1. MICHIGAN ASSOCIATION OF HEALTH PLANS
Michigan Academy of Physician Assistants: MAPA 2013 Spring Conference Affordable Care or Sticker Shock: Where do we end up? March 22, Rick Murdock Executive Director Michigan Association of Health Plans
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MICHIGAN ASSOCIATION OF HEALTH PLANS

2. Affordable Care or Sticker Shock
Presentation Outline
Background on MAHP
Who gets Care now?
Reform Issues Facing the Insurance Industry
Provider Issues/Concerns
Likely Recommendations in the Legislature
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MICHIGAN ASSOCIATION OF HEALTH PLANS

3. MICHIGAN ASSOCIATION OF HEALTH PLANS
MAHP: Who We Are
MAHP Mission is to provide leadership for the promotion and advocacy of high quality, affordable, accessible health care for the citizens of Michigan.
MAHP represents 15 health plans covering all of Michigan and 45 related business and affiliated organizations
MAHP Member Health Plans provide coverage for nearly 2.8 million Michigan citizens—nearly one in every three citizens in Michigan
MAHP Health Plans employ about 8,000 persons—all of whom pay taxes in Michigan.
MAHP members collect and use health care data, supports the use of “evidence based Medicine “ and facilitate disease management and care coordination in order to provide cost-effective care.
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MICHIGAN ASSOCIATION OF HEALTH PLANS

4. MAHP Member Health Plans:
MAHP: Who We Are
MAHP Member Health Plans:
- Coventry Cares of Michigan2,3 -Grand Valley Health Plan 1
Health Alliance Plan 1,3 -Meridian Health Plan2,3
HealthPlus of Michigan 1,2,3 -McLaren Health Plan1,2
Midwest Health Plan2,3 -Molina Healthcare of Michigan2,3
Paramount Care of Michigan 1 -Physicians Health Plan 1,2
Priority Health 1,2,3 -ProCare Health Plan 2
Total Health Care 1,2 -United Healthcare1,2,3
Upper Peninsula Health Plan 2,3
Key : 1 = Commercial Health Plan 2= Medicaid Health Plan 3= Medicare Advantage or Medicare Special Needs Plan
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5. Coverage for Michigan Citizens (Millions)
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6. Support for Affordable Care Act Party Affiliation
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7. MICHIGAN ASSOCIATION OF HEALTH PLANS
Health Care Reform
Medicaid Expansion
Health Insurance Exchange
Insurance Reform
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MICHIGAN ASSOCIATION OF HEALTH PLANS

8. Qualified Health Plans
Issuers
Plans
Bronze – 60% actuarial value
Silver – 70% actuarial value
Gold – 80% actuarial value
Platinum – 90% actuarial value
Catastrophic plans
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9. Essential Health Benefits
1- Ambulatory patient services. 2- Emergency services. 3- Hospitalization. 4- Maternity and Newborn Care. 5- Mental health and substance use disorder services, including behavioral health treatment.
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MICHIGAN ASSOCIATION OF HEALTH PLANS

10. Essential Health Benefits (cont.)
6- Prescription drugs. 7- Rehabilitative and habilitative services and devices. 8- Laboratory services. 9- Preventive and wellness services and chronic disease management. 10- Pediatric services, including oral and vision care.
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11. Employer Responsibility
Must provide health insurance to FT employees of large groups
Minimum value – no less than 60% AV
Affordable – cost to employee for self-only coverage cannot exceed 9.5% of household income
Minimum value calculator enables employers to test
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MICHIGAN ASSOCIATION OF HEALTH PLANS

12. Exchange Determines Eligibility
In addition to enrolling individuals in plans on the exchange, exchange determines eligibility for:
Medicaid – up to 138% of FPL
SCHIP (MiChild)
Premium tax credits
Reduced cost-sharing
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MICHIGAN ASSOCIATION OF HEALTH PLANS

13. MICHIGAN ASSOCIATION OF HEALTH PLANS
Premium Tax Credit
Amount of tax credit is based on the premium for the 2nd lowest cost silver plan and varies by income:
% FPL … 3-4% of income
% FPL … 4-6.3% of income
% FPL … % of income
% FPL … % of income
% FPL … 9.5% of income
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14. MICHIGAN ASSOCIATION OF HEALTH PLANS
Provider Concerns
Provider Capacity:
Primary Care Access for consumers
Medical Home
Linkage to Community Resources
Personal Wellness Options
Information Technology
EMR
Electronic Billing/referrals/
--All Payer Data Base
--Common Processes (Claims Status, Eligibility, etc)
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MICHIGAN ASSOCIATION OF HEALTH PLANS

15. Provider Concerns Using Technology (Where we can do better)
20% of patients records not transferred in time for appointment
25% of patients tests to be re-ordered
One in three hospitalized patients “harmed” during stay
One in five Medicare Patients re-admitted within 30 days
63% of patients don’t know their health care costs and 10% never find out
One/third of health care expenditures doesn’t improve health
(Institute of Medicine/Best Care)
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16. MICHIGAN ASSOCIATION OF HEALTH PLANS(
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17. MICHIGAN ASSOCIATION OF HEALTH PLANS
Insurance Premium
Underlying Cost Pressures For Health Insurance
4.6% overall increase 2010 to 2011
16.2% of per capita spending from individual out of pocket
4.8 % increase in inpatient spending
6/8 % increase in outpatient spending
4.5% increase in professional per capita spending
1 % increase in prescription spending
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MICHIGAN ASSOCIATION OF HEALTH PLANS

18. MICHIGAN ASSOCIATION OF HEALTH PLANS
Insurance Premium
Cost Pressure under ACA
2.3 % Premium tax beginning in 2014
3.5% surcharge on premiums for Insurance Exchange
Limits on Medical Underwriting (Age/Smoking/Geography)
Benefit Design compared to current coverage
Penalties (Individual and Business)
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19. MICHIGAN ASSOCIATION OF HEALTH PLANS
Recommendations
Reimbursement Issues
Reimbursement Reform (Parity?)
Cost Shifting Concerns (Gov’t Payers, Autos, Self-pay)—how to address?
Tax Issues (how to finance Medicaid)
Continued review of scope of practice rules
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MICHIGAN ASSOCIATION OF HEALTH PLANS

20. MICHIGAN ASSOCIATION OF HEALTH PLANS
For more information on health reform, please visit MAHP’s website (
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