Health Reform in Florida


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Health Reform in Florida

  1. 1. Making the Investments Work: Implementing Health Reform in Florida Leda M. Perez, Vice President of Health Initiatives, Collins Center Jack Meyer, Principal, Health Management Associates Sharon Silow-Carroll, Principal, Health Management Associates February 17, 2011
  2. 2. Welcome and introduction Page  The Collins Center for Public Policy finds smart solutions to important issues facing the people of Florida and the nation. We are independent, non-partisan, non-profit and passionately committed to lasting results. Health Management Associates is a consulting firm specializing in the fields of health system restructuring, health care program development, health economics and finance, program evaluation, and data analysis, with a special concentration on addressing the needs of the medically indigent and underserved people and assessing the new health reform legislation.
  3. 3. Commissioning the study Page  <ul><li>Foundation to Promote an Open Society (in partnership with the Open Society Institute) funds Collins Center in December 2009 </li></ul><ul><ul><li>- Collins establishes the Florida Stimulus Program, creating an online community </li></ul></ul><ul><ul><li>Reports on American Reinvestment and Recovery Act (ARRA) spending in Florida </li></ul></ul>
  4. 4. Authors Jack Meyer and Sharon Silow-Carroll Page 
  5. 5. Page 
  6. 6. Goals of the report Page  <ul><li>Present the key features of national health reform in objective, clear terms </li></ul><ul><li>Determine the potential benefits to Florida </li></ul><ul><li>Explain the main challenges involved in implementing the law </li></ul><ul><li>Provide recommendations to address these challenges and maximize the benefits </li></ul>
  7. 7. Should Florida maintain the status quo? Page  <ul><li>Florida has over 4 million uninsured , and this number has been steadily rising </li></ul><ul><li>The state unemployment rate is well above the national average </li></ul><ul><li>Employers, particularly small firms, are under great pressure, and many may drop coverage </li></ul><ul><li>Florida Medicaid has very low eligibility standards , so decline in employer coverage means more uninsured </li></ul>
  8. 8. Should Florida maintain the status quo? Page  <ul><li>Going without insurance has direct costs (e.g. uncompensated care, cost-shift to privately insured) and indirect costs (e.g. work and school absenteeism, lower productivity, premature deaths); indirect costs valued at approx. $8-17billion/year </li></ul>
  9. 9. Key components of health reform <ul><li>Medicaid Expansion </li></ul><ul><li>Health Insurance Exchanges </li></ul><ul><li>Insurance Market Reforms </li></ul><ul><li>Requirements on individuals and employers </li></ul><ul><li>Financing measures </li></ul><ul><li>Grant opportunities </li></ul>
  10. 10. Medicaid expansion <ul><li>Florida would add about 1.0 to 1.4 million enrollees to Medicaid by 2019 </li></ul><ul><ul><li>— about 0.7 to 1.1 million of these would be newly insured </li></ul></ul><ul><li>The additional cost to the state is about $1.2-$2.5 billion over the period of 2014-2019 (over $66.3 billion baseline) </li></ul><ul><li>But the state would draw in $20-24 billion , or at least $10 from federal government for each dollar it spends </li></ul><ul><li>For the newly eligible people, Florida would get $25 in federal funds for each state dollar </li></ul><ul><li>Source: John Holahan and Irene Headen. Urban Institute. May 2010. </li></ul>
  11. 11. Medicaid expansion <ul><li>Hospitals should realize at least $1 billion in savings from reduced uncompensated care; physicians/other providers will also benefit from less “free care” </li></ul><ul><li>Indirect savings will emerge from fewer absences from school and jobs, greater productivity, fewer premature deaths, and better health </li></ul><ul><li>Even if half of indirect costs are realized, the sum of direct and indirect savings to the private and public sectors will more than offset these new state costs </li></ul>
  12. 12. Outreach and enrollment <ul><li>Florida should use 21 st Century enrollment techniques that use data matching from other programs/sources outside health care to determine likely eligibility </li></ul><ul><li>Florida should expand use of community health workers to connect eligible people to programs and help them navigate the health system </li></ul>
  13. 13. Benefits to Florida <ul><li>Improve access to prevention/primary care </li></ul><ul><li>Reduce avoidable ER visits, hospital admissions </li></ul><ul><li>Improve health outcomes, productivity </li></ul><ul><li>Save on total costs per person </li></ul><ul><li>Reduce uncompensated care burden </li></ul><ul><li>Reduce cost-shift to private payers </li></ul>
  14. 14. Challenges in Medicaid Expansion <ul><li>Assuring an adequate health care work force </li></ul><ul><ul><li>This will require raising, not lowering payments for doctors, nurses, and other professionals </li></ul></ul><ul><li>Preparing to serve a population with complex medical needs </li></ul><ul><ul><li>High incidence of chronic illness among poor and near-poor newly eligible adults </li></ul></ul><ul><li>Finding the funds for the state’s contribution amidst competing needs and capturing some of the savings </li></ul>
  15. 15. Health Insurance Exchange <ul><li>Exchange is insurance ‘marketplace’ for individuals and small businesses to compare and purchase health plans, receive subsidies </li></ul><ul><li>Can offer single point of entry to determine eligibility for enrollment and subsidies in Exchange, Medicaid, and CHIP </li></ul><ul><li>FL can create its own Exchange(s) rather than let federal government step in and do it </li></ul><ul><ul><li>Choices re: governance, number of exchanges, funding </li></ul></ul><ul><li>Potential for Exchanges to be active purchasers driving savings and quality gains </li></ul>
