Risk Analysis of the TAA Population. NASCHIP Conference October, 2005

Transcription

1 Risk Analysis of the TAA Population NASCHIP Conference October, 2005

2 The Trade Act of 2002 Tax Credit The Trade Adjustment Act of 2002 created a new health insurance tax credit The credit is for 65% of the cost of qualified health insurance The remaining 35% is paid by the individual The tax credit can be claimed on a monthly basis as premiums are do, or a person can claim the credit on his annual tax return 2

3 Potential Eligibles: 233,000 as of August 2005 Core Topic: Eligibility Trade Adjustment Assistance Participants (TAA) TAA eligibility timeframe is up to 30 mos. Receiving a Trade Readjustment Allowance (TRA) under the Trade Adjustment Assistance Program (TAA) Eligible for TRA under the TAA program but have not exhausted their unemployment insurance (UI) benefits Receiving a benefit under Alternative Trade Adjustment Assistance (ATAA) program Pension Benefit Guaranty Corporation (PBGC) Participants PBGC eligibility timeframe is up to 10 yrs. Between the ages of Receiving pension benefits from the PBGC Currently receiving benefits from the PBGC as a survivor or beneficiary of a PBGC participant Receiving a portion of an ex-spouse s benefit from the PGBC as an alternate payee under a qualified domestic relations order An eligible individual: Is covered by a qualified health plan Cannot be claimed as dependent on another individual s federal tax return Is not enrolled in or entitled to other specified coverage, for example, Medicare Is not imprisoned by a federal, State, or local authority 3

4 Automatic Options 1. COBRA (Consolidated Omnibus Budget and Reconciliation Act of 1986) continuation coverage, unless the employer/former employer pays at least 50% of the cost of coverage 2. Spousal coverage if the employer (or employee through pre-tax contributions) pays less than 50% of the cost of coverage 3. Individual coverage in which the HCTC candidate was enrolled at least 30 days prior to separation from the job that made him/her eligible for TRA benefits, ATAA benefits, or payments from the PBGC Core Topic: Insurance Coverage Types 1. State high risk pool State Alternatives 2. Other State arrangements 3. State-based COBRA continuation coverage 4. State-worker plans 5. Plans similar to State-worker plans 6. Purchasing pool 7. State-operated health insurance plans What Conditions Must the State Alternative Health Coverage Meet? According to the Trade Act of 2002, if a State elects to accept one or more alternative plans as qualified health plans, these plans must meet four additional criteria to qualify. For individuals who have had at least three months of creditable coverage prior to seeking enrollment in a state qualified plan, the plan must meet the following requirements: 1. Guaranteed issue: qualifying individuals are guaranteed enrollment regardless of their medical status and must be permitted to remain enrolled so long as they pay the premium. 2. No preexisting condition exclusion: no preexisting condition exclusion may be imposed on qualifying individuals. 3. Nondiscriminatory premium: the premium charged for a qualifying individual may not be greater than the premium for a similarly situated person who is not receiving the credit. 4. Similar Benefits: benefits are the same (or substantially the same) under coverage provided to similarly situated individuals who are not HCTC participants. 4

5 Potentially Eligible Population * * States with qualified health plans * States with automatic options only Indicates states with mini-cobra only Note: Data as of August 2005 and excludes Puerto Rico as of September 2005 Scorecard. See Notes on the last page. 5

6 The Health Integrated Analysis HCTC Participation in Three Risk Pools Preliminary Findings Predictive Modeling Medical Claims Analysis For Internal Revenue Service October

7 Overview of Risk Analysis Utilized data from 3 high risk pools: Colorado, Illinois, Maryland - Medical Claims set October 2003 through September 2004, extracted September Total members 23,551 in three state CHIP populations - Compared HCTC eligibles and HIPAA eligibles and regular risk pool members Also compared to commercial MEDSTAT population (2.5 million lives 2001 claims) Used diagnostic data for risk adjustment using DxCG Prospective Relative Risk Scores to predict likelihood of future medical spending. - Utilizes a system of weighting diagnostic codes in a hierarchical model to determine comparative risk to a normalized population and high risk pool - Hope to conduct further data review and analysis 7

8 Populations HCTC and Risk Pool Membership Eligible Dates 10/1/03-9/30/04 Standard State Total Risk Pool % HIPAA % HCTC % Illinois % % 321 2% Maryland % 301 7% 381 9% Colorado % % 1 0% Totals % % 703 3% * Only 31 eligible members were TAA all other HCTC were PBGC 8

9 Age/Gender Mix Commercial Total CHIP HIPAA HCTC Risk Members Age 0 to 44 66% 28% 26% 4% 31% Age % 38% 40% 23% 38% Age 60+ 8% 33% 34% 73% 31% 100% 100% 100% 100% 100% Female 51% 56% 58% 46% 56% Male 49% 44% 42% 54% 44% 9

