Health Reform 201: Impact of ACA Repeal & Replace in Utah

1. Health Reform 201
Impact of ACA Repeal & Replace in Utah
Moab Regional Hospital
February 13, 2017

2. Who is UHPP?
Utah Health Policy Project is a
non-profit, non-partisan organization
advancing sustainable health care
solutions for underserved Utahns,
through better access, education,
and public policy
www.healthpolicyproject.org
www.facebook.com/uthpp
@UHPP

3. Private insurance is sold in three markets
Individual
An individual or family policy purchases a policy
directly from a private insurance company
Employer: Self-insured
Employer: Small group
Employer-based insurance often subsidized by
the company for employees and their dependents
A group health plan in which the employer assumes
risk for providing health care benefits to employees
Photo Source: Princeton Public Library; MatthewRoth; VictorPorof
6%
50%-
60%

4. Key Terms
Medicaid
Medicare
Government health
insurance for kids
Government health insurance
for low-income kids, pregnant
women, seniors, and people
with disabilities
CHIP
Government health
insurance for senior citizens
(ages 65+)
Photo Source: jaime22; Albuquerque Public Schools

5. Key Terms
Private insurance plans
sold on healthcare.gov
with monthly premiums
subsidized for some people
ACA or
Obamacare
Insurance

6. Where Utah Stands
in Early 2017

7. April 2014 February 2015 February 2016
706
1,028 1,018
0
200
400
600
800
1,000
1,200
1 2 3
Moab
Enrollment in Grand County leveled off in 2016
Sources: [2014] Plan Selections by ZIP code in the Health Insurance Marketplace; Date: 2014-09-01; 10/1/2013 thru 4/19/14; https://aspe.hhs.gov/plan-selections-zip-code-
health-insurance-marketplace-september-2014;
[2015B] ASPE 2015 Health Insurance Marketplace Plan Selections by ZIP Code; Date 2015-04-01; (Nov. 15, 2014 — Feb. 22, 2015);
http://aspe.hhs.gov/health/reports/2015/MarketPlaceEnrollment/EnrollmentByZip/rpt_EnrollmentByZip_Apr2015.cfm;
[2016] Addendum to the Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report; Date: 2016-03-11; For the period: November 1, 2015 –
February 1, 2016; https://aspe.hhs.gov/health-insurance-marketplaces-2016-open-enrollment-period-final-enrollment-report

8. County Arches customers
(2015)
Beaver 209
Box Elder 592
Cache 2,162
Carbon 719
Daggett 44
Davis 2,254
Duchesne 598
Emery 352
Garfield 244
Grand 885
Iron 1,078
Juab 425
Kane 353
Millard 321
Morgan 122
County Arches customers
(2015)
Rich 80
Salt Lake 7,333
San Juan 307
Sanpete 816
Sevier 731
Summit 1,050
Tooele 714
Uintah 1,160
Unknown 87
Utah 4,566
Utah 220
Wasatch 872
Washington 5,036
Wayne 90
Weber 1,231
The Oct. 2015 collapse of Arches hit Grand County hard

9. 2017: 13 Plans
1 plan
5 plans
5 plans
2 plans
0 plans
Sources: [2014] https://https://insurance.utah.gov/health/Health%20Refrom/ACA_Rate_Individual_20131007_OnExchange.pdf; [2015] Utah – On Exchange Rates (accurate
as of 10/15/14) https://insurance.utah.gov/health/Health%20Refrom/2015IndividualOnExchange20141016.pdf; [2016] www.hea;thcare.gov; See Plans and Premiums
(October 2015); [2017] 2017 Utah Individual Rates; Utah Dept. of Insurance ; version 2; 9/27/16
Altius Health Plans
Arches
BridgeSpan
Select Health
3 plans
12 plans
15 plans
10 plans
0 plans
Select Health (20)
2015: 53 Plans 2016: 20 Plans
Altius Health Plans
Arches
BridgeSpan
Select Health
2014: 40 Plans
Gold
Silver
Bronze
Catastrophic
Platinum
1 plan
5 plans
8 plans
6 plans
2 plans
2 plans
15plans
22 plans
15 plans
0 plans
2014-17 Individual Marketplace Comparison
Grand
County
Select Health (9)
University of Utah (4)

10. Sources: [2014] https://https://insurance.utah.gov/health/Health%20Refrom/ACA_Rate_Individual_20131007_OnExchange.pdf; [2015] Utah – On Exchange Rates (accurate
as of 10/15/14) https://insurance.utah.gov/health/Health%20Refrom/2015IndividualOnExchange20141016.pdf; [2016] www.hea;thcare.gov; See Plans and Premiums
(October 2015); [2017] 2017 Utah Individual Rates; Utah Dept. of Insurance ; version 2; 9/27/16
2014-17 Benchmark Silver Comparison
Grand
County
$167 $167
$221
$261
$0
$50
$100
$150
$200
$250
$300
2014 2015 2016 2017
Unsubsidized Benchmark Silver monthly premium
for 21-year, non-tobacco user (Grand Co.)

