Modifiable.coverage.gap.presentation
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This document discusses Georgia's coverage gap under the Affordable Care Act and the opportunity to close it. Georgia currently has over 300,000 residents who fall into the coverage gap because they earn too much to qualify for Medicaid but not enough to qualify for subsidies on the exchange. Closing the gap would provide affordable health care access for these residents. It would also benefit the economy, health care industry, and workforce by creating jobs and new economic activity. Studies of other states that have expanded Medicaid found budget savings, reduced uncompensated care costs, and improved health outcomes.
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Modifiable.coverage.gap.presentation
- 1. Georgia’s Coverage Gap Your name Title Organization
- 2. Introduction slide • Organization name and logo. • Other important org. info. • Member of Cover Georgia coalition
- 3. Pathways to Coverage under the ACA Employer-based coverage Individual/non-group (healthcare.gov) (Coverage Gap) Public health insurance coverage Medicare Medicaid TriCare (Veterans) Kids: PeachCare/Medicaid People who qualify for Medicaid: •Children (up to age 19) •Women who: •Are pregnant •Have breast, cervical cancer •Low to mid-income •Aged, blind, disabled (very low income) •Very low-income parents (Ex: must earn less than $5500/year for family of three) •People in long-term care (nursing homes)
- 5. An example FYI Federal Poverty Line (FPL)— a measure of income set by US Dept. of Health & Human Services. Used to determine a person’s eligibility for certain programs and benefits
- 6. Family Size Annual Income 1 $11,770 2 $15,930 3 $20,090 4 $24,250 100% Federal Poverty Line 2015 Low-wage workers Construction workers, restaurant servers, retail workers, child care providers Parents Working parents who make 39% FPL and 100% FPL Non-working parents who make 30% FPL to 100% FPL Veterans 20,000 Georgia veterans + 4000 spouses Childless adults who earn less than 100% FPL Source: http://www.urban.org/uploadedpdf/412775- Uninsured-Veterans-and-Family- Members.pdf
- 7. An opportunity for Georgia
- 8. The economics of closing the coverage gap • Georgia can easily cover its share of the costs • State savings & new revenue will offset new spending • “Use it or lose it” • Georgia can opt out at any time Total 4 year costs $575 million Total 4 year revenue $700 million Source Cost estimates: Tim Sweeney, Georgia Budget & Policy Institute
- 9. Other states have closed their gaps
- 10. Expansion • Uninsured rates down 37.7% 1 • Hospitals saved $4.2 billion (2014)2 • Improved health outcomes, especially among older adults, racial/ethnic minorities, and residents of poorer counties3 • State budget savings Non-expansion • Uninsured rates dropped only 9% 1 • Hospitals saved $1.5 billion (2014) 2 • No state budget savings Other states have closed their gaps Sources: 1. http://hrms.urban.org/briefs/taking-stock-at-mid-year.html 2. Dept. of HHS, http://www.hhs.gov/news/press/2014pres/09/20140924a.html 3. New England Journal of Medicine http://www.nejm.org/doi/full/10.1056/NEJMsa1202099#t=articleResu lts
- 11. State budget savings & revenue gains AR $153 M KY $109 M MI $468 M CO $307 M WA $464 M OR $275 M Source: Manatt Health Solutions, States Expanding Medicaid See Significant Budget Savings and Revenue Gains Key sources of savings
- 12. When Georgia closes its coverage gap… People • Affordable health care access for 300,000 Georgians • Financial, health peace of mind Economy • $8 billion per year in new economic activity • $220 million per year in new tax revenue Health Care Industry • $3 billion in federal money annually • Reduce uncompensated care costs for all hospitals • Help to stabilize failing rural hospitals Workforce • 56,000 new jobs created Source: Dr. William Custer, Economic Impact of Medicaid Expansion in Georgia
- 13. What can you do? Now! Sign a postcard to your legislators • Online at: surveymonkey.com/s/closethecoveragegap Share your coverage gap story • Include email address here about where to send coverage gap stories. Can use info@healthyfuturega.org if you’d like. Add your organization’s name to our list of supporters
- 14. Name Contact info Stay in touch! Web address Facebook: Twitter: #coverga
Editor's Notes
- Add your organization’s logo here and talk about who you are and what your organization does. Audience wants to know who they are listening to and what their motivations are. “Our organization is part of a coalition called Cover Georgia, which works to close Georgia’s coverage gap through public education, policy maker engagement, and advocacy.”
