Who is UHPP?
Utah Health Policy Project is a non-profit, non-partisan organization advancing sustainable health care solutions for underserved Utahns, through better access, education, and public policy
www.healthpolicyproject.org
www.facebook.com/uthpp
@UHPP
Private insurance is sold in three markets
Individual
An individual or family policy purchases a policy directly from a private insurance company
Employer: Self-insured
Employer: Small group
Employer-based insurance often subsidized by the company for employees and their dependents
A group health plan in which the employer assumes risk for providing health care benefits to employees
Photo Source: Princeton Public Library; MatthewRoth; VictorPorof
6%
50%- 60%
Key Terms
Medicaid
Medicare
Government health insurance for kids
Government health insurance for low-income kids, pregnant women, seniors, and people with disabilities
CHIP
Government health insurance for senior citizens (ages 65+)
Photo Source: jaime22; Albuquerque Public Schools
Key Terms
Private insurance plans sold on healthcare.gov with monthly premiums subsidized for some people
ACA or Obamacare Insurance
April 2014 February 2015 February 2016
706
1,028 1,018
0
200
400
600
800
1,000
1,200
1 2 3
Moab
Enrollment in Grand County leveled off in 2016
Sources: [2014] Plan Selections by ZIP code in the Health Insurance Marketplace; Date: 2014-09-01; 10/1/2013 thru 4/19/14; https://aspe.hhs.gov/plan-selections-zip-code-health-insurance-marketplace-september-2014; [2015B] ASPE 2015 Health Insurance Marketplace Plan Selections by ZIP Code; Date 2015-04-01; (Nov. 15, 2014 — Feb. 22, 2015); http://aspe.hhs.gov/health/reports/2015/MarketPlaceEnrollment/EnrollmentByZip/rpt_EnrollmentByZip_Apr2015.cfm; [2016] Addendum to the Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report; Date: 2016-03-11; For the period: November 1, 2015 – February 1, 2016; https://aspe.hhs.gov/health-insurance-marketplaces-2016-open-enrollment-period-final-enrollment-report
County Arches customers (2015)
Beaver 209
Box Elder 592
Cache 2,162
Carbon 719
Daggett 44
Davis 2,254
Duchesne 598
Emery 352
Garfield 244
Grand 885
Iron 1,078
Juab 425
Kane 353
Millard 321
Morgan 122
County Arches customers (2015)
Rich 80
Salt Lake 7,333
San Juan 307
Sanpete 816
Sevier 731
Summit 1,050
Tooele 714
Uintah 1,160
Unknown 87
Utah 4,566
Utah 220
Wasatch 872
Washington 5,036
Wayne 90
Weber 1,231
The Oct. 2015 collapse of Arches hit Grand County hard
2017: 13 Plans
1 plan
5 plans
5 plans
2 plans
0 plans
Sources: [2014] https://https://insurance.utah.gov/health/Health%20Refrom/ACA_Rate_Individual_20131007_OnExchange.pdf; [2015] Utah – On Exchange Rates (accurate as of 10/15/14) https://insurance.utah.gov/health/Health%20Refrom/2015IndividualOnExchange20141016.pdf; [2016] www.hea;thcare.gov; See Plans and Premiums (October 2015); [2017] 2017 Utah Individual Rates; Utah Dept. of Insurance ; version 2; 9/27/16
Altius Health Plans Arches BridgeSpan Select Health
3 plans
12 plans
15 plans
10 plans
0 plans
Select Health (20)
2015: 53 Plans 2016: 20 Plans
Altius Health Plans Arches BridgeSpan Select Health
2014: 40 Plans
Gold
Silver
Bronze
Catastrophic
Platinum
1 plan
5 plans
8 plans
6 plans
2 plans
2 plans
15plans
22 plans
15 plans
0 plans
2014-17 Individual Marketplace Comparison Grand County
Select Health (9) University of Utah (4)
Sources: [2014] https://https://insurance.utah.gov/health/Health%20Refrom/ACA_Rate_Individual_20131007_OnExchange.pdf; [2015] Utah – On Exchange Rates (accurate as of 10/15/14) https://insurance.utah.gov/health/Health%20Refrom/2015IndividualOnExchange20141016.pdf; [2016] www.hea;thcare.gov; See Plans and Premiums (October 2015); [2017] 2017 Utah Individual Rates; Utah Dept. of Insurance ; version 2; 9/27/16
2014-17 Benchmark Silver Comparison Grand County
$167 $167
$221
$261
$0
$50
$100
$150
$200
$250
$300
2014 2015 2016 2017
Unsubsidized Benchmark Silver monthly premium for 21-year, non-tobacco user (Grand Co.)