11. In 2017 95% of Utahns will have access to two or more
marketplace insurers – Grand Co. gained UofU Health Plans
Accessible
Insurers
Utah Population
(2014)
% of Utah
Population
(2014)
Molina;
SelectHealth; Univ.
of Utah Health
Plans
2,375,104 80.7%
SelectHealth; Univ.
of Utah Health
Plans
424,851 14.4%
SelectHealth 142,947 4.9%
3 insurers
2 insurers
1 insurer
+
+
+
+
+
+
++
+Gained one insurer in 2017

12. 84,601
140,612
175,637
-
50,000
100,000
150,000
200,000
250,000
10/31/13
11/30/13
12/31/13
01/31/14
02/28/14
03/31/14
04/30/14
05/31/14
06/30/14
07/31/14
08/31/14
09/30/14
10/31/14
11/30/14
12/31/14
01/31/15
02/28/15
03/31/15
04/30/15
05/31/15
06/30/15
07/31/15
08/31/15
09/30/15
10/31/15
11/30/15
12/31/15
01/31/16
02/29/16
03/31/16
04/30/16
05/31/16
06/30/16
07/31/16
08/31/16
09/30/16
10/31/16
11/30/16
12/31/16
01/31/17
Utah’s sign-ups on healthcare.gov reached 197,187 in 2017
[OE1-a] Health Insurance Marketplace: February EnrollmentReport (Oct. 1, 2013-March 1, 2014), http://aspe.hhs.gov/health/reports/2012/ACA-Research/index.cfm; [OE1-b] Health Insurance Marketplace: November EnrollmentReport (November 13, 2013), For the period: October 1, 20134 - November 2, 2013,
https://aspe.hhs.gov/sites/default/files/pdf/180496/rpt_enrollment.pdf[OE1-c]Health Insurance Marketplace: January Enrollment Report (January 13, 2014), For the period: October 1, 2013 – December 28, 2013, https://aspe.hhs.gov/sites/default/files/pdf/177611/ib_2014jan_enrollment.pdf[OE1-d]Health Insurance Marketplace: February
EnrollmentReport February 12, 2014), For the period: October 1, 2013 – February 1, 2014, https://aspe.hhs.gov/sites/default/files/pdf/177606/ib_2014feb_enrollament.pdf[OE1-e]Health Insurance Marketplace: March EnrollmentReport (March 11, 2014), For the period: October 1, 2013 – March 1, 2014,
https://aspe.hhs.gov/sites/default/files/pdf/76811/ib_2014Mar_enrollAddendum.pdf[OE1-f]Health Insurance Marketplace: SummaryEnrollmentReport: State Profile, (May 1, 2014), https://aspe.hhs.gov/sites/default/files/pdf/93806/ut.pdf
-----------
[OE2-a] Health Insurance Marketplace: December EnrollmentReport, (December 30, 2014), For the period: November 15, 2014 – December 15, 2014, https://aspe.hhs.gov/sites/default/files/pdf/77201/ib_2014Dec_enrollment.pdf[OE2-b] Health Insurance Marketplace: January EnrollmentReport, (January 27, 2015), For the period: November 15,
2014 – January 16, 2015, https://aspe.hhs.gov/sites/default/files/pdf/33826/ib_2015jan_enrollment.pdf[OE2-c]Health Insurance Marketplace: March EnrollmentReport, (March 10, 2015), For the period: November 15, 2014 – February 22, 2015, https://aspe.hhs.gov/sites/default/files/pdf/83656/ib_2015mar_enrollment.pdf; [OE2-d]State-Level
Data from the ASPE January Health Insurance MarketplaceEnrollmentReport For The 2016 Open EnrollmentPeriod; March 31, 2015 Effectuated EnrollmentSnapshot; 15-06-02; http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-06-02.html
-----------
[OE3-a] Health Insurance Marketplace: January EnrollmentReport, (January 7, 2016), For the period: November 1, 2015 – December 26, 2015, https://aspe.hhs.gov/sites/default/files/pdf/167981/MarketPlaceEnrollJan2016.pdf; [OE3-b] Health Insurance MarketplaceOpen EnrollmentSnapshot - Week 11; January 10, 2016 - January 16, 2016
(Released: 1/20/16); Health Insurance MarketplaceOpen EnrollmentSnapshot - Week 13 January 24, 2016-February1, 2016; https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-02-04.html; [OE3-c]Health Insurance Marketplaces 2016 Open EnrollmentPeriod: Final EnrollmentReport (March 11,
2016), For the period: November 1, 2015 – February 1, 2016,
https://aspe.hhs.gov/sites/default/files/pdf/187866/Finalenrollment2016.pdf; [OE3-d] March 31, 2016 EffectuatedEnrollmentSnapshot (Released: June 30, 2016), https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-06-30.html
----------
[OE4] - [2017 Final] Biweekly EnrollmentSnapshot; Weeks 12 through 14; Date 2017-02-03; Weeks 12-14; 11/1/16 thru 1/31/17; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-0203.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending; [2017] Biweekly EnrollmentSnapshot;
Date 2017-01-18; Weeks 10-11; 11/1/16 - 1/14/17; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-18.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending;[2016] Biweekly EnrollmentSnapshot; Date 2017-01-04; Weeks 8-9; 11/1/16 - 12/31/16; Link:
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-04.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending
197,187
Utah’s ACA
enrollment
grew 12.3%
in 2017

