1. aca & medicaid expansion in sc

2. tonight’s talk  Background  Hospital impact  Human impact  Economic impact  Final thoughts

3. patient protection & affordable care act On March, 23, 2010, the Patient Protection and Affordable Care Act was signed into law

4. supreme court  Ruled 5-4 on June 28, 2012 to uphold law  Individual mandate, exchanges, insurance rules and other programs still stand  Medicaid expansion is now optional for each state  Subsidies are available to individuals from 100% FPL and above if a state does not opt in

5. The political question: what will states do?

6. some background  January 1966. Only six states originally participated when the program launched: Hawaii, Illinois, Minnesota, North Dakota, Oklahoma, Pennsylvania  20 states signed on later that year  11 states joined in 1967  13 more states (southern) joined in 1968-1972  Arizona last to join in 1982  Eventually all states participated in basic program and SCHIP (enacted in 1997)

7. who will benefit?

8. who isn’t participating? 8 states officially not participating Primarily southern states including South Carolina All but one also not participating in a state-run insurance exchange

9. state impact on hospitals

10. the new coverage gap  Families of four making as much as $94,000 a year will receive subsidies to help buy health insurance  Many poor, uninsured South Carolinians would receive no coverage assistance through ACA if SC opts out of the Medicaid expansion  Parents in low income families of four making between $11,500 and $23,000 a year  Childless adults making under $11,000 a year  65,000 uninsured citizens age 50-64

11. the new coverage gap

12. economic impact in sc

13. USC economic impact report  SCDHHS estimates $11.2 billion in new federal funding will be generated between 2014 and 2020 due to newly eligible enrollees.  By 2020, the annual economic impact will total $3.3 billion in annual economic output, nearly 44,000 jobs, and approximately $1.5 billion in labor income.  This will translate into additional spending, leading to increases in SC general funds totaling $105.6 million by 2020.

14. USC economic impact report  This increased tax revenue will completely offset the required state costs over the first seven years and generate a $9 million net surplus.  From 2020 forward after the federal match rate caps at $9 federal to every $1 state, new tax dollars will generate enough to cover 53% of the state required Medicaid match.

15. how much will the medicaid expansion cost sc?

16. despite the concerns, these facts remain:  SC hospitals will continue to care for uninsured patients; federal law requires them to do so.  The cost of that care must be paid by someone, and there are two options:  We can let the other states help pay 90% of it (they are offering to do so through Medicaid), or  We can absorb 100% of the costs within our borders. Which strategy will make SC more competitive?