Risky Business: The Transition of High Risk Pool Enrollees to Other Coverage in 2014
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Risky Business: The Transition of High Risk Pool Enrollees to Other Coverage in 2014






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Risky Business: The Transition of High Risk Pool Enrollees to Other Coverage in 2014 Risky Business: The Transition of High Risk Pool Enrollees to Other Coverage in 2014 Presentation Transcript

  • Funded by a grant from the RobertWood Johnson Foundation Risky Business – The Transition of High Risk Pool Enrollees to Other Coverage in 2014 Findings from the 2012 Minnesota Comprehensive Health Association (MCHA) Enrollee Survey Elizabeth Lukanen, MPH SHADAC, University of Minnesota State Health Research and Policy Interest Group Meeting AcademyHealth Baltimore, Maryland June 22, 2013
  • Acknowledgements • SHADAC – Lynn Blewett, SHADAC Director and Professor – Kathleen Call, Professor – Heather Dahlen, PhD Student and Research Assistant – Karen Turner, Senior Program Analyst • MCHA – Peggy Zimmerman-Belbeck , Director of Operations – Kirby Erickson, Executive Director • Medica – Kris Messner, Strategic Account Manager – Anton Dmytrenko, Strategic Account Executive • Support for this work was provided by a grant from the Robert Wood Johnson Foundation’s State Health Reform Assistance Network 2
  • Presentation Overview • High risk pools and the Affordable Care Act (ACA) • 2012 MCHA Enrollee Survey • Survey Results • Implications for Outreach 3
  • State High Risk Pools • Established to provide coverage to the “uninsurable” • Financed through assessments on fully-insured health plans, state general fund revenue, and enrollee premiums • Stabilize risk in the individual market by spreading costs associated with individuals with high-cost health care needs • Coverage is similar to underwritten plans offered in individual market and they do have similar rating practices • Premiums are capped between 125% and 250% • As of 2011, there were 35 states with high risk pools, covering approximately 227,000, with over $2.5 billion in paid claims 4
  • The Affordable Care Act (ACA) and Individuals with Preexisting Conditions • Prohibits pre-existing condition exclusions • Introduces premium rate restrictions in individual and small group markets • Prohibits lifetime or annual limits • 100% coverage for preventive care • Provides new subsidized coverage options – Medicaid (income ≤ 138% FPL) – Premium and cost sharing subsidies through the exchange (income 139 to 400% FPL) • Temporary national HRP (enrollment of 107,000 in January 2012) 5
  • Transition of High Risk Pool Enrollees • Three programs to encourage gradual transition, spread risk and minimize adverse selection in exchange – Temporary reinsurance and risk adjustment from 2014 to 2016 and permanent risk corridors • Guidance in December, 2012 stipulated that high risk pools were not eligible for reinsurance money • Incentive for states to transition high risk pool enrollees quickly 6
  • Minnesota Comprehensive Health Association • Five Eligibility Avenues: – Loss of group coverage – Medicare ineligibility – Health-related rejection – Presumptive condition(s) – Health Coverage Tax Credit (HCTC) program • Among the longest-running and largest state high risk pools in the country – Currently, 26,000 enrollees • Premiums capped at 125% of individual market • Lifetime maximum benefit of $5,000,000 • Administered by Medica Health Plan 7
  • 2012 MCHA Survey: Objectives • Provide information to MCHA to help transition enrollees into new ACA coverage options – Assess potential eligibility for Medicaid and exchange – Gauge enrollee familiarity with ACA changes – Collect information to inform outreach and communication strategies • Gain knowledge of how MCHA enrollees might impact risk pools – Collect information on health status, pent-up demand 8
  • Methodology • Mail survey of 5,200 MCHA enrollees – Policy holders enrolled for 12 months – Excluded children and those with Ryan White and HCTC eligibility • $2 incentive payment with survey mailing • Oversampling of low-income enrollees (used receipt of low income subsidy as proxy) and those in rural areas • Survey response rate was 50.2% • Weighting adjustments were conducted • Income imputed for 6% of cases 9
  • Enrollee General Demographics • Mean age is 52 years • Slightly more females than males (53%) • Almost 60% live in an urban area • A quarter have less than a high school education • 70% are employed or self-employed • Majority report incomes above 400% FPG • Most enrollees (82%) have total family assets that exceed $20,000 10