13. Rank State
2016 Open
Enrollment 3
(Final)
2017 Open
Enrollment 4
(Final)
Difference
(#)
Difference
(%)
1 Hawaii 14,564 18,938 4,374 30.0%
2 South Dakota 25,999 29,622 3,623 13.9%
3 Utah 175,637 197,187 21,550 12.3%
4 Oregon 147,109 155,430 8,321 5.7%
5 Wyoming 23,770 24,826 1,056 4.4%
6 New Jersey 288,573 295,067 6,494 2.3%
7 North Dakota 21,604 21,982 378 1.7%
8 Wisconsin 239,034 242,863 3,829 1.6%
9 Nevada 88,145 89,061 916 1.0%
10 Florida 1,742,819 1,760,025 17,206 1.0%
Utah’s marketplace enrollment increased 12.3% this year
Sources: [2017 Final] Biweekly Enrollment Snapshot; Weeks 12 through 14; Date 2017-02-03; Weeks 12-14; 11/1/16 thru 1/31/17; Link:
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-02-
03.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending; [2016 Final] Health Insurance Marketplace Open Enrollment Snapshot - Week 13; Date 2016-02-04;
Week 13; 11/1/15 thru 1/31/16; https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-02-04.html

14. Sources: [2017 Final] Biweekly Enrollment Snapshot; Weeks 12 through 14; Date 2017-02-03; Weeks 12-14; 11/1/16 thru 1/31/17; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-02
03.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending;[2017] Biweekly Enrollment Snapshot; Date 2017-01-18; Weeks 10-11; 11/1/16 - 1/14/17; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-
18.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending; [2016 Final] Health Insurance Marketplace Open Enrollment Snapshot - Week 13; Date 2016-02-04; Week 13; 11/1/15 thru 1/31/16; https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-
sheets-items/2016-02-04.html; [2016] Biweekly Enrollment Snapshot; Date 2017-01-04; Weeks 8-9; 11/1/16 - 12/31/16; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-
04.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending; [2015] Health Insurance Marketplace Open Enrollment Snapshot - Week 9; December 27, 2015 – January 2, 2016; Link: https://WWW.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-
items/2016-01-06.html; [OE3; 2016] Health Insurance Marketplace Open Enrollment Snapshot - Week 11; Date 2016-01-20; Weeks 10-11; 11/1/15 - 1/16/16; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-01-20.html; [2016]
Biweekly Enrollment Snapshot; Date 2017-01-04; Weeks 8-9; 11/1/16 - 12/31/16; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-04.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending; [2015] Health Insurance
Marketplace Open Enrollment Snapshot - Week 9; December 27, 2015 – January 2, 2016; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-01-06.html
43,071
35,534
34,637
8,565
16,014
43,390
54,806
41,245
2,812
8,282
0
10,000
20,000
30,000
40,000
50,000
60,000
Week 4 Week 6 Week 7 Week 9 Week 11 Week 13
OE 3 (2015-16)
OE 4 (2016-17)
President Trump
takes office
Bi-weekly
Enrollment Growth
in Covered Lives
Last-minute sign-ups in January 2017 were 55% lower
than in the previous year (2016)

15. In 2016, 13 of Utah’s top 20 ZIP codes for
ACA enrollment were outside of Salt Lake
County
Source: 2016 Health Insurance Marketplace Plan Selections by ZIP Code; (Nov. 1, 2015 — Jan. 9, 2016); https://aspe.hhs.gov/basic-report/plan-selections-zip-code-health-insurance-
marketplace-january-2016
RANK CITY SELECTIONS % INCREASE
1 Lehi (84043) 3,501 19%
2 South Jordan (84095) 3,346 12%
3 American Fork (84003) 2,948 17%
4 Pleasant Grove (84062) 2,931 20%
5 St. George (84790) 2,829 10%
6 St. George (84770) 2,742 11%
7 Draper (84020) 2,624 13%
8 Bountiful (84010) 2,455 5%
9 Spanish Fork (84660) 2,377 24%
10 West Valley City (84119) 2,368 3%
11 West Valley City (84120) 2,345 13%
12 Provo (84604) 2,289 22%
13 Herriman (84096) 2,276 20%
14 Clearfield (84015) 2,258 3%
15 Riverton (84065) 2,255 23%
16 Cottonwood Heights (84121) 2,254 6%
17 Orem (84058) 2,196 24%
18 Orem (84057) 2,193 16%
19 Ogden (84404) 2,189 1%
20 Layton (84041) 2,110 12%

