health reform in community settings: affordable care act implementation in georgia patricia ketsche,...
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Health Reform in Community Settings: Affordable Care Act Implementation in Georgia
Patricia Ketsche, PhDAssociate Professor and
Fellow, GHPC
Health Insurance Exchange
Private InsuranceMedicaid
Coverage Expansion under the ACA
Changes in Public
Coverage
Changes in Public
Coverage
Medicaid Expansion – Status as of September 16, 2013
http://kff.org/medicaid/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/#map
Changes in Private Coverage
Changes in Private Coverage
Health Insurance Exchange
Private InsuranceGAP
Coverage Expansion without Medicaid
Insurance RegulationIndividual MandateSubsidies for Small Business
Changes in Private Coverage
Changes in Private Coverage
Exchange/Market PlaceSubsidies for Individuals
Changes in Private Coverage
Changes in Private Coverage
Exchange Participation – Status as of May 28, 2013
Changes in Private Coverage
Changes in Private Coverage
ActuarialValue Deductible Coinsurance Monthly Premium
(40 Yr. Old)
Bronze 60% $6,300 0% $251
Silver 70% $3,000 10% $310
Gold 87% $750 0% $394
Features of Exchange PlansBlue Cross Plans - Region 3
Source: : “Insurance company filings with Georgia Insurance Commissioner”
Insurance Regions for Exchange Premiums
Exchange Offerings by Insurance Region
Regions BCBS Peach State Kaiser Alliant Humana
1 Y
2 Y Y Y Y
3 Y Y Y Y Y
4 Y Y Y
5 Y Y
6 Y Y
7 Y Y
8 Y Y Y
9 Y Y
10 Y Y Y
11 Y Y
12 Y Y
13 Y Y Y
14 Y Y
15 Y
16 Y Y
Changes in Private Coverage
Changes in Private Coverage
Determining the Subsidy
• Based on 2nd lowest premium for silver plan in your market
• Compare that to the maximum % of income required based on income as % of poverty
• Difference = subsidy• Available to purchase lower cost
coverage
Changes in Private Coverage
Changes in Private Coverage
Coverage Option - Exchange
2 Adult Household without Employer coverage
Family Income Percent of Poverty
Premium Subsidy in the
Exchange
Family contribution for
coverage
$10,000 64% 0 $6,036
$19,000 123% $5,656 $380
$22,200 142% $5,261 $775
$40,000 258% $3,312 $2,725
$60,000 387% $336 $5,700
*Based on a hypothetical plan premium of $6,036 for a silver plan. Actual subsidy depends upon 2nd lowest cost silver plan based on age and market.
Changes in Private Coverage
Changes in Private Coverage
Variation in Premiums by Region
Region Silver Premium – 40 Year Old
Subsidywith $12,000
income
Net Costs
10 – NW Georgia $245 $225 $20
3 – Atlanta $251 $231 $20
12 – Middle Georgia
$300 $280 $20
15 – SW Georgia $442 $422 $20
1 – SW Georgia $482 $462 $20
Decisions – Families with children below 235% FPL
Does my employer offer Affordable coverage?
EnrollEnroll Self (spouse?)
Medicaid/ PeachCare for Kids™
Enroll Family
Exchange
Determine Subsidy with and without children
Enroll in Family Coverage
Enroll Adults Medicaid / PeachCare for Kids™
Georgia’s Uninsured (in thousands)(2 year average, 2011-2012)
Children (18 and under)
Adults 19-64
Total Uninsured 320 1,529
By Income
<= 100% FPL 135 571 >100-235% of FPL 111 512
>235-400% of FPL 40 261
>400% of FPL 34 186
By Citizenship
Citizen 298 1,278
Non-citizen 23 251
Source: ASEC supplement to the Current Population Survey, 2012 and 2013
Economic Impact Estimates - State
Health Insurance Exchange Medicaid
Direct Effect 2 Billion 4 Billion
Total Effect 4 Billion 8 Billion
Employment 35,000 70,000
Local Tax Revenue 70 Million 146 Million
State Tax Revenue 65 Million 130 Million
Factors:Number of Medicaid EnrolleesCost per EnrolleeEconomic MultiplierState income tax rate
Federal Spending – 10 year estimates from 2012 -CBO
Fees, Taxes and Penalties
Medicaid
Insurance Premium SubsidiesMedicare Savings
+/- 1.78
trillion
+/- 1.67 trillion
Current national estimates – CBO (May 2013)
Source of coverage2013 2018 Change
Employer 57% 56% -1%
Non Group and Other 9% 8% -1%
Medicaid/CHIP 13% 20% +7%
Uninsured 21% 11% -10%
Exchange 0% 9% +9%