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ACA Update 2014-2015 – Denver County
December 2014
Historic Opportunities with the ACA“Sick Care” System• Exclusionary• Episodic• High-costUninsured in Denver:
2012:17%
(American Community Survey)
“Health Care” System• Inclusive • Comprehensive• Preventive• Lower-Cost
2018 Projected:6%
Wellness & PreventionSick Care
ACA Improvements in Coverage - 2010• Insurance companies can no
longer refuse to cover children with pre-existing conditions or drop coverage from people who get sick.
• Children can stay on parents’ insurance until age 26.
• Free preventive services without co-pays, even if deductible has not been met.
Examples of Free Preventive Services
Selected Free Preventive Services
Pregnancy and Newborns Screening for anemia and infections; vitamin supplementation; breastfeeding support and counseling; newborn screening
Well Child Care Screening for autism, hearing, vision, depression, obesity, lead; all recommended vaccinations
Bone Health Osteoporosis screening
Sexual Health Screening for STDs and intimate partner violence; STD prevention counseling; Contraception
Infections Hepatitis C & HIV testing; all recommended vaccinations for adults
Mental Health Depression screening
Cardiovascular Disease Screening for high blood pressure, diabetes, high cholesterol and obesity; dietary and obesity counseling
Cancer Screening for breast, cervical and colon cancer; counseling about sun exposure
Substance Use Tobacco use screening and cessation services; alcohol misuse screening and counseling
More information available at www.Healthcare.gov
0-18 years
19-34 years
35-49 years
50-64 years
65+ years
Male
Female
White
, non-H
isp...
Black,
non-Hisp
...
Hispan
ic
Multi-Racial
/Other
0%
10%
20%
30%
40%
50%
9%
26%23%
17%
1%
21%
14%11%
14%
29%
13%
Perc
enta
ge U
nin
sure
d
Who Lacked Insurance in Denver?1 in 5 Denver residents were uninsured prior to 2014:
Source: American Community Survey, 2011
104,178 Uninsured17% overall
Where were Denver’s Uninsured?
Source: American Community Survey, 2008-2012
ACA Expansion of Coverage - 2014
Based solely on incomeEnrollment is year-round!
0-133% of FPL: $15,282 for single $31,322 for family of
4 (2014
scale)
Assistance to Purchase InsuranceNo Denials for Pre-Existing Conditions
Enrollment in Open Enrollment Period, 10/1/2013-3/31/2014 and after certain life events
133-400% of FPL: $45,900 for single
$94,200 for family of 4Ave. Subsidy: $277/mo (2014 scale)
Key Exclusion for All New Coverage: Undocumented persons and some legal residents.
Individual Insurance Mandate: Everyone must have health coverage or pay a penalty - $95 or 1% of annual income when filing 2014 tax return, increases in later years.
Two New Forms of Subsidized Coverage:91% of eligible uninsured prior to 2014 estimated to qualify (ACS 2012)
The Promise of Expanded Health Coverage
• Improved health for Denver residents – more preventive services, better control of chronic illnesses
• Funds to support the expansion of clinical care for the newly-insured
• Less cost-shifting to government and employer-sponsored health insurance
• Promotes price transparency and health care system collaboration
Denver’s Community Health Improvement Plan (CHIP), 2013-20185-Year Access to Care Goal: By December 2018, at least 95% of Denver residents will have access to primary medical care, including behavioral health care.
Available at:BeHealthyDenver.org
Denver’s CHIP ObjectivesObjective A1: Increase the number of Denver residents with health care coverage by supporting implementation of the Affordable Care Act (ACA).• 40,000 Denver residents enroll in Medicaid and subsidized
insurance by July 1, 2014.• 94% have health care coverage by December 31, 2018.Objective A3: Create a health alliance of important stakeholder organizations in Denver, to increase access to care, better coordinate health care services, and decrease health care costs.
Mile High Health Alliance, 2014First Access to Care Working Group
Denver ACA Enrollment, 2014
Where are People Accessing Care?
Jan-Sept 2013 compared to Jan-Sept 2014
Denver Health Outpatient Visits
• 33,0000 New Medicaid patients Jan-Sept 2014• Increased revenue in 2014• Waiting list to get into primary care reduced by more than half:
10,000 (October 2013) >> 4000 (2014)• Adding 20 new provider teams (15 medical, 5 dental)• Expanded specialty care visits• Expanded hours at some clinics• Favorable bond market rating: New Southwest Clinic opening 11/2015,
renovation of Westside Clinic
More patients with a payer
source
Increased revenue
Increased capacity to provide services
to low-income persons
ACA Impact on Denver Health
ACA Update 2015
0-133% of FPL: $15,521 for single $31,721 for family of
4 (2015
scale)
133-400% of FPL: $46,680 for single
$95,400 for family of 4(2015
scale)Second Open Enrollment Period Shorter! 11/15/2014 - 2/15/2015
Enrollment is Year- Round!
