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Exchanges: A New State Composition

Exchanges: A New State Composition. NASHP 23rd Annual State Health Policy Conference October 4-6, 2010 Governor’s Office of Health Policy and Finance Trish Riley, Director www.maine.gov/gohpf. Goals for Exchanges. Distribute insurance to individuals and small employers with more transparency

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Exchanges: A New State Composition

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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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