Understanding proposals and assessing impacts on Oregons Health - - PowerPoint PPT Presentation

Emerging Federal Health Policy Changes: Understanding proposals and assessing impacts on Oregon’s Health System Transformation

Presentation to the Health Care Workforce Committee March 8, 2017

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Overview

• Collaborative Analysis by OHA & DCBS of Federal

Proposals & Impacts

• Update on Congressional Actions and Potential for ACA

Changes in Current Congressional Session

– Budget Reconciliation process and ACA repeal

• Examining Elements of High Profile ACA Alternative Plans

– Focus on Medicaid reforms & other OHA priorities – Broad Highlights of Key Proposals

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Congressional Timeline for Repealing and/or Replacing ACA Keeps Changing

• Congressional work possible throughout 2017, into 2018
• Scope of repeal & replace remains unclear

– Full, stand-alone repeal appears unlikely – Several targeted repeal & replace proposals introduced – No clear consensus intra-GOP or between House & Senate – Only broad Presidential priorities outlined in congressional address

• Many challenges facing congress:

– Fully repealing entire ACA requires 60 votes in US Senate – Congressional leaders & administration have not agreed upon replacement proposal – Bipartisan set of Govs & Senators from states w/ Medicaid expansion

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Budget Reconciliation – Multi-Step Process Now Underway

• First step: House & Senate enacted a budget resolution

– Resolution DOES NOT repeal ACA; provides framework to repeal parts of ACA through process requiring only 51 votes in Senate

• Reconciliation bill starts in House – drafts emerging

– Limited to budgetary items & may not be able to repeal some policy & regulatory provisions of the ACA – Final bill dependent on Senate rules & parliamentary decisions – Provisions not able to go through reconciliation process require 60 votes in the U.S. Senate

• Drafts of House bill emerging includes aspects of “replace”
• GOP Governors from expansion states also weighing in

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Prominent ACA Alternatives - Summarized

Ryan Price Hatch Cassidy/ Collins Draft House Plan Mandates Repeal Repeal Repeal State option Repeal Medicaid

Block Grant / per-capita Cap Repeal Expansion Per-Capita Cap State opt: ACA

• r HSA-based

Per-capita cap, no enhanced expansion $

X-State Sales

Yes Yes Yes No No

Tax Credits?

Age-Based Age-Based Age-Based ACA cont OR HSA-based Age-based, refundable

HSAs

Higher Contributions Higher Contributions Higher Contributions Roth HSA (post- tax, pay 4 premiums) Higher Contributions

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House Reconciliation Plan Emerging

• Eliminates mandates and ACA’s taxes, fees, and penalties
• Focus on high-deductible, health savings account plans
• Replaces ACA subsidies with age-based tax credits
• Innovation grants to states for high risk pools & more
• Caps tax-exclusion for employer health plans
• Medicaid reforms to cap funds, eliminate expansion
• Eliminates funding to prevention and public health fund,

prevents fed funds to planned parenthood, adds funding for community health centers

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Draft House Plan: Consumer Protections

• House bill keeps:

– Guaranteed renewal, eliminating lifetime/annual benefit caps, maintaining dependent coverage up to age 26 and eliminating pre- existing condition exclusions and medical underwriting

• Limits Guaranteed issue protections to consumers who

maintain continuous coverage for 12 months

– Those without continuous coverage could be charged 30% more

• Eliminating Essential Health Benefits Requirements

– Could shift responsibilities to states to define coverage reqs.

• Increases age-rating band to 5:1 (currently 3:1 per ACA)
• Age-based, refundable tax credits ($2,000-$4,000) replace

ACA’s credit structure in 2020

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Draft House Plan: Medicaid Reforms

• Enhanced federal funding for expansion expires in 2020

– Already enrolled people continue to generate higher match,

• ther enrollees funded at regular FMAP
• Creates per-capita caps starting in 2019

– Caps federal funding on per-enrollee basis

– Set federal allotment for enrollees based on their eligibility category – Elimination of essential health benefits removes some Medicaid requirements – Broad flexibility may require separate legislation, executive action

• Removes 6% federal funds bump for some community-

based, long-term care services (1915 k option)

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House Medicaid Reform Considerations

• Congressional debate RE: ACA’s Medicaid expansion

– 31 expansion states want to protect $ (many with R Gov/Sen) – Non-expansion states want new funding added to baseline – Status of ACA’s CHIP funding bump is unclear

• Federal caps would affect states differently

– States already taking steps to reduce spending growth (Oregon) could be disadvantaged – States with higher Medicaid spending could disproportionately benefit from caps & federal flexibility – Ultimate impact on Oregon will depend on details not yet available – especially regarding expansion funding

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Potential Challenges / Opportunities

• Reduced federal investment likely shifts costs to states

– Medicaid, tax credits for private coverage, public health funds, etc…

• Reduced federal regulatory oversight shifts regulatory

authority back to Oregon

– BUT, cross-state sales of health insurance limits states ability to regulate their own insurance market

• Added state flexibility may be good for Oregon given

historical focus on innovative health policy

• Potential executive branch changes to waiver processes &

allowable provisions may create opportunities / challenges

• Uncertainty related to federal budget process

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Questions?