16. After dropping rapidly from 2013-15,
the U.S. uninsured rate is leveling off
ACA Coverage Available
Source: Gallup Healthways Well-Being Index (Q4 2015)
U.S. Uninsured Rate by Quarter (2008-2015)

17. Source: [2015] U.S. Census: 2006-2015 American Community Survey 1-year estimates , S2701 (https://www.census.gov/programs-surveys/acs/)
[2014] www2.census.gov/programs-surveys/acs/tech_docs/accuracy/ACS_Accuracy_of_Data_2014.pdf
[2006-2013] http://www.census.gov/did/www/sahie/data/interactive/sahie.html
The latest U.S. Census data shows a 16% drop in the
Utah’s uninsured rate between 2014-15
16.7%
15.7%
16.3%
15.9%
16.7%
16.6%
15.7%
14.0%
12.5%
10.5%
8%
9%
10%
11%
12%
13%
14%
15%
16%
17%
18%
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
16%
ACA Coverage Available

18. In Utah, the uninsured rate for people earing over
200% of poverty has declined the most
Source: [2015] U.S. Census: 2006-2015 American Community Survey 1-year estimates , S2701 (https://www.census.gov/programs-surveys/acs/)
[2014] www2.census.gov/programs-surveys/acs/tech_docs/accuracy/ACS_Accuracy_of_Data_2014.pdf
[2006-2013] http://www.census.gov/did/www/sahie/data/interactive/sahie.html
-28% -30%-25%
Utah Uninsured Rate by Income Level (2009-2015)

19. Source: U.S. Census Bureau, 2015 American Community Survey 1-Year Estimates
American Indians and Hispanics experience the
highest rates of being uninsured in Utah
7.1%
10.8%
13.4% 14.1%
22.5%
26.8%
32.8%
36.0%
0%
5%
10%
15%
20%
25%
30%
35%
40%
White alone,
not Hispanic
or Latino
Two or more
races
Black or
African
American
alone
Asian alone Native
Hawaiian and
Other Pacific
Islander alone
Hispanic or
Latino (of any
race)
Some other
race alone
American
Indian and
Alaska Native
alone
Utah average: 10.5%

20. 0% 101% 400%100%
Who is eligible for premium subsidies?
Income as % of the Federal Poverty Level (FPL)
NO YES
70,000
Utahns
in the Gap

21. Sliding-scale subsidies make insurance more affordable
The 2016 FPL guidelines are applied to the 2017 Marketplace plans.
These guidelines only apply to the Lower 48 States (Alaska and Hawaii have their own guidelines).
Source: Link: http://familiesusa.org/product/federal-poverty-guidelines
For 2017, a family of four can earn about $97,000
a year and receive a premium subsidy
If your income/family size is on this chart, you qualify for a subsidy

22. The Hernandez Family
Residence: Moab, Utah
Ages:
Dad : 33
Mom: 29
Kids: 11, 7
Annual income: $26,000
% of poverty level: 109%
Monthly premium: $725
Subsidy pays: $665 per month
The Hernandez’s pay: $60 per month
Primary doctor: $10
Specialist doctor: $15
Emergency room care: $100
Generic drugs: $10
Plan
Details
Deductible: $200
Out-of-pocket maximum: $2,000
Source: https://www.healthcare.gov/see-plans/; Image source: Moodboard
How much does
the Hernandez
family pay for
health insurance?
Kids on
Medicaid
Benchmark
Silver plan
Parent-only
coverage

23. Annual income: $29,000
% of poverty level: 246%
Monthly premium: $362
Subsidy pays: $161 per month
Jill pays: $201 per month
Primary doctor: $35
Specialist doctor: $60
Emergency room care: $500
Generic drugs: $15
Plan
Details
Deductible: $1,300
Out-of-pocket maximum: $5,100
Source: https://www.healthcare.gov/see-plans/; Image source: http://www.tourplicity.com
How much does
Jill pay for health
insurance?
Benchmark
Silver plan
Cheapest
Bronze plan is
$123/month
with $5,700
deductible
Jill
Residence: Moab, Utah
Age: 35

24. Annual income: $44,000
% of poverty level: 220%
Monthly premium: $808
Subsidy pays: $531 per month
The Shumway’s pay: $277 per month
Primary doctor: $35
Specialist doctor: $60
Emergency room care: $500
Generic drugs: $15
Plan
Details
Deductible: $2,600
Out-of-pocket maximum: $10,200
Source: https://www.healthcare.gov/see-plans/; Image source: Moodboard
How much does
the Shumway
family pay for
health insurance?
Benchmark
Silver Plan
(5 Silver plans
available)
Cheapest
Bronze plan is
$105/month
with $11,400
deductible
The Shumway Family
Residence: Castle Valley, UT
Ages:
Dad : 24
Mom: 23
Kid: Newborn

