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The Road to Affordable Care

The Road to Affordable Care The Affordable Care Act – implementation, questions, opportunities, challenges. Public: P ast Confusion and Lack of Trust. If you had to look for health insurance now, what feelings do you think you would have?.

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The Road to Affordable Care

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  1. The Road to Affordable Care The Affordable Care Act – implementation, questions, opportunities, challenges

  2. Public: Past Confusion and Lack of Trust If you had to look for health insurance now, what feelings do you think you would have? Poll: 42% of Americans unsure if Obamacare is still law By Sarah KliffWashington Post|April 30, 2013 How they want to feel is confident, informed, secure, satisfied, and in control. Source: Enroll America Research, November 2012

  3. Limited Public Awareness The majority of uninsured Americans don’t know the health reform law will help them. 78% Three out of four of the newly eligible want in-person assistance to learn about and enroll in coverage. 75% Source: Enroll America Research, November 2012

  4. Affordable Care Act Positive Changes Effective 2010 • Preventive care at no charge • Restrictions on annual spending caps • No lifetime dollar limits on plans • Dependent children covered to age 26 • No pre-ex waiting periods under age 19 • Childhood immunizations and adult vaccinationsat no charge

  5. Affordable Care Act Positive Changes Effective 2014 • No annual coverage limits on health plans • No Pre-Existing Condition Waiting Periods for all • For adultsas well as children • Requires “guarantee issue” and renewability of health insurance regardless of health status • Change to Employer’s eligibility requirements – the wait can be no more than 90 calendar days from date of hire

  6. Messages that Resonate with the Public

  7. Moving from Messages to Reality

  8. “Welcome Door”: What will it look like? or

  9. The 2014 Enrollment Opportunity: USA Enroll at least 15 million people in new coverage options } 7 million in Exchange coverage Millions } 8 million in Medicaid or CHIP Source: February 2013 CBO estimates

  10. Washington 2014 Enrollment Targets Enroll over ½ a million people in new coverage options } 280,000 in Exchange coverage } 350,000 in Medicaid or CHIP

  11. Federal Basic Health Option

  12. Vision for Exchanges • A easy shopping experience • Allow consumers to find and compare Qualified Health Plans (QHPs) on quality and cost • Give consumers clear and easy-to-navigate information about coverage options – Apples : Apples • Help consumers choose the best providers as well as health plans, based on what matters to them • Drive delivery system and payment reforms • Ultimately enroll consumers in the plan that will deliver the highest quality, highest value care that best meets their needs

  13. FPL: Eligibility for Exchange Subsidy

  14. In Addition to Premium Subsidies,Cost-Sharing Assistance is needed:

  15. Consumers are confused by cost-sharing terms • Who knows what these terms mean: • deductible • coinsurance • benefit maximum • allowed amount • out-of-pocket max • Selecting the right plan matters – • Platinum, Gold, Silver, Bronze

  16. Coverage is Here slide

  17. A New Way to Enroll in Coverage Complete single application Enrolled in correct program! Determine eligibility Exchange Consumers can connect to whichever program they are eligible for, no matter where they start. Medicaid In-Person Assistance CHIP Single Application

  18. Going Forward: • What will be seen, learned and evaluated? • Will consumers come to the door and get in? • Will there be true access to care? • Will consumers get the “right” plan? • Feedback – learn from experiences • Don’t delay – if we don’t get it right the first time then we are going to lose trust, and lose the ability to cover uninsured

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