State Option for Health Care Coverage Division of Insurance / Dept. of Health Care Policy & Financing Stakeholder Meeting May 29, 2019 Presented by: Kim Bimestefer, Executive Director, Health Care Policy & Financing Mike Conway, Insurance Commissioner, Division of Insurance
State Option for Health Care Coverage Division of Insurance / Dept. of Health Care Policy & Financing Agenda Opening Remarks • Our Quest • Overview of HB19-1004 Proposal For Affordable Health Coverage Option • Other State’s Actions – New Mexico & Washington • Learnings from CO-OPs • Facilitated Discussion •
Opening Remarks Division of Insurance / Dept. of Health Care Policy & Financing Welcome and Thank You • Our Quest • Maximizing Our Strengths • Beautiful Music • Learning from our History • Governor’s Principles are a Good Guidepost • Value of Diversity of Thought & Collaboration •
Opening Remarks: Our Quest under HB 1004 Division of Insurance / Dept. of Health Care Policy & Financing High Quality Health Care Access • Sustainable Affordability to Customers @ Different Income Levels • Serve Individuals and Small Employers • Address Uninsured rate, which is not equally spread • Maximize Existing Infrastructure, Don’t Disrupt What is Working • Maximize Innovation • Recognize Fed Challenges in Funding; Affordable to the State • Increase Competition •
Overview of HB 19-1004 Proposal For Affordable Health Coverage Option • What else does the bill require us to include in the proposal? • Feasibility and cost of implementing a state option • Identify the most effective implementation of a state option based on affordability to consumers at various Income Levels • Admin. and financial burden to the state (risk-bearing & solvency) • Ease of Implementation • Evaluate the likelihood of meeting the objectives above • Proposal due November 15, 2019
Overview of HB 19-1004 Proposal For Affordable Health Coverage Option • Implementation considerations • Identify potential premium levels and cost sharing for a plan that at a minimum is an EHB compliant plan • Evaluate provider rates necessary to incentivize participation that will encourage adequate networks and high quality health care delivery • Consider eligibility criteria for individuals and small businesses • Determine any impact to the state budget • Determine impact on the stability of the individual market, the small group market, and Connect for Health Colorado – including whether the product should be offered on or off C4
Overview of HB 19-1004 Proposal For Affordable Health Coverage Option • Implementation considerations, cont’d • Determine impact on individuals receiving subsidies • Determine the structure of the plan including who should offer it • Identify expected impacts, if any, to HCPF programs • Investigate funding options including state funds and federal waivers • Evaluate the feasibility, legality, and scope of any necessary federal waivers • Review information related to Senate Bill 19-004 • Create a statewide definition of affordability for consumers
Stakeholder’s Role in Recommendations • Purpose – to advise DOI and HCPF in Recommendations to the legislature • Constraints – the recommendations are accompanied by needed legislative changes and any funding requests • Stakeholder’s responsibilities – be thought partners, identify additional needed input, share with community and bring back feedback • Timeline – Recommendations finalized by middle of October to be received by legislature on November 15. • Stakeholder feedback will be used to inform recommendations
Criteria • Stability of the market • Competition without harm • Affordability to consumers at different income levels • Ease of implementation • Likelihood of success • High quality • Others?
New Mexico Analysis Source: Manatt Analysis, page 6, January 2019
Washington State – Cascade Care • Signed into law May 2019 • Coverage starts in 2021 • Offered on Exchange • Hybrid public-private system • State contracts with private health insurers to administer plans, but will define benefits and negotiate costs • Goal to offer public option plans in all 39 counties • New plan includes capping provider reimbursement rates at 160% of Medicare
Lessons from ACA CO-OPs • Only 4 of 23 ACA CO-OPs still exist today • Two issues that we need to be mindful of as we move forward • CO-OPs were dependent on federal funding – the loss of that funding was key to their failures • Failure of CO-OPs disrupted care for hundreds of thousands of people throughout the country and billions of dollars were lost.
State Option for Health Care Coverage For more information and updates visit: colorado.gov/hcpf/proposal-affordable- health-coverage-option
Discussion • What should be Colorado’s approach to creating a state option • Who do you need to hear from? • Data needed? • What should be the frequency of meetings to get to recommendations by October 15 • Needed workgroups?
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