25. Annual income: $42,000
% of poverty level: 263%
Monthly premium: $1,566
Subsidy pays: $1,231 / month
The Smith’s pay: $335 per month
Primary doctor: $35
Specialist doctor: $60
Emergency room care: $600
Generic drugs: $15
Plan
Details
Deductible: $3,000
Out-of-pocket maximum: $14,300
Source: https://www.healthcare.gov/see-plans/; Image source: Moodboard
How much do
the Smith’s pay
for health
insurance?
Benchmark
Silver plan
Covers 5
doctors in
Moab area
(Drs. Andrew,
Munger, Quinn,
Stevens, K. Williams,
K. Williams)
The Smiths
Residence: Moab, UT
Ages: 62, 60

26. Annual income: $135,000
% of poverty level: 556%
Monthly premium: $1,215
Subsidy pays: $0 per month
The Simonsens’ pay: $1,215 per month
Primary doctor: $35
Specialist doctor: $60
Emergency room care: $600
Generic drugs: $15
Plan
Details
Deductible: $3,000
Out-of-pocket maximum: $14,300
Source: https://www.healthcare.gov/see-plans/; Image source: Moodboard
How much do
the Simonsen’s
pay for health
insurance?
Benchmark
Silver plan
Benchmark
premium
increased 15%
($150) from
2016
The Simonsen Family
Residence: Moab, Utah
Ages:
Dad : 44
Mom: 35
Kids: 11, 7

27. Annual income: $21,000
% of poverty level: 86%
Monthly premium: $1,139
Subsidy pays: $0 / month
The Phillips’ pay: $1,139 / month
Primary doctor: $35
Specialist doctor: $60
Emergency room care: $600
Generic drugs: $15
Plan
Details
Deductible: $3,000
Out-of-pocket maximum: $14,300
Source: https://www.healthcare.gov/see-plans/; Image source: Moodboard
How much do
the Phillip’s pay
for health
insurance?
Kids covered
by Medicaid
Parents are
caught in the
Utah Medicaid
Coverage Gap
The Phillips Family
Residence: Moab, Utah
Ages:
Dad : 35
Mom: 33
Kids: 11, 7

28. Utah has the nation’s highest percentage (25%)
of children enrolled in ACA coverage
Age
37 FFM* states
10%
10%
16%
16%
20%
27%
1%
25%
12%
19%
16%
12%
15%
< 18
Age 18-25
Age 26-34
Age 35-44
Age 45-54
Age 55-64
Age 65+
56% of Utah
enrollees are
under age 34
Source: Health Insurance Marketplaces 2017 Open Enrollment Period: January Enrollment Report; Date: 1/10/17; For period 11/1/16 to 12/24/16; Weeks 8-9; Link:
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-10.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending
Utah
(*) FFM stands for
Federally-managed
marketplace
(healthcare.gov)

29. 85% of Utahns enrolling on healthcare.gov received a
premium subsidy
No subsidy
Received subsidy
Subsidy Status
85%
15%
83%
17%
Source: Health Insurance Marketplaces 2017 Open Enrollment Period: January Enrollment Report; Date: 1/10/17; For period 11/1/16 to 12/24/16; Weeks 8-9; Link:
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-10.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending
Utah
37 FFM states

30. Most Utahns choose Silver-level plans that offer a
balance between premiums and cost-sharing
24%
73%
3%
21%
74%
4% 1%
Bronze
Silver
Gold
Catastrophic
Subsidy Status
Source: Health Insurance Marketplaces 2017 Open Enrollment Period: January Enrollment Report; Date: 1/10/17; For period 11/1/16 to 12/24/16; Weeks 8-9; Link:
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-10.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending
Utah
37 FFM states

31. Most ACA enrollment in Utah is in urban ZIP codes
Urban areas
Rural areas
Geography
Source: Health Insurance Marketplaces 2017 Open Enrollment Period: January Enrollment Report; Date: 1/10/17; For period 11/1/16 to 12/24/16; Weeks 8-9; Link:
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-10.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending
15%
85%
18%
82%
Utah
37 FFM states

32. ACA subsidies cover 69% of average monthly
premiums for Utah enrollees
Impact of monthly subsidies on
ACA insurance premiums
$187
$84
(69%)
(31%)
Utah
Average
Monthly
Premium:
$271
Subsidy
Amount
Consumer
Cost
Subsidy Impact
Source: Addendum to the Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report; For the period: November 1, 2015 – February 1, 2016
https://aspe.hhs.gov/health-insurance-marketplaces-2016-open-enrollment-period-final-enrollment-report; Released: March 11, 2016
Utah
37 FFM states
$290
(73%)
$106
(27%)