In 2017 95% of Utahns will have access to two or more marketplace insurers – Grand Co. gained UofU Health Plans
Accessible Insurers
Utah Population (2014)
% of Utah Population
(2014)
Molina; SelectHealth; Univ.
of Utah Health Plans
2,375,104 80.7%
SelectHealth; Univ. of Utah Health
Plans 424,851 14.4%
SelectHealth 142,947 4.9%
3 insurers
2 insurers
1 insurer
+
+
+
+ +
+ + +
+ Gained one insurer in 2017
84,601
140,612
175,637
-
50,000
100,000
150,000
200,000
250,0001
0/3
1/1
3
11
/30
/13
12
/31
/13
01
/31
/14
02
/28
/14
03
/31
/14
04
/30
/14
05
/31
/14
06
/30
/14
07
/31
/14
08
/31
/14
09
/30
/14
10
/31
/14
11
/30
/14
12
/31
/14
01
/31
/15
02
/28
/15
03
/31
/15
04
/30
/15
05
/31
/15
06
/30
/15
07
/31
/15
08
/31
/15
09
/30
/15
10
/31
/15
11
/30
/15
12
/31
/15
01
/31
/16
02
/29
/16
03
/31
/16
04
/30
/16
05
/31
/16
06
/30
/16
07
/31
/16
08
/31
/16
09
/30
/16
10
/31
/16
11
/30
/16
12
/31
/16
01
/31
/17
Utah’s sign-ups on healthcare.gov reached 197,187 in 2017
[OE1-a] Health Insurance Marketplace: February Enrollment Report (Oct. 1, 2013-March 1, 2014), http://aspe.hhs.gov/health/reports/2012/ACA-Research/index.cfm; [OE1-b] Health Insurance Marketplace: November Enrollment Report (November 13, 2013), For the period: October 1, 20134 - November 2, 2013, https://aspe.hhs.gov/sites/default/files/pdf/180496/rpt_enrollment.pdf [OE1-c] Health Insurance Marketplace: January Enrollment Report (January 13, 2014), For the period: October 1, 2013 – December 28, 2013, https://aspe.hhs.gov/sites/default/files/pdf/177611/ib_2014jan_enrollment.pdf [OE1-d] Health Insurance Marketplace: February Enrollment Report February 12, 2014), For the period: October 1, 2013 – February 1, 2014, https://aspe.hhs.gov/sites/default/files/pdf/177606/ib_2014feb_enrollament.pdf [OE1-e] Health Insurance Marketplace: March Enrollment Report (March 11, 2014), For the period: October 1, 2013 – March 1, 2014, https://aspe.hhs.gov/sites/default/files/pdf/76811/ib_2014Mar_enrollAddendum.pdf [OE1-f] Health Insurance Marketplace: Summary Enrollment Report: State Profile, (May 1, 2014), https://aspe.hhs.gov/sites/default/files/pdf/93806/ut.pdf ----------- [OE2-a] Health Insurance Marketplace: December Enrollment Report, (December 30, 2014), For the period: November 15, 2014 – December 15, 2014, https://aspe.hhs.gov/sites/default/files/pdf/77201/ib_2014Dec_enrollment.pdf [OE2-b] Health Insurance Marketplace: January Enrollment Report, (January 27, 2015), For the period: November 15, 2014 – January 16, 2015, https://aspe.hhs.gov/sites/default/files/pdf/33826/ib_2015jan_enrollment.pdf [OE2-c] Health Insurance Marketplace: March Enrollment Report, (March 10, 2015), For the period: November 15, 2014 – February 22, 2015, https://aspe.hhs.gov/sites/default/files/pdf/83656/ib_2015mar_enrollment.pdf; [OE2-d] State-Level Data from the ASPE January Health Insurance Marketplace Enrollment Report For The 2016 Open Enrollment Period; March 31, 2015 Effectuated Enrollment Snapshot; 15-06-02; http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-06-02.html ----------- [OE3-a] Health Insurance Marketplace: January Enrollment Report, (January 7, 2016), For the period: November 1, 2015 – December 26, 2015, https://aspe.hhs.gov/sites/default/files/pdf/167981/MarketPlaceEnrollJan2016.pdf; [OE3-b] Health Insurance Marketplace Open Enrollment Snapshot - Week 11; January 10, 2016 - January 16, 2016 (Released: 1/20/16); Health Insurance Marketplace Open Enrollment Snapshot - Week 13 January 24, 2016-February 1, 2016; https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-02-04.html; [OE3-c] Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report (March 11, 2016), For the period: November 1, 2015 – February 1, 2016, https://aspe.hhs.gov/sites/default/files/pdf/187866/Finalenrollment2016.pdf; [OE3-d] March 31, 2016 Effectuated Enrollment Snapshot (Released: June 30, 2016), https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-06-30.html ---------- [OE4] - [2017 Final] Biweekly Enrollment Snapshot; Weeks 12 through 14; Date 2017-02-03; Weeks 12-14; 11/1/16 thru 1/31/17; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-02 03.