What’s Driving State Reform?

1. The Building Blocks of State ExpansionsNational Congress of the Un- and UnderinsuredDecember 11, 2007Christine Barber, Cheryl Fish-Parcham and Ella HushagenCommunity Catalyst and Families USA

2. What’s Driving State Reform? Health reform is shifting to the states: • Increased demand • Increased opportunity • Lack of action from federal government • Increased political understanding and willingness to tackle the issue • The “me too effect”

3. States are tackling tough questions • How to make health coverage affordable? • How to expand access in the private insurance market? • How to incorporate comprehensive benefits? • How to increase accessibility of health care services? • How to fund state expansions? • How to improve quality and reduce long term health spending?

4. Core component #1: Medicaid & SCHIP • Kids to 300% FPL or higher • Enacted in CT, MA, MD, NJ, NH, WA; proposed in NY. • All Kids Expansions • Enacted in IL, PA, WI; proposed in CA, OR. • Parents to 200% FPL or higher • Enacted in AZ, DC, ME, MN, WI. • Childless adults to at least 100% FPL • Enacted in HI, MA, ME, MN, NY, OR, VT, MD; proposed in CA.

5. Core component #2:New affordable coverage options • Stack subsidized coverage on top of Medicaid and SCHIP • In MA, choice of regulated private plans offered by Medicaid MCOs (community rated, guaranteed issue, standards on covered benefits, no deductibles, limited cost-sharing) • In ME, single private plan • In VT, standard plan offered by multiple insurers

6. Core component #3:Private market reform • Guaranteed availability of coverage • Guaranteed issuein the nongroup market; enacted in MA, ME, NJ, NY, VT, WA • Affordable high-risk pool or designated carrier. • Community rating (or modified community rating)in the small and nongroup markets • Enacted in small group in CT, ME, MD, MA, NJ, NY, OR, VT, WA. • Enacted in nongroup in ME, MA, NJ, NY, OR, VT, WA. • Rate review

7. Core component #3:Private market reform, new tools • Merged small and nongroup markets • Subsidized reinsurance • Require employers to establish pre-tax Section 125 plans • Extended dependent coverage for young adults (to age 25-26) • Connectors

8. Core component #4:Comprehensive benefits • Medicaid & SCHIP • Good benefits for currently covered and expansion populations • Premium assistance only for qualified private plans • Subsidized coverage • Same benefits as Medicaid or SCHIP? • Private market • Standardized benefit packages • Minimum coverage guidelines

9. Core component #5:Access to Health Services • Improve outreach, enrollment & retention • Medicaid and SCHIP • New subsidized coverage program • Address provider capacity issues • Public programs • Rural and other underserved areas • Reduce racial and ethnic health disparities

10. Core component #6:Secure sustainable financing • Increase federal dollars • Maximize federal match • Redirect current spending • In MA, Uncompensated Care Pool • Generate new dollars • “Sin” taxes, provider assessments, etc. • Employer pay-or-play • Assessment per employee, or % payroll

11. Core component #7:Cost-containment strategies • Medical loss ratios • Preventive care & medical homes • Medical loss ratios & standardized billing • Certificate of Need • Chronic care management • P4P and Hospital Error Reduction • Rx Reform

12. Thank you! Any questions? • Christine Barber, Community Catalyst www.communitycatalyst.org 617-338-6035 • Cheryl Fish-Parcham & Ella Hushagen, Families USA www.familiesusa.org 202-628-3030