State Per State Perspec spective tives s on th on the e Future of Health Care Future of Health Care n4a Aging Policy Briefing Washington, D.C. April 4, 2017 Hemi Tewarson Acting Director, Health Division NGA Center for Best Practices
About NGA About NGA The National Governors Association (NGA) is the nation’s oldest organization serving the needs of governors and their staff NGA Office of Government Relations (OGR): Serves as the collective voice of the nation’s governors in Washington, DC NGA Center for Best Practices (NGA Center): A hybrid think tank/consultancy that works directly with governors on specific policy projects and provides support to OGR. The NGA Center is comprised of five divisions: o Economic Opportunity Division o Education Division o Environment, Energy & Transportation Division o Health Division o Homeland Security & Public Safety Division National Go Na tional Gover ernor nors s Ass Associa ociation tion 2
Health Divis Health Division ion Guiding Principles Guiding Principles The Health Division grounds all of its work in the following guiding principles: • Helping Governors Succeed : Harnessing unbiased expertise to surface and disseminate the most promising evidence-based practices that can assist governors as they strive to improve the lives of their residents • Moving Beyond Theory : Moving beyond theory by breaking down complex challenges and translating best practices into actionable steps governors can take to effectively and efficiently solve problems and create change • Breaking Down Silos : Leveraging expertise across the NGA Center to help governors and their state leaders break down silos and develop integrated, innovative, whole-person solutions that are sustainable over time National Go Na tional Gover ernor nors s Ass Associa ociation tion 3
Health Divis Health Division ion Focus Areas Focus Areas Health Systems Transformation Behavioral Health and Social Medicaid and Health Determinants of Insurance Health Data and Analytics Workforce Public Health National Go Na tional Gover ernor nors s Ass Associa ociation tion 4
U.S. Co .S. Cover erage ge in 2015 in 2015 Employer: 49% Medicaid: 20% Medicare: 14% Uninsured: 9% Individual: 7% Source: Kaiser Family Foundation, “Health Insurance Coverage of the Total Na National G tional Gover ernor nors s As Associa sociation tion Population”, http://kff.org/other/state-indicator/total- 5 population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%2 2sort%22:%22asc%22%7D (accessed March 15, 2017).
Medicaid Facts Medicaid Facts Medicaid covers roughly 68 million people – about 1 in 5 Americans as of December 2016. 1 Medicaid also covers 1 in 2 births nationally. In 2016, Medicaid spending totaled $576 billion; and Medicaid accounted for approximately 29% of all state spending From 1975-2012, roughly 70% of the growth in Medicaid spending was a result of increased enrollment 2 Medicaid is the largest single payer for behavioral health 3 and long-term services and supports in the United States 4 1 Centers for Medicare & Medicaid Services, “December 2016 Medicaid and CHIP Application, Eligibility Determination, and Enroll men t Report” (December 2016). 2 Medicaid and CHIP Payment and Access Commission, “Alternative Approaches to Federal Medicaid Financing,” (November 2016). 3 Medicaid and CHIP Payment and Access Commission, March 2016 Report to Congress. 4 Everette James, Walid Gellad, and Meredith Hughes, Health Affairs Blog , “In This Next Phase Of Health Reform, We Cannot Overlook Long Term Care,” (accessed March 24,2017). National Go Na tional Gover ernor nors s Ass Associa ociation tion 6
Governor Governors are s are Activ Activated on Health Reform ated on Health Reform “It is critical that any changes to Medicaid and the private health insurance market reflect states’ experience as major health care purchasers, regulators and administrators who will be responsible for carrying out new reforms.” - 2017 NGA LETTER TO CONGRESS National Go Na tional Gover ernor nors s Ass Associa ociation tion 7
Stated Path for Health Care Reform Phase 1: Repeal and Replace Through Reconciliation Phase 2: Administrative Actions Phase 3: Other Legislative Action Na National Go tional Gover ernor nors s Ass Associa ociation tion 8
Elements of Proposed Health Care Reforms Replace entitlement with capped federal funding, such Medicaid Caps as per capita caps or block grants Limit or eliminate federal support for Medicaid Medicaid Expansion expansion Replace ACA health insurance mandates with other Insurance Mandates coverage incentives (e.g., continuous coverage) Provide more flexibility for states and insurers by loosening mandates Insurance Market Reforms (e.g., essential health benefits, age-rating) Subsidies for Private Restructure current income-based subsidy structure Insurance Na National Go tional Gover ernor nors s Ass Associa ociation tion 9
Map of State Medicaid Expansion Decisions VT WA ME MT* ND NH* MN MA OR NY WI* SD ID MI* RI CT WY PA NJ IA* NE OH DE IN* IL NV MD UT WV VA CO DC KS MO KY CA NC TN SC OK AR* AZ* NM GA AL MS LA TX Adopted (32 States including DC) AK FL Not Adopting At This Time (19 States) HI NOTES: Current status for each state is based on KCMU tracking and analysis of state executive activity. *AR, AZ, IA, IN, MI, MT, and NH have approved Section 1115 waivers. WI covers adults up to 100% FPL in Medicaid, but did not adopt the ACA expansion. SOURCE: “Status of State Action on the Medicaid Expansion Decision,” KFF State Health Facts, updated January 1, 2017. http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/ National Go Na tional Gover ernor nors s Ass Associa ociation tion 10
Recent Administrative Actions Health Care Executive Order (Jan. 20) • Affirms the Executive Branch’s commitment to repealing the Affordable Care Act • Directs federal agencies to take actions aimed at reducing the fiscal burden of the law on states, patients, providers and insurers HHS/CMS Letter to Governors on Medicaid (Mar. 14) • Commits to improving collaboration with states in several areas: o Streamlining the approval of state plan amendments and waiver applications o Implementing work requirements and community engagement incentives o Aligning benefit designs with private health insurance products o Allowing additional time to comply with the 2014 home and community-based services rule o Providing states with more tools to combat the opioid crisis National Go Na tional Gover ernor nors s Ass Associa ociation tion 11
Governors’ Bipartisan Health Reform Learning Network VT* WA ME MT ND NH MN* MA OR NY WI ID SD* MI RI CT WY PA* NJ IA NE OH DE* IN IL NV MD UT* WV VA* CO DC KS MO KY CA NC TN SC OK AR AZ NM GA AL MS LA TX AK FL HI Na National Go tional Gover ernor nors s Ass Associa ociation tion
Examples of Health Division Examples of Health Division Projects Projects Complex Care Policy Academy Learning Labs on State Strategies Health Care Public (Housing as Healthcare) for Reducing Overdose Deaths from Transformation Health Heroin and Illicit Fentanyl Medicaid Transformation Upcoming: Learning Lab on Governors’ Bipartisan Health Medication Assisted Treatment for Reform Learning Network Justice Involved Populations Upcoming: Complex Care Learning Network Linking Medicaid and Workforce Getting the Right Information to Data and Workforce the Right Provider: How States Analytics Can Improve Information Flow Upcoming: Rural Health Between Providers Learning Network Link to Publications: https://www.nga.org/cms/home/nga-center-for- best-practices/center-publications/page-health-publications.html National Go Na tional Gover ernor nors s Ass Associa ociation tion 13
Questions? Hemi Tewarson Acting Director, Health Division NGA Center for Best Practices htewarson@nga.org 202-624-7803 Na National Go tional Gover ernor nors s Ass Associa ociation tion 14
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