Healthcare 2014
North Coast Association of Health Underwriters
September 10, 2014
Grace-Marie Turner, Galen Institute
Current ACA Coverage Estimates
►25 million more to get health coverage
►+ 13 million through Medicaid expansion
►+ 24 million through federally subsidized
private insurance
► - 12 million lose current coverage
►31 million remain uninsured by 2023
Source: http://www.cbo.gov/sites/default/files/cbofiles/attachments/43900-2013-05-ACA.pdf
2015 Reenrollment challenges
►Goal: Keep “8 million” and enroll 5 million more
►Automatic reenrollment
►But many of 87% getting subsidies could face
higher costs, lose added Silver plan subsidies
► Subsidies tied to second-lowest priced
Silver plan or “benchmark” plan
►Costs for individuals could rise significantly
CALIFORNIA
Sonoma County
Pre- to Post- ACA rates
MEN
Age 27
Age 40
Age 64
$128 to $217
$162 to $265
$509 to $623
70%
64%
22%
California battles over rates
►Proposition 45 - Commissioner Dave Jones/Consumer Watchdog
►70% of voters support state rate regulation
►Weighted average of CCA rates:
+4.2% in 2015
► ACA reinsurance program helps stem losses –
but ends in 2016.
►Insurers are hit with higher admin costs, MLR
rules, new taxes, and soaring hospital costs
►Explain that consumers will be harmed with
even narrower networks, higher OOP cost
Are most ACA subsidies even legal?
U.S. Court of Appeals in
Washington, DC
U.S. Court of Appeals in
Richmond
2-1 decision
3-0 decision
The language of the
ACA “unambiguously
restricts” subsidies to
“Exchanges
established by the
state.”
“…widely available tax
credits are essential to
fulfilling the Act’s
primary goals.”
Court challenges will continue
• En banc hearing by full D.C. Circuit Court of Appeals
• Two more federal courts will rule on similar challenges
• Indiana
• Oklahoma
• Split decisions will send the case back to the Supreme
Court
• A decision against the government will require action by
Congress to protect 5+ million people receiving subsidies
Close to a third of voters either received a
cancellation notification or know someone who did.
Support
Oppose
% Yes
31%
worry I might get
cancellation notice in
the future
25%
69%
I know a family member
or friend
28%
67%
22%
8%
did not receive did not receive
I received
cancellation
cancellation
notification my
notice, but worry notice, but I
coverage was
that I might get know a family
going to be
one
member or
cancelled due to
friend that
Obamacare
Pg. 9
received notice
BASE: ALL QUALIFIED RESPONDENTS
Q705. For each of the following, indicate Yes or No.
received notification my
coverage was cancelled
45%
total national average
47%
51%
53%
Future “worriers” more closely
related to opposition
More than two-thirds of voters believe we should address
health care policy in a step-by-step approach
COMPREHENSIVE
31%
Davis believes that comprehensive
legislation is the only way to bring about
real health care reform. Health care issues
are complex and interconnected. The
comprehensive approach is the best way to
deal with these issues all together to
achieve the real changes that are needed.
Liberal Left: 55%
Support Obamacare: 54%
Liberal: 50%
Democrats: 47%
Hispanic: 44%
Ages 27-34: 41%
Black: 40%
Post grads: 38%
STEP-BY-STEP
69%
Somewhat
like Davis
24%
Somewhat
like Parker
49%
Exactly like
Exactly like
Davis
Parker
7%
20%
Pg. 10
BASE: ALL QUALIFIED RESPONDENTS
Q235. Please read each opinion and indicate which one comes closest to your own:
Parker believes we should address health
care policy improvements in a step-by-step
approach so that we focus on the biggest
problems first and avoid making changes that
may bring unintended consequences or upset
our coverage or other things we like in the
current health care system.
