1. Health Care - What’s Next April 22, 2017
Elisabeth Arenales, Esq.
Colorado Center on Law and Policy
789 Sherman St., Suite 300, Denver, CO 80203
x301, 1

2. Congress Reconvening next week President wants a vote
Congress needs to pass a CR
New additions to the AHCA on the table:
Reinstate Essential Health Benefits
Add limited waivers for states on:
Essential Health Benefits
Health status IF there is a high risk pool.

3. Where are we in this conversation?
Seems like we are back to basics: individual mandate, guarantee issue, affordability

4. Major Proposals Medicaid – financing changes
Per Capita cap or block grant
Structural changes
Eligibility changes
Individual insurance market
Eliminating supports that make Exchanges work
New Market Stabilization Regulations
Uncertainty about Cost Sharing Reductions (CSR)

5. Medicaid’s Role
Long term care- Medicaid makes Medicare work for seniors and people with disabilities.
Children- covers 40% of Colorado kids.
Pregnant women- pays 1/3 of all births.
Parents of low-income children
Low-income adults.

6. Larimer County @ 19% of total population on Medicaid
23,017 Expansion adults
25,497 children
15,708 non-expansion adults (including disabled and elderly).
$326.5 million in total Medicaid expenditures in FY 15/16

7. Medicaid- What’s at Stake?
Per Capita Cap or Block Grant
Net federal $ lost to Colorado under AHCA:
CHI projects $14B over 10 years ( ) with 600,000 loss in enrollment
Avalere projects nationwide cut to Medicaid/Medicare dual beneficiaries of
$44 Billion over next ten years.
2019 and 2028, the Better
Way proposal would reduce federal Medicaid spending
by $841 billion, or 18.1 percent. The AHCA would reduce
Factors to consider: aging of population – costs of current enrollees, vs growth in “old, old”, disease outbreaks, new drugs, therapies.
federal spending by $457 billion, or 9.8 percent. – without enrollment cuts
Edwin Park, Off the Charts, Correcting the History of Medicaid Per Capita Caps; Colorado Health Institute Avalere:

8. AHCA Impact on Medicaid expenditures:
Proposed base year: 2016
CPI Medical Index: growth rate: 3.7%
Average annual growth rate, current: 4.3%
Kids: 4.7%
Adults: 4.5%
Disabled: 1.8%
Elderly: 3.5
Colorado has gone up and down
SOURCE: Urban Institute, Holahan, analysis of:: “Detail of Spending and Enrollment for Medicaid for CBO’s January 2017 Baseline.” Washington DC: Congressional Budget Office, January 2017.

9. Colorado Fiscal Picture
TABOR
State revenue growth at 5% this year and 6% next
Budget Picture
$700M shortfall
Hospital Provider Fee Enterprise
Hospital decline in income: $264 million
$73 million
SB17-267
SB256 Hospital reimbursement protects low income programs

10. Realistic Options to Reduce Spending?
Provider rates, particularly primary care rates, a long time struggle in Colorado
Eligibility gains a two decade effort
We have tried traditional managed care
Tobacco Tax/Hospital Provider Fee
@69,000 expansion adults in City and County, more than 200,000 on Medicaid

11. Individual Market
Some analysts say market beginning to stabilize nationally.
New federal rules –
Limit open enrollment period to six weeks- can Colorado extend this?
Limit access to Special Enrollment Period
Cost Sharing Reductions
President saying he may pull the rug out.

12. Options to reduce spending?
ACC2.0
Delivery Reform models
Medicaid/Medicare eligibles
Payment Reform
Cost containment?
Cost Commission – final report this summer
Transparency efforts
Lt. Governor’s bill package
Delivery System Reform Incentive Payment

13. Looking Ahead Can we talk about making the ACA work?
Regulatory changes? Hurt or help?
Waivers and waiver requirements?
ACA Section will it work both ways?

14. Questions?