To Your Health What the ACA Has Meant and Will Mean for Consumers - - PDF document

To Your Health What the ACA Has Meant and Will Mean for Consumers and Health Insurers

NOLHGA 2016 Legal Seminar, July 22, 2016

To Your Health – Context…

►The Affordable Care Act is making a positive impact:

► Covering the uninsured (Medicaid expansion, Exchanges) ► Protecting vulnerable consumers (EHB, Market Reforms) ► Facilitating the move to value-based healthcare and care integration

► But significant challenges persist:

► Assuring competition and insurer viability across markets ► Assuring adequate benefits and cost sharing for consumers ► Stabilizing financial assumptions: risk pools, drugs, federal payments ► Ever-growing government obligations (Medicare, Medicaid) ► Healthcare system not pointed toward custodial and long term care ► Lingering political and federalism issues

To Your Health

Commissioner Teresa D. Miller, Pennsylvania Insurance Department

►A regulator’s challenges in overseeing health insurance markets that

are still adjusting:

► 2017 rate and form review ► Long-term care insurance ► Non-MEC health insurance products ► Consumer protections (surprise bills and related topics) ► The role of the NAIC and DOIs in challenging times

To Your Health

Patricia M.C. Brown, President, Johns Hopkins HealthCare LLC

►Opportunities for Provider-Insurer integration amidst challenges:

► Integrated health systems are positioned to move into insurance ► Emerging value-based insurer-provider partnerships ► Offering products across markets (i.e., government programs) to mitigate

risk in ACA markets

► Provider-centric considerations about managing risk, and maintaining

solvency

To Your Health

Earl R. Pomeroy III, Alston & Bird LLP (former Congressman and President of NAIC)

►Washington DC considers a challenged health insurance environment

► Comments on bi-partisan embrace of value-based and managed care

payment models

► Comments on GOP and Clinton health care plans ► Comments on insurer, state, and House vs. DHHS lawsuits ► What can be done to address the challenges facing the public

exchanges

To continue the discussion…

► Mike Adelberg, Senior Director, FaegreBD Consulting

Michael.adelberg@faegrebd.com

► Commissioner Teresa D. Miller, Pennsylvania Insurance Department

termiller@pa.gov

► Patricia M.C. Brown, President, Johns Hopkins HealthCare LLC

Pbrowna@jhmi.edu

► Earl R. Pomeroy III, Alston & Bird LLP

Earl.Pomeroy@alston.com