- ACA was developed with the spirit of “everyone is eligible for something”. The way that the ACA was crafted, created three pathways to coverage for everyone. Employer-based coverage—this is offered to employees by their companies. Employers pay part of the cost and employees pay the other part. Individual/non-group coverage—this insurance is available to people who do not get employer coverage or want additional coverage that their employer doesn’t offer. Most people get their individual coverage from the new Obamacare health insurance exchanges, which can also be called “healthcare.gov” or the “Health Insurance Marketplace”. People with low to middle incomes can get financial assistance through the marketplace to help them afford their premiums and other insurance costs. Public insurance—Public insurance like Medicare and Medicaid are offered to certain groups of people. Medicare is for adults above the age of 65. Medicaid has traditionally provided health care coverage for children, low-income adults who are aged, blind, or disabled, low to middle income pregnant women, women with breast or cervical cancer diagnoses, and very low-income parents. Georgia’s Medicaid guidelines are very narrow. For example, a parent with one child would need to make less than $5500 per year to qualify for coverage. If you are an adult without children, you cannot qualify for Medicaid at all unless you are diagnosed with breast or cervical cancer, become pregnant, or become disabled or blind. As you can see on the slide, there’s a fourth box, but I said three pathways to coverage… *Note: Feel free to substitute this person with a better representation of your constituency or the audience you’re presenting to.
- “Around 300,000 Georgians fall into the ‘coverage gap.’ This means their incomes are too low to qualify for tax credits through HealthCare.gov and they do not qualify for Medicaid (remember how narrow the Medicaid eligibility requirements are) . They are stuck in the middle with no affordable insurance options. The coverage gap exists because the Governor and our State Legislature will not accept federal tax dollars that were set aside to help uninsured families in Georgia afford coverage. The Affordable Care Act intended to bridge this gap by extending coverage to these people, but the Supreme Court ruled that this was optional for states. Our state has refused to help those in the gap”
- Here’s an example of how the coverage gap works in real life: Jan works part-time at a store like Target, Walmart, or TJ Maxx. Maybe she works part-time because she’s helping take care of her young grandchild while her daughter works full-time, or maybe she can’t find a full-time job in her field right now, or maybe she’s caring for an aging parent, or she works in a rural community with no real job options. She earns less than $9000 per year, which puts her at 77% of the federal poverty line. Her health care coverage would cost her about $8500 for the year, which is 96% of her salary. She would not be covered by Medicaid in Georgia and she can’t get financial assistance to buy health insurance coverage from healthcare.gov. Jan is in the coverage gap. John is the same age as Jan and works as a manager at a hardware store like Home Depot or Ace. He makes $25,000 per year, which is above 200% FPL. His health care coverage will cost the same as Jan’s (because they are the same age and live in the same area). John will get financial assistance to help him afford his premiums, which reduces the cost of his insurance to less than 7% of his income.
- “When we talk about people in the coverage gap, we are talking about working families. More than half of Georgians in the coverage gap work full or part-time. Many are working low-wage jobs that do not offer health insurance benefits, like construction, food service, and child care. The people in the gap are working parents making about $5000 to $11,770 annually, any childless adult, like recent college graduates, making less than $12,000, and many of Georgia’s veterans who can’t get care at the VA.” *Note: Add in a statistic/comment about how this relates to your organization. (Ex: It’s estimated that 25% of those in the coverage gap have a manageable mental health condition that is currently going untreated.)
- “Georgia has an opportunity to use federal dollars to help these uninsured, low-income Georgians between the ages 19 and 64 get health insurance. This opportunity is funded by money that was set aside by the Affordable Care Act. Georgia has the option to offer affordable health coverage to the 300,000 Georgians who do not get insurance through their jobs, cannot afford it on their own, and do not currently qualify for Medicaid. This would help Georgia by reducing the number of uninsured using hospital emergency rooms, and bringing $6.5 billion in economic benefits to GA, including 50,000 new jobs. This coverage will be paid for with 100% federal dollars through 2016. After 2016, the federal government will pay at least 90% of the costs going forward.
- All of that sounds great, but how can Georgia pay for this? Here are the economics of closing the coverage gap. State share can be paid for easily--at any point in the future, GA will only have to pay for 10% of the costs of covering those who are currently in the gap. GA can pay for this with an increase in our state’s tobacco tax (the 48th lowest in the country); other states have instituted a tax on hospitals to cover the costs. State budget savings and new revenue—closing GA’s coverage gap is cost-neutral for our state. The federal govt. will contribute at least 90% of the costs of covering those who are eligible. According to a study by GA State University economist, Bill Custer, would generate $220 million per year in new state and local tax revenue, which would offset much, if not all, new state expenditures to cover those who are currently in the gap. By closing it’s coverage gap, the state can expect to see budget savings because the federal dollars will pay for things currently being paid for by state dollars. “Use it or lose it”--The federal govt. has set aside it’s share of the money to close the coverage gap as part of the Affordable Care Act. If Georgia does not use it’s portion of that money, the federal govt. keeps it. Georgia taxes stay in Washington, rather than coming back to the state. Georgia can opt out—We have every reason to believe that the federal govt. will pay for its portion of this program, just as it has done for Medicaid and Medicare for the past 50 years. If for some reason, they do not hold up their end of the bargain, the state can opt out at any time. Other states have built a “sunset provision” into their coverage gap bills to ensure this protection remains. If asked, here is some extra info. about how costs and revenues were calculated: Annual spending FY2016 = $0 By FY2019 increased to $250 million per year Revenues produced from: Insurance premium tax $75 million annually State sales and income tax
- 29 states and Washington, D.C. have all closed their coverage gaps. That means we have a lot of great information about how this affects the uninsured, state budgets, and the health care industry.
