Vitalyst Public Policy Committee February 22, 2017 12:00 ‐ 1:30pm 1
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Open Enrollment #4 Activities • Support of 3 Navigator/Assister Organizations • Oversaw Cover AZ Steering Committee and 3 subcommittees • Monthly Call/Webinar • 4 Assister Trainings (Yuma, Tucson, Phx, Flag) • 1 Health Literacy Seminar • Justice Transitions Seminar • Marketing Support – Pima County Enrollment Coalition 3
Arizona Marketplace Open Enrollment ‘17 Arizona: Individual Plan Selections 250,000 196,291 185,497 200,000 182,881 Number of Individuals 150,000 121,931 100,000 76,072 38,222 50,000 0 Week 4 Week 6 Week 7 Week 9 Week 11 Week 14 *Denotes individual plan selections using HealthCare.gov platform. 4
Enrollment Trends OE4 Category Nov Dec Jan Feb Marketplace ‐ 38,222 182,881 196,291 KidsCare 9,184 9,701 13,389 13,770 Prop 204 316,763 318,239 316,007 318,367 Adult Expansion 81,116 81,982 81,795 81,852 5
Comparing OE4 (‘17) & OE3 (‘16) % MARKETPLACE Change OE4 OE3 Change PLANS from OE3 from OE3 SELECTIONS All FFM 9,201,805 9,625,982 (424,177) ‐ 4.4% Arizona 196,291 203,066 (6,775) ‐ 3.3% 6
Outreach/Enrollment Education/Advocacy 7
Repeal & Replace 8
The Latest ‐ HHS • HHS Marketplace Stabilization Rule – Shorter Open Enrollment – Pre ‐ enrollment verification for special enrollment – Reverts back to ‘14 network adequacy standards – Reduces Essential Community Provider requirement from 30% to 20% of ECPs in area – Before beginning coverage, insurers can bill re ‐ enrollees for prior non ‐ payment 9
The Latest – GOP Replacement • GOP 19 ‐ page outline – Repeal individual and employer mandate – Repeal provider and insurer taxes – Age ‐ adjusted, advanceable tax credits (not income ‐ based) for individual market enrollees – Increased HSA contribution limits, apply HSA to premiums – Freeze M ‐ Caid expansion, phase out enhanced M ‐ Caid expansion $, move to per ‐ capita or block grant – Repealing ACA DSH cuts – Providing state “innovation grants” for high ‐ risk pools, reinsure issuers, fund preventive services, etc. 10
The Latest ‐ AZ • Ducey’s Letter to McCarthy – Doesn’t want to see “any Arizonans have the rug pulled out from under them.” – Keep Marketplace subsidies, transition period – Flexibility (work requirements, premiums, limiting coverage) – Repeal taxes – Repeal Essential Health Benefits – Do not increase uncompensated care – M ‐ Caid $ tied to national averages – Sell across state lines – Maintain ADHS/Public Health $ 11
How Will AZ Manage Risk? • Changes will be states’ responsibility and many will be very politically challenging: – Reducing Benefits – Reducing Eligibility Access/Quality Affordability – Reducing Payments – Increasing Cost Sharing – Program Administration – More narrow networks • Will likely be annual discussion as part of state budget negotiations 12 12 Source: AHCCCS
Not Clearly Addressed • Revenue to balance the tax cuts (tax on generous employer ‐ sponsored plans?) • Replacing the individual mandate (continuous coverage?) • Lifetime limits • Impact to prevalence of uninsured • Prevention & Public Health Fund • Centers for Medicaid & Medicare Innovation 13
The Impact • JLBC Analysis (Medicaid) 14
Potential Impact ACA Changes Total $ Removed from Members Losing GF Costs Economy Coverage $328 $3.2 1. Eliminate non ‐ categorical (425,338) adults 0 ‐ 138% Million Billion $599 2. Waiver at regular FMAP 0 ‐ $1 Billion (115,823) 100%, Eliminate 100 ‐ 138% Million $175 3. Waiver at regular FMAP 0 ‐ $1 Billion ‐ 100%, Freeze enroll. 100 ‐ 138% Million 15 15 Source: AHCCCS
Source: http://www.bizjournals.com/phoenix/news/2017/02/08/asu ‐ arizona ‐ will ‐ lose ‐ 62 ‐ 000 ‐ jobs ‐ next ‐ year ‐ if.html 16
Moving Forward • Call w/McCain’s Health Advisor – Ball is in House’s court, 19 ‐ pager – Freedom Caucus influential – Repeal & Delay no longer a topic – Expect proposed plan in mid ‐ late March w/vote in April • Vitalyst $ set aside – Publications, convenings, support, polling… • Hospital Assessment (Biggs v Betlach) 17
Moving Forward • Rumor has it… – Leaked Replacement Plan Draft 2.24.17 (2 weeks old) • Repeals individual mandate, replace w/continuous coverage – $100B over 10yrs for “high ‐ risk individuals” • Decrease FMAP for Medicaid Expansion (starting 2020) • Per Capita Cap for Medicaid (starting 2020) • Repeals ACA taxes, but caps the Employer ‐ sponsored Insurance tax exemption – 90 th percentile of current premiums 18
Moving Forward • Rumor has it… – Leaked Replacement Plan Draft (cont’d) • Age ‐ adjusted, advanceable tax credits (starting 2020) – Not attributable to plans offering abortion coverage • States to define “essential health benefits” • Increases age band from 3x to 5x (old vs young consumers) • Repeals PPHF starting 2019 19
Public Comments Due 2/28 publicinput@azahcccs.gov 5 ‐ Year Lifetime Limits Work Requirements 1 ‐ Year Bans 20
Healthcare Workforce Update 21
Recent Publications Health Impact Assessments Network Adequacy 22
Vitalyst Policy & Advocacy 23
Vitalyst’s Involvement Direct Involvement Indirect Involvement 24
Vitalyst’s Po Vi Policy Pr Priorities Fr Fram amework ork •Health Insurance •Non ‐ Profit Capacity Outreach, Enrollment Building •Medicaid Policy •Enhancing Civic •Network Adequacy Participation •Workforce •Vision Screening Access to Capacity Coverage, Building, Access to Civic Care Engagement Innovation & Community Care Design •Land ‐ Use Planning •CHWs Coordination •Community Plans •Treat and Refer •Food Systems •Accountable Care •Transportation Organizations Systems •Mobile Integrated •Green & Open Space Healthcare •Housing 25
Vitalyst Advocacy Engagement Decision Matrix Cautious as independent, objective & nonpartisan High Risk Supportive Role Do not Do not (consider capacity Engage Engage & level of Assess Reputational Risks influence) Leadership or Moderate Risk Supportive Role Supportive Role Do not (consider capacity (consider capacity Engage & level of & level of influence) influence) Leadership or Low Risk Do not Supportive Role Supportive Role Engage (consider capacity) (consider capacity) Indirect Direct N/A Impact to Vitalyst’s mission, programs and operations 26
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