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The Affordable Care Act and New Hampshire
- 1. Health Reform and Health Insurance Markets 2014 Changes in New Hampshire New Hampshire Insurance Department Tyler Brannen – Health Policy Analyst October 17, 2013 1
- 2. The ACA and NH • Federal law vs. state laws • Health insurance rules • Expanding health insurance coverage • “Exchanges” and the individual mandate 2
- 3. NH’s Health Commercial Insurance Markets • About 55% of “insured” people covered by selffunded employers • 76% of people covered by large employers • Of those people, 29% are regulated as insured (140,000) • 24% of people in small employers or individual market • 110,000 small employer members • 40,000 individual members 3
- 4. Health Insurance Carrier/TPA Member Distribution by Funding Golden Rule American Republic Celtic NovaSys_Health United HealthMarkets Assurant Usable MVP Aetna Harvard Pilgrim CIGNA Anthem 4 - 50,000 100,000 Fully-Insured Members 150,000 200,000 Self-Insured Members 250,000 300,000
- 5. Factors in Insurance Company Competition Main Factors: • Medical claims costs • Provider contracts • Insured population health status • Other Factors: • Membership • Underwritten & self-funded • Organizational efficiency • Return on Investments • Customer service 5
- 6. RSA 420-J:7 Network Adequacy (Ins 2700) • • • • • Anthem’s Pathways Network Complied with NH Network Adequacy requirements Does not apply to most of Anthem’s members Anthem indicates premium savings of at least 25% Primary issue – 10 of 26 hospitals in NH not included • Anthem only medical carrier on the exchange/Marketplace • Significance - only place to access subsidies • Why only Anthem? • Will there be a legislative solution? • How involved should the government be? 6
- 7. What is happening in the delivery system? • Investment in Community Health Centers • Increased use of mid-level providers (NPs, PAs), health coaches, and community health workers • Telemedicine • Hospitalists • Urgent care centers and walk in clinics • Accountable Care Organizations and medical homes • Hospital services provided in non-traditional settings • Incentives exist for restructuring the delivery system with a lower cost structure 7
- 9. What’s New in 2014? • Individual mandate • New rules for individual and small group markets • Essential health benefits – 10 Categories • Emergency services, hospitalization, Maternity & newborn care • Guaranteed issue • New rating factors for calculating premiums • PAST: age, health status, group size, industry, tobacco • FUTURE: Age, tobacco, geographic (not used in NH) • Metal levels • Requirements for large employers (2015) 9
- 10. “The Marketplace” and SHOP Exchange • Individuals and small employers ONLY • NOT Medicare • Federal –state partnership model • https://www.healthcare.gov/ • • • • Medicaid Subsidies for individuals Tax credits for small employers Online Oct 1, 2013 for coverage Jan 1, 2014 • Annual Open Enrollment Periods after that start October 15 and end December 7 • Special Enrollment Periods • You can still buy insurance outside the Marketplace 10
- 11. Subsidy Availability • Substantial subsidies are available through the Marketplace for those at 100%-400% of federal poverty (FPL) • Individuals: $11,490 - $45,960 • Family of 4: $23,550 - $94,200 • Those under 100% FPL are not eligible for subsidies • Assumed to be covered by Medicaid 11
- 12. Sliding Scale for Eligible Individuals Percentage of poverty line Annual dollar amount (2013) Premium contribution as % of income Monthly premium contribution 100 – 133% $11,490 - $15,282 2% $19 - $25 133 – 150% $15,282 - $17,235 3 – 4% $38 - $57 150 – 200% $17,235 - $22,980 4 – 6.3% $57 - $121 200 – 250% $22,980 - $28,725 6.3 – 8.05% $121 - $193 250 – 300% $28,725 - $34,470 8.05 – 9.5% $193 - $272 300 – 350% $34,470 - $40,215 9.5% $272 - $318 350 – 400% $40,215 - $45,960 9.5% $318 - $364 12
- 13. The Individual Mandate • In 2014: • Every individual must have health insurance • Employer coverage, individual coverage, Medicaid, Medicare • Limited exemptions to penalty requirement (e.g., low income) • Administered and enforced by IRS • Penalty amounts: • 2014: $95 per household member (up to $285) or 1% of income (whichever is higher). • 2015: $325 per household member (up to $975) or 2% of income (whichever is higher). • 2016: $695 per household member (up to $2095) or 2.5% of income (whichever is higher). • After 2016 – cost of living adjustments 13
- 14. Consumer Assistance • • • • • • • • • • Federal website (HealthCare.gov) and toll free call center Navigators Certified Application Counselors Small Business Administration NH Health Plan Agents and brokers Health insurance companies IRS Department of Labor Consumer advocates 14
- 15. Federal Resources U.S. Department of Health and Human Services Health Reform Website/Marketplace http://www.healthcare.gov Help Center: 800-318-2596 (24/7) Small Business Administration (Employer information) http://www.sba.gov/healthcare http://business.usa.gov/healthcare SBA Hotline: 800-706-7893 (M - F, 9-5) 15
- 16. New Hampshire Resources NH Insurance Department (603) 271-2261 Consumer Hotline: 800-852-3416 http://www.nh.gov/insurance NH Department of Health and Human Services http://www.dhhs.nh.gov Medicaid – Client Services: (800) 852-3345, ext. 4344 NH Health Plan http://www.nhhp.org/nhhp/ consumerassistance.asp 16