Changes in Health Care Policy: How Could Florida be Affected? Joan - PowerPoint PPT Presentation

Changes in Health Care Policy: How Could Florida be Affected? Joan Alker Executive Director, Research Professor Georgetown University Center for Children and Families March 7, 2017

Childr Children’ en’s Uninsur s Uninsured Rate in Florida ed Rate in Florida and US, 2008-2015 and US, 2008-2015 18% 16% 16.7% 14% 12% 10% United States 6.9% 9.3% 8% Florida 6% 4% 4.8% 2% 0% 2008 2009 2010 2011 2012 2013 2014 2015 Source: CCF analysis of single-year estimates of summary data from the American Community 2 Survey (ACS).

Rate of Childr Rate of Children’ en’s Uninsurance by s Uninsurance by State State Source: Source: J. Alker, A. Chester, “Children’s Health Coverage Rate Now at Historic High of 95 3 Percent,” Georgetown University Center for Children and Families, October 2016.

Long-Term Ef Long-T erm Effects of Childhood fects of Childhood Medicaid Coverage Medicaid Coverage Greater Greater Healthier Academic Economic Adults Achievement Success Gover Government Savings (ROI) nment Savings (ROI) Source: A. Chester and J. Alker. “Medicaid at 50: A Look at the Long-Term Benefits of Childhood Medicaid.” 4 Georgetown University Center for Children and Families. July 2015.

Children’ Childr en’s Coverage in Florida, 2016 s Coverage in Florida, 2016 400% of the FPL 400% of FPL (Family of 3) (Family of 3) $80,360/year Exchange Subsidies $80,640/year (Premiums Based on Sliding Scale, Ranging from 2%-9.5% of Income) 255% of FPL 215% of FPL CHIP (Family of 3) (Family of 3) $51,230/year $43,334/year 138% of FPL 138% of FPL (Family of 3) (Family of 3) $27,724/year $27,821/year Medicaid Source: Based on the results of a national survey conducted by the Kaiser Commission on 5 Medicaid and the Uninsured and the Georgetown University Center for Children and Families. January 2017. �

Public Coverage for Childr Public Coverage for Children in Florida en in Florida Medicaid CHIP Medicaid CHIP 135,000 Medicaid Medicaid Separate CHIP Separate CHIP 293,000 2,264,000 Marketplace Marketplace 122,000 Sources: “Child Enrollment in CHIP and Medicaid by State, FY 2015.” MACPAC. “Health Insurance Marketplaces 2016 Open Enrollment Period: March Enrollment Report.” ASPE. 6 March 11, 2016.

Medicaid Eligibility in Florida, 2017 Medicaid Eligibility in Florida, 2017 215% 215% 215% 215% 211% 211% 196% 196% 145% 145% 138% 138% 88% 88% 88% 88% 33% 33% 0% 0% 18% 18% Childr Children, 0-1 en, 0-1 Childr Children, 1-5 en, 1-5 Childr Children, en, Pregnant Pr egnant Par Parents ents Other adults Other adults Seniors Seniors Disabled Disabled Medically Medically 6-18 6-18 women women needy needy Medicaid Medicaid Separate CHIP Separate CHIP Source for children, pregnant women, parents and other adults: The Kaiser Family Foundation, "Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost Sharing Policies as of January 2017: Findings from a 50-State Survey", January 2017. Source for seniors and individuals with disabilities: The Kaiser Family Foundation State Health Facts, 7 "Medicaid Eligibility, through the Aged, Blind, Disabled Pathway", January 2017 Source for medically needy: MACPAC, MACSTATS, 2016.

Enr Enrollees and Expenditur ollees and Expenditures in es in Florida, FY 2013 Florida, FY 2013 100% 13.1% 13.1% 90% 26.1% 26.1% 80% 15.3% 15.3% 70% 21.9% 21.9% 60% 40.9% 40.9% 50% 40% 30% 14.0% 14.0% 49.7% 20% 10% 19.0% 0% Enrollees Expenditures Child Adult Disabled Aged Source: MACPAC, "MACSTATS", 2016. 8

Medicaid and CHIP Cover 41% of Medicaid and CHIP Cover 41% of Florida’ Florida’s Childr s Children en 7% 7% Medicaid/CHIP 8% ESI 41% Direct Purchase Other Uninsured 37% 9 Source: CCF analysis of 2015 ACS data.

Medicaid and CHIP Cover Mor Medicaid and CHIP Cover More than e than Half of Florida’ Half of Florida’s Childr s Children Age 0-5 en Age 0-5 and Half of All Births and Half of All Births Medicaid and CHIP Coverage, Medicaid and CHIP Coverage, Medicaid Financed Births Medicaid Financed Births Ages 0-5 Ages 0-5 Medicaid 52% 48% Medicaid/CHIP 50% 50% Other Other/Uninsured Sources: Georgetown CCF analysis of monthly November 2016 CMS Medicaid & CHIP Enrollment. 10 “Births Financed by Medicaid.” Kaiser Family Foundation. Florida data is from 2014.

