1. Washington Health Benefit Exchange WA ASSOCIATION OF COMMUNITY AND MIGRANT HEALTH CENTERS MARCH 26 2013 BRAD FINNEGAN

2. The Affordable Care Act ▪Changes to private insurance, e.g., o Young adults on parent’s policies to age 26 o Prohibit lifetime monetary caps o Minimum spending on medical care (medical loss ratio) ▪Closing the prescription “doughnut hole” ▪Expands coverage and imposes an individual mandate in 2014 o Expands Medicaid to 138%* of FPL o Exchanges for individuals and small businesses, with premium tax credits and cost sharing reductions *ACA 133%=138% due to across the board income disregards 2

3. Exchange basics ▪Individuals >138% of FPL and small groups (2-50) ▪Tax credits available for individuals 138%-400% of FPL ▪Cost sharing reductions available for <250% FPL ▪“Qualified health plan” (QHP) offerings ▪Metallic tiers of actuarial value ▪Apples-to-apples comparisons for consumers, one-stop shop ▪10 essential health benefits ▪Navigators, agents/brokers, call center assistance 3

4. Coverage Continuum in 2014 4 3 4 * Federal Basic Health Plan Option for individuals with incomes between 138% and 200% of the FPL will not be available in 2014. *

5. Building the Exchange 5 HCA receives one-year $22.9 million grant to design and develop Exchange SSB 5445 passed creating Exchange as “public private partnership” Governor names Exchange Board members Board begins governing authority ESSHB 2319 passed Deloitte Consulting, LLP, signs on as system integrator Exchange names first CEO and moves into new building Washington becomes second Level 2 establishment grant recipient, $128 million Exchange moves onto own payroll and accounting systems WA HBE receives conditionalcertification to operate state based exchange with HHS/CCIIO Sustainability plan submitted to Legislature Exchange must be certified by HHS Additional legislative action taken as needed Open Enrollment begins (October 1) 2011 2012 2013 2014 Coverage purchased in the Exchange begins Open enrollment ends in March.

6. Exchange Value Proposition Consumer/EmployerPublic/State “No wrong door” – Unprecedented access to plans, programs and support Reduction in uninsured/under-insured and uncompensated care Certified QHPs with essential health benefits Enhanced population wellness Trusted information and customer assistance Better informed consumers Ability to compare and purchase plans Competitive insurance marketplace Group purchasing power for individuals and small businesses (2-50) Single monthly bill and payment for multiple QHP enrollees for small groups 6

7. Individual vs. SHOP Exchange Individual Exchange ‑ Individuals who are not on public or employer sponsored plans SHOP Exchange ‑ Small businesses with 2 - 50 employees ‑ Access to QHPs, federal subsidies through APTC and / or CSR, and referral to alternative options (e.g., CHIP) ‑ Employee access to employer sponsored plans with increased choice ‑ Employer ability to define contributions and access to small business tax credits ‑ Initial open enrollment is open to all with some special enrollment periods pending eligibility status Who: What: When:

8. 8

9. 9 QHP Logo

10. 10

11. 11 QHP Logo

12. 12

13. Membership Growth: “New” Members PROJECTED EXCHANGE MEMBER ENROLLMENT (2014 – 2017 YEAR END)

14. Implications for Providers ▪Expanded insurance coverage for current and new patients. ▪Reductions in patient point of service payments (i.e., copayments, cost sharing) ▪Potential changes in contracts ▪Potential role in enrolling individuals in insurance ▪Potential changes in payment ▪Shop for insurance by provider 14

15. Important Board Policy Decisions Completed ▪Criteria for qualified health plans (QHPs) ▪Premium aggregation ▪Consumer Rating System ▪Pediatric Dental Benefits ▪Navigator program ▪Role of agents/brokers Upcoming ▪Exchange financing/Sustainability 15

16. Key Challenges ▪ Tight timeline – Oct. 1, 2013 o Federal dependencies and guidance o IT flight path – scope, schedule and budget ▪Delivery environment o Critical inter-agency interdependencies ▪Managing expectations o Options deferred to 2.0 or 3.0 o Complex authorizing environment 16

17. http://wahbexchange.org/ Includes information about: ▪Exchange Board ▪Legislation and grants ▪Policy discussion ▪TAC and stakeholder involvement ▪IT systems development ▪HHS guidance ▪Listserv registration ▪ info@wahbexchange.org info@wahbexchange.org 17 More on the Exchange

18. 18

19. 19 Appendix

20. Governance Eleven member, bi-partisan board assumed authority on March 15, 2012 Margaret Stanley – Chair, Retired Executive Director, Puget Sound Health Alliance Steve Appel – Farmer, Past President of the Washington Farm Bureau William Baldwin – Partner, The Partners Group Donald Conant – General Manager, Valley Nut & Bolt, Assistant Professor Doug Conrad – Professor, University of Washington Melanie Curtice – Partner, Stoel Rives Ben Danielson – Medical Director, Odessa Brown Phil Dyer – Senior VP, Kibble & Prentice, and Former Legislator Teresa Mosqueda – Legislative & Policy Director, Washington Labor Council *Commissioner Mike Kreidler – Insurance Commissioner *MaryAnne Lindeblad – HCA Director 20 * non voting, ex officio

21. Washington Healthplanfinder Vision: Redefining People's Experience with Health Care Mission: Radically improving how Washingtonian’s secure health insurance through ▪ innovative and practical solutions ▪ easy-to-use customer experience ▪ our values of integrity, respect, equity and transparency ▪ providing undeniable value to the healthcare community (patients, providers, plans) 21

22. http://www.WAHBExchange.org Includes information about: ▪Exchange Board ▪Legislation and grants ▪Policy discussion ▪TAC and stakeholder involvement ▪IT systems development ▪HHS guidance ▪Listserv registration ▪ info@wahbexchange.org info@wahbexchange.org 22 More on the Exchange