KENTUCKY  Cabinet for Health and Family Services

Health Policy in the Affordable Care Act Era

Emily Whelan Parento, JD, LLM Executive Director

Office of Health Policy

KENTUCKY  Cabinet  for  Health  and  Family  Services  

Presenta(on  Overview    

•  Kynect,  Kentucky’s  Health  Benefit  Exchange  

•  Kyhealthnow,  advancing  our  state  of  wellness  

•  Early  Results  from  ACA  Implementa(on  

Expanding  Access  to  Coverage  and  Care  for  All  Kentuckians  

 Kentucky’s  uninsured  

 640,000  are  currently  uninsured:  •  300,000  may  qualify  for  Medicaid  under  the  new  eligibility  rules  

•  290,000  may  qualify  for  premium  assistance  through  the  Exchange  

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Kentucky’s  Uninsured    •  640,000  esNmated  uninsured  prior  to  first  open  

enrollment  period,  approximately  17.5%  of  the  populaNon  under  65  

•  308,000  potenNally  eligible  for  Medicaid  under  the  new  rules  

•  332,000  potenNally  eligible  for  coverage  through  health  benefit  exchange  

How  Did  We  Get  Here?  Impact  In  Kentucky  

 Kentucky’s  uninsured  

 640,000  are  currently  uninsured:  •  300,000  may  qualify  for  Medicaid  under  the  new  eligibility  rules  

•  290,000  may  qualify  for  premium  assistance  through  the  Exchange  

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Kentucky’s  Under  65  Popula(on  Uninsured  By  FPL    

0%  

5%  

10%  

15%  

20%  

25%  

30%  

35%  

40%  

45%  

50%  

<  138%  FPL   139%-­‐399%  FPL   >  400%  FPL  

Source:  Kaiser  Family  Founda3on,  State  Health  Facts  

 Kentucky’s  uninsured  

 640,000  are  currently  uninsured:  •  300,000  may  qualify  for  Medicaid  under  the  new  eligibility  rules  

•  290,000  may  qualify  for  premium  assistance  through  the  Exchange  

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Kentucky’s  Uninsured  By  Race/Ethnicity    

16%  

22%  

38%  

0%  

5%  

10%  

15%  

20%  

25%  

30%  

35%  

40%  

White   Black   Hispanic  

Rates  of  Uninsured  by  Race/Ethnicity  

Source:  Kaiser  Family  Founda3on,  State  Health  Facts  

White  77%  

Black  10%  

Hispanic  10%  

Other  3%  

Distribu(on  of  Uninsured  by  Race/Ethnicity  

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Kentucky  Health  Benefit  Exchange    Governor  Beshear  signed  an  execuNve  order  which:  

•  Created  the  exchange  and  its  administraNve  structure  

•  Organized  the  exchange  under  Cabinet  for  Health  and  Family  Services  

•  Established  an  Advisory  Board  

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Why  a  state-­‐based  exchange?  

•  Allows  for  flexibility,  including  determinaNons  of  Medicaid  eligibility  

•  Kentucky’s  unique  economic,  health  and  regional  needs  •  Determine  benefits  provided  in  Kentucky’s  exchange  •  Prevent  dual  regulaNon  of  the  health  insurance  market,  and  •  Integrate  support  from  interested  stakeholders.  

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ENROLLMENT  SUCCESS    •  In  the  first  enrollment  year,  over  521,000  Kentuckians  enrolled  in  coverage  

via  kynect,  approximately  75%  of  whom  were  previously  uninsured.  •  As  of  January  7,  2015,  more  than  114,000  individuals  have  enrolled  via  

kynect,  including  renewals  and  new  purchases  of  QHPs,  as  well  as  those  newly  eligible  for  Medicaid.    

•  Reduc(on  in  the  uninsured:  Gallup  Healthways  (summer  2014)  found  that  Kentucky’s  uninsured  rate  dropped  from  20.4%  to  11.9%  in  the  first  half  of  2014.  

How  Did  We  Get  Here?  Before  ACA  

How  Did  We  Get  Here?  Aeer  year  1  ACA  

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•  Governor Beshear announced February 20, 2014 •  7 Statewide Health Goals for next 5 years

–  Reduce Rate of Uninsured Individuals to < 5% –  Reduce Smoking Rate by 10% –  Reduce Obesity Rate by 10% –  Reduce Cancer Deaths by 10% –  Reduce Cardiovascular Deaths by 10% –  Reduce % of Children with Untreated Dental Decay by

25% and Increase Adult Dental Visits by 10% –  Reduce Deaths from Drug Overdose by 25% and

Reduce the Average # of Poor Mental Days of Kentuckians by 25%

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•  Building on the Affordable Care Act –  Enrollment in QHPs and Medicaid –  Capitalizing on Preventive Services and EHB

•  Creating a Long-Term Investment in Kentucky’s Future –  Tackling the Major Drivers of Poor Health in Kentucky –  Comprehensive Approach to Reduction in Uninsured,

Tobacco Use and Obesity •  Health In All Policies

–  All of Government Represented in kyhealthnow –  Multi-Stakeholder Engagement

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kyhealthnow Representative Strategies: Tobacco

•  Support for comprehensive state-wide smokefree legislation •  Support an increase in tobacco tax •  Regulation and taxation of e-cigarettes on par with other

tobacco products •  Support legislation banning sale of e-cigarettes to minors •  Expansion of tobacco free policies to more executive branch

property •  Challenge more school districts to adopt 100% tobacco free

property policies •  Increase use of smoking cessation therapy by 50% in 5

years

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kyhealthnow Representative Strategies: Obesity

•  State employee plan coverage for Diabetes Prevention Program •  Work toward implementing healthier vending and concessions on

executive branch property •  More than $30 million in federal funds directed toward pedestrian

and bike paths by end of 2015 •  10 New Trail Towns Certified by end of 2015 •  School-based strategies such as support for BMI reporting and

increased physical activity •  Engagement with the employer community through development

of initiatives to honor and recognize employers supporting increased physical activity.

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ACA: Early Results •  Updated whitepaper re impact of Medicaid expansion to be

released soon –  5300 health care jobs Nov 2013-Nov 2014, with accelerating pace –  Thousands more administrative and support positions –  Hospitals have received $450 million increase in Medicaid revenue,

which includes only 9 months of expansion payments –  Total infusion of approximately $1 billion into Kentucky in 2014 from

Medicaid expansion

•  Health impacts: –  In Emergency Rooms, 78% drop in charity care, 51% drop in self-pay –  Dramatic increase in use of preventive services, such as cancer

screenings and immunizations –  Significant increase in utilization of behavioral health & substance use

treatment

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Advancing Our State of Wellness

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A Healthier, More Economically Competitive Kentucky