Washington State Health Insurance Exchange

Washington StateHealth Insurance ExchangePhil DyerBoard Member

1Disclaimer;The views and information expressed are my personal opinions and perspectives and do not represent the official position of the State of Washington or the Washington State Health Insurance Exchange Board or Staff.2The WA Health Insurance ExchangeAs laid out in Substitute Senate Bill 5445, twenty nominations for the Exchange Board were submitted by the house and senate caucuses and included individuals with expertise in individual health care coverage, small employer health care coverage, health benefits plan administration, health care finance and economics, actuarial science, and/or administering a public or private health care delivery system. Initial members of the board will serve staggered terms not to exceed four years. On March 15th, 2012, the Board assumed governing authority over the Exchange.

3The WA Exchange BoardChair: Margaret Stanley, retired Executive Director of the Puget Sound Health Alliance, and former Senior Vice-President at Regence BlueShield and head of public employee benefits programs in both Washington and California (Non Voting with exception of Tie Votes)Ben Danielson,MD Medical Director at the Odessa Brown Children's Clinic Bill Baldwin, Partner, The Partners Group Don Conant, General Manager at Valley Nut and Bolt in Olympia and Assistant Professor in the School of Business at St. Martin's University Doug Conrad, Professor of Health Services at the University of Washington School of Public Health Melanie Curtice, partner in the employee benefits section at the law firm of Stoel Rives LLP Phil Dyer, Senior Vice President at Kibble & Prentice/USI and former state legislator Steve Appel, wheat and barley farmer and immediate past-President of the Washington Farm Bureau Teresa Mosqueda, Legislative and Policy Director for the Washington State Labor Council and Chair of the Healthy Washington Coalition Ex-Officio: MaryAnne Lindeblad, Director of the Health Care Authority Ex-Officio: Mike Kreidler, Washington State Insurance Commissioner

4WA Exchange Board GoalsIncrease access to affordable health plans.Organize a transparent and accountable insurance market -- to facilitate consumer choice.Provide an efficient, accurate and customer-friendly eligibility determination process.Enhance health plan competition on value -- price, access, quality, service, and innovation.

5WA Exchange Major CommitteesOperations Chair, Melanie CurticeSteve AppelBill BaldwinDon ConantMargaret StanleyPolicyChair, Teresa MosquedaDoug ConradBen DanielsonPhil DyerMargaret Stanley

6Exchange Board Advisory CommitteeMay 16, the Exchange Board selected 17 committee members to provide expertise and experience on an array of issues related to developing the Health Benefit Exchange in Washington State. Those members include:American Indian Health Commission (AIHC) Representative Sharon Beaudoin, WithinReachTed Blotsky, Employee Benefit Services-Associated Employers TrustGlen Bogner, Molina HealthcareKitti Cramer, Premera Mike Fournier, Washington Farm Bureau Patty Hayes, Public Health Seattle & King County Dhyan Lal, Providence Health & Services Mary McWilliams, Puget Sound Health Alliance Karen Merrikin, GroupHealth Cooperative Hiroshi Nakano, South Sound Neurosurgery Pam Oliver, Community MemberJim Pinkerton, Regence Donna Steward, Association of Washington BusinessLarry Thompson, Whatcom Alliance for Healthcare AccessWashington Association of Health Underwriters (WAHU) RepresentativeJoshua Welter, Mainstreet Alliance

