Health Reform: Where Are We Now and What’s Next?

1. Manny Munson-Regala, JD Assistant to the Commissioner Minnesota Department of Health Health Reform: Where Are We Now and What’s Next?

2. Background: Leader in Spending

3. Background: Laggard in Mortality

4. Goals of Patient Protection and Affordable Care Act • Near-Universal Coverage • Insurance Reforms • Focus on Quality and Value • Shift Focus to Primary Health-Care Access • Investments in Prevention and Community Health

5. PPACA Coverage Expansion Provisions • Individual Responsibility • Tax Credits • Federal High Risk Pools • Medicaid Expansion • Governor Dayton signed early expansion bill in February 2013 • Health Insurance Exchanges • Governor Dayton signed bill in March 2013

6. PPACA Insurance Reforms (Current) • Limits on Rescission • No Pre-Existing Conditions for up to 19 • Dependent Coverage to 26 • Preventative Benefits • Appeals • No Lifetime Limits • Modified Annual Limits • Medical Loss Ratio

7. PPACA Insurance Reforms (2014) • Essential Health Benefits • No Annual Limits • No Preexisting Conditions • Modified Community Rating • Clinical Trial Coverage • Health Insurance Exchanges

8. What is MNsure? A new marketplace where Minnesotans can shop, get financial support and enroll in public or private health care coverage.

9. Projected Enrollment:1.3 million Minnesotans Public Program Enrollees 690,000 Individual Consumers 370,000 Small Businesses and Employees 155,000

10. Mnsure Governance

11. MnSure Funding

12. MNsure Products

13. MNsure Timeline

14. PPACA: Quality and Value • New Payment and Care Delivery Structures • Medical Homes • Accountable Care Organizations • Episodes of Care • Bundled Payments • National Quality Strategy • Focus on measurement and data • Institute for Comparative Clinical Effectiveness Research

15. PPACA: Primary Care Provisions • Prevention and Public Health Fund • Originally $15 billion over 10 Years, cut to $9.75 billion • Community Health Centers ($11 billion) • National Health Services Corps ($1.5 billion) • School-based health centers ($200 million) • Health Workforce Demonstration Grants • Maternal and Child Health Grant Programs ($1.5 billion) • Medicaid Prevention and Wellness Incentives ($100 million) • CHIP Childhood Obesity Demonstration Project ($25 million)

16. Opportunities (and Challenges) for Public Health from PPACA • Funding Opportunities • Expansion of Coverage and Impact on Prevention • Provider Shortages • Translating Coverage Reforms Into Improvements of Care • Role in Informing Wellness Programs • Hospitals and Community Health Planning • Outreach to the Potential Enrollees • Data on Chronic and Complex Conditions • Working with Remaining Uninsured

17. Current Impact of PPACA on MN • 90% of the 420k uninsured eligible for tax credits or Medicaid expansion • 35k young adults covered by dependent definition • Elimination of “donut hole” saved roughly $110 million since 2012 • 899k women have access to preventative services w/o cost-sharing • $18.3 m in Prevention and Public Health grants • 228 Health Service Corps clinicians • 300k Medicare recipients get free preventative services • MLR rule generated $8.9 million in refunds • Commerce received $3.9 million to review rates • 2m have no lifetime limits. • 837 enrolled in federal high risk pool • MnSure received $113 m for planning and development • Heath Center grantees received $37.7 m to support community health centers

18. Beyond the PPACA • Integration of medical care and public health • Rebalance our investment in treatment and prevention • Connect clinical to public health • Back to our roots • Focus on chronic diseases; prevent acute • Public health system restructuring and investment • Population Health • Eliminate health disparities • Requires health in all policies approach • Focus on social determinants of health • Policy systems, and environmental change strategies

19. Balance Integrating Public Health and Health Care Funding skewed towards health care Historically connected; separation of health care is recent development Effective public health reduces demand strain on health care Integration needed to respond to complex, multifactorial diseases Spending on disease prevention is cost effective ACA increased prevention, cut in later budgets

20. Chronic Diseases Stronger Public Health Systems Focused on the Determinants of Health; Chronic Diseases Clinical care accounts for 20% for morbidity and mortality Targeted interventions work; e.g. tobacco measures have reduced deaths Preventative services need strong infrastructure Emerging infectious disease Effectiveness of health services and systems must be evaluated

21. Disparities Location, Location, Location MN has disparities by race, gender and location Genetics is a cause Environmental, social and economic differences are other differences

22. Post-PPACA: To Do Items • Sustainable and Balanced Funding • Reshape environments to make healthy choices viable • Rebuild and strengthen public health infrastructure • Focus on Health in All Policies approaches • Integrate Public Health and Health Care

23. Current MDH Initiatives • Expansion of SHIP statewide • Workforce development initiatives with focus on primary care • “Health-in-All” lens with other agencies • Minnesota Accountable Health Model

24. Other Resources • MnSure’s website http://mnsure.org/ • General health reform information across MN state government http://mn.gov/health-reform/ • MDH specific reform information http://www.health.state.mn.us/healthreform/ • General information on the PPACA and the federal exchange http://www.healthcare.gov/ • Health Reform Hits Main Street http://healthreform.kff.org/the-animation.aspx