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending; [2017] Biweekly Enrollment Snapshot; Date 2017-01-18; Weeks 10-11; 11/1/16 - 1/14/17; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-18.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending; [2016] Biweekly Enrollment Snapshot; Date 2017-01-04; Weeks 8-9; 11/1/16 - 12/31/16; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-04.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending
197,187
Utah’s ACA enrollment grew 12.3%
in 2017
Rank State 2016 Open
Enrollment 3 (Final)
2017 Open Enrollment 4
(Final)
Difference (#)
Difference (%)
1 Hawaii 14,564 18,938 4,374 30.0%
2 South Dakota 25,999 29,622 3,623 13.9%
3 Utah 175,637 197,187 21,550 12.3%
4 Oregon 147,109 155,430 8,321 5.7%
5 Wyoming 23,770 24,826 1,056 4.4%
6 New Jersey 288,573 295,067 6,494 2.3%
7 North Dakota 21,604 21,982 378 1.7%
8 Wisconsin 239,034 242,863 3,829 1.6%
9 Nevada 88,145 89,061 916 1.0%
10 Florida 1,742,819 1,760,025 17,206 1.0%
Utah’s marketplace enrollment increased 12.3% this year
Sources: [2017 Final] Biweekly Enrollment Snapshot; Weeks 12 through 14; Date 2017-02-03; Weeks 12-14; 11/1/16 thru 1/31/17; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-02-03.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending; [2016 Final] Health Insurance Marketplace Open Enrollment Snapshot - Week 13; Date 2016-02-04; Week 13; 11/1/15 thru 1/31/16; https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-02-04.html
Sources: [2017 Final] Biweekly Enrollment Snapshot; Weeks 12 through 14; Date 2017-02-03; Weeks 12-14; 11/1/16 thru 1/31/17; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-02 03.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending;[2017] Biweekly Enrollment Snapshot; Date 2017-01-18; Weeks 10-11; 11/1/16 - 1/14/17; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-18.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending; [2016 Final] Health Insurance Marketplace Open Enrollment Snapshot - Week 13; Date 2016-02-04; Week 13; 11/1/15 thru 1/31/16; https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-02-04.html; [2016] Biweekly Enrollment Snapshot; Date 2017-01-04; Weeks 8-9; 11/1/16 - 12/31/16; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-04.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending; [2015] Health Insurance Marketplace Open Enrollment Snapshot - Week 9; December 27, 2015 – January 2, 2016; Link: https://WWW.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-01-06.html; [OE3; 2016] Health Insurance Marketplace Open Enrollment Snapshot - Week 11; Date 2016-01-20; Weeks 10-11; 11/1/15 - 1/16/16; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-01-20.html; [2016] Biweekly Enrollment Snapshot; Date 2017-01-04; Weeks 8-9; 11/1/16 - 12/31/16; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-04.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending; [2015] Health Insurance Marketplace Open Enrollment Snapshot - Week 9; December 27, 2015 – January 2, 2016; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-01-06.html
43,071
35,534
34,637
8,565
16,014
43,390
54,806
41,245
2,812
8,282
0
10,000
20,000
30,000
40,000
50,000
60,000
Week 4 Week 6 Week 7 Week 9 Week 11 Week 13
OE 3 (2015-16)
OE 4 (2016-17)
President Trump takes office
Bi-weekly Enrollment Growth
in Covered Lives
Last-minute sign-ups in January 2017 were 55% lower than in the previous year (2016)
In 2016, 13 of Utah’s top 20 ZIP codes for ACA enrollment were outside of Salt Lake
County
Source: 2016 Health Insurance Marketplace Plan Selections by ZIP Code; (Nov. 1, 2015 — Jan. 9, 2016); https://aspe.hhs.gov/basic-report/plan-selections-zip-code-health-insurance-marketplace-january-2016