- States have been implementing Medicaid expansion since the beginning of 2014. The data that is available so far paints very positive picture in favor of closing the coverage gap: Uninsured rates dropping faster in expansion states vs. non-expansion states. This data is from July 2014. We expect the uninsured rate in both sets of states to keep falling, but the expansion state rate is expected to drop much faster. Hospital savings--Because of ACA, hospitals are estimated to have saved a large amount of money from uncompensated care costs, meaning costs that come from uninsured patients who cannot pay for their care in 2014. Expansion states: $4.2 billion (74% of savings). $1.5 billion (26%) of savings. (Data is from Sept. 2014. At that time, 28 states had expanded, 22 had not.) Improved health outcomes—a study published in the New England Journal of Medicine looked at 3 states that had expanded their Medicaid programs before the ACA was implemented. They compared the health of people in the expanded states to similar people in neighboring states without expansions. - Reduced deaths, especially among older adults, nonwhites, and residents of poorer counties - Increased self-reported health status of “excellent” or “very good” from participants in expansion states - Decreased rate of delays in seeking medical care because of cost in expansion states - Medicaid enrollees more likely to have a usual source of care than their uninsured counterparts Consistent with preliminary results of a randomized, controlled trial of Medicaid in Oregon States that have expanded are seeing budget savings….more on next slide
- A recent compilation of state savings estimates shows that several states have already booked budgetary savings and have seen revenue gains as a result of closing their coverage gaps. These dollar figures demonstrate the total revenue and savings in the first 1.5 years of implementation (FY2014 and FY2015). If asked for further detail: Savings and revenues fall into three major categories: 1. State savings from accessing enhanced federal matching funds--With expansion, many individuals who were previously eligible for Medicaid under pre-ACA eligibility categories are now eligible for full Medicaid coverage in the new adult group—which means the state will receive enhanced federal funding (100 percent in 2015 and 2016, phasing down to 90 percent in 2020 and beyond) for providing full Medicaid benefits to these populations. Seven out of eight states highlighted in this report projected savings in this category; savings totaled between $4 million (West Virginia) and $342 million (Washington) through 2015. 2. State savings from replacing general funds with federal Medicaid funds--Historically, many states have supported programs and services for the uninsured—mental and behavioral health programs, public health programs, and health care services for prisoners—with state general fund dollars. With expansion, many of the beneficiaries of these programs and services are able to secure Medicaid coverage in the new adult category, which means states can fund these services with federal—not state—dollars. Five of the states in this report identified savings due to new federal Medicaid funds; savings totaled between $20 million (Colorado) and $389 million (Michigan) through 2015. 3. Revenue gains from existing taxes or fees on insurers and health care providers--As provider and health plan revenues increase with expansion, this translates into additional revenue for states. Four states in this report identified revenue gains due to expansion, totaling between $26 million (Michigan) and $60 million (New Mexico) through SFY or CY 2015. *Note: This slide is only necessary for an audience that is conservative, business-focused, or otherwise motivated by economics. It is not necessary for those from faith communities, health & human services advocates, or more liberal audiences.
- Our state has a lot to gain from closing the coverage gap, according to the Georgia State University health economist, Dr. Bill Custer: 500,000 Georgians will have access to affordable health care coverage The economy will see an estimated $8 billion per year in new economic activity, which will result in about $220 million in new tax revenue per year. The health care industry will benefit from the increase in insured patients, reducing the costs of caring for patients who were previously uninsured. Rural hospital in particular could be strengthened and supported by this investment. More than 50,000 new jobs will be created in industries like health care, real estate, restaurants and hospitality, and construction.
- Our state policy makers have the ability to close Georgia’s coverage gap, but they have so far refused to address the issue. We need your support to move this issue forward in our state. There are several things that you can do right now to help: Sign this postcard and return it to me. The postcard will go to both your state senator and state representative to let them know that you support closing the coverage gap. You can also sign the postcard electronically at this web address. If you or someone you know falls into the coverage gap, please share your story with us. Stories from the uninsured have been powerful tools in other states. We want to let policymakers know who is being hurt by their lack of action. If you are a part of a community or faith organization, business, health care provider, or any other organization, and you would like to show your support for closing Georgia’s coverage gap, please let us know. There is no financial contribution and your level of involvement is totally up to you. A bigger list of supporters increases public pressure on our policymakers to consider a solution to Georgia’s coverage gap. Let us know if you would like to be an active coalition member or just listed as a supporter.
- *Note: Include your name and contact info. here. Include your org’s website address, FB & Twitter links.