7Exchange Board Technical Advisory CommitteesDental Technical Advisory Committee Dr. Christopher Delecki Odessa Brown Childrens Clinic David Digiuseppe Community Health Plan of Washington Bracken Killpack - Washington State Dental Association Dr. Alejandro Navarez Sea Mar CHC Dr. Brian Schur Tri-Cities Community Health Center Chris Smith Regence BlueShield Delta Dental Washington Dental Service Foundation Representative Navigator Program Technical Advisory Committee Sofia Aragon Washington State Nurses Association Pam Cowley Tacoma-Pierce County Health Department Rhonda Hauff Yakima Neighborhood Health Services Devon Love Equal State Community Coalition for Multicultural Health Vicki Lowe Jamestown SKlallam Tribe Michelle Sarju Open Arms Perinatal Services Lara Welker Whatcom Alliance for Healthcare Access Role of Agents/Brokers Technical Advisory Committee Lonnie Goodell Group Health Cooperative Dave Guyll Conover Insurance Bryan Marsh Regence BlueShield Nita Petry Gallagher Benefit Services, Inc. Harald Schot LifePlan Financial Inc.

8Health Care National Spending(Deloitte)This year, the federal government will take in about $2.4 trillion and spend about $3.6 trillionthe fourth year in a row of the deficit exceeding $1 trillion.

Spending for health care programsMedicare, Medicaid, Childrens Health Insurance Program (CHIP), military health, federal employee coveragewill be almost one-fourth of the governments outlays and a third of all government revenues from taxes paid by individuals and companies9State Action Toward Creating Health Insurance Exchanges

As of August 24, 20121011Washington is a Leading State in the Process of Securing $178 Million for Exchange Establishment & Medicaid Eligibility Systems

Exchange Functions

Certifying health plans as Qualified Health Plans to be offered in the exchange.The final rule allows Exchanges to work with health insurers on structuring qualified health plan choices that are in the best interest of their customers. This could mean that the Exchange allows any health plan meeting the standards to participate or that the Exchange creates a competitive process for health plans to gain access to customers on the Exchange Standards for Health Plans Exchanges, working with state insurance departments, to set specific standards to ensure that each qualified health plan gives consumers access to a variety of providers within a reasonable amount of time. Exchanges will also establish marketing standards to make sure that qualified health plans do not market plans in a way that discriminates against people with illnesses. 12

Operating a website to facilitate comparisons among qualified health plans for consumersOperating a toll-free hotline for consumer support, providing grant funding to entities called Navigators for consumer assistance, and conducting outreach and education to consumers regarding Exchanges

Exchange FunctionsConsumer Interactions13

Exchange FunctionsDetermining eligibility of consumers for enrollment in qualified health plans and for insurance affordability programs (premium tax credits, Medicaid, CHIP and the Basic Health Plan) Eligibility Determinations Exchanges to consider whether consumers are eligible for all available programs using a single, streamlined application Simple Verification of Data Exchanges to rely on existing electronic sources of data to the maximum extent possible to verify relevant information, with high levels of privacy and security protection for consumers. Coordinating across Programs: The final rule ensures that Exchanges will coordinate with Medicaid, CHIP, and the Basic Health Program

1415Exchange Value Specific FunctionsI. Issuers of QHPsII. Health Care MarketIII. Public and StateMarketing & OutreachEligibility Determination for tax creditsEnrollmentPremium AggregationEasy plan comparison and purchase of health insuranceReporting of cost/quality metricsAwareness of need for health insuranceAppeals of eligibility determinations and individual responsibilityInformation on health insurance carriersCustomer ServiceEnrollment reconciliation with HHSNew Membership opportunity previously uninsured

Supporting use of innovative product designs and payment methodologiesExpanded access to health insurance coverageReduced charity careTrustworthy source of health care reform informationBroad-based Public Information Other impacts of ACAExchange FunctionsExchanges to build partnerships with and award grants to entities known as Navigators who will reach out to employers and employees, consumers, and self-employed individuals to:Conduct public education activities to raise awareness about qualified health plans Distribute fair and impartial information about enrollment in qualified health plans, premium tax credits, and cost-sharing reductions Assist consumers in selecting qualified health plans Provide referrals to an applicable consumer assistance program or ombudsman in the case of grievances, complaints, or questions regarding health plans or coverage Provide information in a manner that is culturally and linguistically appropriate

