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Insuring America

Insuring America. Affordable Care Act Implementation Update Catherine Oakar, MPH Senior Policy Advisor HHS Office of Health Reform April 28, 2013. Outline ACA 3 rd Anniversary: March 23 rd , 2013. Where We’ve Been: Accomplishments Where We’re Headed: Still to Come

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Insuring America

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  1. Insuring America Affordable Care Act Implementation Update Catherine Oakar, MPH Senior Policy Advisor HHS Office of Health Reform April 28, 2013

  2. OutlineACA 3rd Anniversary:March 23rd, 2013 • Where We’ve Been: Accomplishments • Where We’re Headed: Still to Come • The Health Insurance Marketplace • Key Dates • Importance of Outreach

  3. Accomplishments Coverage: • Children: 17.6 million children with pre-existing conditions can no longer be denied coverage • Young adults: 3.1 million young adults now have coverage through parents’ plans • Seniors: 6.3 million seniors saved over $6.1 billion for prescription drugs • Prevention: 105 million Americans received coverage of preventive services without cost-sharing (18+ million children) • Pre-existing conditions: Over 110,000 Americans with pre-existing conditions gained coverage through the Pre-Existing Condition Insurance Plan

  4. Accomplishments Consumer protections, tax credits, readmissions and workforce: • 80/20 rule: 12.8 million consumers received $1.1 billion in rebates due to medical loss ratio rule (average of $151 per household) • Rate review: Insurance premium increases of 10% or more have dropped from 75% to 14% • Tax credits: 300,0000 small businesses have taken advantage of new tax credits to help offset the cost of insurance • Reducing readmissions: The 30-day readmission rate dropped in the last half of 2012 to 17.8 %, after averaging 19 percent for the past five years • National Health Service Corps: Nearly tripled since 2008 to ~10,000 providers in underserved areas • Major expansion of Community Health Centers: ~$9 billion for 2011-2015

  5. Accomplishments Payment & delivery system transformation: • Increases Medicaid payments to Medicare rates for E&M services provided by primary care physicians • For 2013 and 2014 only • Fully paid for by the federal government • Includes Pediatric Subspecialists • 1% FMAP bump for states that offer free preventive services to Medicaid enrollees • Administration Simplification for payment transactions • Standardize patient verification for insurance eligibility, mechanism to check on the status of claims submitted, transfer payments, receive remittance advice, among others.

  6. Accomplishments The CMS Innovation Center “The purpose of the Center is to test innovative payment and service delivery models to reduce program expenditures under Medicare, Medicaid, and CHIP…while preserving or enhancing the quality of care furnished.” • Identify, Test, Evaluate and Scale New Models • Opportunity to “scale up”: The HHS Secretary has the authority to expand successful models to the national level • Resources: $10 billion funding for FY2011 through 2019

  7. Accountable Care Organizations ACO -- A legal entity comprised of groups of health care providers and suppliers that: • Work together to coordinate Medicare beneficiary care • Invest in infrastructure and redesigned, coordinated care processes • Agree to be held accountable for quality, cost, and overall care of fee-for-service beneficiaries assigned to them

  8. Still to Come In 2014: • No American can be denied coverage because of health status, occupation, etc. • Fair premiums- based only on age, family size, tobacco use and geography • Guaranteed renewability • Health Insurance Marketplaces

  9. The Health Insurance Marketplace(aka Exchanges) • New way to buy health insurance: • Enrollment starts October 1, 2013 • Coverage begins January 2014 0% FPL 133% 400%

  10. Essential Health Benefits

  11. Progress Thus Far • >95% of regulations are completed • Federal systems builds are on track (e.g. insurer portal, data services hub, consumer application system) • State-based Marketplaces are progressing

  12. State Status

  13. Key Marketplace Dates for 2013 • April: Finalize State roles in Marketplaces • April: Health plans apply • Review through May and June • June: Call Center launch • July/August: Training for consumer assistance begins • July-August: Web portal loaded with QHPs and tested • October - March: Open enrollment • January 1: Coverage begins

  14. Application & Eligibility • Eligible for Marketplace or • Medicaid/CHIP • Enroll • (Marketplace) • Enroll • (Medicaid/CHIP) • Supported by Data Services Hub • Online • Phone • Mail • In-Person

  15. Enrollment Assistance • Call center • Navigators • FOA: Applications due June 7, 2013 • Proposed rule: Comments due May 6th at 5pm • In-person assistance personnel • Certified application counselors • Agents & brokers

  16. Marketplace Consumers:National Snapshot • Geography • 47.5 million uninsured • 32 million uninsured and 8.7 million non-group in FFM/Partnership states • Need to communicate at national, state and community level at same time • National Demographics • 12 million uninsured speak Spanish/8 million rely on Spanish and one million rely on some other language • 25% have not graduated High School • Poverty Level: • Psychographics • Active Sick and Worried: Need and want insurance but don’t know how to choose • Healthy & Young: Feel invulnerable; unlikely to see value • Passive & Unengaged: Uninterested in insurance; mistrust government

  17. Outreach is Critical • Resources: • Marketplace.CMS.gov • Training materials, PPTs, fact sheets • Healthcare.gov • JAMA article (Koh & Tavenner) Questions? Catherine.Oakar@hhs.gov

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