Health Reform 101 by UHPP

Health Reform 101 The Road Ahead for Healthcare Policy in Utah

September 2016

Key Terms

Private insurance plans sold on healthcare.gov with monthly premiums subsidized for some people

ACA or Obamacare Insurance

Why is the Affordable Care Act (ie. Obamacare) still viewed unfavorably by a majority of Utahns/Americans?

Who is benefiting from the Affordable Care Act now and in the future? Will the Affordable Care Act end up like the G.I. Bill, or “No Child Left Behind ?”

Three Key Questions

1

2

3

Open Enrollment

Open Enrollment

Special Enrollment

2016

JANUARY 1 FEBRUARY 1 NOVEMBER 1

The new health insurance calendar

Next Open Enrollment: Nov. 1, 2016 -- Jan. 31, 2017

OCTOBER 31

Open Enrollment

Open Enrollment

Special Enrollment

2017

JANUARY 1 FEBRUARY 1 NOVEMBER 1 OCTOBER 31

What is a Qualifying Life Event? ….that triggers a Special Enrollment Period

How the ACA changed healthcare (as we know it)

Adults under age 26 can stay on

their parents insurance

plan

Men and women pay the same for coverage

Insurance offers free preventative care like blood pressure checks, flu shots, and health screenings

No one can be denied or priced out of coverage for a

pre-existing condition

No lifetime caps on insurance payments

2010 2013

18.4%

29.0% Utah Uninsured Rate Ages 18-26:

Source: Utah DOH

The ACA’s most popular reforms are also the least likely to be attributed to the ACA…

Source: Kaiser Family Foundation Health Tracking Poll (conducted March 5-10, 2013); http://kff.org/health-reform/poll-finding/march-2013-tracking-poll/

What are the penalties for remaining uninsured in 2016?

[Chart] Kaiser Family Foundation

$285 $975 $2,085 Max per family

$95/adult, $47.50/child

$325/adult $162.50/child

$695/adult $347.50/child

We Are Here

Utah’s ACA sign-ups reached 164,415 in March 2016

[OE1-a] Health Insurance Marketplace: February Enrollment Report (Oct. 1, 2013-March 1, 2014), http://aspe.hhs.gov/health/reports/2012/ACA-Research/index.cfm; [OE1-b] Health Insurance Marketplace: November Enrollment Report (November 13, 2013), For the period: October 1, 20134 - November 2, 2013, https://aspe.hhs.gov/sites/default/files/pdf/180496/rpt_enrollment.pdf [OE1-c] Health Insurance Marketplace: January Enrollment Report (January 13, 2014), For the period: October 1, 2013 – December 28, 2013, https://aspe.hhs.gov/sites/default/files/pdf/177611/ib_2014jan_enrollment.pdf [OE1-d] Health Insurance Marketplace: February Enrollment Report February 12, 2014), For the period: October 1, 2013 – February 1, 2014, https://aspe.hhs.gov/sites/default/files/pdf/177606/ib_2014feb_enrollment.pdf [OE1-e] Health Insurance Marketplace: March Enrollment Report (March 11, 2014), For the period: October 1, 2013 – March 1, 2014, https://aspe.hhs.gov/sites/default/files/pdf/76811/ib_2014Mar_enrollAddendum.pdf [OE1-f] Health Insurance Marketplace: Summary Enrollment Report: State Profile, (May 1, 2014), https://aspe.hhs.gov/sites/default/files/pdf/93806/ut.pdf ----------- [OE2-a] Health Insurance Marketplace: December Enrollment Report, (December 30, 2014), For the period: November 15, 2014 – December 15, 2014, https://aspe.hhs.gov/sites/default/files/pdf/77201/ib_2014Dec_enrollment.pdf [OE2-b] Health Insurance Marketplace: January Enrollment Report, (January 27, 2015), For the period: November 15, 2014 – January 16, 2015, https://aspe.hhs.gov/sites/default/files/pdf/33826/ib_2015jan_enrollment.pdf [OE2-c] Health Insurance Marketplace: March Enrollment Report, (March 10, 2015), For the period: November 15, 2014 – February 22, 2015, https://aspe.hhs.gov/sites/default/files/pdf/83656/ib_2015mar_enrollment.pdf; [OE2-d] State-Level Data from the ASPE January Health Insurance Marketplace Enrollment Report For The 2016 Open Enrollment Period; March 31, 2015 Effectuated Enrollment Snapshot; 15-06-02; http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-06-02.html ----------- [OE3-a] Health Insurance Marketplace: January Enrollment Report, (January 7, 2016), For the period: November 1, 2015 – December 26, 2015, https://aspe.hhs.gov/sites/default/files/pdf/167981/MarketPlaceEnrollJan2016.pdf; [OE3-b] Health Insurance Marketplace Open Enrollment Snapshot - Week 11; January 10, 2016 - January 16, 2016 (Released: 1/20/16); Health Insurance Marketplace Open Enrollment Snapshot - Week 13 January 24, 2016-February 1, 2016; https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-02-04.html; [OE3-c] Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report (March 11, 2016), For the period: November 1, 2015 – February 1, 2016, https://aspe.hhs.gov/sites/default/files/pdf/187866/Finalenrollment2016.pdf; [OE3-d] March 31, 2016 Effectuated Enrollment Snapshot (Released: June 30, 2016), https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-06-30.html