  • Enrollee Health Characteristics 11 • MCHA enrollees report good health, only 15% report fair or poor health • 92% of enrollees report having at least one chronic condition • The most common chronic conditions: • high blood pressure • weight condition • high cholesterol • allergies • arthritis/osteoporosis 8% 18% 21% 18% 35% Number of Chronic Conditions 0 1 2 3 4 or more
  • Enrollee Experience with MCHA • More than two-thirds have been in MCHA for more than 4 years • Almost a quarter have been in MCHA for 10 years or more • Rural enrollees are more likely to have been on the program for 10 years or more (26% vs. 20%) • More than one third of enrollees have high deductible plans ($5,000 and $10,000) • 81% report being somewhat/very satisfied with their MCHA insurance coverage 12
  • Features of MCHA Coverage that are Important to Enrollees 13 73% 66% 62% 38% 17%16% 13% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Rated "Extremely Important" Rx coverage Ability to see a specific provider Cost of premium Ability to go to the Mayo Clinic Low income subsidy program HSA option Coverage for a specific service 1. Routine/annual exams 2. Preventive services and screenings 3. Chiropractic services 4. Mental health/Chemical dependency 5. Chronic conditions
  • Primary Reasons Enrollees Would Leave MCHA 14 27% 23%20% 10% 10% 10% Can no longer afford premium New job with Insurance offer Nothing would make me leave My health improves and I can get in private market Turning 65 Other Of the enrollees that responded, “nothing would make me leave”: • 29% are unaware of other health insurance options • 19% report that other companies will not cover me/my family due to preexisting conditions • 14% report that MCHA is the only coverage that offers Mayo clinic • 13% report other plans will not cover me/my family
  • MCHA Enrollees Potential Eligibility for New Coverage Options in 2014 • The majority of enrollees will likely get no federal financial support for their health insurance coverage 15 Income as % FPG % MCHA Enrollees Eligibility for Financial Support Less than or equal to138% FPG 9% Medicaid 139-400% FPG 37% Premium and cost-sharing subsidies through the exchange Above 400% FPG 55% None
  • Enrollee Familiarity with Health Reform 39% 59% 24% 24% 31% 15% 5% 1%1% 1% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% General familiarity with health reform Familiarity with potential coverage changes No answer Very familiar Somewhat familiar Somewhat unfamiliar Very unfamiliar 16
  • Enrollees Worries About Changes Under Health Care Reform 17 Self Report of Worried/Very Worried % Enrollees Having to pay more for premiums 92% Having to pay more for deductibles and coinsurance 91% Not being able to afford the health care services you think you need 86% Not being able to afford the prescription drugs you need 79% The quality of health care services you receive getting worse 74% Having to change doctors 73% Not being able to get the health care services you need for reasons other than money 73% Having to change health plans 69%
  • Willingness to Enroll in a Public Program 18 49%51% If you learned you were eligible for a public program at no cost, would you enroll? Yes No
  • Possible Outreach Methods 19 72% 16% 4% 3% 2% 2% 1% How would you most like to receive information about coverage changes? Mail Website One-on-One meetings Phone number to call with questions Don't want to receive information Group meetings
  • Implications for Marketing and Outreach • The “selling” of the new coverage options needs to start now in a variety of formats • Messaging should include: – No exclusion based on pre-existing conditions – First dollar coverage for preventive services – No lifetime limits – Financial support (for those that qualify) – Information about finding insurance that covers preferred doctors and Rx 20
  • Implications for Outreach • Messaging and outreach may need to differ by: – Rural vs. urban – Eligibility type (Medicaid vs. exchange) • Outreach will need to address expectations about the cost of new coverage options (very difficult!) • Messaging needs to combat the negative image of “public programs” • Ideally, assistance should be specialized for this population (e.g., special training for in person assisters) 21
  • Sign up to receive our newsletter and updates at www.shadac.org @shadac Contact Information Elizabeth Lukanen Senior Research Fellow elukanen@umn.edu 612.626.1537