1. SustiNet Board of Directors December 2, 2010 Anya Rader Wallack Katharine London Linda Green Stan Dorn

2. Agenda for today Summary of board member input on core SustiNet design choices Brief recap of cost and coverage estimates from November 18 meeting Board discussion 7/3/2016 2

3. BOARD MEMBER INPUT I. 7/3/2016 3

4. Areas of strong agreement State employees, retirees, Medicaid and HUSKY should be in SustiNet Basic Health Plan implementation Build on current board, rather than recreating Add stakeholders and specific expertise to the board Maximize federal HIT funding Encourage but not require PCMH Implement evidence-based guidelines Pursue multi-payer reforms Make public health investments (but differences on whether it is a SustiNet or state/local responsibility) 7/3/2016 4

5. Area of disagreement #1: offering SustiNet to other employers and individuals Majority support for expansion to municipalities Some strong support for expansion to other groups and individuals Some strong expression of caution, need for more information and experience 7/3/2016 5

6. Area of disagreement #2: HUSKY eligibility and access Some support HUSKY expansion before 2014, some oppose due to state fiscal situation Some support increased HUSKY reimbursement, others oppose 7/3/2016 6

7. Area of disagreement #3: SustiNet structure More support for  Quasi-governmental agency run by an independent Board, focused on operating the SustiNet health plan, contracting with DSS and Comptroller  SustiNet Board accountable to political leadership, operates SustiNet health plan and helps guide relevant DSS and Comptroller decisions Least support for superagency overseeing DSS and Comptroller, with Board advising superagency head Tension: desire to buffer from politics versus desire for strong political leadership 7/3/2016 7

8. Other observations Differences were less ideological than practical Many board members did not have strong opinions on design choices and were open to persuasion 7/3/2016 8

9. RECAP OF COST AND COVERAGE ESTIMATES II. 7/3/2016 9

10. Incremental effects of various policy elements: 2017 Uninsured gaining coverage (thousands) Net changes to state spending (millions) Changes to employer costs (millions) SustiNet Membership (thousands) Pess. Scenario Optim. Scenario Pess. Scenario Optim. Scenario Pess. Scenario Optim. Scenario Pess. Scenario Optim. Scenario HUSKY to 138% FPL, federal exchange subsidies, federal incentives/mandates 206 -$174-$371-$485 620 Incremental effects of adding various policy combinations to the above BH 11-$50-$47$26 30 BH + let small firms buy 13-$50-$54$24$19166195 BH + let all firms and individuals buy 13-$50-$56$24-$13324391 BH + let all buy + raise HUSKY payment 13$142$127$24-$13324391 10 Note: net state spending totals include both outlay and revenue effects.

11. Net effects of various policy combinations: 2017 Uninsured gaining coverage (thousands) Net changes to state spending (millions) Changes to employer costs (millions) SustiNet Membership (thousands) Pess. Scenario Optim. Scenario Pess. Scenario Optim. Scenario Pess. Scenario Optim. Scenario Pess. Scenario Optim. Scenario HUSKY to 138% FPL, federal exchange subsidies, federal incentives/mandates 206 -$174-$371-$485 620 Net effects of adding various policy combinations to the above BH 207 -$224-$418-$459 650 BH + let small firms buy 207209-$224-$425-$461-$466786815 BH + let all firms and individuals buy 207209-$224-$427-$461-$4989441011 BH + let all buy + raise HUSKY payment 207209-$32-$244-$461-$4989441011 11 Note: net state spending totals include both outlay and revenue effects.

12. BOARD DISCUSSION III. 7/3/2016 12

13. What will the Board recommend to the Legislature? Areas of strong agreement Areas of disagreement  Offering SustiNet to other employers and individuals  HUSKY eligibility and access  SustiNet structure Second-order questions 7/3/2016 13