Transcript Document

Louisiana and the
Affordable Care Act
October 8, 2013
Kathy H. Kliebert
Secretary
Today’s Discussion
• Louisiana’s Perspective on
the ACA’s Impact to
• Medicaid Expansion
• Health Insurance
Marketplace
• ACA Implementation
• Redefining the Safety Net
System
• DHH Business Plan
2
ACA’s Impact on
Louisiana: (Medicaid
Expansion)
Expansion – Risky Business
• As of Louisiana’s most recent analysis, 10-year impact
figures range from $490 million in savings to $1.64
billion in new state costs.
4
45%
40%
0%
New Mexico
Louisiana
California*
Arkansas
Mississippi
Arizona*
District of Columbia*
Vermont
New York*
Maine*
Tennessee
West Virginia
Georgia*
Illinois
Delaware
Alabama
Kentucky
South Carolina
Oklahoma*
Oregon
Ohio
North Carolina*
Indiana
Missouri*
Texas
Michigan*
Florida*
Massachusetts**
Rhode Island*
Connecticut
Alaska
Hawaii*
Montana
Wisconsin**
Pennsylvania*
South Dakota
Idaho*
Iowa
Nebraska
Kansas*
Wyoming*
Washington*
Minnesota*
Maryland*
Colorado*
Utah**
New Jersey
North Dakota*
Virginia*
Nevada*
New Hampshire*
Expansions Not Created Equal
According to Kaiser projections, La. would have the second highest percentage
of its population on Medicaid if all states expanded – 39%.
35%
30%
25%
37 states would have Medicaid populations (as a
percentage of state residents) at or below
where Louisiana is today (29%), according to
Kaiser figures.
20%
15%
10%
5%
Medicaid Population Today
Medicaid Population in 2022 - Expanded
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Expansion: Not all Uninsured
= 10,000 people
Louisiana Medicaid under ACA
Almost 260,000 would have been newly eligible
individuals that were previously uninsured
More than 20,000 would have been individuals currently
eligible but not enrolled
Nearly 187,000 would have come from private insurance
rolls
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ACA’s Impact on
Louisiana: (Health
Insurance Marketplace)
Consumer Impact
• Biggest impact from increased costs as employers pass along
premium increases linked to new insurance rules like:
• Premiums can only vary by family size, geography, tobacco use,
and age
• Age variance limited by new rules – largest impact to young
healthy people
• Kids can remain on parents policies until age 26
• No denials for pre-existing conditions, and
• A transitional risk adjustment fee that will cost $63 per plan
participant in the first year.
• If an individual is not covered by “minimum essential” health care
coverage, they face an individual mandate tax.
• AHIP/LAHP study estimates that ACA premium tax alone will force
policyholders in La. to pay over $2,000 more for single coverage and
over $4,500 more for family coverage over the next ten years.
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The Employer Mandate
• Treasury announced one-year delay – signaling major concerns
with fall-out.
• Now, beginning in 2015, large employers (50+ FTEs) will be
mandated to offer affordable coverage to full-time employees
or face significant monetary penalties.
Pushing the “train
wreck” further down
the tracks?
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Steepening the “50 Cliff”
The current “50
Employee” Cliff – will
be exacerbated by
provisions of ACA
• The cost to go from
the 49th to 50th FTE is
$40,000 for business
that do not offer
“affordable”
coverage.
• This is a significant
disincentive for small
businesses to grow
beyond this
threshold.
Source: New York Times Economix
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Trickle Down to State Budgets?
• Employer mandate will have largest impact to
employers with predominantly low-wage jobs,
forcing them to pass costs on to customers.
• Major implication for state budgets: home and
community-based service providers in Medicaid.
• Low-wage direct-care jobs that often do not provide
health insurance today.
• Unlike other businesses, costs cannot be easily passed on
to consumers, who in this case are often state Medicaid
programs.
• Already increasing rate pressure for states to pay more.
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Provider Perspective
• ACA will cause immediate changes and shifts in long-term market forces
– with implications for state budgets.
• In the short run:
• Revenue will shift from uncompensated care to insurance for some
individuals.
• Health systems may not be better off in Expansion states as
individuals shift from private coverage to Medicaid – in
Louisiana there are nearly 250,000 individuals who would
either fall off private coverage or lose access to subsidized
coverage on the exchange should Louisiana expand Medicaid.
• Pent up demand may overwhelm the system’s capacity to treat and
serve.
• Over time:
• Market forces will encourage consolidation and integration (e.g.,
ACO’s, bundled payments) - Insurers and state policy makers will
have to watch carefully as this activity may place upward pressure on
rates.
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ACA
Implementation
No Expansion + No Exchange ≠ No Work
• Even given a decision to not expand Medicaid or established a statebased Exchange, states still face significant requirements and mandates
related to ACA. For example, Louisiana (and other states):
• Must convert current income standards to the new MAGI standard for
determining Medicaid eligibility.
• This will require extensive staff training and modifications to the Eligibility
system and external interfaces.
• Created new interface to communicate with the Federally Facilitated
Exchange to share applicant account data for October 1, 2013.
• DHH is had to retrofit existing systems and created new functionality to
ensure real-time eligibility decisions.
• Developed a new “intuitive” single streamlined online application as
defined by CMS for October 1, 2013.
• New online application must provide for real time eligibility decisions by
January 1, 2014.
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ACA Implementation
• Enrollment on the Marketplace has begun
• Louisiana will have a federally facilitated marketplace,
but still many unknowns
• Continual delays of key provisions challenge
implementation
• Uncertainties regarding outreach efforts, information
and confusion will have impacts on all of us
• Despite the uncertainties, DHH has been able to make
the necessary changes to Medicaid for the October 1st
deadline and will continue to make these changes for
the January 1st deadline.
Redefining the
Safety Net System
Redefining the LSU Health System
• Reduction in FMAP funding posed a challenge.
• Opportunity for reform.
• Key strategies:
• Local community partnerships.
• New models of delivery.
• Focus on strengthening graduate medical education.
Establishing Partnerships
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Baton Rouge
• Earl K. Long Medical Center with Our Lady of the Lake Medical Center and Woman’s Hospital
Bogalusa
• Bogalusa Medical Center with St. Elizabeth (Our Lady of the Angels) FMOL
New Orleans
• Interim LSU Hospital and University Medical Center with Louisiana Children’s Medical Center
Houma
• Leonard J. Chabert Hospital with Ochsner Health System and Terrebonne General Medical Center
Lake Charles
• Walter O. Moss Medical Center with Lake Charles Memorial Hospital and West Calcasieu Cameron
Hospital
Lafayette
• University Medical Center (University Health Center) with Lafayette General
Shreveport/Monroe
• LSU Shreveport and EA Conway with the Biomedical Research Foundation
Alexandria
• Huey P. Long with Rapides Medical Center and CHRISTUS St. Francis Cabrini Hospital
DHH Business
Plan
DHH’s Big Bets and Business Plan
Highlights transformational priorities in
three main themes:
• Building Foundational Change for Better
Health Outcomes
• Promoting Independence through Community
Based Care
• Managing Smarter for Better Performance
Questions?
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