164,415

-

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

200,000

The drop of “effectuated” enrollment in 2016 was smaller than in previous years

84601

140,612

175,637

84,601

128,220

164,415

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

200,000

OE1 (2013-14) OE2 (2014-15) OE3 (2015-16)

(REGULAR) [OE1] Health Insurance Marketplace: February Enrollment Report (Oct. 1, 2013-March 1, 2014), http://aspe.hhs.gov/health/reports/2012/ACA-Research/index.cfm; [OE2] Marketplace Plan Selection by Age in States Using the HealthCare.gov Platform, By State (1); 11-15-14 to 2-15-15 (including SEP activity through 2-22-15), (Released: March 10, 2015), http://aspe.hhs.gov/health/reports/2015/MarketPlaceEnrollment/Mar2015/ib_2015mar_enrollment.pdf; [OE3] Addendum to the Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report; For the period: November 1, 2015 – February 1, 2016, (Released: March 11, 2016), https://aspe.hhs.gov/health-insurance-marketplaces-2016-open-enrollment-period-final-enrollment-report (EFFECTUATED) [OE1] Health Insurance Marketplace: February Enrollment Report (Oct. 1, 2013-MArch 1, 2014), http://aspe.hhs.gov/health/reports/2012/ACA-Research/index.cfm; [OE2] March 31, 2015 Effectuated Enrollment Snapshot (Released June 2, 2015), http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact- sheets-items/2015-06-02.html; [OE3] March 31, 2016 Effectuated Enrollment Snapshot (Released: June 30, 2016), https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-06-30.html

-8.8%

-6.4%

Effectuated

Initial

Utah enrollment grew by 36,195 between 2015-16 effectuated enrollment totals

Sources: [OE1] Health Insurance Marketplace: February Enrollment Report (Oct. 1, 2013-MArch 1, 2014), http://aspe.hhs.gov/health/reports/2012/ACA-Research/index.cfm; [OE2] March 31, 2015 Effectuated Enrollment Snapshot (Released June 2, 2015), http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-06-02.html; [OE3] March 31, 2016 Effectuated Enrollment Snapshot (Released: June 30, 2016), https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-06-30.html

84,601

128,220

164,415

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

OE1 (2013-14) OE2 (2014-15) OE3 (2015-16)

Nationally, 20 million Americans have gained health insurance due to the ACA and Medicaid Expansion

Source: The Office of the Assistant Secretary for Planning and Evaluation’s (ASPE) analysis of the Gallup-Healthways Well-Being Index survey data through February 22, 2016.

