health reform in community settings: affordable care act implementation in georgia patricia ketsche,...
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![Page 1: Health Reform in Community Settings: Affordable Care Act Implementation in Georgia Patricia Ketsche, PhD Associate Professor and Fellow, GHPC](https://reader035.vdocuments.net/reader035/viewer/2022062619/551685575503469d698b5fa3/html5/thumbnails/1.jpg)
Health Reform in Community Settings: Affordable Care Act Implementation in Georgia
Patricia Ketsche, PhDAssociate Professor and
Fellow, GHPC
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Health Insurance Exchange
Private InsuranceMedicaid
Coverage Expansion under the ACA
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Changes in Public
Coverage
Changes in Public
Coverage
Medicaid Expansion – Status as of September 16, 2013
http://kff.org/medicaid/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/#map
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Changes in Private Coverage
Changes in Private Coverage
Health Insurance Exchange
Private InsuranceGAP
Coverage Expansion without Medicaid
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Insurance RegulationIndividual MandateSubsidies for Small Business
Changes in Private Coverage
Changes in Private Coverage
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Exchange/Market PlaceSubsidies for Individuals
Changes in Private Coverage
Changes in Private Coverage
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Exchange Participation – Status as of May 28, 2013
Changes in Private Coverage
Changes in Private Coverage
![Page 8: Health Reform in Community Settings: Affordable Care Act Implementation in Georgia Patricia Ketsche, PhD Associate Professor and Fellow, GHPC](https://reader035.vdocuments.net/reader035/viewer/2022062619/551685575503469d698b5fa3/html5/thumbnails/8.jpg)
ActuarialValue Deductible Coinsurance Monthly Premium
(40 Yr. Old)
Bronze 60% $6,300 0% $251
Silver 70% $3,000 10% $310
Gold 87% $750 0% $394
Features of Exchange PlansBlue Cross Plans - Region 3
Source: : “Insurance company filings with Georgia Insurance Commissioner”
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Insurance Regions for Exchange Premiums
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Exchange Offerings by Insurance Region
Regions BCBS Peach State Kaiser Alliant Humana
1 Y
2 Y Y Y Y
3 Y Y Y Y Y
4 Y Y Y
5 Y Y
6 Y Y
7 Y Y
8 Y Y Y
9 Y Y
10 Y Y Y
11 Y Y
12 Y Y
13 Y Y Y
14 Y Y
15 Y
16 Y Y
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Changes in Private Coverage
Changes in Private Coverage
Determining the Subsidy
• Based on 2nd lowest premium for silver plan in your market
• Compare that to the maximum % of income required based on income as % of poverty
• Difference = subsidy• Available to purchase lower cost
coverage
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Changes in Private Coverage
Changes in Private Coverage
Coverage Option - Exchange
2 Adult Household without Employer coverage
Family Income Percent of Poverty
Premium Subsidy in the
Exchange
Family contribution for
coverage
$10,000 64% 0 $6,036
$19,000 123% $5,656 $380
$22,200 142% $5,261 $775
$40,000 258% $3,312 $2,725
$60,000 387% $336 $5,700
*Based on a hypothetical plan premium of $6,036 for a silver plan. Actual subsidy depends upon 2nd lowest cost silver plan based on age and market.
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Changes in Private Coverage
Changes in Private Coverage
Variation in Premiums by Region
Region Silver Premium – 40 Year Old
Subsidywith $12,000
income
Net Costs
10 – NW Georgia $245 $225 $20
3 – Atlanta $251 $231 $20
12 – Middle Georgia
$300 $280 $20
15 – SW Georgia $442 $422 $20
1 – SW Georgia $482 $462 $20
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Decisions – Families with children below 235% FPL
Does my employer offer Affordable coverage?
EnrollEnroll Self (spouse?)
Medicaid/ PeachCare for Kids™
Enroll Family
Exchange
Determine Subsidy with and without children
Enroll in Family Coverage
Enroll Adults Medicaid / PeachCare for Kids™
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Georgia’s Uninsured (in thousands)(2 year average, 2011-2012)
Children (18 and under)
Adults 19-64
Total Uninsured 320 1,529
By Income
<= 100% FPL 135 571 >100-235% of FPL 111 512
>235-400% of FPL 40 261
>400% of FPL 34 186
By Citizenship
Citizen 298 1,278
Non-citizen 23 251
Source: ASEC supplement to the Current Population Survey, 2012 and 2013
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Economic Impact Estimates - State
Health Insurance Exchange Medicaid
Direct Effect 2 Billion 4 Billion
Total Effect 4 Billion 8 Billion
Employment 35,000 70,000
Local Tax Revenue 70 Million 146 Million
State Tax Revenue 65 Million 130 Million
Factors:Number of Medicaid EnrolleesCost per EnrolleeEconomic MultiplierState income tax rate
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Federal Spending – 10 year estimates from 2012 -CBO
Fees, Taxes and Penalties
Medicaid
Insurance Premium SubsidiesMedicare Savings
+/- 1.78
trillion
+/- 1.67 trillion
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Current national estimates – CBO (May 2013)
Source of coverage2013 2018 Change
Employer 57% 56% -1%
Non Group and Other 9% 8% -1%
Medicaid/CHIP 13% 20% +7%
Uninsured 21% 11% -10%
Exchange 0% 9% +9%