Presenters: John McInerney , The Commonwealth Institute Jill Hanken , Virginia Poverty Law Center

1. Implementing the ACA in Virginia: Where things standAdvocate/Stakeholder WebinarMarch 29, 2012Sponsored by The Commonwealth Institute, The Virginia Poverty Law Center, and Virginia Organizing Presenters:John McInerney, The Commonwealth InstituteJill Hanken, Virginia Poverty Law Center

2. Topics U.S. Supreme Court – ACA arguments Exchange Basics/Implementation of the ACA in Virginia to Date What’s Next?

3. U.S. Supreme Court • 3 Days - 6 Hours of Oral Argument! • Decision Expected by End of June March 28 March 26 • Severability • If a part of the ACA is unconstitutional, can the rest of the law still stand? • Medicaid Expansion • Is the required expansion an unlawful abuse of the spending clause provisions of the Constitution? • Anti-Injunction Act • Can ACA Tax Penalties be challenged now? • Minimum Coverage Provision • Is the Individual Mandate Constitutional? March 27

4. What is an Exchange? A new health insurance marketplace.

5. What is an Exchange? Like … only for health insurance.

6. How it works. • Individuals and small businesses can access and purchase affordable private health insurance. • Over 500,000 additional Virginians covered through Exchange & Medicaid in Virginia • Premium affordability tax credits available • Significant Medicaid Expansion

7. Basic requirements. • Develop Exchange for individuals and small employers • Run Web site with comprehensive plan info on price and quality • Choose whether to run Exchange, and decide on governance • Certify plans & determine benefit package • Seamlessly coordinate Exchange w/Medicaid & FAMIS • Provide consumer assistance • Develop IT infrastructure and enrollment systems (or defer role to the federal government)

8. Implementation • August • 24 member Virginia Health Reform Initiative Advisory Council named • Members from business, insurance industry, academia, and providers • No consumer rep 2010 • December • Fall • Series of meetings on six areas of health reform: • capacity, Medicaid expansion, insurance reform, purchaser perspectives, information technology & delivery system reform • Report issued by VHRI to Governor McDonnell

9. Implementation • Age 26 provision • No pre-existing for kids • No lifetime limits • New appeals procedures • Rescission prevention • $1 million planning grant from HHS • Legislation authorized VHRI to begin Exchange design • Final VHRI report publicly released in November 2011 • VHRI meetings spring/summer 2011

10. Implementation • Governor opposed to immediate action 2012 • Several bills filed, none successful • Time to create state-run Exchange growing short

11. Behind but not alone. 41 states have introduced Exchange authorizing legislation Map created by TCI, using data compiled by the Center on Budget and Policy Priorities (CBPP)

12. Behind but not alone. Yet, only12 states and D.C. have enacted Exchange authorizing legislation • Map created by TCI, using data compiled by the Center on Budget and Policy Priorities (CBPP)

13. Behind but not alone. 22 states, including Virginia, have pending/tabled legislation Map created by TCI, using data compiled by the Center on Budget and Policy Priorities (CBPP)

14. What’s next. • Essential Benefits Plans: Report Issued • Comments Due to VHRI on April 4, 2012 VHRI • Exchange Development • More meetings expected on Exchange Planning

15. What’s next. • Online customer portal for • Online applications • Customer accounts • Self-service capabilities • Reporting changes • Renewing benefits • Checking eligibility for other benefits Testing underway DSS Gateway Project Will serve as platform for the Exchange

16. State Legislation • SB 496 (Sen. Watkins) • Only “survivor” of 2012 session • Substitute adopted on 2/13 carried over to 2013 • Off session meetings are expected • Special Session after Supreme Court ruling?

17. State Legislation • Exchange Structure • We want independent Quasi – Governmental entity (VHRI recommendation) • Full focus on Exchange • No real or perceived conflict with other functions • Role and input for all stakeholders • SB 496 puts Exchange in a new division of State Corporation Commission (SCC)

18. State Legislation • Governance • We want strong consumer representation and no voting member with conflict of interest on governing Board • SB 496 creates Advisory Committee • 7 members appointed by SCC • Includes “consumer representative”, “consumer advocate”, “representative of qualified health plan” • Recommendations require majority votes • Ultimate authority rests with Division Director and SCC Commissioners

19. State Legislation • Public Access to Meetings and Information • We want public rulemaking, open meetings, freedom of information, comprehensive website • SB 496 was amended to include all of above • Funding the Exchange • We want all insurers (in and out of Exchange) to help pay for operations • SB 496 was amended to do this

20. State Legislation • Market Rules and Adverse Selection • We want protections to avoid adverse selection • We want provisions to address market instability (VHRI recommendation) • SB 496 requires same premiums inside and outside of the Exchange, but does not include other protections

21. State Legislation • Navigator Program • We want community based organizations and non-profits to participate as Navigators without licensure • We want Navigators to assist with Medicaid/FAMIS outreach and enrollment too • SB 496 was amended to eliminate licensure, mention CBOs, & include education/enrollment for Medicaid/FAMIS

22. State Legislation • Coordination with Medicaid & FAMIS • We want Exchange to streamline access to all programs • SB 496 amendments clarify relationships and require Exchange to enroll eligible people in other programs • Services • SB 496 prohibits abortion coverage in Exchange plans or optional riders except for rape, incest, life of mother

23. Q&A/Resources Virginia Health Reform Initiative www.hhr.virginia.gov/initiatives/healthreform www.healthcare.gov The Commonwealth Institute www.thecommonwealthinstitute.org/health/

24. Thank you for attending!