Utah’s uninsured rate is decreasing… …but the most recent data indicates a slowdown

Sources: Census SAHIE: https://www.census.gov/library/publications/2015/demo/P60-253.html DOH (BRFSS): http://ibis.health.utah.gov/pdf/opha/publication/ins/InsHighlights_2014.pdf Gallup Healthways: “Arkansas, Kentucky Set Pace in Reducing Uninsured Rate;” 2/4/16; [2015] http://www.well-beingindex.com/arkansas-kentucky-reduce-uninsured-rateBeing&utm_medium=newsfeed&utm_campaign=tiles

16.7%

15.7%

16.3%

15.9%

16.7% 16.6%

15.7%

14.0%

12.5%

9.1%

10.2%

11.6%

11.9%

10.6% 10.7%

11.2%

10.6%

13.4%

13.2%

11.6%

10.3%

15.6%

13.3%

12.4%

8%

9%

10%

11%

12%

13%

14%

15%

16%

17%

18%

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

UT: Census/SAHIE

UT:DOH (BRFSS)

UT: Gallup-Healthways

Over half of Utah’s ACA enrollment is under age 34

Utah

Healthcare.gov (34 states)

23%

32% 16%

13%

15%

Under 18

18-34

35-44

45-54

55-649%

28%

16%

21%

25% Under 18

18-34

35-44

45-54

55-64

55%

44% 0-34

35-64

Source: Addendum to the Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report; For the period: November 1, 2015 – February 1, 2016 https://aspe.hhs.gov/health-insurance-marketplaces-2016-open-enrollment-period-final-enrollment-report ; Released: March 11, 2016

Age

Age

Age

37%

62%

0-34

35-64

Age

Race Status Utah


1%

4%

0% 1%

10%

83%

2%

American Indian / Alaska Native

Asian

Native Hawaiian / Pacific Islander

African-American

Latino

White

Multiracial

0%

9% 0%

12%

15% 63%

1%

Source: Addendum to the Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report; For the period: November 1, 2015 – February 1, 2016 https://aspe.hhs.gov/health-insurance-marketplaces-2016-open-enrollment-period-final-enrollment-report; Released: March 11, 2016

17% of Utahns enrolling on healthcare.gov describe themselves as racial minorities

Rural Status Utah



15% of Utahns enrolling on healthcare.gov live in rural ZIP codes

15%

85%

Rural ZIP Codes

Urban ZIP Codes

18%

82%

Rural ZIPCodes

Urban ZIPCodes

Most Utahns choose Silver-level plans that offer a balance between premiums and cost-sharing

15%

74%

11%

Utah

1%

21%

71%

6% 1%



Subsidy Status

85% of Utahns enrolling on healthcare.gov received a premium subsidy

No subsidy

Received subsidy

Source: Health Insurance Marketplaces 2016; Average Premiums After Advanced Premium Tax Credits in the 38 States Using the Healthcare.gov Eligibility and Enrollment Platform; Nov. 1-Dec. 26, 2015; Released 1/21/16

87%

13%

Utah

No subsidy

Received subsidy

85%

15%


Premium subsidies make health insurance more affordable in Utah

Impact of subsidies on Utah consumer costs

ACA enrollment in Utah by % poverty level

Consumer

Cost

2%

34%

25%

21%

16% Under 100%

100% to 150%

150% to 200%

200% to 250%

250% to 400%


$187

$84

Subsidy

Amount

(69%)

(31%)

Average UT Monthly Premium: $271

In 2016, the average monthly per-person premium subsidy in Utah is $187/month

Consumer

Cost

Subsidy

Amount

$187

$290

$84

$106

$0

$50

$100

$150

$200

$250

$300

$350

$400

$450

Utah Hea;thcare.gov (34 states)

Utah Healthcare.gov (34 states)


