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Affordable Care Act (ACA): An Update Presented by: The League of Women Voters of North Carolina.

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Presentation on theme: "Affordable Care Act (ACA): An Update Presented by: The League of Women Voters of North Carolina."— Presentation transcript:

1 Affordable Care Act (ACA): An Update Presented by: The League of Women Voters of North Carolina

2 League of Women Voters: Making Democracy Work Non partisan political organization that encourages informed and active participation in government Founded in 1920- almost 100 years new! No positions on political parties or candidates Instead, positions on issues

3 AGENDA Short History ACA Results: enrollment and costs Open Enrollment 2 Nationally NC Subsidies and penalties Medicaid Today: Who’s covered? How is it financed? What are the enrollment and cost drivers? The Gap: Fiscal Impact to NC Questions?

4 Short History ObamaCare /Affordable Care Act was signed into law on March 23, 2010/never repealed Major objective to expand coverage: Reform Health Insurance Market Provide private subsidized coverage for those between 100%- 400% of FPL ( from $11,670-46,680 single/ $23,850- 95,400 family of 4) Expand Medicaid…

5 Short History: Insurance Reforms No pre-ex No annual or lifetime limits No higher rates by gender Free- no copay- preventive visits Flattened rates between young and old Set out of pocket maximums Impacts ALL PLANS (ex. Grandfathered Plans) Dependent coverage through age 26

6 A CA Results: Enrollment 7.3 million people have signed up for private health insurance in the marketplaces across the nation and have accessed care 60% were previously uninsured Most had gone w/o coverage for 2+ years 50% got help with enrollment 3 million young adults are on their parents’ plans 4.8 million more people were enrolled in Medicaid and CHIP (KFF) 83% of people qualified for premium subsidies equaling $2890 on average Since OE 1 number of uninsured has been reduced by 26% (NEJM) 6

7 ACA Results: Pricing and costs Health care costs are growing at the slowest pace on record- reflected in Medicare, Medicaid and private insurance costs CBO estimates that in 2020 Medicare/Medicaid costs will be $180B below its 2010 estimates Premiums will remain 15% below projections through 2016 Over 8 million seniors and disabled have saved $11.5B on prescription drugs since 2010

8 ACA Results: North Carolina Without state support, without federal or state financing, without infrastructure…357,584 enrolled in NC Huge ‘win’ for North Carolinians Average subsidized enrollee premium cost in NC is $81/ month 91% of enrolled NC’ers received financial assistance Many more enrolled in Medicaid Many allowed to keep their ‘old’ plans Lots of choice in plans, networks and price points

9 ACA Open Enrollment 2: National Update OE Dates: November 15, 2014 - February 15, 2015 Refresh of the Federally facilitated website: Better on-line experience Average premiums for benchmark silver plans will decline by.8% for 2015 Average premiums for Bronze plans will increase by 3.3% Varies by state and area 9

10 ACA Open Enrollment 2: National Update Insurer participation stayed stable or increased in all cities (exc. Portland Ore.) resulting in more choice for consumers Most areas will have 5 or more insurers ; 3 areas will have 10 or more Increase in carriers increases competition and lowers costs 89% of uninsured unaware that Open Enrollment will begin Nov 15 10

11 ACA Open Enrollment 2: NC Update 3 Carriers will offer plans in 2015: BCBSNC Aetna Coventry United Healthcare Renewal Process: Can be ‘automatically’ renewed under current or close plan Members will receive letters from both insurer and Marketplace explaining process starting October 1 Very important to re-assess subsidy status through Marketplace If change carriers must notify old carrier of termination 11

12 Change in ACA Premiums Change in premiums nationally: No change in average premiums Average deductible increased by 1% North Carolina Single Premiums: 2014 Single2015 Single% Change Bronze$242 $270 12% Silver 303 343 13 Gold 358 396 11 Platinum 418 447 7 Overall 292 326 12