RANK CITY SELECTIONS % INCREASE 1 Lehi (84043) 3,501 19% 2 South Jordan (84095) 3,346 12% 3 American Fork (84003) 2,948 17% 4 Pleasant Grove (84062) 2,931 20% 5 St. George (84790) 2,829 10% 6 St. George (84770) 2,742 11% 7 Draper (84020) 2,624 13% 8 Bountiful (84010) 2,455 5% 9 Spanish Fork (84660) 2,377 24%
10 West Valley City (84119) 2,368 3% 11 West Valley City (84120) 2,345 13% 12 Provo (84604) 2,289 22% 13 Herriman (84096) 2,276 20% 14 Clearfield (84015) 2,258 3% 15 Riverton (84065) 2,255 23% 16 Cottonwood Heights (84121) 2,254 6% 17 Orem (84058) 2,196 24% 18 Orem (84057) 2,193 16% 19 Ogden (84404) 2,189 1% 20 Layton (84041) 2,110 12%
After dropping rapidly from 2013-15, the U.S. uninsured rate is leveling off
ACA Coverage Available
Source: Gallup Healthways Well-Being Index (Q4 2015)
U.S. Uninsured Rate by Quarter (2008-2015)
Source: [2015] U.S. Census: 2006-2015 American Community Survey 1-year estimates , S2701 (https://www.census.gov/programs-surveys/acs/) [2014] www2.census.gov/programs-surveys/acs/tech_docs/accuracy/ACS_Accuracy_of_Data_2014.pdf [2006-2013] http://www.census.gov/did/www/sahie/data/interactive/sahie.html
The latest U.S. Census data shows a 16% drop in the Utah’s uninsured rate between 2014-15
16.7%
15.7% 16.3%
15.9%
16.7% 16.6%
15.7%
14.0%
12.5%
10.5%
8%
9%
10%
11%
12%
13%
14%
15%
16%
17%
18%
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
16%
ACA Coverage Available
In Utah, the uninsured rate for people earing over 200% of poverty has declined the most
Source: [2015] U.S. Census: 2006-2015 American Community Survey 1-year estimates , S2701 (https://www.census.gov/programs-surveys/acs/) [2014] www2.census.gov/programs-surveys/acs/tech_docs/accuracy/ACS_Accuracy_of_Data_2014.pdf [2006-2013] http://www.census.gov/did/www/sahie/data/interactive/sahie.html
-28% -30% -25%
Utah Uninsured Rate by Income Level (2009-2015)
Source: U.S. Census Bureau, 2015 American Community Survey 1-Year Estimates
American Indians and Hispanics experience the highest rates of being uninsured in Utah
7.1%
10.8% 13.4% 14.1%
22.5%
26.8%
32.8%
36.0%
0%
5%
10%
15%
20%
25%
30%
35%
40%
White alone,not Hispanic
or Latino
Two or moreraces
Black orAfrican
Americanalone
Asian alone NativeHawaiian andOther Pacific
Islander alone
Hispanic orLatino (of any
race)
Some otherrace alone
AmericanIndian and
Alaska Nativealone
Utah average: 10.5%
0% 101% 400% 100%
Who is eligible for premium subsidies?
Income as % of the Federal Poverty Level (FPL)
NO YES 70,000 Utahns
in the Gap
Sliding-scale subsidies make insurance more affordable
The 2016 FPL guidelines are applied to the 2017 Marketplace plans. These guidelines only apply to the Lower 48 States (Alaska and Hawaii have their own guidelines). Source: Link: http://familiesusa.org/product/federal-poverty-guidelines
For 2017, a family of four can earn about $97,000 a year and receive a premium subsidy
If your income/family size is on this chart, you qualify for a subsidy
The Hernandez Family Residence: Moab, Utah Ages: Dad : 33 Mom: 29 Kids: 11, 7
Annual income: $26,000
% of poverty level: 109%
Monthly premium: $725
Subsidy pays: $665 per month
The Hernandez’s pay: $60 per month
Primary doctor: $10 Specialist doctor: $15 Emergency room care: $100 Generic drugs: $10
Plan Details
Deductible: $200 Out-of-pocket maximum: $2,000 Source: https://www.healthcare.gov/see-plans/; Image source: Moodboard
How much does the Hernandez family pay for
health insurance?
Kids on Medicaid
Benchmark Silver plan
Parent-only coverage
Annual income: $29,000
% of poverty level: 246%
Monthly premium: $362
Subsidy pays: $161 per month
Jill pays: $201 per month
Primary doctor: $35 Specialist doctor: $60 Emergency room care: $500 Generic drugs: $15
Plan Details
Deductible: $1,300 Out-of-pocket maximum: $5,100 Source: https://www.healthcare.gov/see-plans/; Image source: http://www.tourplicity.com
How much does Jill pay for health
insurance?