Subsidy Amount

$271

$396

Over half of re-enrolling ACA consumers in Utah switched health plans in 2016

Origin of all Utah consumers

Plan selection by all Utah re-enrolled consumers

Newly enrolled

Re-enrolled

Switched plan

Same plan

58%

42%


56% 44%

71% of “Active” re-enrolled consumers in Utah switched plans in 2016

Plan selection by all Utah “Active” re-enrolled

Switched plan

Same plan


Plan selection by all Healthcare.gov

“Active” re-enrolled

Switched plan

Same plan

70.8%

29.2%

61.0%

39.0%

Sources: [2014] https://https://insurance.utah.gov/health/Health%20Refrom/ACA_Rate_Individual_20131007_OnExchange.pdf [2015] Utah – On Exchange Rates (accurate as of 10/15/14) https://insurance.utah.gov/health/Health%20Refrom/2015IndividualOnExchange20141016.pdf [2016] www.hea;thcare.gov; See Plans and Premiums (October 2015)

Altius Health Plans Arches BridgeSpan Humana Molina Healthcare Select Health

6 plans

26 plans

34 plans

24 plans

1 plan

Humana (6) Molina Healthcare (3) Select Health (60) University of Utah (5)

2015: 101 Plans 2016: 74 Plans

Altius Health Plans Arches BridgeSpan Humana Molina Healthcare Select Health

2014: 91 Plans

Gold

Silver

Bronze

Catastrophic

Platinum

5 plans

19 plans

27 plans

21 plans

2 plans

5 plans

29 plans

40 plans

27 plans

0 plans

2014-16 Individual Marketplace Comparison Salt Lake County

Note: Humana will exit the marketplace in 2017

(*) Premium costs do not include subsidies

Sources: [2014] https://https://insurance.utah.gov/health/Health%20Refrom/ACA_Rate_Individual_20131007_OnExchange.pdf [2015] Utah – On Exchange Rates (accurate as of 10/15/14) https://insurance.utah.gov/health/Health%20Refrom/2015IndividualOnExchange20141016.pdf [2016] Utah 2016 ACA Individual & Small Group Enrollment and Premium Rates; Utah Dept. of Insurance (October 2015)

In Salt Lake County, benchmark premiums rose 13% in 2016

$112

$197 $209

$301

$424

$115

$202 $215

$309

$436

$131

$229 $244

$350

$494

$-

$100

$200

$300

$400

$500

$600

20 30 40 50 60

Monthly Premiums* for Benchmark Silver Plan by Age (2014-15-16) Salt Lake County

Age

2014 2015 2016

Why are people dropping their coverage mid-year?

Insurance Dropouts Present a Challenge for Health Law New York Times By Abby Goodnough October 11, 2015

Link: http://www.nytimes.com/2015/10/12/us/insurance-dropouts-present-a-challenge-for-health-law.html

1) Premium cost

2) Under utilization

3) Paperwork errors

0% 101% 400% 100%

Who is eligible for premium subsidies?

Income as % of the Federal Poverty Level (FPL)

NO YES 53,000 Utahns

in the Gap

Sliding-scale subsidies make insurance more affordable

Source: http://www.coloradohealthinsurancebrokers.com/wp-content/uploads/2013/08/2015-2016-FPL-Chart-1024x314.jpg

For 2016, a family of four can earn $97,000 a year and receive a premium subsidy

If your income/family size is on this chart, you qualify for a subsidy

The Hernandez Family Income: $26,000 Residence: Salt Lake City, Utah Ages: Dad : 33 Mom: 29 Kids: 11, 7

Annual income: $26,000

% of poverty level: 109%

Monthly premium: $458

Subsidy pays: $410 per month

The Hernandez’s pay: $48 per month

Benchmark Silver Plan

Primary doctor: $5 Specialist doctor: $15 Emergency room care: $150 Generic drugs: $6

Plan Details

2016 rate change: + $4/month

Deductible: $1000 Out-of-pocket maximum: $1,500 Source: https://www.healthcare.gov/see-plans/; Image source: Moodboard





The Shumways pay: $262 per month



Plan Details

Deductible: $2,300 Out-of-pocket maximum: $10,900

2016 rate change: +$1/month

The Shumways Income: $44,000 Residence: American Fork, UT Ages: Dad : 24 Mom: 23 Kid: Newborn

