1. Obama Care: Who is insuring your community now and why should you care?

2. Jimmy Kimmel Asks: Obama Care v. The Affordable Care Act

3. Improvements Guaranteed coverage for people with pre-existing conditions Expanded Medicaid to serve more people Improved access to preventative and primary care Created the Exchange as a marketplace for small businesses and individuals Made insurance reforms Network adequacy Essential health benefits

4. Health Benefit Exchange: Working in Washington! The Doorway to Coverage

5. Exchange: Evaluates income, offers products, serves as a payment mechanism Apple Health 0-138% FPL Putting It All Together AppleHealth: Regulated by Health Care Authority Commercial Plans: Regulated by Office of the Insurance Commissioner 138-400% of FPL (subsidized) > 400% FPL no subsidy

6. Cost Options In the Exchange Premium and subsidy amounts are for a hypothetical 40 year old, single, non-smoker. Income level requirements vary for families.

7. Exchange Carriers for 2014 BridgeSpan Community Health Plan of Washington Coordinated Care Group Health Cooperative LifeWise Health Plan of Washington Molina Health Care of Washington Premera Blue Cross Kaiser Foundation Health Plan of the Northwest Delta Dental of Washington, Kaiser Foundation Health Plan of the Northwest, LifeWise, Premera Blue Cross – (Pediatric Dental Only)

8. Results: 587,000 Have Enrolled

9. Premera Products Dominate the Exchange Market

10. Results: Subsidies Help 80% of Consumers in the Individual Market Total: 164,062

11. Results: Most Choose Plans with Medium Deductibles (“Silver Plans”)

12. Janet Income: $23,000 Subsidy: $136 Plan: Bronze Monthly: $43 - $128 Dan Income: $15,500 Subsidy: $0 Plan: Apple Health Monthly: $0 Mike Income: $35,000 Subsidy: $0 Plan: Silver Monthly: $235 - $357 Gwen Income: $46,000 Subsidy: $0 Plan: Gold Monthly: $282- $409

13. Enrollment is working in rural areas From the Washington Health Benefit Exchange’s Health Coverage Enrollment Report October 1, 2013-March 31, 2014.

14. OIC Report: More People Insured Inside and Outside the Exchange Washington state has succeeded in reducing the number of uninsured by more than 370,000. More people purchased individual plans outside of the Exchange than inside (171,286 vs. 156,155). Silver (medium deductible) plans were more popular inside the Exchange Bronze (low deductible) plans were more popular outside the Exchange.

15. Older Consumers Welcomed the Exchange

16. Targeting Young Consumers

17. Map courtesy Washington State Health Care Authority There’s Still Work to Do

18. Small Businesses and The Exchange

19. Outreach and Enrollment Superstars Haley Hale, Dayton General Hospital Erin Brown, Jefferson Healthcare Wenkie Schultz, Jefferson Healthcare Melissa Sherwood, Jefferson Healthcare Jennie Tjemsland, Jefferson Healthcare Tiffany Hunt, MultiCare Health System Melissa Fried, MultiCare Health System Michele Hill, Skagit Regional Health Angel Abbott, Skagit Regional Health Verenice Cecena, Skagit Regional Health Sheena Williams, Skagit Regional Health Flor Carreon, Skagit Regional Health Tami Dean, Skagit Regional Health Korie Holmes, Skagit Regional Health Teresa McClain, Snoqualmie Valley Hospital Kayla Carson, Summit Pacific Medical Center Janet Hanke, Three Rivers Hospital Collette Carpenter, Valley General Hospital(Monroe)

20. Benefits to Rural Hospitals Preliminary data from Q1, 2013 Operating margins improving Charity care declining Net patient revenue from Medicaid Colorado Hospital Association Study Similar results in other expansion states Parallel decrease in self-pay and charity care shows previously uninsured patients are now enrolled in Medicaid Results similar for urban, rural and CAH

21. What’s Next? 17 insurers filed more than 230 proposed health plans for the 2015 individual health insurance market. The average proposed rate increase was 8.25%; uncertainty about future costs Small business exchange (SHOP) going online Proactive enrollment activities by hospitals and other providers still needed Keeping rural hospitals in networks How to leverage insurance coverage to create better community health outcomes Undocumented residents still uninsured

22. Key Takeaways Whatever you want to call it, your hospital and your community benefit when people are insured Charity care and bad debt will not go away, but they are decreasing Advocacy matters: Ensuring AppleHealth works for hospitals and patients will help both Local partnerships and relationships are key for continuing to enroll residents in health insurance

23. Thank you! Chelene Whiteaker chelenew@wsha.org 206/216-2545 Mary Kay Clunies-Ross marykaycr@wsha.org 206/216-2894