Benchmark Silver plan
Cheapest Bronze plan is $123/month with $5,700 deductible
Jill Residence: Moab, Utah Age: 35
Annual income: $44,000
% of poverty level: 220%
Monthly premium: $808
Subsidy pays: $531 per month
The Shumway’s pay: $277 per month
Primary doctor: $35 Specialist doctor: $60 Emergency room care: $500 Generic drugs: $15
Plan Details
Deductible: $2,600 Out-of-pocket maximum: $10,200 Source: https://www.healthcare.gov/see-plans/; Image source: Moodboard
How much does the Shumway family pay for
health insurance?
Benchmark Silver Plan (5 Silver plans available)
Cheapest Bronze plan is $105/month with $11,400 deductible
The Shumway Family Residence: Castle Valley, UT Ages: Dad : 24 Mom: 23 Kid: Newborn
Annual income: $42,000
% of poverty level: 263%
Monthly premium: $1,566
Subsidy pays: $1,231 / month
The Smith’s pay: $335 per month
Primary doctor: $35 Specialist doctor: $60 Emergency room care: $600 Generic drugs: $15
Plan Details
Deductible: $3,000 Out-of-pocket maximum: $14,300 Source: https://www.healthcare.gov/see-plans/; Image source: Moodboard
How much do the Smith’s pay
for health insurance?
Benchmark Silver plan
Covers 5 doctors in Moab area (Drs. Andrew, Munger, Quinn, Stevens, K. Williams, K. Williams)
The Smiths Residence: Moab, UT Ages: 62, 60
Annual income: $135,000
% of poverty level: 556%
Monthly premium: $1,215
Subsidy pays: $0 per month
The Simonsens’ pay: $1,215 per month
Primary doctor: $35 Specialist doctor: $60 Emergency room care: $600 Generic drugs: $15
Plan Details
Deductible: $3,000 Out-of-pocket maximum: $14,300 Source: https://www.healthcare.gov/see-plans/; Image source: Moodboard
How much do the Simonsen’s pay for health
insurance?
Benchmark Silver plan
Benchmark premium increased 15% ($150) from 2016
The Simonsen Family Residence: Moab, Utah Ages: Dad : 44 Mom: 35 Kids: 11, 7
Annual income: $21,000
% of poverty level: 86%
Monthly premium: $1,139
Subsidy pays: $0 / month
The Phillips’ pay: $1,139 / month
Primary doctor: $35 Specialist doctor: $60 Emergency room care: $600 Generic drugs: $15
Plan Details
Deductible: $3,000 Out-of-pocket maximum: $14,300 Source: https://www.healthcare.gov/see-plans/; Image source: Moodboard
How much do the Phillip’s pay
for health insurance?
Kids covered by Medicaid
Parents are caught in the Utah Medicaid Coverage Gap
The Phillips Family Residence: Moab, Utah Ages: Dad : 35 Mom: 33 Kids: 11, 7
Utah has the nation’s highest percentage (25%) of children enrolled in ACA coverage
Age
37 FFM* states
10% 10%
16%
16% 20%
27%
1%
25%
12%
19%
16%
12%
15%
< 18
Age 18-25
Age 26-34
Age 35-44
Age 45-54
Age 55-64
Age 65+
56% of Utah enrollees are under age 34
Source: Health Insurance Marketplaces 2017 Open Enrollment Period: January Enrollment Report; Date: 1/10/17; For period 11/1/16 to 12/24/16; Weeks 8-9; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-10.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending
Utah
(*) FFM stands for Federally-managed
marketplace (healthcare.gov)
85% of Utahns enrolling on healthcare.gov received a premium subsidy
No subsidy
Received subsidy
Subsidy Status
85%
15%
83%
17%
Source: Health Insurance Marketplaces 2017 Open Enrollment Period: January Enrollment Report; Date: 1/10/17; For period 11/1/16 to 12/24/16; Weeks 8-9; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-10.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending
Utah
37 FFM states
Most Utahns choose Silver-level plans that offer a balance between premiums and cost-sharing
24%
73%
3%
21%
74%
4% 1%
Bronze
Silver
Gold
Catastrophic
Subsidy Status
Source: Health Insurance Marketplaces 2017 Open Enrollment Period: January Enrollment Report; Date: 1/10/17; For period 11/1/16 to 12/24/16; Weeks 8-9; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-10.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending
Utah
37 FFM states
Most ACA enrollment in Utah is in urban ZIP codes
Urban areas
Rural areas
Geography
Source: Health Insurance Marketplaces 2017 Open Enrollment Period: January Enrollment Report; Date: 1/10/17; For period 11/1/16 to 12/24/16; Weeks 8-9; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-10.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending
15%
85%
18%
82%
Utah
37 FFM states
ACA subsidies cover 69% of average monthly premiums for Utah enrollees
