1. Washington Health Benefit Exchange s AAPWA Conference Brian Peyton, Director of Legal Services November 1O, 2015 Some Early Lessons Learned

2. ACA Health Exchanges - Combining commercial health insurance, Medicaid and the Income Tax. What could go wrong? 2

3. Exchange Basics ▪ Entry point for Medicaid, Qualified Health Plans ▪ AHP: Individuals >138% of FPL and small groups (1-50) ▪ Tax credits available for individuals 138%-400% of FPL ▪ Cost sharing reductions available for <250% FPL ▪ Metallic tiers for different coverage levels ▪ Apples-to-apples comparisons for consumers, one-stop shop 10 essential health benefits ▪ Robust Customer Support Network ▪ Call Center ▪ State-Wide Navigator and Broker Enrollment assistance programs 3

5. Using Federal Data to Verify Eligibility: The Federal Data Services Hub But he that filches from me my good name Robs me of that which not enriches him And makes me poor indeed. - Shakespeare, Othello 5

6. Eligibility Criteria Verified ▪ Citizenship/Lawful Presence ▪ Residence ▪ Not Incarcerated ▪ Income 6

7. Common Problems ▪ Citizenship/Legal Residency not Verified ▪ Incarceration ▪ Social Security number not verified ▪ Newborn baby 7

8. Calculating Tax Credits “The hardest thing in the world to understand in the world is the income tax. “ - Albert Einstein 8

9. Advanced Payments & Premium Tax Credit Your Premium Share is a Percent of Income Up to 133% FPL2% of income 133-150% FPL3 – 4% of income 150-200% FPL4 – 6.3% of income 200-250% FPL6.3 – 8.05% of income 250-300% FPL8.05 – 9.5% of income 300-400% FPL9.5% of income

10. BUT……  What income is Included?  Changes in income  Fluctuating income  Household composition  You Must File a Return -”Failure to Reconcile” 10

11. Health Literacy Many kids come out of college, they have a credit card and a diploma. They don’t know how to buy a house or a car or health insurance or life insurance. They do not know basic microeconomics. – Jesse Jackson 11

12. Choosing and Using Health Insurance is New to Many ▪ Language Barriers ▪ Terminology- “deductible”, “coinsurance”, etc. ▪ The lowest premium is not always the best deal. 12

13. 13 Health Literacy Campaign Vision: All Washington residents know how and where to access health insurance. All Washington residents understand their health insurance options, their rights, their cost, their responsibilities and their coverage. All Washington residents know the value of health insurance in staying healthy across the lifespan. Clear and Simple Design Reading Level: 5.3 Key Terms Translated in 8 Languages

14. Health Literacy Campaign ▪ Popular Consumer Tools: ▪ User’s Guide to Key Terms ▪ Road Map to Health ▪ The ABC’s of Health Insurance ▪ New tools in development: ▪ Metal Levels and Cost Sharing Reductions ▪ You Enrolled into Coverage; Next Steps ▪ Focus Navigator training on plan info and costs. Incorporate insurance literacy into the enrollment process. ▪ Broker partnerships ▪ Insurance Literacy website: knowyourplan.org 14

15. And now, some Good News….. 15

16. EXCHANGE ENROLLMENT QHPMedicaid Expansion January 201463,320231,483 May 2014147,154400,728 January 201599,614511,607 May 2015163,778549,000 16

17. Current Snapshot Decreased uninsured rate  One of the largest drops in rate of uninsurance nationwide  Census: 14% (2013) to 9.2% (2014)  Gallup: 16.8% (2013) to 6.4% (mid-July 2015)  44% drop in hospital charity care; 47% drop in hospital bad debt in WA in 2014 Enrollment success (August Dashboard)– nearly 1 in 4 WA residents  QHP: 155,484  Medicaid (new adult): 555,934; 1.47M (total MAGI Medicaid/CHIP) 17

18. 2013 QHP Eligible Uninsured 2015 QHP Eligible Uninsured 2013 Medicaid Eligible Uninsured 2015 Medicaid Eligible Uninsured SOURCE: http://www.ofm.wa.gov/healthcare/healthcoverage/default.asphttp://www.ofm.wa.gov/healthcare/healthcoverage/default.asp *Estimates for 2015 are preliminary and do not account for net changes in employer-sponsored coverage and other private insurance coverage outside the Exchange.

19. “America enjoys the best health care in the world, but the best is no good if folks can’t afford it, access it and doctors can’t provide it.” - Sen. Bill Frist 19

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