16Exchange FunctionsSMALL BUSINESS HEALTH OPTIONS (SHOP)Exchanges will operate a Small Business Health Options Program (SHOP). SHOP will allow employers to choose the level of coverage they will offer and offer the employees choices of all qualified health plans within that level of coverage. This allows employees a choice among plans and can select the one that best fits their needs and their budget. Employers can offer coverage from multiple insurers, just like larger companies and government employee plans, but get a single bill and write a single check. SHOP Exchanges can also allow employers to select a single plan to offer its employee Starting in 2014, small employers purchasing coverage through SHOP may be eligible for a tax credit of up to 50% of their premium payments if they have 25 or fewer employees, pay employees an average annual wage of less than $50,000, offer all full time employees coverage, and pay at least 50% of the premium.

1718Coverage Continuum in 2014

34* Federal Basic Health Plan Option for individuals with incomes between 138% and 200% of the FPL will not be available in 2014.*19SSI PresumptiveMedical Care Services ProgramBasic Health PlanADATSAInvoluntary Treatment ActPsych. Indigent Inpatient ProgramTake Charge Family PlanningFamily Planning ExtensionCHIPMedicaid StandardMedicaid BenchmarkCHIPMedicaid StandardQHP with Subsidy

To-Be Landscape: Continuous Coverage

Note: Transition options to be addressed by State Legislature.QHP without SubsidyDEBORAH20

Post Implementation of the Affordable Care Act (ACA):Subsidized Coverage Landscape in Washington344Individuals (in thousands)Note: Analysis forecast assumes full take up rate and the ACA was in effect in 2011. **Includes individuals who have access to other coverage (e.g., employer sponsored insurance). Sources: The ACA Medicaid Expansion in Washington, Health Policy Center, Urban Institute (May 2012); The ACA Basic Health Program in Washington State, Health Policy Center, Urban Institute (May 2012) ; Milliman Market Analysis; and Washington Health Care Authority for Medicaid/CHIP enrollment.20121.16 million current enrollees2014545,000currently eligible but not enrolled**494,000 newly eligible532,000 eligible for subsidies21Post Implementation of the ACA: Remaining UninsuredUndocumented immigrantsIndividuals exempt from the mandate who choose to not be insured (e.g., because coverage not affordable)Individuals subject to the mandate who do not enroll (and are therefore subject to the penalty)Individuals who are eligible for Medicaid but do not enroll

THE METALLICS

Four Levels of Benefits BronzeSilverGoldPlatinum22Exchange FunctionsApply the Essential Health Benefit Plan Levels established by Essential Health Benefits QHPs must include items and services within at least the following 10 categories:Ambulatory patient servicesEmergency servicesHospitalizationMaternity and newborn careMental health and substance use disorder services, including behavioral health treatmentPrescription drugsRehabilitative and habilitative services and devicesLaboratory servicesPreventive and wellness services and chronic disease management, andPediatric services, including oral and vision care

2324Timeline of Key Tasks: Much Work To Be Done201220132014Oct 1 2013: Open enrollment begins.Jan 1 2014: Exchange goes live.July 1 2013: Finalize QHP contracts.October 2012: Complete business rules and workflow for all eligibility & enrollment operations.Jan 1 2013: Receive conditional or full exchange certification from Secretary. QHP solicitation bids due.Initiate marketing & outreach campaign.Launch assisters training program. Nov 2014: Last Exchange Establishment application deadline.Nov 16, 2012: Request federal certification for Exchange operations.Dec 31 2014: Exchanges must be self-sustaining.Sept 30 2012: Deadline to select benchmark Essential Health Benefits plan.Aug 15, 2012: First of ten new opportunities to apply for Exchange grants25To Learn More About the ExchangeContact: http://www.hca.wa.gov/hbe

Includes information about:Exchange BoardLegislation and grantsPolicy discussionTAC and stakeholder involvementIT systems developmentHHS guidanceListserv registrationQuestions

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