Impact of monthly subsidies on ACA insurance premiums
$187
$84
(69%)
(31%) Utah
Average Monthly
Premium: $271
Subsidy Amount
Consumer Cost
Subsidy Impact
Source: Addendum to the Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report; For the period: November 1, 2015 – February 1, 2016 https://aspe.hhs.gov/health-insurance-marketplaces-2016-open-enrollment-period-final-enrollment-report; Released: March 11, 2016
Utah
37 FFM states
$290 (73%)
$106 (27%)
72% of Utah’s ACA enrollment earns below 250% of the poverty level
Source: Health Insurance Marketplaces 2017 Open Enrollment Period: January Enrollment Report; Date: 1/10/17; For period 11/1/16 to 12/24/16; Weeks 8-9; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-10.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending
31%
22%
19%
9%
8%
34%
22%
14%
8%
9%
100% to 150%
151% to 200%
201% to 250%
251% to 300%
Poverty Level
301% to 400%
Utah
37 FFM states
Over half of re-enrolling marketplace consumers in Utah switched plans in 2016
Origin of Utah ACA enrollment
Active vs. Auto status for re-enrollments
Newly enrolled
Re-enrolled
23%
77%
Source: Health Insurance Marketplaces 2017 Open Enrollment Period: January Enrollment Report; Date: 1/10/17; For period 11/1/16 to 12/24/16; Weeks 8-9; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-10.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending
56% 21%
Active re-enrollment
Auto re-enrollment
The Affordable Care Act, also called Obamacare, is going to be repealed and
replaced in the near future.
DEC
EMB
ER 1
6
The latest health insurance calendar
Next Open Enrollment: Nov. 1, 2017 -- Dec. 15, 2017
Open Enrollment
Open Enrollment
Special Enrollment
2017
FEBRUARY 1 NOVEMBER 1 OCTOBER 31 JANUARY 31 JAN
UA
RY
1
DEC
EMB
ER 1
6
Open Enrollment
Special Enrollment
2018 (proposed)
FEBRUARY 1 NOVEMBER 1 OCTOBER 31
JAN
UA
RY
1
45 days (proposed)
How can ACA insurance premiums vary?
(in billions) 1) Age (new ratio of 3:1)
2) Tobacco use (ratio of 1.5:1)
3) Geography (by counties)
Area 1: Cache and Rich Area 2: Box Elder, Morgan, and Weber Area 3: Davis, Salt Lake, Summit, Tooele, and Wasatch Area 4: Utah Area 5: Iron and Washington Area 6: Beaver, Carbon, Daggett, Duchesne, Emery, Garfield, Grand, Juab, Kane, Millard, Piute, San Juan, Sanpete, Sevier, Uintah, and Wayne
(in billions)
1) Age (new ratio of 5:1)
2) Tobacco use (ratio of 1.5:1)
3) Geography (by counties)
4) Gender (women pay more)
5) Health history (higher premiums for pre-existing conditions)
After Repeal
How the ACA changed healthcare (as we know it)
Adults under age 26 can stay on
their parents insurance
plan
Men and women pay the same for coverage
Insurance offers free preventative care like blood pressure checks, flu shots, and health screenings
No one can be denied or priced out of coverage for a
pre-existing condition
No lifetime caps on insurance payments
2010 2013
18.4%
29.0% Utah Uninsured Rate Ages 18-26:
Source: Utah DOH
Adults under age 26 can stay on
their parents insurance
plan
Men and women pay the same for coverage
Insurance offers free preventative care like blood pressure checks, flu shots, and health screenings
No one can be denied or priced out of coverage for a
pre-existing condition
No lifetime caps on insurance payments
2010 2013
18.4%
29.0% Utah Uninsured Rate Ages 18-26:
Source: Utah DOH
After Repeal
All plans will have essential benefits
1. Ambulatory (ie. out-patient) services 2. Emergency services 3. Hospitalization 4. Maternity and newborn care 5. Mental health and substance use disorder services,
including behavioral health treatment 6. Prescription drugs 7. Rehabilitative and habilitative services and devices 8. Laboratory services 9. Preventive and wellness services and chronic disease
management 10. Pediatric services, including dental and vision care
Source: http://cciio.cms.gov/resources/factsheets/ehb-2-20-2013.html
Adult dental and vision can be purchased as extras
No plans will have essential benefits
After Repeal
In January 2017, Rep. Steve Drazkowski, a state legislator from Minnesota, proposed an amendment that would have
allowed insurers to omit any or all of 68 coverage areas
mandated under the federal Affordable Care Act. The
amendment was removed during a conference committee.
