ACA in Indian Country Marketplace Enrollment: Is It Worth the Effort? - PowerPoint PPT Presentation

ACA in Indian Country Marketplace Enrollment: Is It Worth the Effort? September 9 - 10, 2014 Doneg McDonough, Technical Advisor Tribal Self-Governance Advisory Committee TribalSelfGov.org; d.mcdonough@yahoo.com

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t SOURCE: KCMU analysis of 2009 - 2011 American Community Survey. AI/AN includes people of Hispanic origin. Kaiser Family Foundation, "Health Coverage and Care for American Indians and Alaska Natives", October, 2013 3

SOURCE: Kaiser Family Foundation, "Health Coverage and Care for American Indians and Alaska Natives", October, 2013. 4

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Report source: Fox and Voerner 2012, “Health care coverage and income of American Indians and Alaska Natives: A comparative analysis of 33 states with Indian Health Service funded programs”. Table 2. Health coverage by income level of American Indian and Alaska Native persons who lived in 33 states with Indian Health Service funded programs. 2008-2010. Data are from American Community Survey 2008-2010. 6

Hypothetical Example of Weighted Average Marketplace Costs for AI/AN Member Enrollees Distribution of AI/AN, by Household Income; Premiums and Cost-sharing Costs % w/out Average Weighted Income Level % <139% Costs Average Costs Under 139% FPL 37% -- Between 139% and 400% FPL 42% 67% x $765 = $510 Over 400% FPL 21% 33% x $2,465 = $822 100% 100% Average enrollee costs $1,332 Average total premium and cost-sharing costs $4,366 Average percentage of costs covered by enrollees 31% Source of data on AI/AN income distribution: Fox and Voerner 2012, “Health care coverage and income of American Indians and Alaska Natives: A comparative analysis of 33 states with Indian Health Service funded programs”. Table 2. Health coverage by income level of American Indian and Alaska Native persons who lived in 33 states with Indian Health Service funded programs. 2008-2010. Data are from American Community Survey 2008-2010. 7

SOURCE: Analysis of Kaiser Family Foundation, "Analysis of 2015 Premium Changes in the ACA's Health Insurance Marketplaces", September 2014, Issue Brief. 8

AI/AN enrollment in bronze-level plans: premiums and cost-sharing costs Distribution of Funding - Marketplace Enrollment: American Indians and Alaska Natives, 2015 (family of 3; bronze-level coverage; by income; by number of enrollees) $25,727 (130% FPL) $39,580 (200% FPL) $69,265 (350% FPL) $87,706 (440% FPL) $14,000 $12,000 $5,701 $10,000 $8,662 $8,000 $3,801 $3,801 $12,774 $13,097 $6,000 $7,680 $8,731 $4,000 $7,396 $1,900 $1,900 $1,900 $2,585 $2,887 $4,931 $4,435 $4,931 $4,258 $4,366 $4,366 $2,000 $2,465 $2,465 $2,465 $1,780 $1,051 $322 $1,478 $0 $0 $0 $0 $107 $0 One Two Three Per One Two Three Per One Two Three Per One Two Three Per Enrollee enrollees enrollees enrollee Enrollee enrollees enrollees enrollee Enrollee enrollees enrollees enrollee Enrollee enrollees enrollees enrollee average: average: average: average: Three Three Three Three enrollees enrollees enrollees enrollees Total Enrollee Costs Federal Financial Assistance SOURCE: Analysis of Kaiser Family Foundation, "Analysis of 2015 Premium Changes in the ACA's Health Insurance Marketplaces", September 2014, Issue Brief. 9

Enrollment in silver-level coverage: premiums and cost-sharing costs Distribution of Funding - Marketplace Enrollment: non-"Member of Indian Tribes", 2015 (family of 3; silver-level coverage; by income; by number of enrollees) $25,727 (130% FPL) $39,580 (200% FPL) $69,265 (350% FPL) $87,706 (440% FPL) $14,000 $0 $2,961 $12,000 $10,000 $0 $0 $9,132 $8,000 $12,061 $13,382 $5,251 $6,000 $10,421 $7,868 $0 $8,921 $0 $8,921 $0 $987 $4,000 $1,371 $3,044 $3,675 $4,020 $4,461 $4,461 $4,461 $3,089 $3,669 $4,249 $2,000 $3,474 $1,416 $785 $1,052 $1,320 $440 $0 One Two Three Per One Two Three Per One Two Three Per One Two Three Per Enrollee enrollees enrollees enrollee Enrollee enrollees enrollees enrollee Enrollee enrollees enrollees enrollee Enrollee enrollees enrollees enrollee average: average: average: average: Three Three Three Three enrollees enrollees enrollees enrollees Total Enrollee Costs Federal Financial Assistance SOURCE: Analysis of Kaiser Family Foundation, "Analysis of 2015 Premium Changes in the ACA's Health Insurance Marketplaces", September 2014, Issue Brief. 10

Support tables to prior graphs: premium and cost-sharing costs Distribution of Funding - Marketplace Enrollment: American Indians and Alaska Natives, 2015 (family of 3; bronze-level coverage; by income; by number of enrollees in household) $25,727 (130%) $39,580 (200%) $69,265 (350% FPL) $87,706 (440% FPL) Per Per Per Per enrollee enrollee enrollee enrollee average: average: average: average: One Two Three Three One Two Three Three One Two Three Three One Two Three Three Enrollee enrollees enrollees enrollees Enrollee enrollees enrollees enrollees Enrollee enrollees enrollees enrollees Enrollee enrollees enrollees enrollees Total Enrollee $0 $0 $0 $0 $1,780 $1,051 $322 $107 $2,465 $4,931 $4,435 $1,478 $2,465 $4,931 $7,396 $2,465 Costs Federal Financial $4,366 $8,731 $13,097 $4,366 $2,585 $7,680 $12,774 $4,258 $1,900 $3,801 $8,662 $2,887 $1,900 $3,801 $5,701 $1,900 Assistance Total Funding $4,366 $8,731 $13,097 $4,366 $4,366 $8,731 $13,097 $4,366 $4,366 $8,731 $13,097 $4,366 $4,366 $8,731 $13,097 $4,366 Distribution of Funding - Marketplace Enrollment: Non-"Member of Indian tribe", 2015 (family of 3; silver-level coverage; by income; by number of enrollees in household) $25,727 (130%) $39,580 (200%) $69,265 (350% FPL) $87,706 (440% FPL) Per Per Per Per enrollee enrollee enrollee enrollee average: average: average: average: One Two Three Three One Two Three Three One Two Three Three One Two Three Three Enrollee enrollees enrollees enrollees Enrollee enrollees enrollees enrollees Enrollee enrollees enrollees enrollees Enrollee enrollees enrollees enrollees Total Enrollee Costs $785 $1,052 $1,320 $440 $3,089 $3,669 $4,249 $1,416 $4,461 $8,921 $10,421 $3,474 $4,461 $8,921 $13,382 $4,461 Federal Financial $3,675 $7,868 $12,061 $4,020 $1,371 $5,251 $9,132 $3,044 $0 $0 $2,961 $987 $0 $0 $0 $0 Assistance $4,460 $8,920 $13,381 $4,460 $4,460 $8,921 $13,381 $4,460 $4,461 $8,921 $13,382 $4,461 $4,461 $8,921 $13,382 $4,461 Total Funding SOURCE: Analysis of Kaiser Family Foundation, "Analysis of 2015 Premium Changes in the ACA's Health Insurance Marketplaces", September 2014, Issue Brief. 11