Percent of Childr Per cent of Children in Medicaid/ en in Medicaid/ CHIP by Congressional District, US CHIP by Congr essional District, US 39% 39% – 70% 70% 30% 30% – 39% 39% 9% 9% – 30% 30% Source: Single-year estimates of summary data from the 2015 American Community Survey 11 (ACS). The U.S. Census Bureau publishes ACS summary data on American Fact Finder. Percent estimates were computed.

Per Percent of Childr cent of Children on Medicaid/CHIP by Congr en on Medicaid/CHIP by Congressional District, FL essional District, FL 4 1 2 3 5 6 7 11 10 12 9 15 13 8 14 16 17 18 21 19 20 22 23 25 57-65% 24 49-57% 26 27 41-49% 33-41% 24-33% Source: Single-year estimates of summary data from the 2015 American Community Survey (ACS). The U.S. Census Bureau publishes ACS summary data on American Fact Finder. Percent 12 estimates were computed.

Impact of ACA Repeal Impact of ACA Repeal 13

What Do W What Do We Know About ACA e Know About ACA Repeal? Repeal? o Budget reconciliation process will be used; simple majority needed o Future of marketplace is uncertain o Florida has 1.7 million enrollees o Tax credits replacing subsidies o Entire Medicaid program will be capped o Medicaid expansion being phased down 14

What Does ACA Repeal Mean for Childr What Does ACA Repeal Mean for Children in en in Florida W Florida Without Medicaid Cap? ithout Medicaid Cap? Source: The Urban Institute. “Partial Repeal of the ACA through Reconciliation: Coverage 15 Implications for Florida Residents.” Analysis using HIPSM 2016.

How Quickly Could Repeal and How Quickly Could Repeal and Replace Happen? Replace Happen? o House committees starting tomorrow o Senate may bypass committees and take House bill to the Floor which is extremely unusual. o No CBO score yet. o No hearings on proposed bill. o Senate has to comply with “Byrd Rule.” o This limits the “flexibilities” that can be included in the bill o Goal is to be done by April recess 16

What Changes ar What Changes are Pr e Proposed for oposed for Medicaid? Medicaid? 17

Medicaid/CHIP Medicaid/CHIP o House bill imposes a per capita cap on Medicaid with a base year of FY 2016 and an inflator of Medical CPI o This cap applies to the entire program! o Expansion funding reduced starting on January 1, 2020 – applies only for those who are continuously covered. Everyone else gets regular match. o Small new fund for non-expansion states ($2B a year) o CHIP funding expires on September 30, 2017 unless Congress acts. 18

What Does A Medicaid Cap Mean What Does A Medicaid Cap Mean for Florida? for Florida? 19

A Per Capita Cap Shifts Risk to A Per Capita Cap Shifts Risk to States States o If a new treatment becomes available o If costs per person go up more than expected – especially for expensive populations like the elderly o Aging of the population o If a new epidemic occurs like HIV, Zika, opioids o If a natural or manmade disaster occurs. 20

Medicaid is the Primary Sour Medicaid is the Primary Source of ce of Federal Funds to Florida Federal Funds to Florida Source: Kaiser Family Foundation analysis of National Association of State Budget Officers 21 (NASBO), State Expenditure Report: Fiscal 2014-2016, November 17, 2016.

Federal Government Pays the Federal Gover nment Pays the Majority of Medicaid Costs Majority of Medicaid Costs • Federal government pays state- specific share of total Medicaid costs (FMAP). • FMAP higher for poorer states, lower for wealthier states. State Share 74.5% Federal Match • Florida match hovers around the 58.5% 50.0% median at about 60%. In FY 2018, it’s 61.79%. Median Lowest Highest • Mandatory entitlement funding. State FMAP FMAP States (13) (MS) Source: Office of the Assistant Secretary for Planning and Evaluation. “FY 2017 Federal Medical 22 Assistance Percentages.” ASPE. December 19, 2015.

Medicaid Per Capita Caps Shift Medicaid Per Capita Caps Shift Costs to States Costs to States Current Medicaid Financing Capped Federal Medicaid System Funding VS $120 $120 $100 $100 $100 $60 $80 $50 $60 $50 Federal cap $50 $40 $40 $60 $50 50% FMAP Expected Higher 50% FMAP State Higher spending State spending with spending (unexpected cost cap (unexpected growth) cost growth) Federal Share State Share Federal Share State Share Graphic Credit: Center on Budget and Policy Priorities. 23

Medicaid Anti-Retroviral Drug Spending/ Medicaid Anti-Retr oviral Drug Spending/ Use More Than Doubled Use Mor e Than Doubled • The onset of the HIV/AIDS epidemic in the 1980s and early 1990s led to unexpected Medicaid costs. • Anti-retroviral prescriptions increased from 170,000 to 3 million from 1991 to 2005. • Anti-retroviral prescription spending increased from $31 million to $1.6 billion. Graphic Credit: Center on Budget and Policy Priorities. 24 Source: Yonghua Jing, et. al. “Utilization and Spending Trends for Antiretroviral Medications in the US Medicaid Program from 1991 to 2005.” AIDS Research and Therapy. October 2007.