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State Health Policy Conference: Exchanges & Small Business Insurance Reform

Gain insights on ACA Exchange functions, insurance reforms, and small business impacts. Learn about Medicaid eligibility, affordability tools, and navigating the evolving healthcare landscape at the 23rd Annual State Health Policy Conference presented by NASHP.

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State Health Policy Conference: Exchanges & Small Business Insurance Reform

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  1. Exchanges: A New State Composition NASHP 23rd Annual State Health Policy ConferenceOctober 4-6, 2010 Governor’s Office of Health Policy and Finance Trish Riley, Director www.maine.gov/gohpf

  2. Goals for Exchanges • Distribute insurance to individuals and small employers with more transparency • Coordinate eligibility and facilitate tax credits and employer vouchers • Set standards and implement policies around health insurance • Increase portability and choice • Improve outreach and education • Reduce system costs and improve quality of health care Riley 1

  3. Functions of an ACA Exchange • Determine and Coordinate Eligibility • Create Standardized Benefit Categories • Enroll Individuals and Businesses • Certify Qualified Health Plans • Customer Service (Call center & more) • Establish Website (Quote generation, plan selection & cost calculator) • Assign Quality Ratings • Reward Quality • Set up a “Navigator” Program • Pay Broker Commissions Riley 2

  4. Context for Reform 2014 – New Environment – New Opportunity • Individual & business mandates • Affordability via subsidies (Non-group) • Nationalizes eligibility 0 – 400% • Re-think Medicaid & how it works in Exchange environment 3 Riley

  5. Medicaid & An Exchange 400% FPL [Near Universal Access - delink health & welfare eligibility] • Churning – On/Off ? • Redetermination ? 133% Medicaid [Eligibility for other social services] 0% FPL (MAGI) Riley 4

  6. Insurance Reforms in Place • “Tricks of the Trade” to lower costs eliminated • High deductibles • Waiting Periods • Lifetime & annual limits • Benefit limits • No Pre-Ex Riley 5

  7. Raises Issue – what are the new tools to achieve affordability? - Exchange as market leader ■ Pools Buying Power ■ Effect of National plans ■ Payment Reform ■ Plans In & Out of Exchange? - Navigator vs. Broker ■ Who will represent consumer & drive hard bargains? ■ Who will help small business? ■ How will navigators be held accountable? 6 Riley

  8. Small Business in New Environment Maine’s Dirigo Health Agency • Subsidized coverage for individuals, self-employed and small business employees • Voucher program for part-time workers What does small business want? • Low price • Simplicity / ease of participation Riley 7

  9. Small Business in New Environment (cont’d) What do they get in Exchange? • Tax credits (2 Yrs.) • Transparency & comparability • Potential for lower costs • Incentives to drop coverage? • No mandate • Low wage employees only get subsidy as individual • Free choice voucher – How will small business react? Opportunities to incentivize small employer participation Riley 8

  10. Maine’s Planning Effort • Steering Committee • Advisory Council on Health Systems Development • Jt. Select Committee on Health Reform Preliminary Recommendations Re: Exchange • 1 for ME (Individual & Small Business) • Quasi- or independent agency • Leverage existing state infrastructure www.maine.gov/healthreform 9 Riley

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