WA Association of Community and Migrant Health Centers March 26 2013

1. WA Association of Community and Migrant Health Centers March 26 2013 Brad Finnegan

2. The Affordable Care Act • Changes to private insurance, e.g., • Young adults on parent’s policies to age 26 • Prohibit lifetime monetary caps • Minimum spending on medical care (medical loss ratio) • Closing the prescription “doughnut hole” • Expands coverage and imposes an individual mandate in 2014 • Expands Medicaid to 138%* of FPL • Exchanges for individuals and small businesses, with premium tax credits and cost sharing reductions *ACA 133%=138% due to across the board income disregards

3. Exchange basics • Individuals >138% of FPL and small groups (2-50) • Tax credits available for individuals 138%-400% of FPL • Cost sharing reductions available for <250% FPL • “Qualified health plan” (QHP) offerings • Metallic tiers of actuarial value • Apples-to-apples comparisons for consumers, one-stop shop • 10 essential health benefits • Navigators, agents/brokers, call center assistance

4. Coverage Continuum in 2014 3 * 4 * Federal Basic Health Plan Option for individuals with incomes between 138% and 200% of the FPL will not be available in 2014.

5. Building the Exchange 2013 2012 • Exchange must be certified by HHS • Additional legislative action taken as needed • Open Enrollment begins (October 1) • Board begins governing authority • ESSHB 2319 passed • Deloitte Consulting, LLP, signs on as system integrator • Exchange names first CEO and moves into new building • Washington becomes second Level 2 establishment grant recipient, $128 million • Exchange moves onto own payroll and accounting systems • WA HBE receives conditionalcertification to operate state based exchange with HHS/CCIIO • Sustainability plan submitted to Legislature 2011 2014 • Coverage purchased in the Exchange begins • Open enrollment ends in March. • HCA receives one-year $22.9 million grant to design and develop Exchange • SSB 5445 passed creating Exchange as “public private partnership” • Governor names Exchange Board members

6. Exchange Value Proposition

7. Individual vs. SHOP Exchange Individual Exchange SHOPExchange Who: • Individuals who are not on public or employer sponsored plans • Small businesses with 2 - 50 employees What: • Access to QHPs, federal subsidies through APTC and / or CSR, and referral to alternative options (e.g., CHIP) • Employee access to employer sponsored plans with increased choice • Employer ability to define contributions and access to small business tax credits • Initial open enrollment is open to all with some special enrollment periods pending eligibility status • Initial open enrollment is open to all with some special enrollment periods pending eligibility status When:

9. QHP Logo QHP Logo

11. QHP Logo QHP Logo QHP Logo

13. Membership Growth: “New” Members PROJECTED EXCHANGE MEMBER ENROLLMENT (2014 – 2017 YEAR END)

14. Implications for Providers • Expanded insurance coverage for current and new patients. • Reductions in patient point of service payments (i.e., copayments, cost sharing) • Potential changes in contracts • Potential role in enrolling individuals in insurance • Potential changes in payment • Shop for insurance by provider

15. Important Board Policy Decisions Completed • Criteria for qualified health plans (QHPs) • Premium aggregation • Consumer Rating System • Pediatric Dental Benefits • Navigator program • Role of agents/brokers Upcoming • Exchange financing/Sustainability

16. Key Challenges • Tight timeline – Oct. 1, 2013 • Federal dependencies and guidance • IT flight path – scope, schedule and budget • Delivery environment • Critical inter-agency interdependencies • Managing expectations • Options deferred to 2.0 or 3.0 • Complex authorizing environment

17. More on the Exchange http://wahbexchange.org/ Includes information about: • Exchange Board • Legislation and grants • Policy discussion • TAC and stakeholder involvement • IT systems development • HHS guidance • Listserv registration • info@wahbexchange.org

19. Appendix

20. Governance Eleven member, bi-partisan board assumed authority on March 15, 2012 Margaret Stanley – Chair, Retired Executive Director, Puget Sound Health Alliance Steve Appel – Farmer, Past President of the Washington Farm Bureau William Baldwin – Partner, The Partners Group Donald Conant – General Manager, Valley Nut & Bolt, Assistant Professor Doug Conrad – Professor, University of Washington Melanie Curtice – Partner, Stoel Rives Ben Danielson – Medical Director, Odessa Brown Phil Dyer – Senior VP, Kibble & Prentice, and Former Legislator Teresa Mosqueda – Legislative & Policy Director, Washington Labor Council *Commissioner Mike Kreidler – Insurance Commissioner *MaryAnne Lindeblad – HCA Director * non voting, ex officio

21. Washington Healthplanfinder Vision: Redefining People's Experience with Health Care Mission: Radically improving how Washingtonian’s secure health insurance through • innovative and practical solutions • easy-to-use customer experience • our values of integrity, respect, equity and transparency • providing undeniable value to the healthcare community (patients, providers, plans)

22. More on the Exchange http://www.WAHBExchange.org Includes information about: • Exchange Board • Legislation and grants • Policy discussion • TAC and stakeholder involvement • IT systems development • HHS guidance • Listserv registration • info@wahbexchange.org