1. Dan Schwartzer Wisconsin Office of the Commissioner of Insurance

2.  No lifetime dollar limits on coverage/restrictions on annual dollar limits  Dependent coverage to age 26 ◦ WI law in place prior to PPACA  Coverage of preventive services without cost sharing ◦ Most WI insurers had in place prior to PPACA  Insurers are limited in the amount of administrative expenses they can fund with premium dollars (MLR)  No preexisting condition exclusions for children under age 19

3. Guaranteed Issue  Insurers must sell health insurance policies to any person who applies for coverage except in cases of fraud. (applied to small business in 1997)  Individuals cannot be denied a policy due to a preexisting health condition.  Insurers cannot exclude or limit coverage for a preexisting condition.  The Health Insurance Risk-Sharing Plan (HIRSP) ended March 31, 2014 Rating  Insurers in the individual and small group markets may only take the following into account when pricing their products:  Individual or family coverage;  The area of the state the policy is sold;  Age; and  Tobacco Use

4. Individual and small group plans must cover essential health benefits (EHBs). Ambulatory patient servicesPrescription drugs Emergency servicesRehabilitative and habilitative services and devices HospitalizationLaboratory services Maternity and newborn carePreventive and wellness services and chronic disease management Mental health and substance use disorder services, including behavioral health treatment Pediatric services, including oral and vision care

5.  Low uninsured rate  One of the lowest in the nation  Consumers had numerous choices  Local vs. National  HMO vs. PPO  For profit vs. not for profit  Numerous consumer protections already in WI law  Guaranteed issue (HIRSP)  Pre-x  Rating limits  Adult child coverage to age 26  Guaranteed renewability

6. Wisconsin had a number of important decisions to make in order to protect our market.  Exchange – Will there be a WI Exchange? Early innovator grant Not as much flexibility as promised  State vs. Federal Estimated cost $40-$60 million (IN, MN, OH, TN estimates) in ongoing operational costs  Medicaid Supreme court decision allowed state flexibility  Consumer choice Allow consumers and businesses to keep plans or avoid perceived adverse selection issues

7. In crafting our version of reform, Wisconsin had a number of goals:  Expand coverage – Governor Walker’s goal is to reduce Wisconsin’s uninsured rate by half  Protect the vulnerable – those in poverty should be able to access the safety net.  Preserve consumer choice – consumers are best positioned to understand their own needs  Protect consumers – consumers need knowledgeable people assisting them with their coverage  Educate the public – the public needed to understand the impact of the changes

8. In order to achieve these goals, we knew Wisconsin had to take the lead in regulating our own market.  We changed Medicaid  For the first time, expanded coverage to everyone in poverty  Transitioned those over 100% of poverty into coverage in the private market  We regulated our market  Became an effective rate review state  Reviewed filings both on and off the exchange  We informed the public  Issued numerous FAQ’s, and press releases on issues  Held town halls throughout the state  We let the federal government do its job  Where the state had no authority, we let the federal government do its job.  We held the federal government accountable for their problems

9. Our main goal is and was to make sure consumers were protected.  Navigators and Certified Application Counselors  Ensured consumers could be made whole if the Navigator or CAC actions harmed the consumer  Ensured that the Navigator and CAC’s met training requirements  Wisconsin businesses and consumers could keep their plans  OCI allowed insurers to offer early renewals to their clients  Allowed insurers to use the transition policy to keep plans through 2017  Advocated for consumers on issues  Worked with insurers to solve problems caused by exchange failures  Informed consumers of problems, and issues and solutions  Advocated for consumers with federal exchange personnel

10. The rollout was anything but perfect, but Wisconsin results look good from major outreach effort.  Relatively high enrollment  Over 165,000 individuals signed up for coverage during open enrollment both on and off the exchange.  This number is especially high considering we allowed early renewals  Successfully enrolled childless adults and others in Medicaid  Problems on the exchange  The Wisconsin OCI advocated on behalf of consumers for quick resolutions  Worked as a regulator of our market  Required communications and solutions for consumers  No surprises  Town halls were covered by local press and well attended  Issued numerous press releases to inform public of issues and concerns

11. In late 2013, we confirmed Wisconsinites would be able to take advantage of “grandmother” plans. Consumers and businesses may be able to keep their non-ACA compliant plans into 2017.  OCI began accepting 2015 rate and form filings in June  Using the same process as 2013  Announced companies that applied for QHP status in September  15 companies in 2015  2 more companies that offered in 2014  Wisconsin continues national leadership on health insurance issues  Vice-chair of Health Insurance Committee  Chair of Health Care Reform Regulatory Alternatives Work Group  Chair Regulatory Framework Task Force  Chair Network Adequacy Subgroup

12.  Open Enrollment  New dates 11/15/14 to 2/15/15  Consumers more experienced  Will consumers keep their existing plans or change?  SHOP Exchange  Newly Opened for 2015  Will it work?  Employee Choice option  Very complicated for employers  Individual Exchange  Focus has been on getting SHOP opened  Will the consumer experience improve?  Agents, Navigators, CAC’s  Will consumers continue to have access to good advice?  Renewals  Agent Involvement  Exchange Opens on 11/15, renewals begin 11/1 No information on 2 nd least cost silver plan (subsidy) May have to find information on exchange