The Affordable Care Act and the Fight Against Cancer ***** Arkansas Cancer Summit

1. The Affordable Care Act and the Fight Against Cancer ***** Arkansas Cancer Summit North Little Rock, March 18, 2014 ***** Cindy Crone, APRN, Deputy Commissioner Arkansas Insurance Department Arkansas Health Connector Division Arkansas Cancer Coalition

2. Arkansas Healthcare Landscape • Many Remain Uninsured • Low Per Capita Income • Poor Health Status • Multiple Health System Improvement Efforts Arkansas Cancer Coalition

3. Selected Health Indicators(Kaiser Family Health, 2012) Arkansas Cancer Coalition

4. Health – Related Indicators(Kaiser Family Health 2013) Arkansas Cancer Coalition

5. Affordable Care Act President Obama’s signature domestic policy achievement, signed into law March 23, 2010. Establishes Health Insurance Marketplaces and Essential Health Benefits, among other things. Arkansas Cancer Coalition

6. ACA benefits to cancer patients • No more bans, rescissions, or upcharges for pre-existing conditions, including cancer. • Closing of Medicare drug coverage “donut hole.” • Elimination ofannual or lifetime benefit limits. • No out-of-pocket consumer expenses for preventivecare, including selected cancer screenings. Arkansas Cancer Coalition

7. What is a Health Insurance Marketplace (Exchange)? • Competitive marketplace where individuals, families and small employers can shop for, select and enroll in high quality, affordable private health plans that meet their specific needs at competitive prices. • Exchanges will also help eligible individuals receive premium tax credits and cost sharing reductions or help them enroll in other state or federal public health programs. Arkansas Cancer Coalition

8. What is covered? Arkansas Cancer Coalition

9. Essential Health Benefits • Outpatient Services • Hospitalization • Emergency Services • Maternity and Newborn Care • Mental Health and Substance Use Disorder Treatment • Prescription Drugs • Rehabilitative and Habilitative Services/Devices • Laboratory Services • Preventive, Wellness, and Chronic Disease Management • Pediatric Services, Including Oral and Vision Care Arkansas Cancer Coalition

10. An ounce of prevention … • A major focus of the ACA is empowering consumers to take charge of their health, heading off problems before they start, including cancer. • The ACA calls for Marketplace plans to cover a multitude of preventive services without charging a co-payment or co-insurance. • The ACA helps provide peace of mind for consumers. Arkansas Cancer Coalition

11. Preventive services include • Abdominal Aortic Aneurysm one-time screening • Alcohol Misuse screening and counseling • Aspirin use to prevent cardiovascular disease for men and women of certain ages • Blood Pressure screening • Cholesterol screening • Cancer screening, including breast, cervical, colorectal • Depression screening • Diabetes (Type 2) screening • Diet counseling • HIV screening • Immunizations / vaccines • Obesity screening and counseling • Sexually Transmitted Infection (STI) prevention counseling • Syphilis screening • Tobacco Prevention/Brief Intervention Counseling for Youth/Adolescents and Tobacco Use screening and cessation interventions for all adults

12. Breast cancer drugs • In January, the federal government announced that women with high-risk of developing breast cancer may receive needed drugs without out-of-pocket costs. • Those drugs include tamoxifen and raloxifene. • Study showed they cut the incidence of invasive breast cancer from 16 events to 9events per 1,000 women over five years. (USA Today, Jan. 9, 2014) Arkansas Cancer Coalition

13. ACA helps catch cancer early “We are making significant advancements in combating this disease — and for women who are shown to be at a higher relative risk for breast cancer, today, access to early treatments can improve their health.” HHS Secretary Kathleen Sebelius Arkansas Cancer Coalition

14. Insurance Key to diagnosis • Teens and young adults without health insurance are more likely to be diagnosed with late-stage cancer, according to American Cancer Society study released this month. • Men 1.51 times more likely. • Women 1.86 times more likely. (American Cancer Society, news release, Feb. 24, 2014) Arkansas Cancer Coalition

15. ACA helps catch cancer early “The findings suggest that policies such as the Affordable Care Act that increase the number of people in America with health coverage will result in fewer late-stage cancer diagnoses and save lives.” — Study by American Cancer Society, Dr. Anthony Robbins, Director of Health Services Research. Arkansas Cancer Coalition

16. Grandfathered plans — Be Wary • The federal government on March 5 extended by two years (through plan years beginning no later than Oct. 1, 2016) certain plans that do NOT comply with ACA protections. • Second such extension: In November, deadline was delayed from January 1, 2014 to October 1, 2014. Arkansas Cancer Coalition

17. Consumer notice A notice from the carrier must state that the plan: • Might exclude consumers with pre-existing conditions. • Might not provide limits to out-of-pocket expenses. • May limit participation in clinical trials. • May not cover Essential Health Benefits. Arkansas Cancer Coalition

18. Status of Marketplaces State-Based Marketplace State-Based Marketplace (SHOP only) Partnership Marketplace Federal Marketplace Arkansas Cancer Coalition

19. Individual Premium Tax Credit Eligibility • Household income 139% to <400% FPL • Enrolled in a QHP through the Marketplace • Lawfully present • Not incarcerated post conviction • Not eligible for other coverage such as Medicare, Medicaid, or affordable employer-sponsored insurance. • Open Enrollment (October 1, 2013 – March 31, 2014 this year) and Special Enrollment Periods (with significant life changes). Arkansas Cancer Coalition

