Implementing the ACA in
Virginia: Where things
stand
Advocate/Stakeholder Webinar
March 29, 2012
Sponsored by The Commonwealth Institute, The Virginia
Poverty Law Center, and Virginia Organizing
Presenters:
John McInerney, The Commonwealth Institute
Jill Hanken, Virginia Poverty Law Center
Topics
U.S. Supreme Court – ACA arguments
Exchange Basics/Implementation of the ACA in
Virginia to Date
What’s Next?
U.S. Supreme Court
• 3 Days - 6 Hours of Oral Argument!
• Decision Expected by End of June
March 28
March 26
Severability
•
• Anti-Injunction Act
• Can ACA Tax
Penalties be
challenged now?
If a part of the ACA is
unconstitutional, can the
rest of the law still
stand?
Medicaid Expansion
•
Is the required
expansion an unlawful
abuse of the spending
clause provisions of the
Constitution?
March 27
• Minimum Coverage Provision
• Is the Individual Mandate
Constitutional?
What is an Exchange?
A new health insurance marketplace.
What is an Exchange?
Like …
only for health insurance.
How it works.
Over 500,000
additional Virginians
covered through
Exchange & Medicaid
in Virginia
Individuals and small
businesses can access and
purchase affordable private
health insurance.
Premium affordability
tax credits available
Significant Medicaid
Expansion
Basic requirements.
Develop Exchange for
individuals and small employers
Run Web site with
comprehensive plan info on
price and quality
Choose whether to run
Exchange, and decide on
governance
Seamlessly coordinate
Exchange w/Medicaid &
FAMIS
Certify plans & determine
benefit package
Develop IT infrastructure
and enrollment systems
(or defer role to the
federal government)
Provide consumer
assistance
Implementation
• 24 member Virginia Health
Reform Initiative Advisory
Council named
• Members from business,
insurance industry,
academia, and providers
• No consumer rep
August
2010
December
Fall
• Report issued by VHRI to Governor
McDonnell
• Series of meetings on six areas of
health reform:
• capacity, Medicaid
expansion, insurance reform,
purchaser perspectives,
information technology &
delivery system reform
Implementation
$1 million
planning grant
from HHS
Final VHRI report
publicly released in
November
2011
VHRI meetings
spring/summer 2011
•
•
•
•
•
Age 26 provision
No pre-existing for kids
No lifetime limits
New appeals procedures
Rescission prevention
Legislation authorized
VHRI to begin
Exchange design
Implementation
Governor opposed
to immediate action
2012
Time to create
state-run Exchange
growing short
Several bills filed,
none successful
Behind but not alone.
41 states have introduced Exchange authorizing
legislation
Map created by
TCI, using data
compiled by the
Center on Budget
and Policy
Priorities (CBPP)
Behind but not alone.
Yet, only12 states and D.C. have enacted Exchange
authorizing legislation
Map created by TCI,
using data compiled by
the Center on Budget and
Policy Priorities (CBPP)
Behind but not alone.
22 states, including Virginia, have pending/tabled
legislation
Map created by TCI, using
data compiled by the Center
on Budget and Policy
Priorities (CBPP)
What’s next.
Essential Benefits Plans: Report Issued
•
Comments Due to VHRI on April 4,
2012
VHRI
Exchange Development
•
More meetings expected on Exchange
Planning
What’s next.
Online customer portal for
•
•
•
Testing underway
DSS
Gateway
Project
Will serve as platform for
the Exchange
Online applications
Customer accounts
Self-service capabilities
• Reporting changes
• Renewing benefits
• Checking eligibility for other
benefits
State Legislation
SB 496 (Sen. Watkins)
•
•
•
•
Only “survivor” of 2012 session
Substitute adopted on 2/13 carried over to 2013
Off session meetings are expected
Special Session after Supreme Court ruling?
State Legislation
Exchange Structure
• We want independent Quasi – Governmental entity (VHRI
recommendation)
• Full focus on Exchange
• No real or perceived conflict with other functions
• Role and input for all stakeholders
SB 496 puts Exchange in a new division of State
Corporation Commission (SCC)
State Legislation
Governance
• We want strong consumer representation and no voting member with
conflict of interest on governing Board
• SB 496 creates Advisory Committee
• 7 members appointed by SCC
• Includes “consumer representative”, “consumer advocate”,
“representative of qualified health plan”
• Recommendations require majority votes
• Ultimate authority rests with Division Director and SCC
Commissioners
State Legislation
Public Access to Meetings and Information
• We want public rulemaking, open meetings, freedom of information,
comprehensive website
• SB 496 was amended to include all of above
Funding the Exchange
• We want all insurers (in and out of Exchange) to help pay for
operations
• SB 496 was amended to do this
State Legislation
Market Rules and Adverse Selection
• We want protections to avoid adverse selection
• We want provisions to address market instability (VHRI
recommendation)
• SB 496 requires same premiums inside and outside of the Exchange,
but does not include other protections
State Legislation
Navigator Program
• We want community based organizations and non-profits to
participate as Navigators without licensure
• We want Navigators to assist with Medicaid/FAMIS outreach and
enrollment too
• SB 496 was amended to eliminate licensure, mention CBOs, &
include education/enrollment for Medicaid/FAMIS
State Legislation
Coordination with Medicaid & FAMIS
• We want Exchange to streamline access to all programs
• SB 496 amendments clarify relationships and require Exchange to
enroll eligible people in other programs
Services
• SB 496 prohibits abortion coverage in Exchange plans or optional
riders except for rape, incest, life of mother
Q&A/Resources
Virginia Health Reform Initiative
www.hhr.virginia.gov/initiatives/healthreform
www.healthcare.gov
The Commonwealth Institute
www.thecommonwealthinstitute.org/health/
Thank you for attending!