Transcript Slide 1
AFFORDABLE CARE ACT
:
WHAT COMMUNITIES NEED TO KNOW
CINDY ZELDIN EXECUTIVE DIRECTOR , GEORGIANS FOR A HEALTHY FUTURE PRESENTATION AT THE GEORGIA LEGISLATIVE BLACK CAUCUS HEALTH SYMPOSIUM J ULY 8, 2013
The Big Picture, The Big Opportunity: Covering the Uninsured
• Overall, in Georgia: Nearly two million uninsured (1.86 million); one-fifth of the population and one fourth of working-age adults • Georgia consistently ranks in the top 10 among the states in number and percentage of uninsured <100% FPL • A majority of the uninsured are low 100-138% FPL or moderate-income • <100% FPL……. 43% • • 100-138% FPL… 11% 139-250% FPL… 23% • • 251-399% FPL…. 12% 400% FPL+......11% 139-250% FPL 251-399% FPL *100% of FPL for an individual is $11,490 in annual income or $19,530 for a family of 3.
400% FPL+ Source: CPS data, 2-year average ’10 – ‘11 (Kaiser State Health Facts)
Why Does Coverage Matter for Individuals, Families, and Communities?
• Access to the health care system, usual source of care, and full spectrum of prevention and treatment • Financial protection against high medical costs, peace of mind • Increased productivity • The health of parents can play an important role in the well being of children; when parents gain coverage, their children are likely to enroll as well • Spillover effects on communities; high numbers of uninsured can impact community providers and the economic vitality of communities
ACA: Overall Approach to Coverage
• Guiding principle: everyone is eligible for something (citizens and most legal immigrants) • Maintain employment-based health insurance system • Restructure the individual and small group health insurance marketplace through exchanges and market reforms • Expand Medicaid for low-income individuals and families (made optional by SCOTUS) • Individual mandate
The Health Insurance Marketplace (exchange)
• Transparency • Competition & Accountability • Navigation & Assistance • Information & Tools • Affordability
Who will be eligible for the Marketplace?
• Individuals and families who don’t already have access to an affordable health insurance plan through their workplace (or other coverage such as Medicare) • Individuals with pre-existing conditions • Individuals and families with incomes between 100% and 400% of the federal poverty level (FPL) will receive tax credits that can be applied directly to the plan premiums at the time of enrollment (note that individuals BELOW 100% FPL are ineligible for subsidies—we’ll return to this when we discuss Medicaid expansion) • Children in families with incomes up to 235% of FPL will remain eligible for PeachCare for Kids or Medicaid, depending on their family income level
What will the marketplace do?
• Enroll individuals and families into health insurance plans • Provide information, services, and tools, including a web portal, to navigate consumers through the process of selecting and enrolling in a plan • Provide an online calculator so consumers can calculate their premiums after factoring in a new tax credit that will be available to make coverage more affordable • Display information about health plan costs, benefits, and quality and satisfaction ratings in a consumer friendly manner
What will the marketplace do (cont’d)?
• Provide a toll-free consumer assistance hotline • Certify that plans available on the exchange have adequate provider networks • Certify that plans available on the exchange have at minimum a core set of benefits • Present plan options in tiers (platinum, gold, silver, bronze) so that consumers can objectively identify which plans are more comprehensive than others and select a plan that best meets their needs • Provide plain language information on enrollee rights, claims denials, and other consumer protections
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Health Insurance Navigators
78% of the uninsured don’t know about the health insurance exchange, and when told about it most say they will need help navigating it • 83% of people who could be eligible for the new Medicaid expansion don’t know about it • Approximately 800,000 Georgians could be eligible for coverage through the exchange: if the goal were to get all signed up during the initial 6-month open-enrollment period, that would be thousands per day! If Georgia expands Medicaid, even more Georgians will need assistance • The navigator program will serve as a source of unbiased information and assistance for uninsured consumers
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Health Insurance Navigators
Because Georgia is a state with a federally facilitated marketplace, the U.S. Department of Health and Human Services will operate a navigator program in Georgia Navigator functions include: – – – – – – Maintain expertise in eligibility, enrollment, and program specifications; Conduct public education activities to raise awareness about the Exchange; Provide information and services in a fair, accurate, and impartial manner; Facilitate selection of a qualified health plan Provide referrals for grievances, complaints, or questions Provide information in a manner that is culturally and linguistically appropriate
Medicaid Expansion
Medicaid Expansion
• Creates a new eligibility category for Medicaid based solely on income ; Congress did not intend for it to be optional for states (but SCOTUS decision made it so) • When a state expands, newly eligible individuals include those with incomes up to 138% FPL ($15,856 for an individual or $26,951 for a family of 3), Medicaid-eligible regardless of “category” • Estimated 650,000 Georgians could gain coverage • Expansion initially financed with 100% federal dollars (2014-2016) and then scales down such that by 2020 and thereafter the expansion population is 90% federally financed
Why Expand Medicaid?
• People with low-incomes disproportionately lack access to job-based health insurance (nationally, 28% of predominately low-wage firms offer v. 77% of predominately high-wage firms)* • Purchasing a private, individual policy is cost-prohibitive for people with very low incomes • Medicaid is an existing program; many states have used it as a vehicle to expand coverage for low-income families over the past 20 years * Source: Kaiser Family Foundation Employer Health Benefits 2012 Survey
Why Expand Medicaid, cont’d
?
• Improves health access and outcomes for individuals and families: • Oregon health insurance experiment: Medicaid more likely to have a usual source of care than their uninsured counterparts • New England Journal of Medicine study: states that expanded Medicaid saw lower mortality rates than neighboring states that did not, after controlling for a range of factors • Strengthens the health care delivery system in communities: • Reduces the burden of uncompensated care • Stimulates local economies: • Federal funds coming into the health care economy have a stimulative effect: Estimated 70,000 new jobs would be created, annual $8.2 billion in economic activity would be generated, an additional $276 million in tax revenue would be raised each year
Expanding Medicaid, cont’d
• The coverage gap: tax credits for health insurance through the exchange begin at 100% FPL because the lowest-income Americans were to be routed to Medicaid; if states don’t implement the Medicaid expansion, the poorest Georgians will have no affordable coverage options • This complicates outreach and enrollment efforts: many consumers who knock on the door will be eligible for nothing; this violates the “no wrong door” spirit of the ACA
Georgia Medicaid Income Limits Today
Includes PeachCare
235% 200% 200% 224% 250 % 200% 50% 29%
Can’t qualify
75% 150 %
138%
ACA Medicaid Expansion
100%
100% Federal Poverty Level 2013
50%
Family Size
1
Annual Income
$11,490 2 3 $15,510 $19,530 4 $23,550