10 Preliminary Risk Profile Commercial Benchmark Total: CHIPS HIPAA Eligibles HCTC (Trade Act) Regular CHIP only Age/Sex Adjusted (1) Prospective Risk Score (2) Additional Risk (2/1) Note: Includes members with no claims history in the data set. 10

11 Co-Morbidity With High Risk Pools HCTC are much less co-morbid than either the HIPAA or Risk Pool Members - 78% less Transplants - 63% less Cognitive Disorder - 62% less Neurological - 54% less Metabolic and Liver - 47% less Cardio-Respiratory - 50% less Infectious Disease Note: Comparison between HIPAA, Risk, and HCTC within Total CHIP population. We hope to be able to compare HCTC and HIPAA populations to a standardized commercial population as well. 11

12 Appendix Program Information 12

13 States with State-Qualified Plans As of August 31, 2005 Potentially Eligible Population Registered & Enrolled Population State Qualified Plan Type State PBGC TAA/ATAA Total State Qualified COBRA Individual Total High Risk Pool Private Mini-COBRA Other State Plan AK 69 * AL 2,420 1,506 3, * AR 690 1,006 1,696 * AZ 1, , * CA 8,715 1,437 10, CO 1, , * CT 1, , * DC * FL 11, , * IA ,471 * 21 * ID IL 8,385 3,999 12, * IN 7,344 3,625 10, KS ,241 * 29 * KY 1,473 6,849 8, LA 1, , MD 3, , * ME , * MI 5,244 4,349 9, * MN 1, , * MO 5,129 1,165 6, * MT * * NC 9,071 11,003 20, ,291 * 2, ND 26 * 26+ * NE * * NH ,067 * 39 * NJ 3,415 1,084 4, * NY 7,574 2,139 9, OH 12,679 2,809 15, , OK ,639 * 39 * OR 578 1,397 1, PA 16,734 4,558 21, , , RI * 83 * SC 2,609 4,915 7, * TN 3,516 3,819 7, * TX 3,969 2,838 6, * UT , * VA 3,579 3,409 6, * VT * * * WA 2,464 1,060 3, * WI 1,743 2,934 4,677 * 150 * WV 3, , * Total: 139,953 73, ,607 6,253 8, , Enrolled numbers are specific to advance pay option only. * Denotes a value less than 10. This data cannot be released due to IRS Disclosure and Privacy guidelines. 13

14 States without State-Qualified Plans As of August 31, 2005 Potentially Eligible Population Registered & Enrolled Population State PBGC TAA/ATAA Total COBRA Individual Total DE GA 6,440 3,150 9, * 157+ HI * * * MA 4, , * 125+ MS 1, , NM * 0 0+ NV SD * 0 0+ WY Total: 14,090 5,347 19, Note: Excludes Puerto Rico as of September 2005 Scorecard. Enrolled numbers are specific to advance pay option only. * Denotes a value less than 10. This data cannot be released due to IRS Disclosure and Privacy guidelines. 14

15 As of August 31, 2005 Participation Summary Number of States Advance Credit Enrolled by Coverage Type State Qualified COBRA Individual States with State Qualified Plans 42 6,253 8, States without State Qualified Plans 9 N/A Total 51 6,253 (40%) 9,216 (59%) 194 (1%) Note: Excludes Puerto Rico as of September 2005 Scorecard. Potentially Eligible Population Percentage of Potentially Eligible Population Advance Credit Potentially Eligible by Eligibility Type PBGC TAA/ATAA States with State Qualified Plans 213,607 92% 139,953 73,654 States without State Qualified Plans 19,437 8% 14,090 5,347 Total 233, % 154,043 (66%) 79,001 (34%) Enrolled numbers are specific to advance pay option only. ATAA numbers have been combined with TAA numbers because of the small size of the ATAA population (there were fewer than 1000 potential eligibles in August). * Denotes a value less than 10. This data cannot be released due to IRS Disclosure and Privacy guidelines. See Notes on the last page. 15

16 Average Premiums Paid to Health Plan Administrators Advance Credit Average Monthly Premium per Coverage Type as of August 31, 2005 # of People On Policy State Qualified Avg. COBRA Avg. Individual Avg. Average of All Types 1 $ 499 $ 391 $ 378 $ $ 967 $ 815 $ 806 $ $ 798 $ 925 * $ $ 807 $ 919 N/A $ 893 Premiums represent the 100% monthly premium charged by HPA to the participant: 35% to be paid by participant and 65% to be paid by the IRS. Caution should be exercised in making comparisons or drawing conclusions from premium averages. There is considerable variation in the benefits and deductibles offered by health plans, state and plan premium rating rules, and plan demographics. All of these factors can affect premium rates significantly. * Denotes a value from a sample of less than 10. This data cannot be released due to IRS Disclosure and Privacy guidelines. 16