33. 72% of Utah’s ACA enrollment earns below
250% of the poverty level
Source: Health Insurance Marketplaces 2017 Open Enrollment Period: January Enrollment Report; Date: 1/10/17; For period 11/1/16 to 12/24/16; Weeks 8-9; Link:
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-10.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending
31%
22%
19%
9%
8%
34%
22%
14%
8%
9%
100% to 150%
151% to 200%
201% to 250%
251% to 300%
Poverty Level
301% to 400%
Utah
37 FFM states

34. Over half of re-enrolling marketplace consumers
in Utah switched plans in 2016
Origin of Utah
ACA enrollment
Active vs. Auto status for
re-enrollments
Newly enrolled
Re-enrolled
23%
77%
Source: Health Insurance Marketplaces 2017 Open Enrollment Period: January Enrollment Report; Date: 1/10/17; For period 11/1/16 to 12/24/16; Weeks 8-9; Link:
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-10.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending
56%
21%
Active re-enrollment
Auto re-enrollment

35. The Affordable Care Act, also called
Obamacare, is going to be repealed and
replaced in the near future.

36. DECEMBER16
The latest health insurance calendar
Next Open Enrollment: Nov. 1, 2017 -- Dec. 15, 2017
Open
Enrollment
Open
Enrollment
Special
Enrollment
2017
FEBRUARY 1 NOVEMBER 1OCTOBER 31JANUARY 31
JANUARY1
DECEMBER16
Open
Enrollment
Special
Enrollment
2018 (proposed)
FEBRUARY 1 NOVEMBER 1OCTOBER 31
JANUARY1
45 days (proposed)

37. How can ACA insurance premiums vary?
(in billions)
1) Age (new ratio of 3:1)
2) Tobacco use (ratio of 1.5:1)
3) Geography (by counties)
Area 1: Cache and Rich
Area 2: Box Elder, Morgan, and Weber
Area 3: Davis, Salt Lake, Summit, Tooele, and Wasatch
Area 4: Utah
Area 5: Iron and Washington
Area 6: Beaver, Carbon, Daggett, Duchesne, Emery,
Garfield, Grand, Juab, Kane, Millard, Piute, San Juan,
Sanpete, Sevier, Uintah, and Wayne

38. (in billions)
1) Age (new ratio of 5:1)
2) Tobacco use (ratio of 1.5:1)
3) Geography (by counties)
4) Gender (women pay more)
5) Health history (higher premiums
for pre-existing conditions)
After Repeal

39. How the ACA changed healthcare
(as we know it)
Adults
under age 26
can stay on
their parents
insurance
plan
Men and women pay
the same for coverage
Insurance offers free preventative care like blood
pressure checks, flu shots, and health screenings
No one can be denied or
priced out of coverage for a
pre-existing condition
No lifetime caps on
insurance payments
2010 2013
18.4%
29.0% Utah Uninsured
Rate
Ages 18-26:
Source: Utah DOH

40. Adults
under age 26
can stay on
their parents
insurance
plan
Men and women pay
the same for coverage
Insurance offers free preventative care like blood
pressure checks, flu shots, and health screenings
No one can be denied or
priced out of coverage for a
pre-existing condition
No lifetime caps on
insurance payments
2010 2013
18.4%
29.0% Utah Uninsured
Rate
Ages 18-26:
Source: Utah DOH
After Repeal

41. All plans will have essential benefits
1. Ambulatory (ie. out-patient) services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services,
including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease
management
10. Pediatric services, including dental and vision care
Source: http://cciio.cms.gov/resources/factsheets/ehb-2-20-2013.html
Adult dental and vision can be purchased as extras

42. No plans will have essential benefits
After Repeal
In January 2017, Rep. Steve
Drazkowski, a state legislator
from Minnesota, proposed an
amendment that would have
allowed insurers to omit any or
all of 68 coverage areas
mandated under the federal
Affordable Care Act. The
amendment was removed
during a conference committee.
Source: ”Drazkowski "Pick Sicks" amendment stripped from MN health care insurance premium relief bill,” Bluestate Prairie;
http://www.bluestemprairie.com/bluestemprairie/2017/01/drazkowski-pick-six-amendment-stripped-from-mn-health-care-insurance-premium-relief-bill.html

43. What is the ACA marketplace like?

44. After Repeal

45. What are the penalties
for remaining uninsured in 2017?
$695 per adult
$347.50 per child
Up to $2,085
per household*
…or 2.5%
of adjusted
gross
income**
(*) Flat fee is adjusted for inflation after 2016
(**) Gross income minus
the filing threshold
Which-ever is higher…

46. $695 per adult
$347.50 per child
Up to $2,085
per household*
…or 2.5%
of adjusted
gross
income**
(*) Flat fee is adjusted for inflation after 2016
(**) Gross income minus
the filing threshold
The new administration could eliminate the
individual mandate/fine in 2017… …as well as the
employer mandate
After Repeal

