Reform’s impacts in HI | Budget takes hit | Carla D’Angelo

It’s hard not to watch the events in Washington DC health policy right now. We’re tracking the impacts on Hawaii from an implementation of the Congressional Republicans’ ACA replacement bill.

“Replace,” this week’s House budget, and a few key legislative bills. It’s what we’re watching in Hawaii health care for March.

1.  AHCA: Read the CBO memo for yourself

Much has been written about the Republicans’ ACA replacement bill, the American Health Care Act or AHCA. Virtually every stakeholder voice (save one) has declined to support the bill, including conservative think tanks in DC. Only Anthem has supported it, a large publicly traded parent of many Blue plans.  It’s also trying to get a large merger federally approved.

If you read one thing on the AHCA, I’d suggest you read the Congressional Budget Office “score.” That’s the memo detailing the impacts of the bill. The details of the CBO report are not quite the same as what advocates are pushing in the media. Ironically, the AHCA creates 1m more uninsured than simply repealing the ACA. At 37 pages, the CBO score is easier than the 122 pages in the underlying bill.

2. The AHCA impact on Hawaii

In Hawaii, net insurance premiums (meaning after applying tax credits or subsidies) on the individual market in Hawaii will rise 178% compared to the current law, according to one study (pg 9).  That’s primarily a function of the proposed tax credits being 32% lower in Hawaii than the subsidies provided today.

Congressional Democrats break down the numbers by congressional district. Rep. Hanabusa has 45,000 beneficiaries of expanded Medicaid set to lose coverage (assuming the state doesn’t pick up the tab), while Rep. Gabbard has 62,500.  Kaiser Family Foundation has a tool that shows some Hawaiians will find lower premiums under the AHCA (though it doesn’t include what will likely be higher deductibles and co-pays).

3.  Video:  Carla D’Angelo on “replace”

Carla D’Angelo is Vice President of COPE Health Solutions, a Medicaid consultancy focused on delivery system transformation with clients across the country including Hawaii.  In this edition of “What They’re Watching,” Carla is connecting the dots between the conversation on repeal and the importance of community.

“In Hawaii with the different dynamics of the marketplace here and you have rural health and each island has its own mircro-regions, its going to be important that the Hawaiian community stays really close together with their payers.”

4. Mid-session update in the legislature

HSAs and HCRs take focus in our mid-session legislative update this week (read the story for the acronyms).  Last week, we had a run down of health care bills that survived the cross-over deadline, including those that would adopt the consumer protections of the ACA into state statute.

Tomorrow, the House budget will move from the floor to the Senate. It passed out of the Finance Committee by putting off $80m of Gov. Ige’s funding of public employee retirement accounts. More cuts will be needed though. Last night the Council on Revenue lowered its revenue forecast another $250m, giving the House some last minute work before approving its budget Wednesday.

5.  SB7, homelessness and supportive housing

According to Sen. Josh Green, 3.61% of Medicaid patients consume 61% of Medicaid spending. Many of these folks are homeless – about 7,921 according to SB7 – or housing insecure.  Green’s bill and his complementary bill, SB2, have moved out of the Senate with unanimous approval. “The moment we get a roof over someone’s head… their Medicaid spend drops 43%” says Green.

California and Washington State have similar but less ambitious initiatives in place. Washington’s 1115 waiver provided federal funds for housing and employment support through Medicaid, but explicitly kept out funding for rent. California’s 1115 waiver includes housing elements in a “Whole Person Care” model for folks “who have a demonstrated medical need for housing or supportive services.”