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August 2013

Health Exchange Overview. August 2013. ACA Phase-in of Selected Provisions. 3/23/2010 6/21/2010 7/1/2010 9/23/2010 2011 2012 2013 2014 2017 2018. Increased Medicaid Drug Rebate; quality of care task forces. High risk pools.

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August 2013

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  1. Health Exchange Overview August 2013

  2. ACA Phase-in of Selected Provisions 3/23/2010 6/21/2010 7/1/2010 9/23/2010 2011 2012 2013 2014 2017 2018 Increased Medicaid Drug Rebate; quality of care task forces High risk pools National Prevention, Health Promotion, Public Health Council Initial health insurance reforms take effect (e.g. dependent coverage to 26) Additional tax reporting, insurer spending requirements Long-term care component declared not viable Additional Medicare tax on income over $200,000/$250,000 Most coverage provisions become effective, Medicaid expansion, individual insurance mandate, exchanges, subsidies States allowed to apply for waivers Tax on high cost health insurance (so-called “Cadillac plans”), no co-payments on preventive care

  3. Short-term Issues • Most states are not running their own exchanges • Virginia has a “federally facilitated exchange” (FFE) • Bureau of Insurance conducts regulatory oversight (plan management) • 2013 General Assembly choose to have a federally run health exchange but to preserve the state’s regulatory authority over the health insurance products • Relative scarcity of federally-funded outreach/education resources in federally-run exchanges (potential role for the non-profit sector) • Community rating is (i) part of the Affordable Care Act, (ii) a new approach for Virginia, and (iii) will have winners and losers in terms of price

  4. Virginia Strengths • Comprehensive “federally-facilitated exchange” legislation from the 2013 General Assembly • Preserves state’s regulatory authority through the Bureau of Insurance over health plans • Long history of professional, apolitical insurance regulation and tradition of careful deliberation and thoughtful study before making major health care changes • Reflected in the ongoing health reform efforts in the executive and legislative branches • Strong, well-integrated healthcare providers and robust managed care plans with statewide coverage • Reflected in the relatively large number of offerings

  5. Health Plans Participating in the FFE *These are all Aetna products

  6. FFE Timeline January 1, 2014: Exchanges Open *This does not include the timeline for dental plans

  7. Long-term Issues • Coordination (not quite the right word) of the exchange with Medicaid, FAMIS, and employer-based insurance • Crowd out of employer-based insurance (is this a bad thing?) • Equity issues (in either direction) with Medicaid and FAMIS • Underappreciated role of the exchanges in child health, including mental health and oral health (ACA requires a pediatric dental benefit offering either through the qualified health plan or as a stand-alone benefit) • Avoiding adverse selection • It is not just young adults (though they are listed first for a reason) • The penalties, once imposed, likely will not move the needle • Importance of community wellness—is a good gym the most important health facility in any community? • Importance of cost containment overall

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