1. Health Reform in Kansas Murphy Society University of Kansas School of Medicine October 25, 2012 Suzanne Schrandt, J.D. Kansas Health Institute 1

2. The Kansas Health Institute is an independent, nonprofit health policy and research organization that informs policymakers about important issues affecting the health of Kansans. Our mission is to inform policymakers by identifying, producing, analyzing and communicating information that is timely, relevant and objective. 2

3. Health in Kansas Health Outcomes Ranking, by County Source: County Health Rankings and Roadmaps Project, Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute, 2012 3

4. Kansas Compared to U.S. Source: Kaiser Family Foundation, State Health Facts, retrieved October 2012 4

5. Health Insurance Coverage Primary Sources of Health Insurance, All Kans ans (2010-2011) 5

6. Distribution of Kansas Hospitals Source: Kansas Hospital Association, 2011 STAT Report 6

7. Kansas Health Institute 7 Source: Kansas Association for the Medically Underserved

8. Primary Care HPSAs January 2012 Source: KDHE Bureau of Community Health Systems, 2012 8

9. Why Health Reform? 9

10. Three Primary Components of the ACA 10

11. Public Health ACA Public Health Funding March 2010 – September 2012 Source: Kaiser Family Foundation ACA Funds Tracker, September 2012 11

12. Cost Containment, Payment and Delivery Reform  Quality Improvement  Payment Adjustments  Delivery Reform  Transparency/Financial Relationships 12

13. What’s happening in Kansas? Kansas  55 hospitals  Average penalty of.20% 13

14. What’s happening in Kansas? 14

15. What’s happening in Kansas? 15

16. Coverage and Access Primary Sources of Health Insurance, All Kans ans (2010-2011) 16

17. ACA Coverage Provisions Access rules  Guaranteed Issue  Pre-existing condition exclusions Cost impacts  Rating rules  Federal assistance Navigation  Health insurance exchanges 17

18. Employment-Based Coverage in Kansas Source: KHI Analysis of 2011 Medical Expenditure Panel Survey Data Private Kansas Employers by Number of Employees 18

19. Uninsured Kansans by ACA Eligibility Category Source: KHI Analysis of 2010-2011 Current Population Survey Data 19

20. Medicaid Expansion? Uninsured Kansas Adults, age 19-64, by ACA Eligibility Category Source: KHI Analysis of 2010-2011 Current Population Survey Data 20

21. Medicaid Expansion?  Cost concerns  DSH payment reductions  Employer liability? 21

22. Coverage Changes Already in Place 22 ProvisionImpact in Kansas Dependent coverage to age 26 As of June 2011, 22,000 young adult Kansans were covered through this provision—and that number has likely grown Preventive services at no cost 529,000 Kansans in private plans and 313,000 Kansans in Medicare have received free preventive care through this provision Early Retiree Reinsurance Program 62 Kansas employers including Koch Industries, Sprint, City of Topeka, and Wolf Creek Federal funding Around $90 million has been awarded to public and private Kansas recipients Lifetime limit prohibition 1.02 million Kansans no longer have lifetime maximum limits on their health insurance plans

23. Workforce Funding Opportunities 23 Primary care loan repayment/forgiveness programs Pediatric specialty/underserved area Public health workforce loan repayment Allied health workforce loan repayment National Health Service Corps Community Health Workforce grants Rural physician/underserved area

24. Loan Repayment Changes 24 Income-Based Repayment (IBR)  Reduction from 15 to 10 percent of adjusted gross income—begins in 2014 for new borrowers  Maximum loan forgiveness period from 25 to 20 years

25. Looking Forward November elections Sequestration Health insurance exchange preparation Medicaid expansion decision Ongoing legal challenges 25

26. Questions? 26

27. Information for policy makers. Health for Kansans. Kansas Health Institute 27