August 23, 2018 LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE UNIVERSAL ACCESS TO CARE WORK GROUP 2018 1
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE AGENDA Welcome, Opening Remarks ………………………………………………………………………………..8:00—8:10am ◦ Representative Salinas, Chair, Work Group Path to Universal Coverage in California – A Comprehensive Report …………………………8:10-—9:15 am ◦ Andrew Bindman, MD, University of California San Francisco DCBS Marketplace Advisory Committee………….…………………………………………………….9:15—9:45am ◦ Dan Field, Chair, Marketplace Advisory Committee ◦ Chiqui Flowers, Administrator, Health Insurance Marketplace America’s Health Insurance Plans: Medicaid Buy-in………………………………………………..9:45—10:15am ◦ Elise Brown, AHIP ◦ Sunshine Moore, AHIP Medicaid Buy-in: Oregon Policy Goals and Design Considerations…………………………….10:15—11:00am ◦ Tim Sweeney, OHA Zachary Goldman, OHA ◦ Jesse O’Brien, DCBS Oliver Droppers, LPRO Work Group Discussion: Medicaid Buy -in …………………………………………………………….11:00—11:45am ◦ Representative Salinas, Chair Public Comment………………………………………………………………………………………………11:45—12:00pm ◦ Representative Salinas, Chair 2
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE Today’s Objectives Learn about California’s path to universal coverage including identified strategies for improving their health care system Learn about Oregon’s Marketplace Advisory Committee Committee’s policy priorities in 2018 Consider Medicaid buy-in option in Oregon; preliminary design considerations Identify and confirm potential policy goals Identify initial design considerations Discuss next steps –September For September, the goals are to: 1. Review potential straw models for a Medicaid buy-in in Oregon based on preferred policy goals identified today 2. Consider advantages and disadvantages 3. Identify feasibility considerations (e.g., 1332 waiver, risk pools, on/off exchange, potential changes in APTC) 3
The Marketplace Advisory Committee
The Marketplace advisory committee • Established in ORS 741.004 • Created to advise DCBS regarding: - The assessment paid by insurance companies - Outreach strategies for reaching minority and low-income communities - Solicitation of customer feedback - The affordability of health benefit plans offered through the exchange. 5
The Marketplace advisory committee • New committee workgroup on market stability for consumers • Their initial work identified indicators of market stability: affordability, choice, accessibility • Affordability is first area of focus • Rising premiums, out-of-pocket maximums • People who qualify for subsidies protected from premium increases 6
The Marketplace advisory committee • A second workgroup is reviewing options for eligibility and enrollment platforms • Group respects public’s and leaders’ sensitivity around this topic • Costs to use HealthCare.gov have gone up • HealthCare.gov fee structure ensures costs will continue to rise • Landscape of technology options has changed • Different technology may permit more flexibility 7
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE M EDICAID B UY - IN : O REGON C ONSIDERATIONS 8
Abou out A AHIP IP Accident & Health Business Markets America’s Health Insurance Plans (AHIP) represented by AHIP in the United States: is the national association whose members • Major Medical provide coverage for health care and related • Medicaid services to millions of Americans every day. • Medicare Advantage Through these offerings, we improve and • Medicare Supplemental Insurance protect the health and financial security of (Medigap) consumers, families, businesses, • Supplemental Health communities and the nation. We are • Long-Term Care committed to market-based solutions and • Disability Income Insurance public-private partnerships that improve • Dental affordability, value, access and well-being • Vision for consumers.
