SLIDE 1 Recent SHBP Changes & the Health Care Landscape in Georgia
Medicaid Expansion | www.gbpi.org
Georgia Budget & Policy Institute
Timothy Sweeney, Director of Health Policy
Presentation to Georgia Assoc. of School Personnel Administrators
May 29, 2014
SLIDE 2 Budget Overview | www.gbpi.org
Who We Are
The Georgia Budget and Policy Institute produces research and state budget analysis to show ways Georgia can provide better education, health care and
SLIDE 3 Budget Overview | www.gbpi.org
Our Policy Area Focus
Taxes Budget Education Health Care Economic Security Economic Development
SLIDE 4
Our work isn’t about the numbers… It’s telling the story of people using numbers
SLIDE 5 Budget Overview | www.gbpi.org
Setting Stage for 2014 – Recent SHBP History & Impact of ACA on SHBP 2014 Overview – Initial Plan Changes & Mid-Year Revisions
Overview
2015 Overview & Out Year Expectations Broader Health Policy Landscape
SLIDE 6 SHBP by the Numbers >630,000
Georgians Receiving Health Coverage
>$3 B
Worth of Health Services Delivered Annually
State Employees - Active, 111,709 State Employees - Retired, 47,396 Teachers - Active, 260,855 Teachers - Retired, 68,432 Non- Certificated
143,440 Non- Certificated
27,034 Misc, 5,202
SLIDE 7 Notable SHBP Trends
Plan reserves exhausted in 2009 & 2010 to offset new state contributions to SHBP ($500-700 M tot) Employee Premium Increases
- 2010, 2011, 2012 – 10% each year
- Increased surcharge for Tobacco Use
- Targeted increases related to ACA provisions –
notably around dependent coverage up to 26
SLIDE 8 SHBP Trends Cont…
Declining Active Employees & Increased Retirees Strains Plan (Retiree Rate up 5 points from 07 to 12) Funding Issues for Non-Certificated Employees
- State funds to help districts with these costs
eliminated in aftermath of Recession
- District costs up >$300 M since 2010, still don’t
cover costs for SHBP
- Planned 2014 increase apparently delayed
SLIDE 9 The ACA and the State Health Benefit Plan
Limited Impact on SHBP Because it is Self-Insured ACA Provisions Generate SHBP Savings:
- Temporary Funding Through Early Retiree
Reinsurance Program
- Allows Children of State Employees to Enroll in
PeachCare (saves $ for employees & for plan)
SLIDE 10
ACA “Costs” Mean New Benefits for Members
Dependent coverage up to age 26 added 20,000+ Georgians to the plan Out of pocket maximum saves money for employees and families Preventive services covered without co-pays or deductibles
SLIDE 11
2014 SHBP Changes Enacted in Fall 2013
Single Vendor for Medical: Blue Cross Blue Shield Abandon HMO & HSA Options in Favor of 3 Tiers of HRA Plans Separate Pharmacy Benefit Manager: Express- Scripts Premiums increase/decrease depends on plan selection
SLIDE 12
Deductibles & HRA Contributions Vary by Tier
SLIDE 13 2014 Plan Choices Skewed to Cheaper Plans With Higher Deductibles
Projected Enrollment Split
Gold 30% Silver 50% Bronze 20%
Actual Enrollment by Tier
Gold 19% Silver 39% Bronze 42%
SLIDE 14
Mid-Year Revisions to 2014 Plan design
Restore HMO-like qualities (all tiers): Co-pays for office visits Co-pays for pharmacy benefits $115 million annual cost to plan (half in FY 2014) Promise to Revisit Plan Design & Vendors for 2015
SLIDE 15
SHBP Financial Status (DCH Approp Pres)
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2014 Revisions Do Not End Controversy
Co-pays are the same regardless of HRA tier – despite wide premium variation Co-pays do NOT count towards deductible, cannot be paid with HRA funds Lawsuit recently filed alleging state overcharging some SHBP enrollees
SLIDE 17
More Plan Options Available in 2015
Blue Cross adds statewide HMO to current plans New statewide vendor for HMO, high-deductible, and Medicare Advantage plans Atlanta to get 3rd option: in-network-only, fully insured (29-county metro area)
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29-County Metro Atlanta
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Key issues in 2015 and beyond
For plan: employee choice vs. employer affordability For members: premiums vs. out-of-pocket spending Wellness plans: limited proof of effectiveness at reducing costs How will Georgia address larger health care issues: coverage, provider capacity, health status
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Georgia by the Numbers – Health Care 50th in Medicaid spending per patient 49th in statewide health care spending per capita 5th most uninsured residents 4th most uninsured kids
SLIDE 21
Rural Georgia’s Health Care Complications
Hospital closings prompt rule change for stand-alone ERs High uninsured, poverty squeeze health system Expanding Medicaid especially beneficial, politically difficult
SLIDE 22 Failing to Expand Medicaid Eligibility Leaves Significant Coverage Gap
Graphic Credit: Kaiser Family Foundation Graphic Credit: Kaiser Family Foundation
SLIDE 23
Expansion Could Cover Workers in Many Jobs
SLIDE 24 Expanding States See Falling Uninsured Rates
Graphic Credit: Urban Institute
SLIDE 25 Broader Health Care Landscape in Georgia
High uninsured, low state investment, poor health
- utcomes – could these stats be related?
Toxic politics around Affordable Care Act / Obamacare complicate policy intervention Not expanding Medicaid eligibility prevents Georgia from boosting health infrastructure
SLIDE 26 Q & A
Budget Overview | www.gbpi.org
SLIDE 27
Visit us: www.gbpi.org
SLIDE 28 LET’S STAY CONNECTED
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