20. Private Option Eligibility • Household income 138% of FPL or below. • Enrolls in a qualified health plan for sale on the Marketplace. • Childless adults 0% - 138% of FPL • Custodial parents 17% - 139% FPL • Not disabled or with a complex medical conditions better served through traditional Medicaid • Not incarcerated • Enrollment is year-round. Arkansas Cancer Coalition

21. AR State Partnership Marketplace Health Insurance Medical Issuers - 2014 • Arkansas Blue Cross and Blue Shield • Blue Cross and Blue Shield Multi-State • QualChoice of Arkansas • Celtic, doing business as Arkansas Health and Wellness Solutions (Ambetter) Arkansas Cancer Coalition

22. Qualified Health Plansin Arkansas Marketplace - 2014 Additionally, 8 catastrophic plans are offered Arkansas Cancer Coalition

23. Stand-Alone Dental IssuersOffer 24 Plans • Arkansas Blue Cross and Blue Shield • Best Life and Health • Delta Dental of Arkansas • DentegraInsurance Company Arkansas Cancer Coalition

24. Premium Limits Based on Income Arkansas Cancer Coalition

25. 2013 Federal Poverty Guidelines Arkansas Cancer Coalition

26. Tax Credits at Work With an average base individual monthly premium of $259 in Arkansas for second-lowest price Silver plan, these examples show what a 30-year-old non-smoker will pay in monthly premium: Arkansas Cancer Coalition

27. Tobacco surcharges • The ACA allows surcharges of as much as 50 percent. • Arkansas chose to limit the surcharge to 20 percent. • Two issuers doing business on the Marketplace have added the surcharges: QualChoiceand Celtic. • The Arkansas Blue Cross Blue Shield plans and the Blue Cross Blue Shield Multi-State Plan are not charging different rates for tobacco users. Arkansas Cancer Coalition

28. What about family costs? Arkansas Cancer Coalition

29. With an average base monthly premium of $874 for a family of four (two adults age 40 with two children) in a second-lowest cost silver plan, these examples show monthly costs: Arkansas Cancer Coalition

30. Premiums Vary by Age Arkansas Cancer Coalition

31. Seven rating areas in Arkansas Arkansas Cancer Coalition

32. Issuers/Plans per Service/Rating Area Rating areas are identified by their geographic area and their assigned number. The number of low dental plans is the same as the number of high dental plans. Arkansas Cancer Coalition

33. Regional variancesPremiums without tax credits Arkansas Cancer Coalition

34. Important for Families! Maximum Annual Out of Pocket Maximums (which include Deductibles, Co-Insurance and Co-pay) for Plans on Marketplace: • $6,350 per individual • $12,700 per family Maximum Deductibles in SHOP: • $2,000 individual • $4,000 family HSAs available on some plans Arkansas Cancer Coalition

35. What about business coverage? • The Small Business Health Options Program (SHOP) is part of the Marketplace. • Aim is to help reduce health care costs for small business. • Eligible businesses have 50 or fewer full-time equivalent employees. • Shopping on Healthcare.gov delayed until November 2014. Arkansas Cancer Coalition

36. SHOP in AR SPM in 2014 • One Issuer – Arkansas Blue Cross Blue Shield • Three Plans Offered in 2014 • One Gold • One Silver • One Bronze • Only way for Business to get Tax Credits. Arkansas Cancer Coalition

37. Who can help?(as of March 7, 2014) Arkansas Cancer Coalition

38. Outreach and Education Broad multi-media “Get Informed” campaign across Arkansas July 1 – September 30, 2013 Arkansas Cancer Coalition

39. Outreach and Education • Speakers’ Bureaus active • “Get Enrolled” Enrollment Action Phase scheduled to begin October 1, 2013 not implemented due to Arkansas Legislature’s denial of continuing outreach and education contract. • Healthcare.Gov now working well after rocky start. • AR Health Connector website redirected to AID-AHCD web page. • Currently working enrollment events across state with Guides/others. Arkansas Cancer Coalition

40. http://ahc.arkansas.gov/ Arkansas Cancer Coalition

41. Steady progress for Arkansans with incomes >138% FPL Arkansas Cancer Coalition

42. New Challenges Compromise on Insurance Department appropriation bill to: • Eliminate outreach and promotional programs by the AID to educate consumers about their options for coverage. • Eliminatethe In-Person Assister program Arkansas Cancer Coalition

43. Why compromise? • A way to gain votes for the “Private Option” Medicaid expansion. • The possibility of more than 105,000 Arkansans in need losing their new health care coverage. • Private Option helps improve the “risk pool” for the Marketplace as a whole, keeping premiums down. Arkansas Cancer Coalition

44. Meanwhile … We are doing everything we can to get the word out at enrollment events throughout Arkansas Arkansas Cancer Coalition

45. Call to Action What can advocates for cancer patients do to help? • Spread the word about the March 31 enrollment deadline. • Educate patients about the ACA benefits. • Find out who wants more information and tell them how to get it. • Let us know how we can help. Arkansas Cancer Coalition

46. Open enrollment ends March 31! Arkansas Cancer Coalition

47. Contact Cynthia.Crone@arkansas.gov 501-683-3634 www.ARHealthConnector.org 855-283-3483 Arkansas Cancer Coalition