1. Implementing the ACA in Virginia: Where things stand Advocate/Stakeholder Webinar March 29, 2012 Sponsored by The Commonwealth Institute, The Virginia Poverty Law Center, and Virginia Organizing Presenters: John McInerney, The Commonwealth Institute Jill Hanken, Virginia Poverty Law Center

2. Topics U.S. Supreme Court – ACA arguments Exchange Basics/Implementation of the ACA in Virginia to Date What’s Next?

3. U.S. Supreme Court 3 Days - 6 Hours of Oral Argument! Decision Expected by End of June March 26 Anti-Injunction Act Can ACA Tax Penalties be challenged now? March 27 Minimum Coverage Provision Is the Individual Mandate Constitutional? March 28 Severability If a part of the ACA is unconstitutional, can the rest of the law still stand? Medicaid Expansion Is the required expansion an unlawful abuse of the spending clause provisions of the Constitution?

4. What is an Exchange? A new health insurance marketplace.

5. What is an Exchange? Like … only for health insurance.

6. How it works. Individuals and small businesses can access and purchase affordable private health insurance. Premium affordability tax credits available Significant Medicaid Expansion Over 500,000 additional Virginians covered through Exchange & Medicaid in Virginia

7. Basic requirements. Develop Exchange for individuals and small employers Choose whether to run Exchange, and decide on governance Certify plans & determine benefit package Provide consumer assistance Develop IT infrastructure and enrollment systems (or defer role to the federal government) Seamlessly coordinate Exchange w/Medicaid & FAMIS Run Web site with comprehensive plan info on price and quality

8. Implementation 2010 August 24 member Virginia Health Reform Initiative Advisory Council named Members from business, insurance industry, academia, and providers No consumer rep Fall Series of meetings on six areas of health reform: capacity, Medicaid expansion, insurance reform, purchaser perspectives, information technology & delivery system reform December Report issued by VHRI to Governor McDonnell

9. Implementation 2011 $1 million planning grant from HHS Legislation authorized VHRI to begin Exchange design VHRI meetings spring/summer 2011 Final VHRI report publicly released in November Age 26 provision No pre-existing for kids No lifetime limits New appeals procedures Rescission prevention

10. Implementation 2012 Governor opposed to immediate action Several bills filed, none successful Time to create state-run Exchange growing short

11. Behind but not alone. 41 states have introduced Exchange authorizing legislation Map created by TCI, using data compiled by the Center on Budget and Policy Priorities (CBPP)

12. Behind but not alone. Yet, only12 states and D.C. have enacted Exchange authorizing legislation Map created by TCI, using data compiled by the Center on Budget and Policy Priorities (CBPP)

13. Behind but not alone. 22 states, including Virginia, have pending/tabled legislation Map created by TCI, using data compiled by the Center on Budget and Policy Priorities (CBPP)

14. What’s next. VHRI Essential Benefits Plans: Report Issued Comments Due to VHRI on April 4, 2012 Exchange Development More meetings expected on Exchange Planning

15. What’s next. DSS Gateway Project Online customer portal for Online applications Customer accounts Self-service capabilities Reporting changes Renewing benefits Checking eligibility for other benefits Will serve as platform for the Exchange Testing underway

16. State Legislation SB 496 (Sen. Watkins) Only “survivor” of 2012 session Substitute adopted on 2/13 carried over to 2013 Off session meetings are expected Special Session after Supreme Court ruling?

17. State Legislation Exchange Structure We want independent Quasi – Governmental entity (VHRI recommendation) Full focus on Exchange No real or perceived conflict with other functions Role and input for all stakeholders SB 496 puts Exchange in a new division of State Corporation Commission (SCC)

18. State Legislation Governance We want strong consumer representation and no voting member with conflict of interest on governing Board SB 496 creates Advisory Committee 7 members appointed by SCC Includes “consumer representative”, “consumer advocate”, “representative of qualified health plan” Recommendations require majority votes Ultimate authority rests with Division Director and SCC Commissioners

19. State Legislation Public Access to Meetings and Information We want public rulemaking, open meetings, freedom of information, comprehensive website SB 496 was amended to include all of above Funding the Exchange We want all insurers (in and out of Exchange) to help pay for operations SB 496 was amended to do this

20. State Legislation Market Rules and Adverse Selection We want protections to avoid adverse selection We want provisions to address market instability (VHRI recommendation) SB 496 requires same premiums inside and outside of the Exchange, but does not include other protections

21. State Legislation Navigator Program We want community based organizations and non-profits to participate as Navigators without licensure We want Navigators to assist with Medicaid/FAMIS outreach and enrollment too SB 496 was amended to eliminate licensure, mention CBOs, & include education/enrollment for Medicaid/FAMIS

22. State Legislation Coordination with Medicaid & FAMIS We want Exchange to streamline access to all programs SB 496 amendments clarify relationships and require Exchange to enroll eligible people in other programs Services SB 496 prohibits abortion coverage in Exchange plans or optional riders except for rape, incest, life of mother

23. Q&A/Resources Virginia Health Reform Initiative www.hhr.virginia.gov/initiatives/healthreform www.healthcare.gov The Commonwealth Institute www.thecommonwealthinstitute.org/health/

24. Thank you for attending!