1

The Road to Affordable CareThe Affordable Care Act – implementation,

questions, opportunities, challenges

2

How they want to feel is confident, informed, secure,

satisfied, and in control.

If you had to look for health insurance now, what feelings do you think you

would have?

Public: Past Confusion and Lack of Trust

Poll: 42% of

Americans unsure if

Obamacare is still

lawBy Sarah Kliff

Washington Post|

April 30, 2013Source: Enroll America Research, November 2012

3

Limited Public Awareness

The majority of uninsured Americans don’t know the health reform law will help them.

75%

Three out of four of the newly eligible want in-person assistance to learn about and enroll in coverage.

Source: Enroll America Research, November 2012

78%

Affordable Care Act Positive Changes

Preventive care at no chargeRestrictions on annual spending capsNo lifetime dollar limits on plansDependent children covered to age 26No pre-ex waiting periods under age 19Childhood immunizations and adult vaccinations

at no charge

Effective 2010

No annual coverage limits on health plans No Pre-Existing Condition Waiting Periods for all

For adults as well as childrenRequires “guarantee issue” and renewability of

health insurance regardless of health statusChange to Employer’s eligibility requirements – the

wait can be no more than 90 calendar days from date of hire

Effective 2014

Affordable Care Act Positive Changes

• The leading perceived benefit of coverage across populations

Financial Security & Peace of Mind

• A key message for womenPrevention

• Resonated most with men and young adults in some states

Protection from Financial Ruin or Injury

• Resonated with African Americans, Latinos, and Medicaid eligibleAccess To Care

• Key message for low income, Medicaid eligible

Low cost or free health insurance coverage

Messages that Resonate with the Public

• Will people be able to compare plans?• Will people select the right plan?

Financial Security & Peace of Mind

• Will people understand their benefits?• Will people access preventative services?Prevention

• Will the exchange be easy to understand?• Will people get into Medicaid if eligible?

Protection from Financial Ruin or Injury

• Will coverage be more than just a card?• Will the public’s experience be heard?Access To Care

• Will coverage be affordable?• Will services and Rx be affordable?

Low cost or free health insurance coverage

Moving from Messages to Reality

8

or

“Welcome Door”: What will it look like?

9Series1

0

5

10

15

Source: February 2013 CBO estimates

Mill

ions

Enroll at least 15 million people in new coverage options

}7 million in Exchange coverage

8 million in Medicaid or CHIP}

The 2014 Enrollment Opportunity: USA

10

Washington 2014 Enrollment Targets

Series1

Enroll over ½ a million people in new coverage options

}280,000 in Exchange coverage

350,000 in Medicaid or CHIP}

Federal Basic Health Option

12

Vision for Exchanges

• A easy shopping experience• Allow consumers to find and compare Qualified

Health Plans (QHPs) on quality and cost• Give consumers clear and easy-to-navigate

information about coverage options – Apples : Apples• Help consumers choose the best providers as well as

health plans, based on what matters to them• Drive delivery system and payment reforms• Ultimately enroll consumers in the plan that will

deliver the highest quality, highest value care that best meets their needs

FPL: Eligibility for Exchange Subsidy

Premium Subsidy: Your Premium Share is a Percent of Income

Up to 133% FPL 2% of income

133-150% FPL 3 – 4% of income

150-200% FPL 4 – 6.3% of income

200-250% FPL 6.3 – 8.05% of income

250-300% FPL 8.05 – 9.5% of income

300-400% FPL 9.5% of income

Annual Out-of-Pocket Maximums: 100% FPL $1,983 OOP max/individual

200% FPL $2,975 OOP max/individual

300% FPL $3,967 OOP max/individual

> 400% FPL $5,950 max/individual

15

In Addition to Premium Subsidies,Cost-Sharing Assistance is needed:

Cost Sharing Subsidies100-150% FPL 94% Actuarial Value

150-200% FPL 87% Actuarial Value

200-250% FPL 73% Actuarial Value

16

Consumers are confused by cost-sharing terms

Who knows what these terms mean: • deductible• coinsurance• benefit maximum• allowed amount• out-of-pocket max

Selecting the right plan matters –

Platinum, Gold, Silver, Bronze

Coverage is Here slide

17

18

A New Way to Enroll in Coverage

Consumers can connect to whichever program they are eligible for, no matter where they start.

Complete single application Determine eligibility

Enrolled in correct program!

Medicaid

CHIPIn-Person Assistance

Exchange

Single Application

19

Going Forward:

• What will be seen, learned and evaluated?• Will consumers come to the door and get in?• Will there be true access to care? • Will consumers get the “right” plan? • Feedback – learn from experiences• Don’t delay – if we don’t get it right

the first time then we are going to lose trust, and lose the ability to cover uninsured

Covering the Uninsured