Status of Health Reform Spring 2013 Mt. Sinai Hospital John Bouman President Shriver Center Chicago, IL April 26, 2013

Remember: Current system a big problem Cost ever-increasing, but access to care decreasing Little choice or control or guarantee of quality No peace of mind: what if you lose coverage and never get it back? 50 million uninsured – decreasing employer- based coverage, cost-shift to everyone else Billions of uncompensated care

Illinois – layers of change Affordable Care Act (ACA) (2010) Market Reforms Subsidized ins. individuals and small business Fill the Medicaid gap System reforms Medicaid Reform Act (2011) Care coordination (50% by 2015) Long term care re-balancing Lots of health IT SMART Act (2012) Cuts

Illinois Status -- general Quinn Administration committed, supportive, competent specialists but stretched very thin DHFS leads; DOI, human services agencies Democrats – strong champions; others timid Republicans – opposed, but… Insurance industry strong with both parties Strong politics around children Dramatic changes everywhere, and so … Lots of denial Lots of opportunity

ACA Status – market reforms Pre-existing condition discrimination banned Lifetime and annual limits Discriminatory pricing for pre-ex, women Young adult coverage “Medical Loss Ratio” Tax credits for small business “individual mandate” – penalty if uninsured “shared responsibility” tax – larger businesses that don’t insure employees

ACA Status: Healthcare Marketplace Web portal for policies, common language All plans good insurance Plans being filed and evaluated now “Co-op” option – Land of Lincoln Subsidies for premiums: % FPL Subsidies for out of pocket costs IL will do hybrid federal-state in 2014 Enrollment October, live January -- DOI will regulate policies sold -- Feds manage subsidies and website

ACA Status – Marketplace Issues Plan: Illinois Marketplace 2015, but… Wait and see re: hybrid SB 34 is pending bill -- maybe Board composition: how much industry? Powers – how much actual regulation of insurance prices (Mass-Colorado-Utah) Financing – fees and assessments, not GRF

ACA status: Medicaid Completion Medicaid gap: 19-64, not disabled or parent 350,000 at least: young adults, empty nesters, unofficially disabled, veterans NFIB S.Ct. decision hands it to state politics SB26: passed Senate, pending House IHA, Chamber, strong coalition Republicans? Speaker? October enrollment; January 2014 “on” date BIG deal

ACA Status – Cook County Waiver One year early Medicaid eligibility Up to 114,000 Live in Cook County Age 19-64, not eligible for current Medicaid Income below 133% FPL ($14,856) Citizen or 5-year LPR Have SSN or applied for one Phone: (855) , (312) But paper application (with assistance) 2014 folds into statewide expanded Medicaid

Illinois Status – Care Coordination Medicaid Reform Act of 2011: 50% by 2015 Lots: 90% in ITS HERE Integrated Care Pilot: 40,000 senior and people with disabilities in suburbs Innovations RFP: Six projects selected, all aimed at “high user” populations -- Medical homes plus network of specialists -- Some include housing and social services Medical Home Network (parents and kids) Managed Care contracts to handle “duals”

Illinois Status – Innovations RFP winners Be Well Partners in Health (organized around long term care) Healthcare Consortium of IL (community based networks, south suburbs) Macon County Care Coordination (downstate, features mental health providers) Precedence Care Coordination (downstate) Together4Health (Heartland, hard to reach populations, housing and social determinants)

Illinois Status – Long-term Care Medicaid Reform Act of 2011 emphasis More community based options Transition from nursing and institutional care Three court orders Capital budget includes funds Need to build sites Need to build workforce

Illinois status – Budget cuts FY 13 budget (now), SMART Act FamilyCare to 133% from 185% (26,000) Illinois Cares RX eliminated DON score and other limits to in-home care Adult dental eliminated Some provider rate cuts Maximus contract – redetermination project 4 prescription limit (not kids for now)

Illinois Status – food for thought Make managed care work Re-define relationships and networks Social services, Case management Housing Legal and advocacy Prevention: medical home=prevention and wellness and smart use of IT=cost savings Health IT Immigration reform

Information Federal: National: Kids: Legal: Seniors: State: ages/default.aspx State NGOs: Shriver Brief:

John Bouman Shriver Center 50 E. Washington, Suite 500 Chicago, IL (312)