of pooling [customers to create leverage for better prices]. And we have a distribution system that is more expensive than we can afford."! Source: Kaiser Health News!
  • 37. Georgetown Health Policy Institute
 Center for Children and Families!o  Tricia Brooks, Senior Fellow! •  pab62@georgetown.edu ! •  202-365-9148!o  Visit our Website: http://ccf.georgetown.edu/!o  Read Say Ahhh! Our child health policy blog: http://www.theccfblog.org/!o  Friend us on Facebook: www.facebook.com/georgetownccf !