47. • Insurers will exclude benefits and charge higher premiums
for some people with pre-existing conditions
• Annual and lifetime payment caps will come back
• High-risk pools will return to cover the uninsurable
• Women will be charged higher premiums than men
• Premiums will increase for people over age 40
• Caps on high-deductible plans will be lifted
• Essential health benefits will be eliminated
• Premium tax credits likely will be based on age, not income
or family size
Individual market insurance after the ACA…

48. Stopping discrimination against pre-existing
conditions requires an insurance mandate and
premium subsidies

49. Remove the mandate to purchase insurance, and
the whole system collapses

50. Discrimination against pre-existing conditions is
common to all ACA replacement plans
Rep. Tom Price
H.R. 2300 “Empowering Patients First Act”
Page 151
Speaker Paul Ryan
“A Better Way Plan”
Page 20

51. Utah newspaper headlines from 2010…. or 2018?

52. All ACA replacement plans include exclusion
periods for pre-existing conditions if continuous
coverage is not maintained

53. Consumers
will be
caught by
trapdoors
and fine
print

54. Annual and lifetime caps on insurance
benefits will return for many plans

55. Insurers will review medical records for evidence
of pre-existing conditions

56. Speaker Paul Ryan
“A Better Way Plan”
Page 21
High-risk pools are only needed if consumers are
denied or priced out of insurance coverage
because of pre-existing conditions

57. Real premiums for different age groups
Repealing the ACA will double the insurance costs
for the Shumway family….
Source: healthcare.gov; “See Plans and Premiums;” Salt Lake County, identical family size and ages; accessed 2/3/17
Many low and middle-income Utah families
will pay more for insurance if the ACA is repealed

58. Income
(annual)
$120,000
$120,000
Premium
(monthly)
[annual
$936
[$11,232]
$800
[$9,600]
-15%
Deductible
(annual)
$3,000
$6,000
+100%
Out-of-
Pocket Max
(annual)
$14,300
$10,000
-14%
Total Cost
(premiums
+ max)
$25,632
$19,600
-23%
Total Cost
minus tax
credit
$25,632
$11,200
-56%
Total
Cost as %
Income
21%
9.3%
-55%
Premium
Subsidy
(annual)
None
$6,000
Source: healthcare.gov; “See Plans and Premiums;” Salt Lake County, identical family size and ages; accessed 2/3/17
ACA
Replace
Plan
(H.R. 2300)
Repealing the ACA will cut insurance costs
for the Simonsen family by 50%….
The Simonsens| Family of 4
Yet, higher-income Utah families will pay less
for insurance if the ACA is repealed
Difference between Plans

59. • Allow health plans to expand the age ratio from 3:1 to 3.49:1, letting
insurers increase premiums for older customers
• Cut the 2018 enrollment period in half by ending it on December 15
rather than January 31 (start date would remain November 1)
• Require extra documentation to prove special enrollment applicants are
eligible before coverage takes effect
• Allow insurers more wiggle room on plan actuarial values so that Silver
plan cover 66%of medical costs—2% less than now.
• Tightens rules around the 90-day-grace period for enrollees who stop
paying premiums.
Trump administration weighs Obamacare
changes sought by insurers
February 6, 2017
By Dan Diamond, Jennifer Haberkorn, and Paul Demko
Source: Trump administration weighs Obamacare changes sought by insurers; 2/6/17; http://www.politico.com/story/2017/02/trump-obamacare-insurance-
companies-234707

60. Timeline* for ACA Repeal and Replace
(*) Absolutely going to change.
March/April
2017:
April/May
2017:
Initial House votes on repeal legislation
using budget reconciliation process
(avoiding Senate filibuster). Yet Senate
wants to slow down this time-table
Insurers start to file rates and
intentions for 2018 marketplace—
must have assurances on risk pools
Statement by President Trump on 2/5
about his slower timeline for ACA
repeal—hints at plan to “repeal now,
replace later”
“…by the end of
the year, at least
the rudiments…"

61. Ways to Repair the ACA
• Fix the “family glitch” so that family members priced out of
employer-based coverage can get subsidies to purchase
marketplace insurance
• Add tax credits for consumers on individual market earning
above 400% of poverty level
• Increase contribution amounts to health savings accounts (HSAs)
• Create “Copper Plan” with high deductibles, low premiums, and
open to all consumers regardless of age, income
• Allow more small business “association health plans” sponsored
by business and professional organizations
• Allow Medicare to negotiate for prescription drugs
• Allow insurers to sell policies across state lines (mostly harmless)

62. Proposal by Speaker Paul Ryan
Free preventive screenings: none.
Essential health benefits: none. Tax penalty: none.
A Better Way
Our Vision for a Confident America
There will be a cap on the
pre-tax value of job-based
insurance. Pre-tax
contributions to an HSA will
be excluded.
5:1 instead of 3:1, but
states have the power to
choose.
Women will once again be
charged more for health
insurance than men.
1) Pre-existing
conditions
2) High risk
pools
3) Employee
contribution
4) Age ratio
5) Women vs.
men
Cannot be turned away due
to illness. Patient protection
for those who maintain
continuous coverage. But, if
there is a lapse in coverage
(likely 62 days), you can be
charged above standard rates.
$25 billion of federal funding
allocated to “robust” high risk
pools. Premiums will be
capped and wait lists
prohibited.
1