Penalties Increasing!Tax Year Financial Incentive: Whichever is Greater
2014 $95 per adult, $47.50 per child (up to $285)OR 1.0% of family income
2015 $325 per adult + $162.50 per child (up to $975)OR 2.0% of family income
2016 and Beyond
$695 per adult + $347.50 per child (up to $2,085)OR 2.5% of family income
Who Still Needs Insurance in Denver?
Sources: 2012 American Community Survey, HCPF, Connect for Health Colorado, Kaiser Family Foundation (2014) Survey of Non-Group Insurance Enrollees
The Big Work Ahead: Connect for Health Colorado Enrollment!Remaining Uninsured
• 82.3% of those eligible to purchase plans at C4HCO are expected to qualify for financial assistance!
• Subsidies are substantial - 2013-2014 C4HCO average $277/family
Potential Barriers to Enrollment • Negative media coverage about the ACA• Continued access to CICP, although it does not satisfy the individual
mandate to have insurance• Lack of knowledge about:
• new forms of coverage – Medicaid and Connect for Health CO – and eligibility• availability of financial assistance to purchase insurance• generous size of the subsidies (average $277/family, C4HCO 2013-2014)• Insurance generally – what it is, how to use it, why have it?
• Perception of unaffordability of insurance• Unwillingness to pay for insurance, even with subsidies• Many plans to choose from - 176 plans at Connect for Health
Colorado in 2014-15
Overcoming the Barriers• People do want insurance – 84% of those who did not enroll in
2013-2014 want it (Enroll America survey).• Accurate and widely available information about the benefits of
health insurance and how the ACA helps people get covered.• Assistance to sign up for Medicaid and insurance plans.• CICP does NOT satisfy the individual mandate – holders will pay
penalty. They can use CICP as secondary coverage to help with co-pays.
• Tax penalty going up – from $95 to $325 per adult or 1% to 2% of family income in 2015.
• Connect for Health CO is working – individual plans went up by only 0.71% on average statewide this year.
• Medicaid is free, good coverage for those who qualify.• Many others are getting it - 42,351 new adults got Medicaid in
Denver in 2014, up 79% from 2013. 1/5 people in CO have it now!
Identify:• Most uninsured people in Denver will qualify for Medicaid subsidies at C4• Nearly all people with CICP will qualify for Medicaid (CICP E rating or
lower and some with F rating) or subsidies + CICP does not cover the individual insurance mandate
• Parents whose children have Medicaid or CHP+ are likely to qualify for the new coverage programs
Inform:• Importance of health insurance - better health, regular source of care,
free preventive services! • New sources of coverage – Medicaid and Connect for Health Colorado• Provide brochures and information about how and where to enroll –
importance of in-person assistance and where to get it!
What You Can Do to Help Get People Enrolled
What You Can Do to Help Get People EnrolledPiton Foundation: For copies contact [email protected]
Denver Health: For copies contact [email protected]
Provide Brochures!
What You Can Do to Help Get People Enrolled
Refer to Phone and Online Enrollment SitesGive patients and clients information about how to check their eligibility and sign up for Medicaid or subsidized insurance by phone or online
Phone: Toll-free: 1-800-221-3943TDD: 1-800-659-2656
Apply Online: Colorado.gov/PEAK
Phone: Toll-free: 1-855-PLANS4YOUToll-free: 1-855-752-6749
Apply Online: ConnectforHealthCO.com
What You Can Do to Help Get People EnrolledRefer to In-Person Enrollment Assistance Sites!Refer clients to organizations that can assist with enrollment in Medicaid or purchasing insurance on the insurance exchange. Sites may have interpreters to help clients enroll.
Lists of sites available at: colorado.gov/apps/maps/hcpf.map
List of sites available at: connectforhealthco.com/let-us-help/assistance-network/
Medicaid and Connect for Health Colorado Enrollment Assistance Sites in Denver
Summary - Key messages for 2014-2015
• Health insurance is important for physical and financial well-being.
• Most of Denver’s pre-ACA uninsured (91%) will qualify for assistance to get covered.
• The level of support is significant: $277/mo in 2013-14.• The penalty increases to 2% of income, $325/person.• The open enrollment period is only 3 months – 2/15/15.• The marketplace is keeping costs contained - average
increase in cost for plans in CO was 0.71%.
Questions?
Contact Information: Dr. Lisa McCannAdvisor to the Denver Access to Care Task Force and Mile High Health [email protected]
