thanks to our sponsors sprague israel giles inc. finney, neill & co. p.s
TRANSCRIPT
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Thanks to our Sponsors
Sprague Israel Giles Inc. Finney, Neill & Co. P.S.
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Remy Trupin, Executive Director
Kim Justice, Policy Analyst
Andy Nicholas, Senior Fiscal Analyst
TITLE
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What Opportunities Does the
Exchange Offer Washington?
Emily Brice, Northwest Health Law AdvocatesDecember 2012
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Easier Plan Comparisons
Qualified Health Plans Available to individual and small
group in Exchange Must meet certification criteria Will have metallic tiers indicating
actuarial value Goal: Make value clearer to
consumers Calculation: In-network, Essential
Health Benefits Tiers: Bronze – Platinum, plus limited
catastrophic (if under 30 or exempt from minimum essential coverage)
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Richer Benefits
Essential Health Benefits Must cover 10 categories of services
Must be one of benchmark plans: Regence Innova (largest small group)
Must cover preventive services without cost-sharing Based on U.S. Preventive Services Task Force A & B
recommendations: www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html
This aspect largely already in effect
Ambulatory Rehabilitative & habilitative
Emergency Laboratory
Hospitalization Preventive, Wellness, & Chronic Disease Management
Maternity & Newborn Pediatric (including oral & vision)
Prescription Drugs Mental health & substance use disorder (including behavioral health)
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Greater Affordability
Sliding Scale Subsidies & Cost Reductions Eligibility:
Under 400% FPL Not undocumented Not eligible for Medicaid, Medicare, CHIP, TriCare, etc. Not offered “affordable” coverage of “minimum value”
through employer Not actually enrolled in coverage through employer
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Greater Affordability
Premium Tax Credits Cost-Sharing Reductions
Income Level
Maximum Premium
Up to 133% FPL
2% of income
133-150% FPL
3-4% of income
150-200% FPL
4-6.3% of income
200-250% FPL
6.3-8.05% of income
250-300% FPL
8.05-9.5% of income
300-400% FPL
9.5% of income
Income Level
Reduction in OOP Costs(compare to 70% silver)
100-150% 94% AV
150-200% 87% AV
200-250% 73% AV
• Select any AV tier except catastrophic
• Receive monthly in advance (paid directly to plan) or at close of tax year
• Possibility of reconciliation
• Select silver only! • Only applies to in-network, in-
EHB• Plus: For those under 400%
FPL, additional caps on maximum OOP spending
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What Can Washington Do to Maximize
the Exchange Opportunity?
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Promote Affordability
Above 400% FPL: Much still unknown about pricing...
Under 200% FPL: Even with subsidies, Exchange may be
unaffordable for 162,000 WA residents in this income bracket due to heightened price sensitivity.
Outcome: Many will remain uninsured, or enroll and then drop coverage.
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Promote Affordability: Basic Health Option
Source: Urban Institute, “Using the Basic Health Program to Make Coverage More Affordable to Low-Income Households” (2012)
Average Annual Costs for Adults Nationally with Incomes Between 138-200% FPL: BHP vs. Subsidized Coverage in the Exchange
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Consumer Education
Trade-off: Plan Selection v. Cost-sharing Ex: 30-year old Ana earns 150% FPL.
Unsubsidized age-adjusted monthly premium for the second-lowest cost silver-level plan estimated at ~ $3,440 per member annually.
Based on her household size and income, Ana will pay a maximum of 4% of her income toward coverage – about $690 annually, or 20% of the total premium. She can receive a tax credit for the remaining 80% of the premium, $2,750.
Which plan will she choose? Silver Reference Plan
Bronze Plan
Net premium (annual after credit)
$690 Under $690
Cost-sharing Reduction
Yes ( 70% increases to 94%)
No (60%)
OOP Maximum Yes ($2,084) Yes ($2,083)Source of estimates: Kaiser Subsidy Calculator
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Maintain Sustainable ExchangeFunding Exchange Operations? Insurance Premium Assessment
Starting 1/2014: Premium tax assessment totaling 0.5% of all premiums and prepayments for health care services received.
Starting 1/2015: Premium tax would rise to 1% of same.
Repurpose Existing Assessment (Hybrid) Starting 1/2014: Authorize and apportion to the Exchange the
premium tax collected on all premiums and prepayments for health care services attributable to the Exchange-generated premiums received.
Any funding shortfalls augmented by assessing a service charge payable by QHPs in the Exchange.
QHP Issuer-Based Revenue Model Starting 1/2014: Assess a service charge payable solely by QHPs
in the Exchange.
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Kim Justice, Policy [email protected]