13 2014-2015 Change in Premiums North Carolina Family Premiums 2014 Family2015 Family% Change Bronze $726 $808 11% Silver 908 1026 13 Gold 1071 1186 11 Platinum 1252 1339 7 Overall 874 975 12

14 ACA Open Enrollment 2: NC Update BCBSNC Will offer 27 plans/100 counties Will have 4 provider networks: Blue Advantage, Blue Select, Blue Value, Blue Local Answer Spot: Quick Start Website 7 retail locations Aetna Coventry: Doubled their enrollment projections in 2014 Will send two ‘renewal notices’ Offering 6 plan designs and 5 networks Will be in 39 counties- same as 2014 14

15 ACA Open Enrollment 2 UNITED HEALTH CARE Covering 77 counties Offering 10 plans Compass product: HMO One provider network for all marketplace plans 1-844-join-UHC

16 Two New Websites ACA financial help Health insurance basics Enrollment assistance Deadlines and fines Operational November 13 centralized scheduling system- state wide Public facing Operational this week Lots of enrollment events Insurance carrier outreach programs 16

17 2015 Subsidies and Penalties 2015 Subsidies Subsidy based on cost of second lowest cost Silver Plan This could be higher or lower than2014 plan Members must go to Marketplace and obtain re- certification of subsidy or 2014 subsidy rates will apply 2015 Penalties: $325 or 2% taxable income ( $40K= $800) 2016 Penalties: $695 or 2.5% of taxable income Continues to increase

18 ACA Assistance at the CH Library New enrollments and re-enrollments Tax prep services during tax time In the computer lab and conference room Mondays 5-8:00pm Tuesdays 2-5:00pm Fridays 2-5:00pm Saturdays by appointment No sessions Thanksgiving and X-Mas weeks



21 Medicaid and CHIP Nationally Total national enrollment as of 10/14: 68,529,576: 68+ million +9,683,006 16.76% increase since 10/13

22 Current Medicaid program has strict eligibility guidelines: covers only 30% of low income adults Pregnant women/Disabled Children/ Parents of young children Aged/In nursing facilities Older adults and disabled must have no more than $2000 in ‘countable assets’ 22 Current NC Medicaid: Who’s Covered?

23 1 Medic aidExp ansion inNort hCarol ina Presen tedby:TheLe agueofWom enVotersofN orthCarolin a 2 League ofWome nVoters: MakingD emocra cyWork Nonparti sanpolitic alorganiza tionthaten couragesin formedan dactivepar ticipationi ngovernm entFound edin1920- almost100 yearsnew! Nopositio nsonpoliti calpartieso rcandidate sInstead, positionso nissues 3 L eagueP osition onHeal thCare ‘TheLeagu esupports quality,aff ordablehe althcarefo rallUSresi dents.Wes houldallha veaccessto abasiclevel ofcare,incl udingdisea sepreventi on,primar ycare(incl udingpren atalandrep roductiveh ealth),acut elong- termcare, mentalhea lthcareand healthpro motionan deducatio n.’(April19 93) 4 AGE NDA Ba ckground Politicso fExpansi on Impa ctonPeop le Impac tonGover nment I mpacton Business Impacto ntheEcon omy Wh atyoucan do Finalt houghts 5 Whoare theUnin suredin NorthCa rolina? 1. 6millionor1 9% 234,8 00or15%kid s1,133,100 or85%adults Byrace: 4 8%White/19 %Hispanic/ 27%African American 6 0%haveatle astonewage earner/pre dominately lowwageear nersOver5 0%ofalluni nsuredarei n<25emplo yeefirms6 6%liveinur banareas 6 U ninsure dbyCou nty:Top 6 County#Uninsur edMecklenburg(Charl otte)152,458Wake(R aleigh)125,353Guilfor d(Greensboro)80,759 Cumberland(Fayettev ille)48,085Durham44, 454Buncombe(Ashev ille)40,791 7 Sho rtHisto ry Obama Care/Affor dableCareA ctwassigne dintolawon March23,2 010/neverr epealed M ajorobjectiv etoexpand coverage: ▫ ReformHe althInsuran ceMarket ▫ P rovideprivat esubsidizedc overageforth osebetween1 00- to400%ofFP L(from$11,4 90- 45,960singl e/$23,550- 94,200famil yof4) ▫ Expa ndMedicaid- madeoption albythe2012 SupremeCo urtdecision 8 Medicai dExpans ion Current Medicaidprog ramhasstricte ligibilityguide lines:covers3 0%oflowinco meadults ▫ Pr egnantwome n/Disabled ▫ Children/Par entsofyoungc hildren ▫ Innu rsingfacilities Intentwasto expandMedic aidtocoverupt o138%FPL($1 5,856single) Wouldhaveco vered500,00 0lowincome NorthCarolin iansManyad ultswillbeleft withnocovera geoptions ▫ U pto100%FPL noteligiblefor subsidiesinM arketplace ▫ C hildlessadults noteligible 91210 11 ClicktoaddtitleClickto addtext


