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The Times They Are a Changin’ –

Published byLaurel Copeland Modified over 6 years ago

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Presentation on theme: "The Times They Are a Changin’ –"— Presentation transcript:

1 The Times They Are a Changin’ –
Current State of the Healthcare Industry Kevin Ericson Vice President Finance United Health Group Wayne Johnson Senior Director Risk & Regulatory Consulting, LLC ©Risk & Regulatory Consulting LLC - Not to be Duplicated Without Prior Consent

2 Health Insurance Market Background
10/22/2015 ACA Implementation 2010- ACA Signed into Law 2014- Additional Provisions Decrease in Uninsured Rates $357 + Billion 2015 Premiums Approximately 11.5 Million On-Exchange Policyholders for 2017 Coverage ©Risk & Regulatory Consulting LLC - Not to be Duplicated Without Prior Consent

3 Forces Shaping the Health Insurance Market
Medical Costs Technology The Patient Protection and Affordable Care Act Public Debate over Access to Health Care Public Debate over More Government ©Risk & Regulatory Consulting LLC - Not to be Duplicated Without Prior Consent

4 Current Status of the Market
©Risk & Regulatory Consulting LLC - Not to be Duplicated Without Prior Consent

5 National Healthcare Policy
Key Proposed Changes to the ACA Exchanges- Individual Market Cost Sharing / Tax Credits Underwriting / Pricing and MLR ©Risk & Regulatory Consulting LLC - Not to be Duplicated Without Prior Consent

6 National Healthcare Policy
Key Proposed Changes to the ACA Coverage Requirements New State Stability Funds Medicaid Expansion / Medicaid Contraction ©Risk & Regulatory Consulting LLC - Not to be Duplicated Without Prior Consent

7 Total Medicaid Spending
FY2016 Medicaid Spending 10/22/2015 State Medicaid Expansion Total Medicaid Spending Arizona Yes $11,112,248,057 Florida No $21,841,384,373 Georgia $9,837,218,481 Illinois $19,298,315,096 Missouri $9,904,675,663 North Carolina $12,382,079,896 Ohio $21,744,648,983 Vermont $1,679,754,722 Washington $10,935,089,585 FY 2016 refers to the period from October 1, 2015 through September 30, 2016. ©Risk & Regulatory Consulting LLC - Not to be Duplicated Without Prior Consent

8 Market Drivers Prescriptions Value Based Contracting and Primary Care
Mental Health Data and Technology Consumer Transparency ©Risk & Regulatory Consulting LLC - Not to be Duplicated Without Prior Consent

9 Industry Challenges On or Off Exchange Rates
Profitability in the Individual Market Open Enrollments and Anti-Selection ©Risk & Regulatory Consulting LLC - Not to be Duplicated Without Prior Consent

10 Industry Challenges CMS Reimbursements Billing Issues Lawsuits
Grace Periods Reinstatements APTC Credits Changes in APTC Credits ©Risk & Regulatory Consulting LLC - Not to be Duplicated Without Prior Consent

11 Health Insurer Insolvencies
ACA Cooperatives Other Health Insurers Liquidations Withdrawal from Markets ©Risk & Regulatory Consulting LLC - Not to be Duplicated Without Prior Consent

12 ACA Health Insurance Cooperatives Status 2/1/2015
None Closed Operating

13 ACA Health Insurance Cooperatives Status 1/31/2017
None Closed Operating

14 ACA Health Insurance Cooperatives
10/22/2015 Cooperative Issues Major functions outsourced Large number of vendors Fees paid to vendors Expertise of vendors Contract issues Experience of management Unpaid Federal Receivables ©Risk & Regulatory Consulting LLC - Not to be Duplicated Without Prior Consent

15 Regulatory Challenges
Affordability Availability Solvency Impact of Insurer Failures ©Risk & Regulatory Consulting LLC - Not to be Duplicated Without Prior Consent

16 Health Insurance Issues
10/22/2015 Affordability Public disconnect Rates too high Solvency concerns Medical costs Tax credits State rate approval Availability ©Risk & Regulatory Consulting LLC - Not to be Duplicated Without Prior Consent

17 Health Insurance Market
10/22/2015 Financial Issues Risk Corridor Risk Adjustment Permanent Budget Neutral Federal Offsets Risk Adjustment Payments against Federal Reinsurance Reinsurance against Federal Start-up Loans ©Risk & Regulatory Consulting LLC - Not to be Duplicated Without Prior Consent

18 Health Insurance Issues
10/22/2015 Adequacy of Rates Pre-existing conditions Utilization 4th Quarter surge Special enrollment periods Individual market losses ©Risk & Regulatory Consulting LLC - Not to be Duplicated Without Prior Consent

19 Questions 10/22/2015 Oregon Territorial Capitol Corvallis 1855
©Risk & Regulatory Consulting LLC - Not to be Duplicated Without Prior Consent

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