1. Understanding Health Insurance Coverage Expansion
Health Care Industry Committee
Understanding Health Insurance Coverage Expansion
Ready-to-Use Presentation Slides

2. State Participation in Medicaid Expansion2
Majority of States Expanding Medicaid
State Participation in Medicaid Expansion
September 2014
Participating
Will Not Participate
Undecided
Source: FamiliesUSA.org, available at accessed on Nov. 6; Marketing and Planning Leadership Council interviews and analysis.

3. Budget Pressures Creating Impetus for Reform
Pushing Risk to Providers and Payers
Three Non-Traditional Models of Medicaid Reform
Full Medicaid Managed Care
E.g., Florida’s Statewide Medicaid Managed Care Program
Provider-Led Care Management
E.g., Oregon’s “Coordinated Care Organizations”
Expansion of Traditional Medicaid
Exchange-Based Privatization
E.g., Arkansas’ “Private Option”
Source: Health Care Advisory Board interviews and analysis.

4. Public Exchange Enrollment Exceeds 8 Million
Insurance Exchanges 4
Public Exchange Enrollment Exceeds 8 Million
Bumpy Rollout Did Not Dampen Projections
Projected and Actual Enrollment in Qualified Health Plans
Unchanged despite flawed rollout
Source: Radnofsky L and Nelson CM, “Obama Says Health-Insurance Enrollees Reach 8 Million,” Wall Street Journal, April 17, 2014, available at: CBO, “The Budget and Economic Outlook: 2014 to 2024,” February 2014, available at: Demko P, “UnitedHealth to Expand Exchange Presence as Profits Dip,” ModernHealthcare, April 17, 2014, available at: Cheney K and Norman B, “Insurers See Brighter Obamacare Skies,” Politico, April 15, 2014, available at: Health Care Advisory Board interviews and analysis.

5. Metal Tiers of Plans Chosen on Public Exchanges5
Individuals Gravitating Toward Leaner Plans
Metal Tiers of Plans Chosen on Public Exchanges
October 2013 to April 2014
Bronze
Silver
Gold
Platinum
Catastrophic
Enrollees Without Premium Subsidies
All Enrollees
Source: HHS, “Health Insurance Marketplace: Summary Enrollment Report for the Initial Annual Open Enrollment Period,” May 1, 2014; HHS, “Health Insurance Marketplace Premiums for 2014,” September 2013; Health Care Advisory Board interviews and analysis.

6. Degree of Hospital Exclusion Across Public Exchange Plans
Networks Narrowing on the Public Exchanges
Payers Responding to Anticipated Premium Sensitivity
Average Percent of PPO Network Specialists Included in Exchange Plan Networks1
Degree of Hospital Exclusion Across Public Exchange Plans
Anthem BlueCross BlueShield, 2014
20 Urban Markets, December 2013
100% PPO Network Breadth
Broad
“Ultra-Narrow”
“Narrow”
Excludes 30% of 20 largest hospitals
Excludes 70% of 20 largest hospitals
26%
Median premium reduction directly attributable to network narrowing2
“Pathway X” bronze plans compared to leading PPO plan offering across nine states.
Comparing products by the same carrier of the same tier, across 7 carriers.
Source: Gottleib S, “Hard Data On Trouble You’ll Have Finding Doctors in Obamacare,” Forbes, March 8, 2014, available at: McKinsey & Company, “Hospital Networks: Configurations on the Exchange and Their Impact on Premiums,” December 2013; Health Care Advisory Board interviews and analysis.

7. Exchanges 2015: What to Watch7
Exchanges 2015: What to Watch
Second Round of Open Enrollment Will Reveal True Dynamics
Trends to Watch: 1
Enrollment
Are the technical glitches really fixed?
Will higher individual mandate penalties change anyone’s mind?
Will the young and healthy turn out in force? 2
Choice and Mobility
How will automatic reenrollment affect consumer behavior?
Will last year’s bargain hunters regret choosing high deductibles and narrow networks?
Can plans that raise premiums maintain market share? 3
Market Reaction
How aggressively will providers court the newly insured?
Will employers dump workers onto the exchanges?
Source: Health Care Advisory Board Interviews and Analysis.