Source: https://www.healthcare.gov/see-plans/

Mr. and Mrs. Smith Income: $42,000 Residence: Santa Clara, Utah Ages: 60, 62



Monthly premium: $1,188


The Smiths pay: $323 per month



Plan Details

Deductible: $2,500 Out-of-pocket maximum: $13,700

2016 rate change: + $13/month

Source: https://www.healthcare.gov/see-plans/; Image source: Moodboard

The Simonsen Family Income: $135,000 Residence: Alpine, Utah Ages: Dad : 35 Mom: 44 Kids: 11, 7





The Simonsen’s pay: $757 per month



Plan Details

Deductible: $2,500 Out-of-pocket maximum: $13,700 Source: https://www.healthcare.gov/see-plans/; Image source: Moodboard



Expected contribution: 100%

Monthly premium (for 2): $482

The Smith’s pay: $482

Subsidy pays $0

The Smith Family Income: $21,000 Residence: Orem, Utah Ages: Dad : 35 Mom: 33 Child: 7 Child: 11

No Subsidy

The Smith’s healthcare costs would be 27% of their total income

Who lives in the Coverage Gap?

Source: https://www.healthcare.gov/see-plans/; Image source: Fotozalc

Window-shop for insurance

https://www.healthcare.gov/see-plans

Who is signing up for the ACA in Utah?

Image source: WarrenFree

In 2016, 13 of Utah’s top 20 ZIP codes for ACA enrollment were outside of Salt Lake

County

Source: 2016 Health Insurance Marketplace Plan Selections by ZIP Code; (Nov. 1, 2015 — Jan. 9, 2016); https://aspe.hhs.gov/basic-report/plan-selections-zip-code-health-insurance-marketplace-january-2016

RANK CITY SELECTIONS % INCREASE 1 Lehi (84043) 3,501 19% 2 South Jordan (84095) 3,346 12% 3 American Fork (84003) 2,948 17% 4 Pleasant Grove (84062) 2,931 20% 5 St. George (84790) 2,829 10% 6 St. George (84770) 2,742 11% 7 Draper (84020) 2,624 13% 8 Bountiful (84010) 2,455 5% 9 Spanish Fork (84660) 2,377 24%

10 West Valley City (84119) 2,368 3% 11 West Valley City (84120) 2,345 13% 12 Provo (84604) 2,289 22% 13 Herriman (84096) 2,276 20% 14 Clearfield (84015) 2,258 3% 15 Riverton (84065) 2,255 23% 16 Cottonwood Heights (84121) 2,254 6% 17 Orem (84058) 2,196 24% 18 Orem (84057) 2,193 16% 19 Ogden (84404) 2,189 1% 20 Layton (84041) 2,110 12%

County Open Enrollment #3

(1/9/16) % Change since Open Enrollment #2

(2/22/15) County Population

(2014)

Salt Lake

52,360 7.1%

1,091,742

Utah

32,987 17.3%

560,974

Davis

14,263 9.8%

329,692

Weber

9,753 5.2%

240,475

Washington

10,437 12.4%

151,948

Cache

5,672 8.0%

118,343

Tooele

2,086 4.4%

61,598

Box Elder

2,023 9.4%

51,518

Iron

2,380 12.2%

47,269

Summit

3,034 13.3%

39,105

Uintah

1,039 7.1%

36,867

Sanpete

1,272 7.4%

28,477

Wasatch

2,118 5.7%

27,714

Carbon

638 -2.6%

20,660

Grand

904 -12.1%

9,429

Utah and Washington counties continue to lead ACA sign-ups in Utah

Sources: [OE2] Plan Selections by ZIP Code in the Health Insurance Marketplace (November 15, 2014 thru February 22, 2015) http://aspe.hhs.gov/health/reports/2015/MarketPlace-Enrollment/EnrollmentByZip/rpt_EnrollmentByZip_Apr2015.cfm [OE3] Plan Selections by ZIP Code in the Health Insurance Marketplace: (November 1, 2015 thru January 9, 2016) https://aspe.hhs.gov/basic-report/plan-selections-zip-code-health-insurance-marketplace-january-2016

Recent data suggests that Utah is falling behind other states in key health reform metrics

Sources: 2013, 2014; Gallup Healthways Well-Being Index (2/24/15); 2Q 2015 US: Gallup Healthways Well-Being Index (7/10/15); 2Q 2015 UT: Gallup Healthways Well-Being Index (8/10/15) ; Smith, Jessica C. and Carla Medalia, U.S. Census Bureau, Current Population Reports, P60-253, Health Insurance Coverage in the United States: 2014, U.S. Government Printing Office, Washington, DC,2015.