25 How is Medicaid Financed? Costs shared between Federal and State govt’s Rate is FMAP: Federal Medical Assistance Percentages Feds pay: 65.88% NC pays: 34.12% Federal rate is based on per capita income in state NC spending: 2004: $ 7.4B 2013: $10.4B NC Medicaid spending by category: Aged: 17% Disabled: 45% Adult: 13% Children: 24% Aged and disabled account for 63% of all costs 25

26 NC Medicaid: Enrollment and Cost Drivers 1999 - 2000: 1.2M individuals covered 2009: 1.8M individuals covered: a 50% increase 2013: 2.0M individuals covered Distribution of costs: Acute Care Costs: 73.1% (37.5% inpatient hospital) Long Term Care: 24.4 % DSH Payments 2.5% Cost Drivers: Recession/economic downturn Aging population: % aged 65+ years 2011 13.3% 2031 19.6% 26

27 NC Medicaid Costs Costs per enrollee category: Aged: $ 9,973 Disabled: 15,369 Adult: 3,934 Children: 2,634 Average annual growth rate by Fiscal Year: 1990-2001 14.0% 2001-2004 9.8% 2004-2007 5.5% 2007-2010 3.5% 2010-2012 6.1% 27

28 The Bottom Line for North Carolina 300,000-500,000 too poor for Marketplace options while not eligible for Medicaid Impact on public health Impact on provider community- hospitals and medical professionals- disproportionate to rural providers Impact on worker productivity and absenteeism 28

29 Fiscal Impact of NOT Expanding… North Carolina is forfeiting $4.9 million/day Forfeited dollar- our tax dollars- will be used in other states North Carolina businesses will incur between $80 and $120M in fees once the E mandate is fully implemented (Jackson Hewitt) NC hospitals will lose $650M in ‘charity care’ costs (NCIOM) American Academy of Actuaries estimates that premiums for private ins. will be at least 2% higher in states that fail to expand Medicaid Low income legal immigrants eligible for subsidies on Marketplace while low income citizens will go uninsured Rural hospitals will suffer financially- larger proportion of uninsured coupled with reduction in DSH Funds (due to ACA) 29

30 If NC Expands… Federal gov’t pays 100% for first three years then 90% State will SAVE $65.4M over first 8 years of ME (NCIOM) NC will bring in $4.5 MILLION A DAY!!! According to the CBO ME would bring $13-15B into NC for the first 6 years NC will gain 25,000 new jobs 30

31 In Summary… The ACA is working: 300+k enrolled in NC 10+M enrolled nationally Uninsured rate reduced by 26% Open Enrollment 2: More carriers Stable rates More plan and price choices BUT 300+K North Carolinians left in the ‘Gap’ and 89% of uninsured unaware that Open Enrollment will begin Nov 15

32 Questions? 32

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