Considerations for Medicaid Buy-In I. Level Setting – Coverage in Context II. Key Questions 1. Why and For Whom? 2. What is it and how does it work? 3. Market impact and affordability? III. Alternatives 1. Increase enrollment, improve the risk mix 2. Lower costs for consumers 3. Lower costs for everyone 10
I. Level Setting – Coverage in Context Point in time uninsured = 6.2% but… Long-term uninsured = 3.3% Top reason for long- term uninsured = cost …more than 80% of uninsured people qualified for either OHP or financial assistance . There are currently about 243,000 uninsured people in Oregon. If 80% of these people gained health insurance coverage, about 34,000 Oregonians would remain uninsured 11
II. Key Questions I. Level Setting – Coverage in Context II. Key Questions 1. Why and For Whom? 2. What is it and how does it work? 3. Market impact and affordability? III. Alternatives 1. Increase enrollment, improve the risk mix 2. Lower costs for consumers 3. Lower costs for everyone 12
III. Alternatives 1. Increase Enrollment/Improve the Risk Mix o Marketing and outreach for those already eligible o Promote continuous coverage o Promote health and wellness/social determinants of health o Protect non-medical, consumer-oriented benefits and services 13
III. Alternatives 2. Lower costs for consumers o State-based premium assistance programs o State-based reinsurance (i.e. 1332 waiver) o Tax Changes (i.e. Tax-deductible premiums, HSA flexibility) 14
III. Alternatives 3. Lower costs for everyone o Promote lower list prices, transparency, competition, and value in prescription drug pricing o Protect consumers from surprise out-of-network bills o Curb inappropriate steering/third-party payments o Support efforts to address over/under/misuse of goods and services – maximize health care dollars o Support efforts to target fraud, waste, and abuse o Expand telehealth, wellness programs, and other innovative approaches o Eliminate taxes/fees that harm consumers and increase premiums 15
Where Does Your Health Care Dollar Go? 16
III. Alternatives 3. Lower costs for everyone o Promote lower list prices, transparency, competition, and value in prescription drug pricing o Protect consumers from surprise out-of-network bills o Curb inappropriate steering/third-party payments o Support efforts to address over/under/misuse of goods and services – maximize health care dollars o Support efforts to target fraud, waste, and abuse o Expand telehealth, wellness programs, and other innovative approaches o Eliminate taxes/fees that harm consumers and increase premiums 17
Market Instability Adds to Premiums E MPLOYER M ARKET I NDIVIDUAL M ARKET Medical Trends/Drugs +5.7 - 6.5% AHPs +2. +2.7 7 - 4% 4% HIT +3% +3% State Ma St Manda dates Exchange U User Fees Short Ter erm Pl m Plan ans No Ind ndividual M Mand ndate +9 to 1 10% Risk C Corr rridors rs +$12 +$12.3 b 3 billion CSRs +20 +20 to 25% 25% Source: https://www.ahip.org/2019-premiums-individual-market/ 18
Questions? Thank you! @ahipcoverage ahip.org AHIP /ahip smoore@ahip.org | 916.996.2376
Appendix
5 Factors Impacting Premiums Source: https://www.ahip.org/5-factors-that-impact-your-health-insurance-premium/ 21
Lowering Drug List Prices Promote generic competition (CREATES Act). • • Develop a robust and competitive market for biosimilars and interchangeables. • Expand the leverage and tools plans have to negotiate lower drug costs (e.g., flexibility to better manage formularies). • Increase transparency in how drug companies set prices. Develop an infrastructure for independent • reporting of value. “Reducing list prices is the fundamental goal of our policy solutions for prescription drugs” - AHIP https://www.ahip.org/wp-content/uploads/2018/07/AHIP-Part-D-Rebates-20180716.pdf 22
23 Premium Impacts 2013-2015 Majority of premium increase is attributable to the change in Health Status (“Morbidity”). Source: “Stabilizing the Individual Insurance Market”, Oliver Wyman, August 23, 2017; Accessed at http://health.oliverwyman.com/c ontent/dam/oliver- wyman/blog/hls/featured- images/August2017/_Stabilizin g_the_Individual_Health_Insur ance_Market.pdf
High Cost Drugs: Is It the R&D? Source : Vox, “9 of 10 top drugmakers spend more on marketing than research”, February 27, 2015, http://www.vox.com/2015/2/11/8018691/big-pharma-research-advertising
A Broken and Distorted Market Market Government-granted HIGH PRICES monopolies via patent Dysfunction HIGHER COSTS system and market (via problematic marketing, legal, and regulatory practices) exclusivity provisions in federal law 25
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