  16. 16. Benefits of Exchanges <ul><li>Broad choice of private insurance for people who have had no choice or very limited choice </li></ul><ul><li>Small firms get affordable choices </li></ul><ul><li>Subsidies scaled to income will help moderate and middle-income people afford coverage </li></ul><ul><li>Exchanges could improve quality and lower costs through smart purchasing </li></ul>
  17. 17. Exchange Challenges <ul><li>Build an electronic-based system of determining eligibility for multiple programs </li></ul><ul><li>Create secure data sharing with federal agencies </li></ul><ul><li>Match federal tax credits with household contribution and get total to health plans </li></ul><ul><li>Develop capacity to assess health plans on rates, quality of care, provider networks, medical loss ratio </li></ul>
  18. 18. Insurance Market Reforms <ul><li>2010: already in force </li></ul><ul><li>No lifetime caps, restricted annual caps, limits on rescinding </li></ul><ul><li>Children may stay on parents’ plans until age 26 </li></ul><ul><li>No pre-existing condition exclusions for kids </li></ul><ul><li>2011 </li></ul><ul><li>Plans must report how premiums are spent </li></ul><ul><li>Process for state review of premium increases </li></ul>
  19. 19. Insurance Market Reforms <ul><li>2012 </li></ul><ul><li>Rebates to consumers if Medical Loss Ratio<80% (individual and small group plans) or 85% (large group plans) </li></ul><ul><li>2014 </li></ul><ul><li>Guaranteed issue and renewability (no one denied) </li></ul><ul><li>Rates may not vary with health status, limited variation on age </li></ul><ul><li>No annual limits on value of coverage </li></ul>
  20. 20. Benefits of Insurance Market Reforms <ul><li>Child (and later, anyone) with disability or prior illness will not be denied coverage or face exorbitant rates </li></ul><ul><li>Young adult without job-based insurance can remain on parent’s plan until age 26 </li></ul><ul><li>Person requiring expensive treatments would not see coverage terminated after reaching health plan cap </li></ul><ul><li>Older adults not yet eligible for Medicare would see more affordable insurance rates </li></ul>
  21. 21. Insurance Market Reform Challenges <ul><li>Premiums for younger workers likely to rise; some may decline coverage and pay the modest penalty </li></ul><ul><li>State must develop and implement new regulations and procedures to review insurers’ premiums and how they are used </li></ul><ul><li>State must determine whether rate increases are “reasonable” to keep premiums affordable, without leading to many insurers leaving the state </li></ul>
  22. 22. Federal Funding Opportunities <ul><li>Community Health Centers </li></ul><ul><li>Expand capacity, test wellness plans </li></ul><ul><li>Medicaid </li></ul><ul><li>“ Health homes” for chronically ill patients </li></ul><ul><li>Quality measurement program </li></ul><ul><li>Global & Bundled payment demos </li></ul><ul><li>Pediatric Accountable Care Organization demo </li></ul><ul><li>Employers </li></ul><ul><li>Workplace wellness programs </li></ul><ul><li>Other: med malpractice demo, diabetes prevention… </li></ul>
  23. 23. Employer & Individual Obligations <ul><li>Employers </li></ul><ul><li>Small businesses not required to provide insurance; but if they do, eligible for up to 30% tax credit </li></ul><ul><li>Businesses with more than 50 workers must offer coverage or pay a fee </li></ul><ul><li>Businesses with up to 100 workers may buy through Exchange; larger firms may do so in 2017 </li></ul><ul><li>Firms with more than 200 employees must automatically enroll workers unless employee opts out </li></ul><ul><li>Individuals </li></ul><ul><li>2014: US citizens & legal residents must obtain coverage or pay penalty (exemptions for hardship cases) </li></ul>
  24. 24. Financing <ul><li>Smaller increases in Medicare payments to providers </li></ul><ul><li>Lower payments to Medicare Advantage plans </li></ul><ul><li>Board recommends cost-containment strategies if Medicare grows too fast </li></ul><ul><li>0.9% payroll tax increase for couples $250k+ and individuals $200k+, and 3.8% tax on unearned income for high-income taxpayers (affecting about 2% households) </li></ul><ul><li>Excise tax on insurers selling “Cadillac” policies </li></ul><ul><li>$2,500 limit on FSA medical contributions </li></ul><ul><li>Fees on pharmaceutical and medical device manufacturers, health insurers, and tanning salons </li></ul>
  25. 25. Action Steps <ul><li>Prepare Medicaid </li></ul><ul><li>Conduct innovative outreach and enrollment of those newly eligible for Medicaid </li></ul><ul><ul><li>Community Health Workers, auto-enrollment, etc. </li></ul></ul><ul><li>Develop statewide plan for Medicaid managed care </li></ul><ul><ul><li>with quality and access protections </li></ul></ul><ul><li>Assess and address higher-risk and chronic care needs of newly eligible </li></ul><ul><ul><li>E.g. care management, self-management education, transitional care </li></ul></ul><ul><li>Apply for federal grants (planning, demos, etc.) </li></ul>
  26. 26. Action Steps <ul><li>Design Insurance Exchange </li></ul><ul><li>Consumer-friendly web portal for screening, eligibility determination, links to appropriate programs & subsidies </li></ul><ul><li>Insurance risk-adjustment mechanism </li></ul><ul><li>Health plan accountability for cost and quality </li></ul><ul><ul><li>E.g. develop & collect quality measures for diabetes. asthma </li></ul></ul><ul><li>Enact Necessary Legislation </li></ul><ul><li>Authority to Insurance department and AHCA to implement reforms </li></ul>
  27. 27. Page  Thank you. Do You Have Any Questions? ? ? ?
  28. 28. Page  Thank you. To download the report visit: Contact information: Leda Perez: [email_address] Jack Meyer: