Washington Health Benefit Exchange. Leading Age 2014 Annual Conference. Phil Dyer Board Member

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1 Washington Health Benefit Exchange Leading Age 2014 Annual Conference Phil Dyer Board Member DISCLAIMER; 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 Health Benefit Exchange Board or Staff. 1

2 The Washington Health Benefit Exchange As 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. The Exchange Board Goals Increase 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. 2

3 /8/2014 Exchange Committee Structure Exchange Board Policy Committee Operations Committee Advisory Committee Agents & Brokers TAC Dental TAC Health Equity TAC Navigator TAC SHOP TAC Workgroups The U.S. Healthcare Industry Currently under enormous financial strain and demographic pressure, healthcare will have to reinvent itself over the next few decades. National Health Expenditures (Billions USD) 3,000 2,500 2,000 1,500 1, National Health Expenditure as Share of GDP (Percent) In 2012: $2.8 Trillion dollars $8,937 per person By 2020: $13,709 per person (projected) SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group 6 3

4 Source: Deloitte Washington is a Leading State in the Process of Securing $178 Million for Exchange Establishment & Medicaid Eligibility Systems 8 4

5 Building The Exchange 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 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 Sustainability plan submitted to Legislature WA HBE receives conditional approval from HHS/CCIIO to operate the state exchange 2013 Exchange must be certified by HHS Additional legislative action taken as needed Open Enrollment begins (October 1) 2014 Coverage purchased in the Exchange begins Open enrollment ends March 31. Year 2 open enrollment in Oct. 9 Exchange Functions Certifying health plans as Qualified Health Plans to be offered in the exchange. o 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 o 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. 5

6 Exchange Functions Consumer Interactions Operating a website to facilitate comparisons among qualified health plans for consumers Operating 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 12 6

7 Affordable Care Act Terminology Illustration Issuer Issuer Product Plan Product 1 Plan 1 Plan 2 Product 2 Plan 3 Plan

8 Exchange Value Specific Functions I. Issuers of QHPs Marketing & Outreach Eligibility Determination for tax credits Enrollment Premium Aggregation Customer Service Enrollment reconciliation with HHS New Membership opportunity previously uninsured II. Health Care Market Easy plan comparison and purchase of health insurance Reporting of cost/quality metrics Awareness of need for health insurance Supporting use of innovative product designs and payment methodologies Expanded access to health insurance coverage Reduced charity care III. Public and State Appeals of eligibility determinations and individual responsibility Information on health insurance carriers Trustworthy source of health care reform information Broad-based Public Information Other impacts of ACA 15 Exchange Functions SMALL 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. 8

9 Coverage Continuum in * * Federal Basic Health Plan Option for individuals with incomes between 138% and 200% of the FPL will not be available in To-Be Landscape: Continuous Coverage Medicaid Standard CHIP Family Planning Extension Take Charge Family Planning Psych. Indigent Inpatient Program Involuntary Treatment Act ADATSA Basic Health Plan Medical Care Services Program SSI Presumptive Medicaid Standard Medicaid Benchmark CHIP QHP with Subsidy QHP without Subsidy Note: Transition options to be addressed by State Legislature. 18 9

10 Individuals (in thousands) 6/8/2014 Post Implementation of the Affordable Care Act (ACA): Subsidized Coverage Landscape in Washington million current enrollees ,000 currently eligible but not enrolled** 494,000 newly eligible Current Enrollees Currently Eligible Newly Eligible but Not Enrolled ,000 eligible for subsidies Eligible for Subsidies in the Exchange Currently Enrolled (Medicaid) Currently Enrolled (CHIP) Total Eligible Likely to Take Up 2014 Note: Analysis forecast assumes full take up rate and the ACA was in effect in **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. 19 Membership Growth: New Members PROJECTED EXCHANGE MEMBER ENROLLMENT ( YEAR END) 10

11 The Metallics 60/40 70/30 80/20 90/10 Bronze Silver Gold Platinum Four Levels of Benefits No One Ever Washes A Rental Car 11

12 The Current Marketplace MARKET % Employer Direct Purchase Medicaid Medicare Military Uninsured 4% 13% 14% 47% 14% 8% 12

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14 Post Implementation of the ACA: Remaining Uninsured Undocumented immigrants Individuals 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 27 Exchange Functions Apply the Essential Health Benefit Plan Levels established by Essential Health Benefits QHP s must include items and services within at least the following 10 categories: Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management, and Pediatric services, including oral and vision care 14

15 Exchange Functions and Services Highlight Products, Oversee Navigators Develop, Host Website Customer Support, Quality Rating System Review & Certify Qualified Plans Aggregate Premiums Determine Eligibility, Tax Credits 29 Washington State QHP Issuers Per County 15

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17 Questions Optional Discussion Slides 17

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