1. Health Reform and Public Health in Kansas Kansas Association of Local Health Departments Topeka, Kansas January 15, 2013 Suzanne Schrandt, J.D. Kansas Health Institute

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.

3. Three Primary Components of the ACA

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

5. What’s happening in Kansas?

6. Accountable Care Organizations (ACOs)

7. ACA Coverage Provisions Access  Guaranteed Issue/Pre-existing condition exclusion  Medicaid expansion Navigation  Health insurance exchanges Cost  Rating rules  Federal assistance Responsibility

8. ACA Coverage Provisions Grandfathered New Large Group New Small Group New Indiv FISIIndivFISIFISIIndiv No lifetime limits No rescissions Plain language Dependent coverage to 26 No annual limits No PEC Exclusions Preventive services MLR limit Guaranteed Issue Rating limits

9. Largest ACA Impact on Small Group and Individual Market Health Insurance Coverage, Kansans Under Age 65 (2010-2011) Source: KHI Analysis of CPS and MEPS data, 2010 - 2011

10. Coverage Changes Already in Place 10 ProvisionImpact in Kansas Medical Loss Ratio Rebates $4 million total, $3.5 million in individual market paid to Kansas consumers under this rule 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 No lifetime limits 1.02 million Kansans no longer have lifetime maximum limits on their health insurance plans Dependent Coverage to Age 26 As of December 2011, 3.1 million young adults nationwide newly covered by parents’ plans

11. Public Health  Prevention and Public Health Trust Fund  Employer wellness programming and premium/cost contribution adjustments  National Prevention and Wellness Strategy

12. Public Health Spending ACA Public Health Funding March 2010 – January 2013 Source: Kaiser Family Foundation ACA Fund Tracker, January 2013

13. Public Health Spending in Kansas 13 Community and State prevention: $639,000 Tobacco use prevention: $64,000 Public health workforce: $150,000 Detection and response capacity: $964,000 Public health infrastructure: $500,000 Health care data analysis and planning: $577,000 Access to Critical Wellness and Preventive Health Services: $3,115,000 Source: CCIIO website, retrieved January 14, 2013

14. Workforce Funding Opportunities 14 Public health workforce loan repayment Community Health Workforce grants Rural physician/underserved area

15. ACA Impact on Public Health System Health Outcomes Ranking, by County Source: County Health Rankings and Roadmaps Project, Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute

16. ACA Impact on Public Health System Greater access needs Immunizations and other preventive care Rethinking the role of public health

17. Access Source: Kansas Hospital Association, 2011 STAT Report Distribution of Kansas Hospitals, by County

18. Kansas Health Institute

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

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. Immunizations and other Preventive Services

22. Essential Health Benefits Health Insurance Coverage, Kansans Under Age 65 (2010-2011) Source: KHI Analysis of CPS and MEPS data, 2010 - 2011

23. Contraception Mandate

24. A New Landscape Outcome-based payments Collaborative care models Comparative effectiveness research

25. Questions?

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