Riled-Up Individualists: 89%
Oppose Obamacare: 84%
Conservatives: 84%
Republicans: 83%
Discouraged Conservatives: 81%
Tea Party supporters: 80%
HS or less education: 75%
Ages 35-54: 74%
Alienated Liberals: 74%
Majority of voters would prefer to try a new alternative to
Obamacare or go back to the old system
If it were up to you to make a decision about Obamacare, which
would you choose?
Most likely to want to try a new
alternative:
Alienated Liberals: 49%
Discouraged Conservatives: 43%
Riled-Up Individualists: 42%
Republicans: 41%
HS education or less: 40%
Conservatives: 40%
Not employed: 39%
Independents: 39%
Pg. 11
Most likely to want to go back to
old system:
Riled-Up Individualists: 54%
Tea Party supporters: 51%
Republicans: 50%
Discouraged Conservatives: 45%
Those receiving coverage cancellation
notices: 35%
South East: 35%
HS education or less: 34%
Ages 18-26: 33%
Try a new
alternative,
34%
Keep
Obamacare
38%
Mostly likely to want to keep
Obamacare
Liberal Left: 80%
Democrats: 68%
Liberals: 69%
Black: 62%
Moral Citizens: 53%
Hispanic: 48%
West: 47%
Post grads: 47%
Ages 27-34: 46%
Moderates: 43%
Go back to the
system before,
28%
BASE: ALL QUALIFIED RESPONDENTS
Q275. Thinking about things a little differently, if it were up to you to make a decision about Obamacare, which would you choose?
What’s next with health reform?
Two
different
visions
“We need to pass our own
replace bill to show what we
are for”
Providing help to buy health
insurance
Difficult
choices
• Tax deduction?
How much?
• Tax credit?
Refundable?
Advanceable?
Age adjusted?
Targeted?
Tax cap?
What level?
Start by painting a new vision
…not by first getting bogged
down in these hard choices
and difficult details
Moving to a Patient-Centered
Health Care Sector
Private sector
Public sector
• Align incentives
• Transparency
• Genuine competition
• Benefit choices
• Pre-existing condition
protection
• Nurture innovation
• Choice of private plans
in Medicare
• Escape from the
Medicaid ghetto
• More flexibility and
incentives for states to
take the lead on
reform
Coburn/Burr/Hatch
Patient Choice,
Affordability,
Responsibility and
Empowerment Act
Broun
Patient OPTION
Act
Price
Empowering
Patients First Act
Scalise/Roe
The American
Health Care
Reform Act
Coburn/Burr/Hatch
Patient Choice,
Affordability,
Responsibility and
Empowerment Act
Scalise/Roe
The
American
Health Care
Reform Act
Broun
Patient
OPTION
Act
Price
Empowering Patients
First Act
Genuine
choice,
better
coverage
through real
competition
Patients
and
doctors
make
decisions
Making
insurance
at work
more
affordable
More
stability
for
Medicare
Giving
the poor
more
options
Holding
hospitals
accountable
Focus groups with
independent women
Make policy personal
and relevant
Examples…
A young mother
• Pick your own plan and doctors
A young, single guy
• Affordable catastrophic coverage
A small business owner
• Choices of plans she can afford
Someone with chronic or serious illness
• A strong safety net
Conveying a fresh vision of
health freedom
More choices of more affordable coverage
that lets you pick your own plan, your own
hospital, and your own doctor
Straightforward guarantees you can keep
your coverage
A safety net that protects the vulnerable and
those with pre-existing conditions
Joint public/private initiatives
• Using claims data, EHRs to gather information to
improve consumer engagement
• Cost transparency + incentives for consumers to shop
wisely
• Consumer priorities in selecting plans:
Price. Access. Brand.
• Access to providers via phone, email, and social media
• Hot buzz-terms:
• Value-based payment
• Channeled partnerships
• Vertical integration (ACOs) to share risk and rewards
Repeal
Replace
with
Bipartisan
Reform
Grace-Marie Turner
Galen Institute
703-299-8900
gracemarie@galen.org
Twitter @GalenInstitute
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