Source: ”Drazkowski "Pick Sicks" amendment stripped from MN health care insurance premium relief bill,” Bluestate Prairie; http://www.bluestemprairie.com/bluestemprairie/2017/01/drazkowski-pick-six-amendment-stripped-from-mn-health-care-insurance-premium-relief-bill.html
What are the penalties for remaining uninsured in 2017?
$695 per adult
$347.50 per child
Up to $2,085 per household*
…or 2.5% of adjusted
gross income**
(*) Flat fee is adjusted for inflation after 2016 (**) Gross income minus
the filing threshold
Which-ever is higher…
$695 per adult
$347.50 per child
Up to $2,085 per household*
…or 2.5% of adjusted
gross income**
(*) Flat fee is adjusted for inflation after 2016 (**) Gross income minus
the filing threshold
The new administration could eliminate the individual mandate/fine in 2017… …as well as the
employer mandate
After Repeal
• Insurers will exclude benefits and charge higher premiums for some people with pre-existing conditions
• Annual and lifetime payment caps will come back
• High-risk pools will return to cover the uninsurable
• Women will be charged higher premiums than men
• Premiums will increase for people over age 40
• Caps on high-deductible plans will be lifted
• Essential health benefits will be eliminated
• Premium tax credits likely will be based on age, not income or family size
Individual market insurance after the ACA…
Stopping discrimination against pre-existing conditions requires an insurance mandate and
premium subsidies
Discrimination against pre-existing conditions is common to all ACA replacement plans
Rep. Tom Price H.R. 2300 “Empowering Patients First Act” Page 151
Speaker Paul Ryan “A Better Way Plan” Page 20
All ACA replacement plans include exclusion periods for pre-existing conditions if continuous
coverage is not maintained
Speaker Paul Ryan “A Better Way Plan” Page 21
High-risk pools are only needed if consumers are denied or priced out of insurance coverage
because of pre-existing conditions
Real premiums for different age groups
Repealing the ACA will double the insurance costs for the Shumway family….
Source: healthcare.gov; “See Plans and Premiums;” Salt Lake County, identical family size and ages; accessed 2/3/17
Many low and middle-income Utah families will pay more for insurance if the ACA is repealed
Income (annual)
$120,000
$120,000
Premium (monthly)
[annual
$936 [$11,232]
$800 [$9,600]
-15%
Deductible
(annual)
$3,000
$6,000
+100%
Out-of-
Pocket Max (annual)
$14,300
$10,000
-14%
Total Cost (premiums
+ max)
$25,632
$19,600
-23%
Total Cost minus tax
credit
$25,632
$11,200
-56%
Total
Cost as % Income
21%
9.3%
-55%
Premium Subsidy (annual)
None
$6,000
Source: healthcare.gov; “See Plans and Premiums;” Salt Lake County, identical family size and ages; accessed 2/3/17
ACA
Replace Plan
(H.R. 2300)
Repealing the ACA will cut insurance costs for the Simonsen family by 50%….
The Simonsens| Family of 4
Yet, higher-income Utah families will pay less for insurance if the ACA is repealed
Difference between Plans
• Allow health plans to expand the age ratio from 3:1 to 3.49:1, letting insurers increase premiums for older customers
• Cut the 2018 enrollment period in half by ending it on December 15 rather than January 31 (start date would remain November 1)
• Require extra documentation to prove special enrollment applicants are eligible before coverage takes effect
• Allow insurers more wiggle room on plan actuarial values so that Silver plan cover 66%of medical costs—2% less than now.
• Tightens rules around the 90-day-grace period for enrollees who stop paying premiums.
Trump administration weighs Obamacare changes sought by insurers February 6, 2017 By Dan Diamond, Jennifer Haberkorn, and Paul Demko
Source: Trump administration weighs Obamacare changes sought by insurers; 2/6/17; http://www.politico.com/story/2017/02/trump-obamacare-insurance-companies-234707
Timeline* for ACA Repeal and Replace
(*) Absolutely going to change.
March/April 2017:
April/May 2017:
Initial House votes on repeal legislation using budget reconciliation process (avoiding Senate filibuster). Yet Senate wants to slow down this time-table
Insurers start to file rates and intentions for 2018 marketplace—must have assurances on risk pools
Statement by President Trump on 2/5 about his slower timeline for ACA repeal—hints at plan to “repeal now, replace later”
“…by the end of the year, at least the rudiments…"
Ways to Repair the ACA • Fix the “family glitch” so that family members priced out of
employer-based coverage can get subsidies to purchase marketplace insurance
• Add tax credits for consumers on individual market earning above 400% of poverty level
• Increase contribution amounts to health savings accounts (HSAs)
• Create “Copper Plan” with high deductibles, low premiums, and open to all consumers regardless of age, income
• Allow more small business “association health plans” sponsored by business and professional organizations
• Allow Medicare to negotiate for prescription drugs
• Allow insurers to sell policies across state lines (mostly harmless)
Proposal by Speaker Paul Ryan
Free preventive screenings: none. Essential health benefits: none. Tax penalty: none.