63. State insurer boundaries: none. Deductible caps: none.
Healthcare.gov: none.
Young adults will be
covered on their parent’s
plan until 26 years, but
states will have the
authority to change this.
States can choose to
receive block grant
funding or default into a
per capita allotment.
Effective 2019.
6) Open
enrollment
7) Tax credits
8) Coverage
until 26
9) Medicaid
There will be a one-time open
enrollment for the uninsured
to join the health care market.
If you “choose” not to enroll,
you will lose “continuous
coverage protection.
Universal advanceable,
refundable tax credits that
will be fixed by age. Anyone
not offered job-based
coverage, Medicare, or
Medicaid can receive credits.
A Better Way
Our Vision for a Confident America
2
Proposal by Speaker Paul Ryan

64. Proposal by Rep. Tom Price
Free preventive screenings: none.
Essential health benefits: none. Tax penalty: none.
H.R. 2300
Empowering Patients First Act
Employer exclusions of
health care coverage
allowed up to $20,000 per
family and $8,000 per
individual. Funds exceeding
these limits will be taxed.
States will determine their
age ratio.
1) Pre-existing
conditions
2) High risk
pools
3) Employee
contribution
4) Age ratio
Insurers could impose 18-
month waiting periods on pre-
existing conditions with a 6-
month look-back window, or
impose a premium surcharge
up to 150% of the standard
premium if pre-existing
conditions are not excluded.
$1 billion of federal funding
allocated to high
risk/reinsurance pools.
Effective 10-1-2018.
1

65. State boundaries: none | Deductible caps: none |
Healthcare.gov: none
Women will once again
be charged more for
health insurance than
men.
Medicaid expansion will
be eliminated. More tbd.
5) Tax credits
6) Coverage
until 26
7) Women vs.
men
8) Medicaid
Fixed credits based on age.
Tax incentives for
maintaining health coverage.
Available only to US citizens
and lawful permanent
residents.
States have the authority to
determine the age by which
young adults can remain on
their parents plan.
H.R. 2300
Empowering Patients First Act
2
Proposal by Rep. Tom Price

66. Empowering Patients First Act
Annual tax credit break down
$900 per child up to age 18
$1,200 for ages 18 to 35
$2,100 for ages 35 to 50
$3,000 for ages 50+
*maximum amount allotted per person per year

67. ACA Replacements side by side
A Better Way Empowering Patients First
Medicaid
Source: A Better Way our Vision for a Confident America and Empowering Patients First Act (H.R. 2300)
Pre-existing
conditions
High Risk Pools
Tax credits
Open
enrollment
Employee
Contributions
Tax penalty
Free preventive
care
One-time open enrollment. If you “choose” not to
enroll, you will lose “continuous coverage protection”
Cap the pre-taxable amount for job-based coverage
Fixed credit based on age. Universal advanceable,
refundable tax credit.
“Robust” high risk pools -$25 billion federal
funding. Premium caps, no wait lists
Patients protected if they maintain continuous
coverage
None
None
Waiting period up to 18 months, or 150% surcharge
High-risk/reinsurance pools -$1 billion federal funding
TBD
Employer exclusion allowed to $8K/$20K, any funds
above are taxable
Tax incentives for maintaining coverage, fixed amount
based on age.
None
None
States decide: block grant or per capita allotment Medicaid expansion eliminated

68. Rep. Jason Chaffetz
UT-3
WASHINGTON, DC
2236 Rayburn House
Office Building
Washington, DC 20515
Phone: (202) 225-7751
Hours: M-F 9AM-6PM EST
PROVO
51 S University Ave.
Suite 318
Provo, UT 84601
Phone: (801) 851-2500
Get Involved….

69. Download this presentation
http://www.slideshare.net/UHPP
Share/health-reform-201

70. Eric Armstrong
Navigator
Utah Health Policy Project
801-599-2768
eric@healthpolicyproject.orgs
Luis Rios
Navigator
Utah Health Policy Project
801.433.2299 x26
luis@healthpolicyproject.org
Got Questions?

71. What ACA enrollment looks like

72. Window-shop for insurance now…
https://www.healthcare.gov/see-plans

73. What is a Qualifying Life Event?
….that triggers a Special Enrollment Period

74. Who are the helpers?
Navigator
Certified Application
Counselor
Experts trained to help others evaluate their
insurance options on the new insurance marketplace.
Image: Paramount Pictures Corporation

75. www.takecareutah.org | call 2-1-1
TCU’s trained counselors are ready to help you
understand your new options to find affordable
health care coverage today
Where can Utahns find help
applying for health insurance?