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Healthcare 2014

North Coast Association of Health UnderwritersSeptember 10, 2014Grace-Marie Turner, Galen InstituteCurrent ACA Coverage Estimates25 million more to get health coverage+ 13 million through Medicaid expansion+ 24 million through federally subsidized private insurance - 12 million lose current coverage

31 million remain uninsured by 2023Source: http://www.cbo.gov/sites/default/files/cbofiles/attachments/43900-2013-05-ACA.pdf2015 Reenrollment challengesGoal: Keep 8 million and enroll 5 million moreAutomatic reenrollment

But many of 87% getting subsidies could face higher costs, lose added Silver plan subsidies Subsidies tied to second-lowest priced Silver plan or benchmark planCosts for individuals could rise significantly

CALIFORNIASonoma CountyPre- to Post- ACA rates

MEN

Age 27 $128 to $217 70% Age 40 $162 to $265 64%Age 64 $509 to $623 22%

California battles over ratesProposition 45 - Commissioner Dave Jones/Consumer Watchdog70% of voters support state rate regulationWeighted average of CCA rates: +4.2% in 2015 ACA reinsurance program helps stem losses but ends in 2016.Insurers are hit with higher admin costs, MLR rules, new taxes, and soaring hospital costsExplain that consumers will be harmed with even narrower networks, higher OOP cost

Are most ACA subsidies even legal?U.S. Court of Appeals in Washington, DC

2-1 decision

The language of the ACA unambiguously restricts subsidies to Exchanges established by the state.U.S. Court of Appeals in Richmond

3-0 decision

widely available tax credits are essential to fulfilling the Acts primary goals.Court challenges will continueEn banc hearing by full D.C. Circuit Court of Appeals

Two more federal courts will rule on similar challengesIndianaOklahoma

Split decisions will send the case back to the Supreme Court

A decision against the government will require action by Congress to protect 5+ million people receiving subsidiesClose to a third of voters either received a cancellation notification or know someone who did.Pg. 9BASE: ALL QUALIFIED RESPONDENTSQ705. For each of the following, indicate Yes or No.

Future worriers more closely related to oppositionMore than two-thirds of voters believe we should address health care policy in a step-by-step approachPg. 10COMPREHENSIVE 31%STEP-BY-STEP 69%Parker believes we should address health care policy improvements in a step-by-step approach so that we focus on the biggest problems first and avoid making changes that may bring unintended consequences or upset our coverage or other things we like in the current health care system.

Riled-Up Individualists: 89%Oppose Obamacare: 84%Conservatives: 84%Republicans: 83%Discouraged Conservatives: 81%Tea Party supporters: 80%HS or less education: 75%Ages 35-54: 74%Alienated Liberals: 74%Davis believes that comprehensive legislation is the only way to bring about real health care reform. Health care issues are complex and interconnected. The comprehensive approach is the best way to deal with these issues all together to achieve the real changes that are needed.

Liberal Left: 55%Support Obamacare: 54%Liberal: 50%Democrats: 47%Hispanic: 44%Ages 27-34: 41%Black: 40%Post grads: 38%

BASE: ALL QUALIFIED RESPONDENTSQ235. Please read each opinion and indicate which one comes closest to your own:10Majority of voters would prefer to try a new alternative to Obamacare or go back to the old systemPg. 11BASE: ALL QUALIFIED RESPONDENTSQ275. Thinking about things a little differently, if it were up to you to make a decision about Obamacare, which would you choose?If it were up to you to make a decision about Obamacare, which would you choose? Most likely to want to go back to old system:Riled-Up Individualists: 54%Tea Party supporters: 51%Republicans: 50%Discouraged Conservatives: 45%Those receiving coverage cancellation notices: 35%South East: 35%HS education or less: 34%Ages 18-26: 33%Most likely to want to try a new alternative:Alienated Liberals: 49%Discouraged Conservatives: 43%Riled-Up Individualists: 42%Republicans: 41%HS education or less: 40%Conservatives: 40%Not employed: 39%Independents: 39%Mostly likely to want to keep ObamacareLiberal Left: 80%Democrats: 68%Liberals: 69%Black: 62%Moral Citizens: 53%Hispanic: 48%West: 47%Post grads: 47%Ages 27-34: 46%Moderates: 43%

Whats next with health reform?

Two different visions

We need to pass our own replace bill to show what we are forDifficult choices

Providing help to buy health insurance

Tax deduction?How much?

Tax credit?Refundable?Advanceable?Age adjusted?Targeted?

Tax cap?What level?Start by painting a new vision

not by first getting bogged down in these hard choices and difficult detailsMoving to a Patient-Centered Health Care SectorPrivate sector

Align incentivesTransparencyGenuine competitionBenefit choicesPre-existing condition protectionNurture innovationPublic sector

Choice of private plans in MedicareEscape from the Medicaid ghettoMore flexibility and incentives for states to take the lead on reform

Coburn/Burr/Hatch Patient Choice, Affordability, Responsibility and Empowerment ActBrounPatient OPTION ActPriceEmpowering Patients First ActScalise/RoeThe American Health Care Reform ActGenuine choice, better coverage through real competition

Patients and doctors make decisions

Making insurance at work more affordable

More stability for Medicare

Giving the poor more options

Holding hospitals accountable

Focus groups with independent women

27ExamplesMake policy personal and relevantA young motherPick your own plan and doctors

A young, single guyAffordable catastrophic coverage

A small business ownerChoices of plans she can afford

Someone with chronic or serious illnessA strong safety net

Conveying a fresh vision of health freedomMore choices of more affordable coverage that lets you pick your own plan, your own hospital, and your own doctor

Straightforward guarantees you can keep your coverage

A safety net that protects the vulnerable and those with pre-existing conditions

Joint public/private initiativesUsing claims data, EHRs to gather information to improve consumer engagementCost transparency + incentives for consumers to shop wiselyConsumer priorities in selecting plans: Price. Access. Brand. Access to providers via phone, email, and social mediaHot buzz-terms:Value-based paymentChanneled partnershipsVertical integration (ACOs) to share risk and rewardsRepealReplacewithBipartisanReform

Grace-Marie TurnerGalen Institute703-299-8900gracemarie@galen.org

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