A Better Way Our Vision for a Confident America
There will be a cap on the pre-tax value of job-based insurance. Pre-tax contributions to an HSA will be excluded. 5:1 instead of 3:1, but states have the power to choose.
Women will once again be charged more for health insurance than men.
1) Pre-existing conditions
2) High risk pools
3) Employee contribution 4) Age ratio 5) Women vs. men
Cannot be turned away due to illness. Patient protection for those who maintain continuous coverage. But, if there is a lapse in coverage (likely 62 days), you can be charged above standard rates. $25 billion of federal funding allocated to “robust” high risk pools. Premiums will be capped and wait lists prohibited.
1
State insurer boundaries: none. Deductible caps: none. Healthcare.gov: none.
Young adults will be covered on their parent’s plan until 26 years, but states will have the authority to change this. States can choose to receive block grant funding or default into a per capita allotment. Effective 2019.
6) Open enrollment
7) Tax credits
8) Coverage until 26 9) Medicaid
There will be a one-time open enrollment for the uninsured to join the health care market. If you “choose” not to enroll, you will lose “continuous coverage protection. Universal advanceable, refundable tax credits that will be fixed by age. Anyone not offered job-based coverage, Medicare, or Medicaid can receive credits.
A Better Way Our Vision for a Confident America
2
Proposal by Speaker Paul Ryan
Proposal by Rep. Tom Price
Free preventive screenings: none. Essential health benefits: none. Tax penalty: none.
H.R. 2300 Empowering Patients First Act
Employer exclusions of health care coverage allowed up to $20,000 per family and $8,000 per individual. Funds exceeding these limits will be taxed. States will determine their age ratio.
1) Pre-existing conditions
2) High risk pools
3) Employee contribution 4) Age ratio
Insurers could impose 18-month waiting periods on pre-existing conditions with a 6-month look-back window, or impose a premium surcharge up to 150% of the standard premium if pre-existing conditions are not excluded. $1 billion of federal funding allocated to high risk/reinsurance pools. Effective 10-1-2018.
1
State boundaries: none | Deductible caps: none | Healthcare.gov: none
Women will once again be charged more for health insurance than men. Medicaid expansion will be eliminated. More tbd.
5) Tax credits
6) Coverage until 26
7) Women vs. men 8) Medicaid
Fixed credits based on age. Tax incentives for maintaining health coverage. Available only to US citizens and lawful permanent residents. States have the authority to determine the age by which young adults can remain on their parents plan.
H.R. 2300 Empowering Patients First Act
2
Proposal by Rep. Tom Price
Empowering Patients First Act
Annual tax credit break down
$900 per child up to age 18
$1,200 for ages 18 to 35
$2,100 for ages 35 to 50
$3,000 for ages 50+
*maximum amount allotted per person per year
ACA Replacements side by side
A Better Way Empowering Patients First
Medicaid
Source: A Better Way our Vision for a Confident America and Empowering Patients First Act (H.R. 2300)
Pre-existing conditions
High Risk Pools
Tax credits
Open enrollment
Employee Contributions
Tax penalty
Free preventive care
One-time open enrollment. If you “choose” not to enroll, you will lose “continuous coverage protection”
Cap the pre-taxable amount for job-based coverage
Fixed credit based on age. Universal advanceable, refundable tax credit.
“Robust” high risk pools -$25 billion federal funding. Premium caps, no wait lists
Patients protected if they maintain continuous coverage
None
None
Waiting period up to 18 months, or 150% surcharge
High-risk/reinsurance pools -$1 billion federal funding
TBD
Employer exclusion allowed to $8K/$20K, any funds above are taxable
Tax incentives for maintaining coverage, fixed amount based on age.
None
None
States decide: block grant or per capita allotment Medicaid expansion eliminated
Rep. Jason Chaffetz UT-3
WASHINGTON, DC 2236 Rayburn House Office Building Washington, DC 20515 Phone: (202) 225-7751 Hours: M-F 9AM-6PM EST
PROVO 51 S University Ave. Suite 318 Provo, UT 84601 Phone: (801) 851-2500
Get Involved….
Eric Armstrong
Navigator Utah Health Policy Project 801-599-2768 [email protected]
Luis Rios
Navigator Utah Health Policy Project 801.433.2299 x26 [email protected]
Got Questions?
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