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Colorado’s Changing Health Insurance Landscape. May 2, 2013. Progressive 15 Summit. Colorado Health Institute: An Introduction. CHI is a trusted and leading source of credible health information for Colorado leaders. We are nonpartisan. We do not take positions on bills.
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Colorado’s Changing Health Insurance Landscape May 2, 2013 Progressive 15 Summit
Colorado Health Institute: An Introduction • CHI is a trusted and leading source of credible health information for Colorado leaders. • We are nonpartisan.We do not take positions on bills. • Our insight is used to:
Today’s Discussion • How Coloradans get health insurance. • What’s changing.
Questions You May Be Asking Yourself • I can’t afford health insurance. Will that change in 2014? • What’s happening to my Medicare? • I employ a handful of people. Will I be required to buy them health insurance? • Can large employers just switch everyone to part-time and avoid this whole mess?
Three Takeaways • Change in health insurance is coming for many of you. • Small employers will have complex choices. • Heads up! The Affordable Care Act definition of “affordability” may not match yours - or that of people in your community.
Why Does Health Insurance Matter? Source: Institute of Medicine. “America’s Uninsured Crisis”
At a Glance: Who is covered by individual policies? About 8 percent of Coloradans. 7.7%
Individual Market in Colorado Individual (or Non-Group) Market High-Risk Pools • Not manymandated benefits • Can be turned down for a pre-existing condition
Understanding Guaranteed Issue • Insurance plans can’t reject individuals based on pre-existing health conditions. • Implemented in 2010 for children • Will be implemented in 2014 for adults • Plans agreed to provision only if coupled with “individual mandate.”
Understanding the Individual Mandate Beginning in 2014, individuals and families will be required to have health insurance or pay penalties: • 2014 - Greater of $95 or 1 percent of income • 2015 - Greater of $325 or 2 percent of income • 2016 - Greater of $695 or 2.5 percent of income
What’s in Store for the Individual Market? • May be eligible for premium credits for health insurance depending on income level. • Can access credits for individual insurance through the Connect for Health Colorado Exchange starting in 2014.
Levels of Premium Credits The government will provide tax credits to families buying health insurance through the Exchange, limiting the percent of annual income spent on health insurance. Source: Kaiser Family Foundation • For a family of four, at 400% FPL in 2012: • Annual income: $92,200 • Maximum percent of income for health insurance: $8,759
At a Glance: Who is covered by Employer-Sponsored Insurance? Nearly two of three Coloradans. 57.8%
Small Group Market in Colorado • 1-50 employees • Mandated benefits • Guaranteed issue and renewal • Premium rating: • Smoking status • Industry • Age • Family size • Location
What’s in Store for the Small Group Market? • Eligible for tax credits if insurance is offered. • Small Business Health Options Program (SHOP) Exchange in 2014 • For businesses < 100 employees
Understanding Employer Responsibilities • Large employers not offering insurance pay penalty ($2,000 per full-time employee) if employee receives a tax credit. • Large employers offering insurance will pay penalty if at least one full-time employee receives premium tax credit.
At a Glance: Who is covered by Medicaid? Low-income children, parents, pregnant women, individuals with disabilities and the elderly.
S.B. 200 – Medicaid Expansion • Would expand Medicaid to 133% of FPL. • Passed House and Senate • Governor Hickenlooper supports
Eligibility Standards in Colorado After Expansion NOTES: Federal health reform does not make changes to Medicaid eligibility for seniors and people with disabilities. CICP will likely continue to serve individuals who do not qualify for Medicaid or CHP+ or who are uninsured or underinsured.
At a Glance: Who is covered by Medicare? People 65 and older as well as younger people with disabilities. 9.2%
Nearly All Colorado Seniors Have Medicare Many also have supplemental insurance Source: 2011 Colorado Health Access Survey
Health Reform: Mostly Good News for Seniors • Phases in coverage of the “donut hole” (Medicare Part D drug benefit coverage gap). • Improves coverage of prevention services. • Changes and reductions in payment. • But uncertainty about providers
At a Glance: Who is Uninsured in Colorado? About 16 percent of the population, up from about 14 percent in 2009. 15.8%
Estimate: 390,000 Will Still be Uninsured Source: Colorado Health Benefit Exchange Research, Prepared by Jonathan Gruber, January 2012
I Can’t Afford Health Insurance. Will That Change in 2014? • Answer: For many of us, insurance will become more affordable. • Subsidies for families up to 400% of FPL • Preventive Services with no cost sharing • But many of us will still pay something.
I Employ a Handful of People. Am I Going to Have to Buy Them Health Insurance? • Answer: You won’t be required. • Tax credits available for small employers (1-25 employees) • Think about defined contributions (not a defined benefit) • Individuals (your employees) will have to get insurance
As a Large Employer, Can I Switch Everyone to Part-Time and Avoid This Whole Mess? • Answer: You could, but … • Individual mandate still holds • Benefits packages are a competitive differentiator • “Combinations” of part-timers add up to full time equivalents (IRS rules)
What’s Happening to My Medicare? • Answer: Mostly things that are helpful to seniors. • The closing of the donut hole • Covering preventive services
Three Takeaways • Change in health insurance is coming for many of you. • Small employers will have complex choices. • Heads up! The Affordable Care Act definition of “affordability” may not match yours - or that of people in your community.
