1. Health Reform in Community Settings: Affordable Care Act Implementation in Georgia Patricia Ketsche, PhD Associate Professor and Fellow, GHPC

2. Health Insurance Exchange Private Insurance Medicaid Coverage Expansion under the ACA

3. 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

4. Changes in Private Coverage Health Insurance Exchange Private Insurance GAP Coverage Expansion without Medicaid

5. Insurance Regulation Individual Mandate Subsidies for Small Business Changes in Private Coverage

6. Exchange/Market Place Subsidies for Individuals Changes in Private Coverage

7. Exchange Participation – Status as of May 28, 2013 Changes in Private Coverage

8. Actuarial Value DeductibleCoinsurance Monthly Premium (40 Yr. Old) Bronze60%$6,3000% $251 Silver70%$3,00010% $310 Gold87%$7500% $394 Features of Exchange Plans Blue Cross Plans - Region 3 Source: : Insurance company filings with Georgia Insurance Commissioner

9. Insurance Regions for Exchange Premiums

10. Exchange Offerings by Insurance Region RegionsBCBSPeach StateKaiserAlliantHumana 1Y 2YYYY 3YYYYY 4YYY 5YY 6YY 7YY 8YYY 9YY 10YYY 11YY 12YY 13YYY 14YY 15Y 16YY

11. Changes in Private Coverage Determining the Subsidy Based on 2 nd 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

12. Changes in Private Coverage Coverage Option - Exchange 2 Adult Household without Employer coverage Family IncomePercent of Poverty Premium Subsidy in the Exchange Family contribution for coverage $10,00064% 0$6,036 $19,000123%$5,656 $380 $22,200142%$5,261 $775 $40,000258%$3,312$2,725 $60,000387%$336$5,700 *Based on a hypothetical plan premium of $6,036 for a silver plan. Actual subsidy depends upon 2 nd lowest cost silver plan based on age and market.

13. Changes in Private Coverage Variation in Premiums by Region RegionSilver Premium – 40 Year Old Subsidy with $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

14. Decisions – Families with children below 235% FPL Does my employer offer Affordable coverage? Enroll Enroll 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

15. Georgias Uninsured (in thousands) (2 year average, 2011-2012) Children (18 and under) Adults 19-64 Total Uninsured3201,529 By Income <= 100% FPL135 571 >100-235% of FPL111512 >235-400% of FPL40261 >400% of FPL34186 By Citizenship Citizen2981,278 Non-citizen 23251 Source: ASEC supplement to the Current Population Survey, 2012 and 2013

16. Economic Impact Estimates - State Health Insurance ExchangeMedicaid Direct Effect2 Billion4 Billion Total Effect4 Billion8 Billion Employment35,00070,000 Local Tax Revenue70 Million146 Million State Tax Revenue65 Million130 Million Factors: Number of Medicaid Enrollees Cost per Enrollee Economic Multiplier State income tax rate

17. Federal Spending – 10 year estimates from 2012 -CBO Fees, Taxes and Penalties Medicaid Insurance Premium Subsidies Medicare Savings +/- 1.78 trillion +/- 1.67 trillion

18. Current national estimates – CBO (May 2013) Source of coverage 20132018Change Employer57%56%-1% Non Group and Other9%8%-1% Medicaid/CHIP13%20%+7% Uninsured21%11%-10% Exchange0%9%+9%