Professional Documents
Culture Documents
Elisabeth R. Benjamin, JD, MSPH, Vice President of Health Initiatives, Community Service Society
Presentation Outline
ACA Refresher What impact has the ACA had on New York so far? Potential Supreme Court scenarios What each scenario means for New York
2
www.cssny.org
ACA REFRESHER
www.cssny.org
ACA Refresher
Individual mandate, guaranteed issue, community rating States to establish health insurance Exchanges Exchanges are health insurance marketplaces that allow people and small businesses to:
Enroll in Medicaid or get subsidies to buy commercial coverage Compare plans on an apples to apples basis on a website Only citizens and immigrants who are lawfully present can use the Exchange
Medicaid savings
Urban Institute estimates annual Medicaid savings of $2.3 billion Increases funding for 800,000 Medicaid waiver enrollees 90% funding for childless adults up to 138% of FPL
5
www.cssny.org
251%-300% FPL
301%-400% FPL
$45,775 - $54,930
$54,930 - $73,240
$2,883 - $4,421
$4,421 - $6,957
$5,800
$7,733 6
www.cssny.org
NY Coverage Estimates
With and Without Health Reform
No Reform
Uninsured (2,724,000) 16% Other (including Medicare) (349,000) 2% Medicaid/C HP (4,067,000) 24% Other (including Medicare) (349,000) 2% Uninsured (1,700,000) 10%
In 2014, the Exchange will enroll 1.68 million New Yorkers. Post Reform
7
www.cssny.org
Order is broadly written (uses term among other things a lot) 7 Operational Paragraphs state: 1. Exchange is established in the Department of Health
DOH will work with Dept. of Financial Services and other agencies to perform the functions of the ACA
3. Enable eligible individuals to get tax credits and cost-sharing reductions and eligible small business to get tax credits
8
www.cssny.org
5. Exchange shall convene regional advisory committees to offer advice and make recommendations about establishment and operation of the Exchange:
consumer advocates small businesses consumer representatives health care providers agents, brokers insurers labor organizations any other appropriate stakeholders
6. Must be financially sustainable by Jan 2015. 7. No preemption of duties of DOH, DFS or other State agency.
9
www.cssny.org
www.cssny.org
Over 2 million New Yorkers with Medicare received free preventive services
11
www.cssny.org
12
www.cssny.org
Health IT
68,000 providers already registered for $173m in incentives to adopt EHRs
14
www.cssny.org
16
www.cssny.org
Recap of SC Scenarios?
Option #1: Supreme Court upholds entire law. Option #2: Court decides that the constitutional challenge is premature. Option #3: Just the individual mandate is struck down. Option #4: The mandate is struck down, together with guaranteed issue and community rating. Option #5: The Medicaid expansion is struck down. Option #6: Supreme Court strikes down entire law.
17
www.cssny.org
20
www.cssny.org
Next Steps: Essentially, same next steps as in Option #1, but much more uncertainty Will NYS Senate will enact Exchange legislation?
21
www.cssny.org
700,000 uninsured low-income New Yorkers will still be eligible for federal subsidies to make purchasing insurance affordable. Numbers of uninsured will decline, but not as much. State still to save $2.3 billion on Medicaid/FHP/CHP. Many other ACA benefits remain: young adult coverage to age 26, Exchange will make comparing and enrolling into insurance easier, etc. Hospital cuts remain, but decreased offsets due to fewer gains in coverage
22
www.cssny.org
Option #4: Mandate struck together with guaranteed issue and community rating.
Impact for New York: Similar impact as Option #3.
Unlike many other states, New York already has guaranteed issue* and community rating under state law.
* New Yorks guaranteed issue law allows plans to exclude coverage of preexisting conditions for up to 12 months. This would have been barred under the ACAs guaranteed issue rules. 24
www.cssny.org
90,000 low-income childless adults who would have been eligible for Medicaid under the expansion will not gain eligibility State will lose $2.3 billion in funding gains that would have been achieved through increased federal matching funds
(From enhanced funding for nearly 900,000 beneficiaries)
The ACAs other benefits will remain, including subsidies to help lowincome people afford coverage, an Exchange, and insurance regulation
25
www.cssny.org
Family Health Plus and Child Health Plus remain Consider renewing Medicaid waiver for adults up to 200% of FPL?
Modeled after the Basic Health Plan in the ACA and Washington State
Significant affordability problem for low-income people using the Exchange remains unaddressed
26
www.cssny.org
28
www.cssny.org
29
www.cssny.org