What ACA enrollment looks like

Who are the helpers? Navigator

Certified Application Counselor

Experts trained to help others evaluate their insurance options on the new insurance marketplace.

Image: Paramount Pictures Corporation

www.takecareutah.org | call 2-1-1

TCU’s trained counselors are ready to help you understand your new options to find affordable

health care coverage today

Where can Utahns find help applying for health insurance?

Utahans are still falling through the cracks

Source: “Utahns brace for Obamacare enrollment, year 2,” by Kristen Moulton, Salt Lake Tribune, 11/11/14; http://www.sltrib.com/news/1812058-155/insurance-hobson-says-utah-gov-plans?page=1

“First, the HealthCare.gov website had her application "processing" for two months. Then the exchange needed a

form from her employer. When she finally got insurance, it was at a rate far higher than it should have been and she was never given a card or even an address for sending a payment.” …. It’s irritating, because I really tried.”

November 11, 2014

Coverage Gap 101 Fixing Utah’s Persistent Healthcare Challenge

405,000 Utahns received Medicaid in 2014

The largest Medicaid recipient category in Utah are children under age 19 (238,950 recipients)

Utah adults without children aren’t eligible for Medicaid at any income level

59.0% 13.8%

11.8%

4.0%

6.4% 5.0%

Children (age 0-18)

Parents

Visually Impaired and People with Disabilities

Elderly (age 65+)

Pregnant Women

Primary Care Network (PCN)

Source: Utah Dept. of Health 2014 Medicaid Report (p. 29); http://health.utah.gov/medicaid/stplan/LegReports/MedicaidAnnualReport_2014.pdf

In June 2012, the Supreme Court declared Medicaid expansion optional. Utah is among 22 states that

have not expanded coverage.

0% 138% 400%

Income as % of the Federal Poverty Level

101% 400% 0% 100%

AC A in 2 0 1 0 AC A af ter 2 0 1 2

Originally, the ACA required Medicaid Expansion

Income as % of the Federal Poverty Level

What is the Coverage Gap?

Utahns in the Gap 63,000

0% 101% 400% 100%

Premium subsidies aren’t available for people earning under the poverty line

Income as % of the Federal Poverty Level (FPL)

NO YES 53,000 Utahns

in the Gap

• People who can’t receive Medicaid include adults without kids, parents who earn more than 50% of poverty, and people with unqualified disabilities

• Many people who don’t quality for Medicaid are uninsured and live in Utah’s “Coverage Gap”

Who isn’t eligible for Medicaid?

Who is in the Coverage Gap?

Parents… students… full-time workers… family care-givers… people with disabilities… part-time workers… veterans… women who just gave birth

Todd Dad… grad student… has two part-time jobs

Wendy Single-mom… student… child on LDS mission

Rachel Mom… employee… in long-term recovery

FYI: People in the coverage gap work

The national picture...

Source: The Advisory Board Daily Briefing (1/13/16); https://www.advisory.com/daily-briefing/resources/primers/medicaidmap

31 states, D.C. expanding Medicaid

Who could be covered in Utah?

Utah’s coverage gap costs lives each year

0% 100%

How does full expansion differ from partial?

0% 100% 138%

70%

30%

10%

90%

STATE

FEDERAL

WHO PAYS

$82 million/year $513 million/year

Partial Expansion Full Expansion TYPE

PEOPLE COVERED

TAXES RETURNED*

Source Cost estimates based on Milliman Numbers Revised 12 /17/14 and Dept. of Health Estimates 03/03/15; Taxes Returned data for 2017.

Utah voters support a coverage gap solution

Government & Nonprofit

Health Reform 101 by UHPP