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Riley: Exchanges: A New State Composition


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Riley: Exchanges: A New State Composition

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