ACA Update 2014-2015 – Denver County
December 2014
Historic Opportunities with the ACA
Uninsured in Denver:
2012:
17%
(American Community Survey)
2018 Projected:
6%
“Sick Care” System
• Exclusionary
• Episodic
• High-cost
“Health Care” System
• Inclusive
• Comprehensive
• Preventive
• Lower-Cost
Sick Care
Wellness & Prevention
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
Well Child Care
Bone Health
Sexual Health
Infections
Mental Health
Cardiovascular Disease
Cancer
Substance Use
Screening for anemia and infections; vitamin supplementation;
breastfeeding support and counseling; newborn screening
Screening for autism, hearing, vision, depression, obesity, lead; all
recommended vaccinations
Osteoporosis screening
Screening for STDs and intimate partner violence; STD prevention
counseling; Contraception
Hepatitis C & HIV testing; all recommended vaccinations for adults
Depression screening
Screening for high blood pressure, diabetes, high cholesterol and
obesity; dietary and obesity counseling
Screening for breast, cervical and colon cancer; counseling about sun
exposure
Tobacco use screening and cessation services; alcohol misuse
screening and counseling
More information available at www.Healthcare.gov
Who Lacked Insurance in Denver?
1 in 5 Denver residents were uninsured prior to 2014:
104,178 Uninsured
17% overall
Percentage Uninsured
50%
40%
30%
26%
23%
21%
17%
20%
10%
29%
14%
9%
11%
14%
13%
1%
0%
Source: American
Community Survey, 2011
Where were Denver’s Uninsured?
Source: American
Community Survey,
2008-2012
ACA Expansion of Coverage - 2014
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.
Key Exclusion for All New Coverage:
Undocumented persons and some
legal residents.
Two New Forms of Subsidized Coverage:
91% of eligible uninsured prior to 2014 estimated to qualify (ACS 2012)
Based solely on income
Enrollment is year-round!
0-133% of FPL: $15,282 for single
$31,322 for family of 4
(2014 scale)
Assistance to Purchase Insurance
No Denials for Pre-Existing Conditions
Enrollment in Open Enrollment Period, 10/1/20133/31/2014 and after certain life events
133-400% of FPL: $45,900
for single
$94,200 for family of 4
Ave. Subsidy: $277/mo (2014 scale)
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 newlyinsured
• 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), 2013-2018
5-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 Objectives
Objective 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, 2014
First Access to Care Working Group
Denver ACA Enrollment, 2014
Where are People Accessing Care?
Denver Health Outpatient Visits
Jan-Sept 2013
compared to
Jan-Sept 2014
ACA Impact on Denver Health
More patients with
a payer source
Increased
revenue
Increased capacity
to provide services
to low-income
persons
• 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
Penalties Increasing!
ACA Update 2015
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
0-133% of FPL: $15,521 for single
$31,721 for family of 4
(2015 scale)
Enrollment is Year- Round!
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
Who Still Needs Insurance in Denver?
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
Sources: 2012 American Community Survey, HCPF, Connect for Health Colorado, Kaiser Family Foundation (2014)
Survey of Non-Group Insurance Enrollees
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!
What You Can Do to Help Get People Enrolled
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
Piton Foundation: For copies
contact mviola@piton.org
Provide Brochures!
Denver Health: For copies contact
Betty.Rueda@dhha.org
What You Can Do to Help Get People Enrolled
Refer to Phone and Online Enrollment Sites
Give 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: 1-800-221-3943
TDD: 1-800-659-2656
Apply Online: Colorado.gov/PEAK
Phone:
Toll-free: 1-855-PLANS4YOU
Toll-free: 1-855-752-6749
Apply Online: ConnectforHealthCO.com
What You Can Do to Help Get People Enrolled
Refer 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-ushelp/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 McCann
Advisor to the Denver Access to Care Task Force and Mile High
Health Alliance
Lisa.McCann@dhha.org