Vitalyst Public Policy Committee February 22, 2017 12:00 1:30pm 1 - - PowerPoint PPT Presentation

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Vitalyst Public Policy Committee

February 22, 2017 12:00‐1:30pm

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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

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Arizona Marketplace Open Enrollment ‘17

*Denotes individual plan selections using HealthCare.gov platform.

38,222 76,072 121,931 182,881 185,497 196,291 50,000 100,000 150,000 200,000 250,000 Week 4 Week 6 Week 7 Week 9 Week 11 Week 14 Number of Individuals

Arizona: Individual Plan Selections

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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

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Comparing OE4 (‘17) & OE3 (‘16)

MARKETPLACE PLANS SELECTIONS OE4 OE3 Change from OE3 % Change from OE3 All FFM 9,201,805 9,625,982 (424,177) ‐4.4% Arizona 196,291 203,066 (6,775) ‐3.3%

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Outreach/Enrollment Education/Advocacy

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Repeal & Replace

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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

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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.

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The Latest ‐ AZ

• Ducey’s Letter to McCarthy

– Doesn’t want to see “any Arizonans have the rug pulled

• ut 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 $

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How Will AZ Manage Risk?

• Changes will be states’ responsibility and many

will be very politically challenging:

– Reducing Benefits – Reducing Eligibility – Reducing Payments – Increasing Cost Sharing – Program Administration – More narrow networks

• Will likely be annual discussion as part of state

budget negotiations

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Source: AHCCCS Access/Quality Affordability

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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

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The Impact

• JLBC Analysis (Medicaid)

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Potential Impact ACA Changes

GF Costs Total $ Removed from Economy Members Losing Coverage

• 1. Eliminate non‐categorical

adults 0‐138%

$328 Million $3.2 Billion (425,338)

• 2. Waiver at regular FMAP 0‐

100%, Eliminate 100‐138%

$1 Billion $599 Million (115,823)

• 3. Waiver at regular FMAP 0‐

100%, Freeze enroll. 100‐138%

$1 Billion $175 Million ‐

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Source: AHCCCS

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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)

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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

– 90th percentile of current premiums

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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

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Public Comments Due 2/28

publicinput@azahcccs.gov

5‐Year Lifetime Limits Work Requirements 1‐Year Bans

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Healthcare Workforce Update

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Recent Publications

Health Impact Assessments Network Adequacy

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Vitalyst Policy & Advocacy

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Direct Involvement Indirect Involvement

Vitalyst’s Involvement

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• Land‐Use Planning
• Community Plans
• Food Systems
• Transportation

Systems

• Green & Open Space
• Housing
• CHWs
• Treat and Refer
• Accountable Care

Organizations

• Mobile Integrated

Healthcare

• Non‐Profit Capacity

Building

• Enhancing Civic

Participation

• Health Insurance

Outreach, Enrollment

• Medicaid Policy
• Network Adequacy
• Workforce
• Vision Screening

Access to Coverage, Access to Care Capacity Building, Civic Engagement Community Design Innovation & Care Coordination

Vi Vitalyst’s Po Policy Pr Priorities Fr Fram amework

• rk

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Impact to Vitalyst’s mission, programs and operations Direct N/A Indirect Assess Reputational Risks as independent, objective & nonpartisan Low Risk Moderate Risk High Risk Do not Engage Supportive Role

(consider capacity)

Leadership or Supportive Role

(consider capacity)

Do not Engage Supportive Role

(consider capacity & level of influence)

Cautious Supportive Role

(consider capacity & level of influence)

Leadership or Supportive Role

(consider capacity & level of influence)

Do not Engage Do not Engage

Vitalyst Advocacy Engagement Decision Matrix